Exercise and PVC's

[ScottH]

I am a 51-year old male. My entire life, I have experienced stress-induced PVC’s, and if high enough stress, VT. It usually takes physical stress for the VT to occur, such as when jogging. I have had ep study, cardiac cath, monitors, echo, …, about every test I think is possible. Most have been repeated often over the last 35 years. About 10 years ago I found a cardiologist who has helped me, and has me on mexitil and tambocor, along with altace for the bp. He implanted an ICD, and it has gone off twice. We tried beta blockers, but I have always reacted negatively, they make things worse. With the combination of current meds and ICD, I have been able to exercise at a modest level, even run some marathons over the past 8 years.

Although I get PVC’s frequently, I have noticed one particular pattern: when I exercise, jogging, the PVC’s start immediately, with bigeminy, or worse, continuously. This makes it exceedingly difficult to exercise, especially to run, as my body feels very heavy, I get lightheaded, short of breath, etc. With the medications, it does not progress to VT. Almost always, after about 45 minutes to an hour of jogging, all the PVC’s gradually stop, completely. I can run for another hour or two, and no PVC’s. I feel great, all the heaviness, lightheadedness, etc. go away. This pattern is very repeatable, and has been occurring for years.

My question is – is there any significance to this pattern of PVC’s that go away after about an hour of exercise ? And, is there any way to accelerate this process – that is have the erratic rhythm disappear sooner ?

[Cleveland Clinic]

Scott,

Thanks for the post.

1) Is there any significance to this pattern of PVC’s that go away after about an hour of exercise ?

None that I know of. It might be helpful to have a holter monitor on you to see if there is any change in your heart rate during that time that could be the trigger.  Without having more in depth knowlege of your physiologic state at that time, I cant comment.

It sounds like you've really been able to markedly overcome your condition.  Good job!

good luck

[Abeybaby]

Incidently, do you have any cardopathy or structural heart disease? Its rare to get PVC's that turn ugly into VT? I am curious did your VTAC come at later yrs in your life or was it always there during stressful periods even at a younger age?

Curious as I am 39 yrs- male and have had pvc's for 8 yrs and are getting worse now... used to get them every 3-4 months last for a two days now getting them more frequently lasting for a week. I notice now I get them more during excercise. When I tell my cardio he says ignore them...

I am curious to your insights.

Thanks Very Much.

[Konopka1955]

Hi Scott,  I read your post and I am also a runner and I have experienced the same as you in the beginning of my runs.. I have an ICD as well for VT.  

But, I have found that for ME over the years 'most' of the times I get my arrhythmias in the beginning of my runs because I'm more excited about getting out there and running.  As the miles go by and I 'calm' down - I don't get as many arrhythmias.  My husband says I'm like the little energizer bunny when I first start to run.  Could be my adrenaline is pumping faster in the beginning of a race..  

Try staying 'focused' and 'calm' and start off your run alittle slower and see if that makes a difference.  It did for me.  I have faster race 'times' on my longer runs - I'm able to make up the time later in the race as I think my heart without the arrhythmia is functioning better and that generally means I'm able to breath better.

Happy Trails
Marilyn  (runner)

[Konopka1955]

Hi,  Just out of curiouslity what is your ICD programmed at:  Which Mode?  DDD?  and so forth?  

Marilyn

[Bob R.]

I am 48 and also a runner.  I first noticed PVC's last May that occurred at a rate of about 1 every 2 min.  Lately they have increased to an average of about 2 to 3 per minute; that amount varies widely throughout the day.  I take my pulse and record them over 15 minute intervals, because that is approximately 1000 total heart beats.  So the amount that you detect in 15 minutes divided by ten is your percentage of PVC's.  For example, 23 PVC's detected over 15 minutes is about 2.3 percent of your heart beats.  Sometimes I have 6 in 15 minutes and sometimes 79 (this morning).  Like many people on this website, I noticed that there seems to be no rhyme or reason for their occurence.  Diet, caffeine, alcohol, meditation, praying, etc. have random or no effect at all on them, although stress is undoubtedly directly related.  Most of the studies that I have read concerning drugs indicates that, although they may provide comfort by reducing PVC frequency, they do nothing to attack the cause (renegade ventricular cells), and mortality rate seems to be higher with people who take them.

