Arrhythmia Question

[rhia]

Hi, thanks for this wonderful service.

My question involves a number of things. Firstly, I am a fit 23 y.o female who has according to my doctor excellent physical health. However, I have a history of the usual PVC's etc.

Recently, my heart seems to go from a normal rate to a very sudden rapid series of beats (3-5 in number) and then switch back automatically to its normal pace. I have discussed this with my doctor and after an ECG, Holter and echocardiography have been told it is anxiety and perhaps muscular tremors. I take zoloft for the anxiety.

My questions are:

1.)This "symptom" always occurs at night when I am very tired and perhaps a little anxious. Does this sound heart related or like anything serious?

2.)I'm really concerned mainly about VT. Can anxiety and PVC's alone trigger VT?

3.) Also one night at around 4am I woke up and the rapid beats seemed to occur while I was having PACs and PVCs. It gave me a huge fright and I was wondering what your opinion was.

4.) Can the fact I have anxiety be causing such a symptom when I have had such good test results, numerous check ups and am managing the anxiety to the best of my ability?

I guess my main concern is that it is not muscle tremors but a quick series of rapid beats.

Thanks for taking my questions,

Rhia

[CCF-M.D.-MJM]

Hi Rhia,

1.) This "symptom" always occurs at night when I am very tired and perhaps a little anxious. Does this sound heart related or like anything serious?

This is very common for people to notice more PVCs when they are still.  Whether this is anxiety while trying to fall asleep or just you body positioned in a way that makes it easier to feel your heart (you’re left side for example).  It is often difficult to figure out what these sensations are, especially if they are infrequent enough that we don't capture it on a 24 hour holter.   An event monitor or home telemetry are sometimes more helpful.  That would be my next stop.  This is almost always benign, but worth a close look nonetheless.

2.) I’m really concerned mainly about VT. Can anxiety and PVC's alone trigger VT?

Very, very, very, very rarely in the right person.  There are probably a couple thousand simple PVCs for anyone that gets VT.  Remember that normal heart (like yours) VT almost never causes significant health problems and is usually treated with a beta blocker or calcium channel blocker.

3.) Also one night at around 4am I woke up and the rapid beats seemed to occur while I was having PACs and PVCs. It gave me a huge fright and I was wondering what your opinion was.

It is near impossible to comment unless I see rhythm strips.  Holter or event monitor could help with this.

4.) Can the fact I have anxiety be causing such a symptom when I have had such good test results, numerous check ups and am managing the anxiety to the best of my ability?

We subjectively notice that the people that notice the PVC tend to be more anxious.  People with anxiety are more like to perseverate on the symptoms while a more stoic personality will like just ignore it and move on.  Managing anxiety is difficult.  If it is real problem for you, you could consider some counseling or medications.  Often both work best in tandem.

Even if it is a quick series of heart beats, the odds of that significantly affecting your medical health are very low, you just have to make sure it doesn't control your emotional health.

I hope this helps.  Good luck and thanks for posting.

[Momto3]

Some people experience increases in their ectopics when they are tired and/or anxious.  Getting plenty of rest may help eliminate or reduce the number of ectopics you are experiencing.  

I have had pvcs for at least 25 years (in very high numbers) and the pvcs never led to VT (unless pharmaceutically provoked during an electrophysiology study, and in a highly controlled medical environment).  I did have occurrences of NSVT which is a nonsustained VT, not a true VT. In general, the doctors are not concerned about NSVT absent relevant cardiac anomolies.  

Anxiety can trigger pvcs and pvcs can trigger anxiety.  I am not a doctor, but to the best of my knowledge, anxiety will not set you up for VT.  Hopefully, the doctor can provide some expert advice on this topic.  Reassurance is great medicine : )

[rhia]

Thanks for your assurance. I can sympathise with you! Can I ask you a question? What does NSVT feel like? If you were to lay a hand over your chest would it feel like a sudden vibration that thats and just stops abruptly? I hope you don't mind me asking! Its just that I'd like to have this resolved so that I can get on with things and not be anxious!!

