Ectopic beats presenting as bradycardia?

[AlisonInCanada]

Hi,
I'm a 33 yr-old female, non-smoker, non-drinker, 5'8", 145lbs.  My normal resting heart rate is 55 - 60 bmp.  

For the past 3 months I have been experiencing bradycardia, where my heart rate is about 30 bpm.  Episodes would last anywhere from 15 seconds to 3 minutes with a steady slow, strong beat.  They would start and end abruptly. Episodes occur up to 50 times a day, most often induced with a very small amount of exertion (like getting up and walking across the room).  I notice them because they occur with strong palpitations, & are accompanied by extreme chest tightness.  My exercise tolerance has been greatly reduced.  Going up the stairs seems like considerable effort. Had a normal 24-hour holter & echocardiogram, and then a 2 week loop test, after which the cardiologist told me I was simply having benign ectopic beats, and not to worry.  I was advised to reduce stress and get some exercise. I asked him why it appeared to be bradycardia with these "extra beats", but he didn't really explain very well.

I have since greatly reduced my stress, but I'm still having the epidsodes, so I'm afraid to exercise.

Here are my questions:

1) Can ectopic beats/PVCs/PACs present as bradycardia?  I've been trying to research this, but I can't seem to find anything.

2) Why would "extra" beats present as fewer beats (bradycardia)?  Why would I only feel a few of them? As I said, my cardiologist's was vague at best.

3) Should I get a second opinion or am I still worried without cause?

Thanks for your time,
Alison

[CCF-M.D.-MJM]

Hi Alison,

Did the holter monitor confirm the bradycardia?

1) Can ectopic beats/PVCs/PACs present as bradycardia? I've been trying to research this, but I can't seem to find anything.

If you heart rate slows down, this can allow a focus beating slower than you normal sinus rhythm to take over.  The most likely cause of bradycardia like this in some one your age is increased vagal tone.  I would want to see these bradycardic episodes on monitor and correlate the timing with your symptoms.

If you heart slow downs, that gives your heart more time to fill and stretch creating a stronger beat than normal. With out seeing the strip I don't know if you are having bradycardia or pvc's/pac's.


2) Why would "extra" beats present as fewer beats (bradycardia)? Why would I only feel a few of them? As I said, my cardiologist's was vague at best.

I don't know how to answer this one.  I am not sure what these beats are.  I think you need to pin down your cardiologist about what exactly they mean.  I am at a loss without seeing the actual strips.

3) Should I get a second opinion or am I still worried without cause?

I would only get a second opinion if you can't pin down your current cardiologist about what exactly they mean.  There should be a fairly logical answer.  Odds are his conclusion is correct -- these are a nuisance and detrimental to your health.  But at the very least you should get an answer.

I hope this helps.  Good luck.

[Momto3]

Welcome!!

I don't know if this is what you are experiencing, but I had what appears to be a similar experience.  I had what seemed to be a very slow heart rate.  After a number of tests, I finally remembered to ask about the seemingly low HR in the presence of ectopics.  He said when you are having extra beats, and you try and take your own pulse, it will APPEAR slower, but there are actually beats occuring that you don't feel.  I would get readings in the 40's, but the doctor would get readings in the 70's.  Maybe that's what's happening in your case too.  Did your strips have lots of ectopics?

[AlisonInCanada]

Thanks to both of you for your comments.

I would have given more details had I been allowed more characters in my original post.  :)

I never saw the EKG results - my cardiologist actually gave me the results on the phone.  The holter didn't show any bradycardia as low as 30 bpm, but I also didn't have any episodes during that 24 hours (always the way, isn't it?).  The loop (event monitor) results (that my cardiologist gave to me on the phone) were "just benign ectopic beats" and that I wasn't actually experiencing bradycardia of 30 bmp.  That's why I wanted to know why I would perceive it that way.  It would drop to the low 40's occasionally, but that wasn't related to the extra beats.

Initially, I had an episode in my GP's office - she said she could only feel 30 bpm, but that she thought she could hear some alternate beats that she couldn't feel.  So that may be exactly what you're talking about, momto3.  