I run on a treadmill and wear a Polar Heart Rate Monitor.  I run for 3 miles and then walk at a 6 degree incline at 4.5 mph for another half hour resulting in an average HR over an hour of about 150 bpm.  As my heart rate increases, the amount of PVC's decrease until about 140 bpm when they stop altogether.  That's the good news.  When I stop running and my HR slows to about 80 to 90 bpm (5 to 10 min after stopping), they come back in a flurry.  For example, I detected 130 (my record) in 15 min. last week upon stopping running.  That frightened me so much that since then I have just been walking at the incline and am wondering if it's worth trying to run again.  The amount of PVC's generally rapidly decreases and things are back to "normal in about an hour.

I believe the reason your and my PVC's stop at a certain HR is that offending renegade cells don't have enough time to discharge their stored chemical energy(?).  Of course this changes when you stop exercising and your HR gets close to normal.  This may be something you want to monitor yourself.

[dafan]

When I read your comment it could have been coming straight from me. I am 50 yrs old. Mine started one evening last February and continued on until May last year. Then they almost stopped to the tune of about 20 per day. Then in November my wife went for gall bladder surgery and i got really stressed out and they came back with a vengeance. Up until now they have essentially been occurring at a rate of a bout 2 to 6 a minute in the morning then they usually..... stop for the rest of the day. But they do respond to stress by coming on. All my tests were normal. so it is a mystery to me. I have been very athletic all these years so i suppose it may be due to that... And i must say some days they really bother me and others i can stand them pretty well. The running part is exactly like yours Rob. As a side note, when they first started an evening meal usually brought them on for a couple of hours. Now if... im having them at meal time eating makes them subside...For sure they are fickle.

[dafan]

Oops sorry just saw you were Bob not Rob*S*

[ScottH]

Thanks to all who have shared thoughts. Here are a couple of answers to some of the questiosns:

- The gradual disappearance of the PVC's after about 45 min to an hour does not appear to be related to heart rate. I have worn a monitor often, as recently as for a couple of weeks in March, and it showed no relation to heart rate. My heart rate remains pretty steady even over 3 hr exercise.

- I have had many echo tests, and always show normal, no apparent disease.

- The observation about adrenaline is interesting. My cardiologist suggested this part of my problems might be related to the level of adrenaline changing after some time. (So I asked how to make it change SOONER, and he did not have an answer !) I thought it might be related to changes in electrolytes because of long periods of sweating while running. My bp, which is normally say 150/90, can be down to 95/60 after a long run.

- The observation about (emotional) stress level is also interesting. It is true that days when I am under extra stress emotionally, it can take longer, even 2+ hr for PVC's to subside.

- The episodes of VT have been there my entire life. I can actually remember a severe episode when I was age 5. The VT is almost exercise induced, as normal stress causes problems, but don't progress to VT.

- I am not sure how my ICD is programmed. I have had 5 of them (another long story), and with the present one, I know the atrial wire came out, and the doctor did not want to go back in again to fix it. So ICD is not pacing any more, just defib.

Thanks ... Scott

[Konopka1955]

Hi Scott,  5 ICD's !!!  You've had your share of ICD's certainly.  You have NO heart disease along with those VT's?  
I think your one lucky guy.  

I can only tell you from my experience - and I DO have heart disease (rheumatice fever) that MY VT's started out as 'exercise' induced and within a few years from the onset they later became an everyday occurance, whether I sat, or I was walking or just plain talking to someone.. I got them all the time..  VT's - non-sustained and sustained.  My EP said during my EP study - that I actually stayed in sustained VT for quite some time..  I didn't ask how long and I really didn't want to know.  Luckily I never experienced those long ones while I was awake.  A couple nights I woke up out of sound sleept just gasping for air !!!  I found short VT's really put a damper on my race times.  Thank goodness I complained - running down those back roads with no one around and gasping for air was very foolish behavior.  I just didn't know how 'foolish' until they ran those EP tests..  I had no idea and I was so naive.  My cardio told me they were just pvc's and don't worry about them.  Only problem is pvc's never made me 'gasp' for air.  They certainly didn't feel like a pvc.  They were much longer and faster..  Very FAST..  I also found the minute I stopped running and was doing my cool down that I got more vt's also..    

I know you probably have a fantastic doctor - but if you should start getting shocks from your ICD - they may want to increase your meds and you'll be needing your other lead. I'm not sure I would go without mine - actually I can't - I go into Full Heart Block without the meds and the pacemaker.  I've had shocks and I'm sure as you probably know - they hurt like the dickens..  I'd take the meds over shocks anyday..  Its a no win situation and certainly at best a give and take..  

Wish you lots of Luck and I bet you've seen a tremendous difference from the old ICD's to the NEWER one !!!   Technology has certainly come a long way..  and it seems by now YOU must be a pro at it..  My hat goes off to you.  You've certainly come a long way. I can't imagine being one bit intimidated by pvc's after you've had VT' and GASP for AIR !!!   It felt like someone just SUCKED the air out of my LUNGS - real quick..  with no warning at all.    