[fearfactor]

Hi, Connie - I have a question for you.  I know you're not a doctor but that you do know a lot about PVCs.  Yesterday was a good PVC day for me, then when I sat down to watch TV last night I started having fluttering feelings in my chest and neck.  I said to myself I will just sit here and see what happens instead of jumping up and panicking like normal.  Well, they seemed to go on and on and I never passed out or anything - my pulse felt pretty normal, so I don't think it was Afib.  I guess it wasn't v-tach because I probably would've passed out after a while of getting no pumping action to the heart.  This happens so infrequently I doubt getting a 24 hour holter would help.  What does this sound like to you and what would you do?  I'm so afraid - I thought I'd never wake up this morning and would die in the night.  Thanks for any input!
Stacy

[LynnSB]

No one here, including the doc, can tell you what the rapid beats are -- you'll need an event monitor that captures them or EP study  to tell for sure. But I can tell you that I have been through the proverbial mill with these things and what I had -- and still have brief bursts of -- are atrial tachycardia... salvos of very fast beats. You could be having very brief PSVT  , which is very common, especially in someone your age but it is NOT going to harm you , especially if non-sustained. I understand your anxiety and the best advice I have is to keep on pushing until you are satisfied that a doc has seen your runs of fast beats and an accurate diagnosis is made.

[Momto3]

For me, NSVT feels like my heart is rumbling.  It does not feel like it is really beating, rather like it is stumbling to get into rhythm.  NSVT can last up to 30 seconds, but mine never went on that long (that I know of).  I would feel something for about 3-10 seconds.  

Hope that helps : )

[Momto3]

Hi Stacy,

I seem to notice almost all of my pvc storms (a rush of pvcs) when I am still.  If I were watching TV or typing on my computer, stuff like that.....whammo!!  Good for you for riding them out.  How long did the feeling last?  Was it like bigeminy or a bunch of short runs?  Do you have a stethoscope?  I picked one up and it actually helped me to understand what was going on when I felt weird.  However, I will say, they can be addictive.  Just like when we keep taking our pulses.

Has your doctor ever suggested an "event" monitor?  They are awesome for captuing things that only happen once in awhile.  You can wear them for any amount of time your doctor wants.  I usually wore mine for 30 days, though sometimes I turned it in early b/c I was able to capture the "new" weird feeling.  That might be a really great thing for you to ask your doctor about.  The only really drawback is the sticky patches (2) cuz they can get really itchy and irritating to the skin.  I started asking for pediatric patches and that helped quite a bit.

I really don't think you were in AF or VT, but maybe it would help you to "capture" the feeling and know for certain.

My two suggestions (based solely on my own personal experiences) would be for you to listen to your heart when it's acting up. I found that to be so therapeutic and I learned so much about my own heart's patterns.  You might hear runs (a bunch in a row), but don't panic.  You'll just learn what YOUR heart does when it feels weird.  The nurses in the EP lab were so surprised when I could tell them what was going on (palp-wise). They would be watching the monitor behind my head and I would say "there's another one" and I was always right on target with the EKG strip.  Also, you may want to consider asking your doctor if he/she would prescribe an event monitor.  They work differently than holters in that you have to "record" the event when you feel it.  The monitor continually records your heartbeat in approx. a one minute loop.  Then, when you press the reocrd button, the monitor backtracks about 15 seconds and records about a 1 minute strip.  Then, you call the phone number they give you and they tell you how to transmit your recordings. You can usually store 4 recordings and send them all at once.  Hope I explained that so that you are not confused.  Please feel free to ask any questions based on my experiences.  I'm happy to help.

Connie

[fearfactor]

Thanks so much for the advice!  I've called my cardio's office and asked for the event monitor; I hope that maybe wearing that for a month will allow me to catch one of these feelings.  Thanks again!

[kitcurious]

Can't we please wait till the doctor responds before putting potentially conflicting ideas out there?

[LynnSB]

>>Can't we please wait till the doctor responds before putting potentially conflicting ideas out there?<<

I'm lost on this one.
I thought " post a comment" meant "post a COMMENT".. not wait until the doctor responds and then don't -- gasp -- write anything that " conflicts"  with what someone else might have COMMENTED. Comments are comments.

I don't think these boards are meant to be that formal. And some of us have enough personal -- even professional -- experience dealing with these issues that, while we can not offer medical advice, I hardly thing refraining from commenting when we have time and want to is somehow unwarranted.

