Arrhythmia and EF

I am a 38 year old male.  History (20+ years) of PAC

[CCF-M.D.-MJM]

Hi Jeff,

1. The tachyarrhythmia I occasionally get starts with an ectopic beat followed by a long pause and then my heart erupts into violent fast beating for a few seconds and then I get another long pause and it reverts back to normal. Given that the preceding ectopic has a long pause, would you think it likely that this is a PVC (based upon my reading a PVC is more likely to have the compensatory pause) and therefore the tachycardia is a VT? Do you think it important to capture this?

I don't think the logic necessarily makes since.  The best way to show it is VT is to capture it on an event monitor.  But with a structurally normal heart, even if you did have nonsustained VT or SVT, it does not portend a worse prognosis.  The answer lies in capturing the rhythm on an ekg or event monitor.

2. I have noticed when I get single ectopics that if I monitor my pulse at my neck the pulse

[jkf]

Hi
I have exactly the same thing.  I get some type of early beat that creates a very long pause (longer than the normal pauses you feel with the every day pvc's).  This pause makes me feel like I'm fading out for a second, then it kicks into a fast beat (clocked at 220) WITH pvc's so it is very irregular.  It has been recorded as PAT.  It lasts 30 seconds or so and then I feel that long pause and it is back to normal.  One time the fast beat lasted about 20 minutes.  I hate those more than anything else.  Fortunately it only happens 3-4 times a year. Does your initial pause feel longer than the average pause with the every day pvc's.  That is what I hate the most because I really feel like I'm spaced out for at least 2 or 3 seconds.
Jodie

[kuc]

Jodie,

I have had pat for 20 years, and occasionally before my heart kicks in to this arrhythmia, I will get the "fading" out feeling.  Not everytime,but it has done it on several occasions.  I hate that feeling.  Just wanted you to know you're not alone.

[jkf]

Thanks for your feedback.  That feeling is awful.  I'm sure it is because your heart pauses for 2 seconds or so and you really feel like you are not in your body.  Nothing goes black and I've never passed out.  It is a very hard feeling to describe.  It just feels like you are numb and are going to die.  That is worse than the PAT for me.  I'm glad there are others out there who know what I mean.  It makes you feel better.
Jodie

[tickertock]

Great questions. My Ecg showed the mimimal voltage criteria for LVH, also stated it could be the noraml variant/ echo showed measurements of between 10mm and 12mm described as borderline LVH,now with ultimate B/P control, ECG is not suggestive of LVH. Will soon know, having an echo done in about a week and a half, will let you all know the results.

Ecgs can be very sensitive, at other times completely misleading, mostly they are fairly accurate, depends on the person's anatomy sometimes, if in doubt a cardiac cath is very definitve.

Jeff, I know the feelin you are speaking of, a long pause and thump then the heart goes into high gear, like jodie i used have pvcs occuring with this high rate, caught on ecg told PAT with pvcs rate around 170-180 bpm. Though very frightening after consultion with numerous cardios , including EPs ,told this is very common, never had to be given intravenous drugs for control, told never to pursue an ablation, the benefits don't outweigh the risks for a non life  threatening problem that occurs very infrequently and determined to be benign, unlike yours mine have been caught on ECG, so the same might not apply to you, but in this case an ECG while the problem is a very defintive diagnosis in the vast majority of cases.

Jyst want to add although i still experience the occasonal pvc, no tachycardia at all while on atenolol, that is a big plus!!

[wmac]

I have noticed when I had my 26 beat run of vtach, I had a hard thump and then what appeared to be a very very long pause and then a hard thump again. I think it felt like a long long pause due to the fact my heart rate was so fast I couldnt feel it. My heart rate was 187 beats per min and I know this and I also know it was vt for sure because I had the loop recorder implanted and I had the doc down load immeditaly. On the other hand when having the other episodes of vt that were shorter in duration it just felt like my heart was continuing rolling. Just when I think I have it all figured out it changes on me.
wmac

[Jeff-67]

Tickertock,

So was it PAT or NSVT you had? During the tachy did your beats feel vigorous and weird or just like they were fast?

[Bromley]

Hi.  I believe that PAT can be an old medical diagnosis.  A diagnosis of PSVT is more recent, and refers to paroximal Supra Ventricluar Tachycardia, an arrythmia that may involve the ventricles, but originates in the tissues above the ventricles.  This is different from NSVT, which is pure ventricular rhythm.

Before I had an ablation, I had it PSVT. Mine definitely gave a "Kick Back" in the neck.  The duration of the episodes increased slowly over the years.  At its worst, mine went for short spurts lasting 6 minutes (some people have it for hours).  I felt a little fatigued is all, and had to sit down when it would happen.

After I had pretty much given up on getting it diagnosed though, a friend of mine encouraged me to persevere and to seek closure.  I went to an internist across the street from me who followed standard medical protocol, and two weeks later I placed a heart card on my chest and caught it.