We are sooo lucky to have such great technology - I just wish they could program me for 8:00 minute miles !!!  I keep asking and my EP doc just keeps smiling at me..  :-)

Happy Trails
Marilyn  (runner)

[runnertom]

Maybe you can just do a 60 min warmup to get rid of the PVCs! LOL
   I also am a runner/biker who started noticing PVCs about 10 years ago (am now 57).They occurred while running or riding whenever my pulse exceeded 110 bpm but would quit at about 140. I cannot say I ever noticed reduced performance due to the PVCs. A cardio supervising a stress test commented that I was "overdriving the focus". He seemed unconcerned as did two other cardios, one of which did a 24 hr holter that showed trigeminy during exercise with a few runs of VT.
   Over the last several years, the PVCs seemed to be increasing based on my Polar HR monitor. When they started, the monitor would quit updating as it could not calculate a pulse rate due to the variability of pulse to pulse timing. (I have neve been able to directly feel the PVCs unless I was actually counting my pulse manually.) At one point, my GP sent me to a fourth cardio based on the PVCs and VT I was getting on a stress test-actually pulmonary function test to look for cause of shortness of breath early in a run. The fourth cardio did a cath-because of the PVCs he said-and found a 95% blockage of the LAD. I had bypass surgery the next day (2 years ago) and all has gone well since.
   I had no chest pain or other symptoms likely due to heavy collateral development. I now question whether the sugery was really needed. Even the surgeon was soft-selling the surgery based on me not really having any symptoms. The cardio had said however that he was not going to let me out of the hospital until they fixed this thing.
   Anyway, post surgery, if anything the PVCs were much worse. The Polar was useless. However, over the last year, the PVCs have seemed to almost totally gone away. I don't use the Polar any more, as I have come to question its value and realize it just raises my anxiety level and keeps me from enjoying my rides.
   I am not sure what the lesson in this is. I guess the PVCs at least raised my awareness of my heart issues prior to possibly having a massive MI. Maybe I was essentially immune anyway due to the collaterals. I do know that I am now obsessive about keeping track of my risk factors (homocysteine was high) and am doing my best to minimize them.
   The jury is still out as to whether the PVCs were due to the blockage. My GP swears they were, and my latest cardio is not too sure. I do know that the cardios on this board alway precede comments on PVCs with "in the setting of a structurally normal heart..."

[tickertock]

sound like you had a rough time but you never let it keep you down , good for you. I think you said you had a cardiac cath, EPS study, echos, stress test and every thing is structurally normal with your heart, no blockages, no valve disease , no cardiomyopathy, only PVCs and exercised induced VT.

i am curious as to why you had an ICD implanted despite the exercised VT, were you considered high risk for sudden cardiac death  10 years ago and the ICD implanted as a so called insurance policy.

i understand that normal heart idiopathic vt that is induced by exercise pose very little to no risk to a person and doesn't qualify one for an ICD as it might have done years when arrhythmias, especially ventricular ones were more poorly understood and not well studied as now. Is your VT diagnosed as normal heart idiopathic VT, just curious? Thanks.

[bama jane]

I have multiple arrhythmias and follow these posts. I noticed you said that you at times wake up at night gasping for air.  While I do have some pvc's.  They have never captured v tach on any of the  monitoring.  I wake up gasping for air quite often and wondered if you or anyone else knows if a fast atrial arrhythmia could also cause this gasping for air thing.  I have atrial tach, pac's, bigeminy trigeminy, sinus tach, sinus arrhythmia, junctional rhythms, acelerated rhythms, and some pvc's as well. No strucutral problems, and no known coronary artery disease. It only seems to happen in my sleep.I do have some shortness of breath with these arrhytmias but nothing like the gasping that wakes me up on some nights.  It seems to stop as soon as I am awake.  Any insight would be greatly appreciated.

[WPWGuy]

Hi everybody. I am 45 and also a runner. Similar problem with PVC's during running and occasional short run VT's at rest.  Not much of a problem by comparison to some of the stuff you read here --- at least so far.  

Just a thought though --- the occurance of these PVC's is quite variable, even when not influenced by external factors.  So if caffeine or alcohol do have an effect, might it be difficult to distinguish normal "background noise" from effect of caffeine etc?  

Higher frequency of PVC's only struck me recently (had RFCA for WPW last year that brought em on), and it took several months to realize that there was any connection to caffeine. I could have a 20 oz coke and not notice much of anything if I was in a "good period". Consistently cutting back though has noticeably improved things.  I have fewer bad days. The running also helps the PVC's, as long as I persist with it, and also add plenty of rest to my schedule.

