A/V Block (Wenkebach)

  I am a 30 year old woman and was diagnosed with a second degree heart block four years ago when I was ill with a virus.  At the time I was told the block was of no concern to the doctor and it was rarely noticeable to me.
  For the last few months, I have had frequent episodes of what feel like very strong palpitations (like someone knocking around in my chest to get out!)
  followed by lengthy lapses between beats.  It is now occuring daily, especially upon falling asleep.  I awaken frequently at night, am tired all day, and am constantly "catching my breath" when I get that skipped beat feeling.  I have no family physician because I am subject to the military health care system and am not being taken seriously about this now. This is affecting my ability to function, my energy level, and  my happiness.  What kind of testing/questions should I be discussing with the doctor to get this resolved?  Is there anything I can do to relieve the discomfort?
  Thanks, Jennifer

[CCF Cardio MD - MTR]

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Dear Jennifer, thank you for your question.  If you did indeed have second degree AV block (Wenkebach), then this is a benign disorder that does not indicate that you have a serious problem with the electrical conduction system of your heart.  I suspect that you are currently having premature ventricular contractions (PVC's) that cause the heart rhythm to reset (hence, you experience a "skipped" beat, when there really isn't one).  In most cases, PVC's are entirely benign, especially when someone is otherwise healthy with no known cardiac disease.  Common precipitants of PVC's that should be avoided are alcohol, tobacco, and caffeine.  There also appears to be a connection between anxiety and PVC's.  The most useful test for you would be a portable cardiac monitor (Holter Monitor) that can be worn for 24-48 hours to continuously monitor the heart rhythm.  The results of this test should determine what type of heart rhythm is causing you to have the symptoms you complain of.  Before suggesting possible therapies, I think a diagnosis needs to be made with the Holter Monitor results
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
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