For most people, this step can spell the end of it.  After that the EP's will step in and take care of it. There's nothing to it.

[Jeff-67]

Hi Jodie,

Thanks for your comment.

I have to say that my pauses are as long as any other ectopic that I get.  The thing that gets me is the way the heart feels during the tachy - very vigoruous and punchy type beats until it reverts back to normal rythm.  This is much different to other tachy's I have had where the beats during the tachy feel normal but fast. Do you get differences like this?

Jeff

[tickertock]

Like bromley stated PAT is old term , but is the same as PSVT, they are still used interchangably, both occurs above the ventricles. PVCs , not pacs trigger my PSVT.

Mine was an SVT with PVCs occuring with the PSVT. IT was a fast pounding and rolling over feelin , then a pause with each PVC.

When it first starts it makes you feel like you are going to pass out, then it stabilizes and you can tolerate it better. The nasty feeling is usually anxiety , I had it last up 20-25 minutes thats why i got it caught on an ECG monitor 12 lead at that , after reasssurance and a beta blocker orally it stopped within 5 minutes. Hope this helps.

[hapecamper]

I know how you feel about not feeling right and can't discribe how you feel except that you know something is wrong and then as fast as that feeling comes it goes then you feel a little better.I never get the pvc's and pac's with the fast hr it's usally when it slows down in the 40"s and 50's. either way they are scarry.

[dafan]

Then it is possible to have false echo readings due to a state of nervousness. Is the Dr. saying that your EF could actually be say 45% and due to nervous adrenaline activity you could be showing an ef of say 60%?? Just wondering....

[jkf]

HI Jeff,
Yes mine could be described the same as yours.  However, I can count my beats.  My heart is going all over the place, but there is no rolling feeling like you wouldn't be able to count the beat.  It is just very fast and irregular because single and double pvc's kick in with it.  It is also very hard and extremely easy to feel just by putting my hand over my chest. Are you able to count each specific beat?  I feel for you because I just hate hate hate those.  I just pray they don't become more frequent.  They haven't over the last 10 years but you never know.  -Jodie

[Jeff-67]

Interesting comment.  I am sure there are many people who are nervous when they have an echo.  As I recall my HR during the test was fast and it was pounding, so the Doctor is right in that I was definitely under the influence of huge amounts of adrenaline.  However, I have read that EF does not change by many percent from rest to vigorous exercise, so I don't know that the magnitude of the change due to nervousness can be all that great.

[Jeff-67]

Jodie,

Yes, I can distinguish between beats, even though the rate can be quite fast.

Jeff

[Duchess47]

I am new to this forum and find it very helpful. I do not understand all of the lingo you all use, you all seem to have been through much testing and are very knowledgable.  My problem is similar to everyone elses here.  Lateley,  while at total rest, I suddenly felt my heart rate go up high and fast.  I have a bp monitor in the house as I have had tacchycardia before, so when I took my vitals I had a reading of 160/90 and heart rate 123, oxygen was good. This lasted 5-10 minutes, but I was so scared I called 911.
By the time I got to the hospital, everything was pretty much back to normal.  It happenned again 3 days later, but went back to normal almost immediatly.  As you all know, this is so scary. I am afraid to leave my house.  I keep thinking that I will be driving in the car and my heart rate will just go out of control at some point and I will just pass out.  I have have had an echo stress test and holter monitor and ekg's.  The echo showed possible hyperkinetic heart, but rest of it was notmal. I have Graves disease with hyperthyroidism which is controlled with meds.  I was on prednisoone when all of this happened and at the hospital was told my glucose was high and so was white count (which is probably related to the steroids).  It is frustrating having to call the doctor all the time and still not feel satisfied with his answers.  You all have been through much of this and I would appreciate some of your advice as to how worried I should be about these attacks?  Thank you

[xanaxmick]

Hi, I get super over-stressed and anxiety ridden every year because I am a tax accountant that works long hours in a home office.  I was spared this year by using xanax when I experienced tachycardia, which only occurs in the middle of the night during sleep.  I am searching for more information on how stress hormones cause tachycardia, what type is it, one doctor called it PAT and said it is common in women. I normally have optimal BP of 110/60 during the daytime but during these episodes it shoots up to 160/78 or higher and the heart rate goes up as high as 140.  This year it has taken me almost 4 months to get back to sleeping normally.  But I had a very stressed lifestyle immediately after the deadline due to family obligations.  My cousin who has 8 children did get the oblation (ablation) procedure and doesn't get the PAT's any more.  My sister is on atenolol - she is a stressed out school teacher.  I am hoping that the stress management clinician will help some also.  My insurance is a PPO plan and I was advised that I am eligible for 3 free hour sessions per year.  My next idea is to get an echocardiogram to check out whether or not a virus settled in.  I hate those tachycardia feelings.