Regarding the gasping for air at night, I used to experience this with mild alchohol use. My WPW never acted up at night, and while my current arrhythmias do act up at night, they never cause breathlessness. It did take me an incredibly long time to figure out the connection between alchohol use before bedtime, and "gasping".  Now that I stopped that (except for an occasional beer no later than dinner time), it stopped --- completely.

I would like to qualify all of this by saying, in summation, that I am not a doctor, and that I am also not a drunk.  Only a doctor is qualified to tell you about health matters :).

[Konopka1955]

Hi, bama jane
your quote - While I do have some pvc's. They have never captured v tach on any of the monitoring. I wake up gasping for air quite often and wondered if you or anyone else knows if a fast atrial arrhythmia could also cause this gasping for air thing.  - end of quote

Hi, I'm sorry to say but I don't know what tachy's produces your gasping for air - I know what it was for ME as I had started off with pvc's (years ago) and then over the years it progressed to vt's with exercise and then I got them even without exercising.  I do remember it happening during a time that my vt's were quite active.  Which I think was from having several vt ablations.  When I had those ablations it often stirred my vt's up.  I don't drink alcohol.  I don't smoke but on occasion I do "swear" !!  and I love a chocolate bar now and again..  :-)  I DO have structural heart disease. Anyways, I'm not a doctor and I don't know.  But I definently would take those nightly 'gasping' events serious.  I've heard many ICD patients get those events and have been woken up with 'shocks' from their ICD during them!!!  I would think if you got a 24 hour monitor and got it recorded they could tell.  

I would talk to your doctor. I am not a doctor..  

I'm just amazed about Scott having 5 ICD's and 2 shocks !!! I hope his pvc's get better.  

Best Wishes
Marilyn  (runner)


  

  

[ScottH]

Once again, thanks for such a good discussion.

My ICD was implanted because the VT sometimes lasts so long (over a minute) that I loose consciousness. The cardio feared that I would not always come out of it on my own, hence the ICD for “insurance” as he put it. One of the times the ICD went off, I had already lost consciousness, and it had to deliver 6 shocks to get me out of VT. Also, my resting pulse is about 40. I am now taking daily 400 mg flecainide (tambocor) and 600 mg mexitil to “control” the VT, and my pulse will get down in the 30’s with all this med. The doctor was uncomfortable with this, so he also paced me at something like 60. But, as I mentioned, the atrial wire came out, so he is no longer pacing me with it.

The short story on why I’ve had 5 ICDs has to do with finding one with enough energy so that it does not take 6 shocks to get the rhythm normal (and I only weigh 165 lb), as well as some serious infections that resulted in removal for a while. I hope I did not confuse anyone into thinking I have 5 in me at one time, just over time, 5 different ones. (I have now asked that a zipper be installed in my chest.)

I do not really know if the VT is “normal heart idiopathic”. No doctor has ever been able to offer a reason for the problem.

For those with sleeping problems, you have my sympathy. I really don’t have trouble at rest. But, I am sure, regardless of when it happens, the PVCs, VT and all the rest of the nasty stuff is just as troubling.

Thanks to all.

[Mantels]

What are PVCs?

[Mantels]

What are PVC's?

[Abeybaby]

Premature Ventricular Contractions

[Konopka1955]

Hi Scott,  I knew you didn't have 5 ICD's in at once - I should have written that better.  But even so to have had 5 different ICD's is quite process on you.  

I would ask for another lead - you must feel awful when your pulse gets down to 30's - I know when I had the meds without my pacemaker - I got down in the 40's and I could barely stay awake.  Office co-workers decided to call the Rescue Squad and get my pulse going again.   Well, I took one look at the paramedics and let me tell you my heart rate rose very quickly..  But, I certainly did not decline a ride to the ER with them !!!   All that happened on 12.5 mg of atenolol twice a day !!  Thank god I have a pacemaker - I'd hate to think what it would do without my minimum beats as I take mexiltene as well as atenolol..  

I thought if they programmed your pacemaker correctly you can get 'paced' out of your vt's and not get shocks if programmed according to your algorhythms.  I would think it might also keep you from passing out..

I think the newer ICD models come packed with 35 Joules - vs mine which is 31 Joules which was enough Joules to take me out of VT..  Too much if you ask me..  But it did work.  

If you don't mind my asking - what do you mean by 'zipper' and how does that correlate with VT's?  