[tickertock]

Lynnsb,You hit the nail square on the head , I could never have worded it so eloquently. All the Best to you and everyone for the Holiday Season.

[rhia]

Just wanted to say thank you to the Doctor who responded. Also to momto3 - thanks for your response as well.

[blan3556]

I know this questions has probably been answered a couple of times but could someone tell me what are the chances of pvc's turning into a dangerous arrythmia?  How many can you have in a row before you go to the hospital?  Can thet turn into Vfib?  I have had them for about 2 years.Two years ago I had a echo, holter,and EKG which showed PVC'S and mild regurg, they put me on Atenenol but I didn't tolerate it well so I went off.  The Pvc's come and go but I am scared that they will go to Vfib or just keep beating wrong....any advice?  I don't have insurance so constant doctors visits are out of the question.  When I told the echo lady about  the PVC's I told her "I try to ignore them" and then she said "you shouldn't ignmore them because you never know" and it scared me...could someone please help me with this......

[upbeat63]

Hello, while I can't offer you any medical advice--I can answer one of your questions--I have high frequency PVCs (well over 20,000/day)so I get many of my PVCs in a row. I have had days and days of bigeminy--a pvc on EVERY second beat, constantly, thought it would drive me mad. But that wasn't the worst. I've also had non-sustained VT, strings of PVCs without a normal beat at all, but under 30 seconds. Believe me I sat there many times listening and watching the clock and hoping I would hear a normal beat. But I am still here!. And I have read on this forum, *from the doctor* that the mechanism for setting up VT or A-fib is different for the way PVCs are set up. And nsvt isn't supposed to hold any more significance than PVCs in a structurally normal heart.

Luckily both the bigeminy and nsvt stopped after 3 days of toperol, but like you I don't tolerate BB very well. And like you I have such a high deductible, I pay out of pocket for everything anyhow. I understand how expensive it can be, but I also know that unless you get that assurance from your doctor, you will pay a much greater price and that price will be living in fear of the PVCs. Basically PCVs will rob you of life even if they don't kill you.

Hope you get some relief.

[wmac]

Very good decription of nsvt! A rumbling feeling or like its stumbling! You hit the nail right on the head I always have a hard time describing it. Stumbling to get back into rhythm is really good. Thats how I feel it or even maybe like when your skin twitches in your leg or arm a twitch that goes on and on. But I really love your description.
Thanks wmac

[tictock]

I've had PVC's for over 35 years and yet they still worry me because over this long period of time they have got increasinly worse. I can't begin to tell you all about the disabling effect it had on my life when i was young when they first appeared.Looking back now the PVC's at that time were nothing compared to what i am experiencing now, i get weeks on end when i am in total bigeming rythym during this time i get pain in the chest and shortness of breath, this last time it drove me to hospital to seek medical help but i was told to increase my sotolol to 80mg twice a day,they are just easing off i little but not gone. The cardiologist has put me back on the list to have RF ablation done again. 7 years ago i had R F ablation done it wasn't 100% successful but i wasn't getting them so often.Since then i wasn't worried and was getting on with my life the only time when they appeared  was when i had flu or a virus but they soon settled.All of a sudden here they were again back with a vengence for no reason at all no cold, no flu,as i said this has been going on for several weeks It's this bigeminy rythym that gets me down because the ache in the chest and the breathlessness when they are occuring.I know that there are lots of people that experience these abnormal beats and it's good to know that i'm not alone and i can relate to the many comments that's on this forum which i just came across. All i can say to the many people that have these ectopic beats is, alarming though they are try to get on with your life. just look at me i'm 53 now, got 2 grown up children and grand children which i thought i'd never live to see. ectopic beats will come and go for some this will be normal but it dosn't stop you from being worried it's only natural.

[rickyc]

I like you, have had these skipped beats for years.  More so now that I am retired and sit around quite a bit; especially in the winter months.  It has gotten to the point where I ignore them although they remain frustrating at times.  Last week they had disapeared for almost a month.  Go figure... Can't seem to put anything in line as to what would increase their intensity or decrease it.  Maybe we should all keep a journal:  what we do, what we eat, drink etc, etc.  Who knows.  Good luck.  This is a great site.