I was actually skeptical that I was having a heart rate of only 30 because I wasn't passing out (or coming close).  As I said before, my chief complaint is severe chest tightness (not exactly pain, more like pressure).  Occasionally I would feel dizzy or light-headed.  But I am often short of breath with little exertion.  That's why I'm scared to start exercising again (I played soccer all summer).  The "extra beats" and perceived bradycardia ALWAYS appear just after moderate or heavy exertion.

Fortunately I have an exercise stress test tomorrow.  If that doesn't show anything troublesome, then I'll feel a lot safer about starting up an exercise routine, and maybe my ectopic beats will wane when I am in better condition.

Thanks for taking the time to comment,
Alison

[tictock]

i'm no doctor just a sufferer like you but it sounds like what i you may be getting bigeminy rhythm where by every other beat is a ectopic so when you feel your pulse only feel the heavy beat and not the ectopic.Ive been getting mine continuously now for over one month never had it like this before i can't even go out without it going into this rhythm and i get pain in the cheast and am breathless it's making my life a misery. the doc has given me medication Sotolol but it has made little difference.you may find that it will calm down after awhile mine has in the passed i've been having these on and off for 36 years so you would think i'd be used to them by now but they are such a nuisence.

[Lecah]

Hi. Are you saying you get pains from bigeminy? I have had bigeminy for I can't remember but I do not have pain from it; it is like my normal rhythm. I remember a cardiologist telling me that the kind of arrythmia I have would not cause me to have chest pains and it is nothing to worry about but you say you have them and I just wondered why or what makes your bigeminy different.

[chrisr]

Since my last CABG 5 months ago I have been on cardizem initaily and then Coreg for high HRT (80-90). The latter worked fine with a HRT of 60-70 for the past 3 months but then just 3 days ago I am also experiencing lots of ectopics and of course the added anxiety that goes with these. However my measured HRT has remained 60-70 but with an increased syst BP (140-150)and moderate LVH as indicated by a MUGA scan. Past holter monitoring indicated a SVT type of arrhythmia with few ventricular ectopics. I have been advised to increase my Coreg to 6mg 2x/dy and Diovan to 160mg. If these extra beats apparently are only felt is it wise to increase the Coreg since I am very sensitive to BBs in general.
Any comments appreciated.
Thanks, ChrisR.

[wmac]

That is what my nsvt feels like. Its actually going fast tachycardia but it feels like its slow. Kinda like BOOM, BOOM, BOOM, BOOM. Nsvt is many pvcs in a row.
wmac

[AlisonInCanada]

Thank you all for taking the time to comment. I sincerely appreciate it.

I just came back from my exercise stress test.  The results were, well... perfect, actually.  I didn't have any episodes of PVCs at all, even after the exertion (which is my norm).  My heart rate made it up to my max (about 170) and my BP was good, so I feel a lot better about getting back to an exercise routine now.

The only problem was that I felt extremely dizzy & nauseous at about the 9 minute mark, so I had to stop the test.  The technician said I looked really pale when I was recovering, and now I feel a bit weak.  But apparently none of that is cardiac related.

It sounds like we're experiencing something similar, anacyde.  I would have liked to hear the information you just told me from my cardiologist, but he didn't seem to want to give me the time of day.  Guess I'll have to get info from your docs by proxy.  :)
It's funny that you mention drinking more water.  I have actually just started to do that in the last week.  I've been seeing some signs of dehydration, so I thought I should try it.  We'll see how it goes.  

Thanks again to all.  I feel a lot better today (mentally and emotionally) than I did yesterday.

Hope I can pass on the favor to others down the road,
Alison

[upbeat63]

You mentioned in an earlier post that you've already had one RF ablation for your PVCs. I just wanted to ask why you were recommended that course of action because some doctors won't even consider an ablation unless your PVCs are debilitating or are causing other issues like cardiomyopathy.

You also said earlier that your cardio suggested another RF ablation because of this latest bigeminy episode. I've been in trigeminy with nsvt runs for weeks and weeks and weeks now. Can't get them to stop even with toperol (but that's only 25mg/day). I am so worried about the potential of developing a more serious arrhythmia from an ablation, or other complication that I can't even imagine getting one unless this becomes unbearable, luckily it only feels that way for very short periods.