Best
Marilyn (runner)

[ScottH]

Hi Marilyn - the "zipper" comment was a lame attempt at humor ... the upper left part of my chest has been cut open and sewn back so many times, it would be nice if there were just a zipper there to make it easier !

[jkf]

Hi,
I also wake up about once a month feeling like I'm not breathing.  (sometimes gasping sometimes it just feels like I'm not breathing.  It is hard to explain). I think anxiety can cause this too.  It only lasts a second or two and my pulse is always normal but just a little fast.  Unfortunately I've never caught this episode on a holter.  I have PAT and PVC's.  I've mentioned it to my doctor however he didn't seem to worried about it.  I just wanted to let you know that there are probably a lot of people this happens to and it doesn't always mean something "BAD".  I'm  not a doctor, just my opinion.

[Konopka1955]

Hi Scott,  I'm sorry - I thought perhaps you meant something more medical intervention.  

There is a zapper board (ICD) that I sometimes visit and we often refer to the zipper as someone who has had Open Heart Surgery and then there's the phrase zapper which we refer to as the ICD scar..  Just 'words' we use..  I unfortunately have both the zipper and zapper and thank goodness there aren't anymore scar phrases..  :-)    

Best
Marilyn (runner)

[Jeff67]

ScottH, your post has generated some great discussion.  It is unfortunate that the moderator limits the number of responses for each question that is posted as this makes it difficult to continue interesting discussions.

I have been wondering, when doctors talk about a person having an insignificant increase in risk when they have VT in the setting of a "structurally normal" heart, does anyone know whether "structurally normal" includes the electrophysiology of the heart? I ask this because based upon my reading SVTs and VTs mostly occur due to extra pathways and a reentrant circuit and are rarely due to one area of the heart just firing repetitively.  Therefore, the structure may be normal, but the electrophysiological characteristics are not.  If it were not for these extra pathways people probably would not get the SVTs or VTs to start with, so I guess I kind of answered my own question. Any comments?

[Abeybaby]

Someone from another post had this to say about PVC's.. any comments ? Because I think this person is 100% correct. Do you just ignore them? Or what?



Just wanted to thank you for asking an excellent question! I wanted to ask a similar thing. When the doctor tells you PVCs are benign and not to worry about them, does that mean you are cleared to climb Mt Everest? Undergo astronaut training? And when you get a run of PVCs do you just ignore it and continue going about your business whatever you are doing at the time? Even when a string of PVCs occur and I can prevent myself from being worried, I still feel like I should take it easy a bit until they calm down. Are all of us PVC suffers to understand that during a run of PVCs we can continue doing bench presses or heavy squats without any concern in the slightest? I think if the doctors made this absolutely clear to us what boundaries exist, or if there are simply none at all, it would set all our minds to ease (and perhaps a few fewer PVC posts as well!). Just hard to experience a run of kicks in the chest and not believe that something is going haywire in there (as well as one's actions making it worse). I'd appreciate your thoughts and comments, and if the kind doctor ever reads these comments it would really help to clear this up once and for all. Thanks so much. Overall you all are a wonderful bunch!

[salis110]

hi dear guys
i've an odd feeling , sometimes i feel dizzy but when i check my pulse it is normal as always for example it is 60 or little more or less.but sometimes it beats faster till 90-100 without any activity, at this period of beats i feel something happens in my chest, it is not pain or ? and after a short time (1 or 2 secs)i feel a heavy pulse and after that every thing goes ok but some anxiety.If casually through this event I check my pulse I feel an interrupt or skipping pulse.It makes me crazy.Also sometimes i feel pain in my chest bones dr.s siad they are due to ur anxiety.
I did echo which was ok and 24 hrs holter i had a period of 43 bpm during sleep at night and a 2.14 secs rest in hearts beat plus 2 rests less than 2 secs.
whats going on me? what are skips in my heart with odd feeling i dont know is it pvc or not?

[Red_]

You make a good point Abeybaby, it is just hard to experience a run of kicks in the chest and not believe that something is going haywire in there.

I am 27 years old and experience PVC's sometimes often sometimes not at all.  Compared to other postings my problem may not seem like a problem at all.  I have had a holter done twice and the only thing the cardiologists is "yes you do have PVC's but that is normal".  Sometimes I feel light headed when they occur but I am not sure if that is because of the PVC's or the anxiety that follows.  My PVC's started after 8 years of smoking.  Oddly enough the PVC's scared me to stop smoking cold turkey (a blessing in disguise maybe).  Regardless of all this information I too am curious if these PVC's (happen consecutively) are really harmless and if there are any other tests that I should inquire about?  Thanks.