Arrhythmias

Posted By  CCF CARDIO MD - MTR on March 20, 1998 at 13:36:51:

In Reply to: Arrhythmias posted by Adam on March 19, 1998 at 22:04:29:

: I am a 36 year old male with a history of arrhythmias, mainly PAC's and PVC's.  These have
  been documented by holter monitor tests.  I am on Lopressor, 50mg twice per day.  I have seen
  local doctors and cardiologists at UCLA and no one has been able to help or cure this problem.  
  My life is basically on hold, as these episodes of irregular heart beats are so frighting that
  I almost do not want to leave the house.  I have been told that they are nothing to worry about,
  but that is very hard to believe.  Many times my heart begins to "flutter" for no reason at all.  
  These episodes can be stoped by a quick change in body position, or sometimes by coughing.  After
  they stop, I always have to clear my throat as there is fluid build-up.
  Heavy meals alway trigger the arrhythmias, and certain body positions trigger them also.  I use to
  be very active and athletic, and am luckily still in good shape.  The problem is that I am afraid
  to do anything.  I have had episodes where my heart will just begin to race, very irregular for a
  few minutes, then go back to normal.  After which I am very tired.  Other times it will beat slowly,
  but skip, the flutter, then stop, then skip...etc.  I am so frustrated with doctors telling me that
  nothing is wrong when I feel so terrible....I know that this is a very disjointed explination of my
  problems...They are so hard to describe properly.  I just hope that someone can give me some sort of
  help....
  Thank you.

[CCF Cardio MD - MTR]

_
Dear Adam, thank you for your question.  You describe a history of palpitations and
"skipped" heartbeats that were diagnosed as PAC's (premature contractions of the atria)
and PVC's (premature contractions of the ventricles) by a Holter Monitor.  PAC's and
PVC's are common and occur without causing symptoms in most people.  When they become more
frequent or occur repetitively, symptoms like those you describe develop.  PAC's are
more benign and can be precipitated by stress, caffeine, many different prescription drugs,
and sometimes, hyperthyroidism.  PVC's can also be precipitated by the above factors
but are also seen with ischemic heart disease and congenital cardiac malformations.  In
your case, at age 36, structural or ischemic heart disease would be very unlikely.  
   It sounds like you have supraventricular arrhythymias - originating from above the
ventricles in the atria.  You are probably having more than just isolated PAC's - from you
symptoms, I suspect you may have some form of PSVT (paroxysmal supraventricular tachycardia).
PSVT refers to repetitive bursts of fast supraventricular heart rhythyms.  PSVT can be
caused by abnormal electrical activity in the atria called atrial fibrillation or atrial
flutter, an accessory electrical conduction between the atria and the ventricles which
facilitates a fast heart rhythym, or disordered conduction in the AV node.  Normally,
electrical activity initiates in the sinus node in the top of the right atrium, travels to
the AV node (which connects the atria and the ventricles), and goes through the AV node
to the ventricles to initiate a heartbeat.
    Atrial fibrillation/flutter (AF) can be caused by many conditions including high blood
pressure,leaky heart valves, hyperthyroidism, and infections.  An accessory electrical
pathway is seen in a disorder known as Wolf-Parkinson-White syndrome.  Disordered conduction
in the AV node is called atrioventricular nodal reentry tachycardia (AVNRT).  These
disorders are all picked up on a portable heart monitor (Holter) which it sounds like you've
already worn.  
    In your case, I would recommend that you wear a Holter monitor or a longer-term monitor
for at least a week and note on the monitor when your symptoms are occuring.  Once your
rhythym can be adequately determined from this monitor, the true cause can be ascertained.
You may well have only PAC's and PVC's but it would be good to document that again, in
my opinion.  If any of the aforementioned arrhythymias are seen, then you may need a
blood test to exclude hyperthyroidism and/or an echocardiogram to image the heart with
an ultrasound probe to exclude any structural heart disease.  You seem incapacitated by
your symptoms so a reevaluation certainly seems in order.   I hope this information helps.
Information provided in the heart forum is for general purposes only.  Specific diagnoses
and therapies can only be provided by your physician.