I've read a lot of people on here who have ablations, some good some bad. Wish I could get an answer that could help me decide one way or the other if it came down to that.
Thanks for listening.

[AlisonInCanada]

LOL, anacyde...  a list!  I've done that with my GP before!  Otherwise I tend to forget some of the things I wanted to ask. :)

I do have a couple more questions for everyone, if you'll indulge me:

1) My ectopic beats seem to be provoked (on the whole) by exertion that is more anaerobic in nature.  By that I mean, I get the palpitations when I'm resting after lifting something heavy.  But not so much after something aerobic, like a small jog (or my stress test, apparently).  Is there any significance to that?

2) The only time my ectopic episodes have been recorded were when I was on the event monitor, which only had 2 electrode leads (one above my right breast, one below my left).  They were never captured by an ECG, the holter, or the stress test, which use more leads (10?) to measure more vectors and such (I think).  Is it at all possible for something to be missed or misinterpreted by the event monitor?

I appreciate your patience with me.  :)
Alison

[tictock]

Hi, i had the ablation about 8 years ago in a well known teaching hospital in London England. At that time this proceedure was fairly new over here at the time and very few doctors new how to do it, as in the passed this same proceedure was done as open heart surgery and it was usually done for people who had wolf parkingson white syndrome (Abnormallity in the heart that causes irregular beats.)The doctor didn't think at the time that i was a good candidate for the ablation as my ectopic was not continuous and i could never predict when they would occur but they tried anyway because doc said that he will try and provoke them. Anyway they did it but they came back doc said that sometimes the electical stimulus finds another route in the heart and that sometimes it may take a few ablations to be done.Over the years every time that i've had a rough patch with ectopic i've asked to be put on the list but it use to be one years wait for the op that when my time came i was fine and was not getting that many to speak of that i cancelled. i've been so bad this time and it's different because of the pain and breathless and the disabling effect it has had on me that even if by some magic it goes away when they call me i'm still going to take that chance with the op. doc thinks that reason why i maybe getting pain while i'm in bigeminy because the heart has filled up so much with blood and has stretched nore than usual can't say that i'm a very fit person at the best of  times so after every normal beat the heart is stressed. They do say that Ablation is 95%successful but i don't know how they measure success, is it getting rid of the ectopic completely or having very fewer than before? I wonder.Again it's what you expect from the op, to be honest if they could just stop this bigeminy i'd be happy.

[Momto3]

I had two "successful" ablations in 2003.  Prior to the procedures I was having over 20,000 pvcs daily.  After the first procedure, a Holter monitor recorded 5600 and I was thrilled. Doctor was not completely satisfied so I went for a second procedure.  Since that time, I still get occasional pvcs, but nothing measurable and most days I don't feel them at all.  It was a miracle cure for me!  good luck

[upbeat63]

I am grateful for the fact ablation is an option, and encouraged by your success stories......what a great laugh BUT sooo very true, to get only 5600PVC/day would feel like a blessing!  

Momto3, I don't think your doctors even considered ablation until you developed the CM right? I might have to investigate the insurance requirements, because ablation hasn't been recommended to me for PVCs even with 20,000+/day. Insurance might think of it as "elective"!

Thanks for the info, again.

[tictock]

yes it's so nice to hear that your rf ablation worked for you 2nd time, so i'm hoping that will be the case with mine. tomorrow i shall have a good idea of when my proceedure will be. I'm trying to hurry them. Today was the first time i've taken my dog for a walk in 4 weeks even though i'm still getting the PVC and bigeminy pain did not stop me, think it may be the higher dose of sotolol 160mg twice a day but i'm light headed and slow heart rate at times. i have noticed i do get i break for bigeminy rhythm for awhile  but i'd better not speak too soon you can never tell.

[Momto3]

Prior to the first ablation, I asked my doctor about it and she said it was an option. But, I definitely got the feeling it was not the preferred option.  She preferred alternatives to treating the symptoms associated with the pvcs. After the CM, we worked at getting things under control with anti-arrythmics.  After that is when we discussed ablation more seriously.

Yeah, hey I thought 5600 was awesome!!  WOOHOO!!  The doctor did not agree. I would have had to go back on the anti-arrythmics... :(

I'm so glad that you are keeping up with your options.  Like I said, I was shocked when I found out the EF had dropped.  

Hope you are doing well (despite the bigeminy).  If/when you get past those buggers, its gonna probably feel strange to have a "normal" rhythm.  Kinda like you or I having 5600/day : )

[Momto3]

Actually, both procedures were considered successful.  Each procedured tackled a different foci.  First time, RVOT and the second time, LVOT.  At the time of the tests, it was determined that I had pvcs of 4 different morphologies, but 2 appeared predominant.  

Good luck tomorrow!  I took my dog for a good walk yesterday...Guess who was more tired?  hahahaha

Prior to the ablations, I was in pretty consistent bigeminy with couplets, triplets, and some nsvt.  I was lucky in that I had no pain...That would be tough.  Wishing you the best.

[tictock]

Thanks for your comments. Yes it can be hard to Ablate heart if you have multifocial points you were lucky, mine they say is unifocal but when i had the first ablation done got rid of that but then it set up another foci or maybe it was always there but just kicked in when one was ablated (just thought of that.)thanks again

[kidsuk]

This is the first time i have contacted anyone about my arrhythmia problems, i have been having palpitations for many years, i am, at the moment in perminate bigeminy rhythm.I visited my consultant on Monday and he has decided to send me to London St Georges hospital to have a mapping EP study and ablation. I have already had 1 ablation done 12 months ago, unfortunately this made things worse so am very anxious about the new EP study, they have assured me that this procedure using the mapping system is the best way forward and hopfully will have a positive outcome.Has anyone had a EP study using the mapping technic?  
I feel like most on this forum, the arrhythmia has total taken over my life!! i would like to go back to exercise but am afraid of the consequence's feel i need help and support from others at this time, unless you have suffered with this problem no-one knows how i feel not even my husband.

[tictock]

Hi firstly let me tell you i totally understand what you mean unless someone has this they'll never know what it's like. i've been in bigeminy now for 6 weeks although it's weaning off a bit but i still can't walk too far because i get pain with mine. i to have had ablation done about 8 years ago at St Thomas's hospital London,but i still got pvc's now and then only for short time they didn't bother me too much at that time, more so when i had cold or virus or was over tired. they did use the mapping system i don't know the in's and out's but they test every part of the heart they also try and provke the abnormal rhthms and when they find where the abnormal focus is in your heart they ablate it. It could take up to 8 hours or more.They get better results if you are having the  the pvc's at the time as i said they can provke pvc's at the time but it may not be the same focal point where your bigeminy rhthm is if you know what i mean.A lot of doctors don't do ablations for pvc's or bigeminy as it's is harder to map and find but as you know it can be so disabling in some like us.I am now waiting to have it dome again i'm told it should be by April if not before as i said i'll take a cancelation anytime. may i ask where did you have your last ablation done? if you want to email me chat some more feel free to. kath.***@**** (use the letter o in o2 and not the zero)take care. kath

[JHTmom]

Hi everyone.  I've been watching the site for a few days, since my cardiologist blew me away with the news that my bigeminy is just "normal" for me.  It's good to know I am not alone in my frustration with this.  I am a 34 year old nonsmoker, nondrinker, who consumes limited caffeine and virtually no cold medicines or major stressors (all the typical causes).  My comment is-and I know situations are different for everyone- I see many are afraid to excercise.  Even though I can get winded walking up a flight of stairs, pushing a grocery cart, taking a shower, or reading my child a bedtime story; excercise causes me no problems.  I still work out 3x a week and most of the time, I feel great when I do.  It makes little sense.
My questions are, 1)if constant PVC bigeminy is normal for me, why did it seem to just "appear" several weeks ago?  2)Also, as I research, I find electrolye imbalance can be a possible cause, how can this be corrected? and 3)My stress test was normal except for hypertension (otherwise I have low b.p.)in recovery phase-anyone have any insight on or experience with this problem?  Thanks everyone-and happy excercising!

[3dragons]

A related discussion, Post ablation improvement for cardiomyopathy patients with bigeminy was started.