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Having PVC's/PAC's, bigeminy & trigeminy with no answers,...
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Having PVC's/PAC's, bigeminy & trigeminy with no answers, complication of other illnesses?

I'm a 31 y.o. female who recently spent nearly a week in the hospital after a visit to the emergency room with chest pain/tightness, shortness of breath, extreme fatigue and diziness. Last year I was hospitalized for having the PVC's and bigemeny for 3 days. I have dealt with some of these symptoms off and on for the last couple of years with the symptoms getting progressively worse over the last year... There seems to be no predicting or aggrevating factor that causes my symptoms as they happen both when I am at rest or when I am doing any kind of activity. However I have noticed that I get exaughsted really fast... not just tired, but out of breath, heart pounding, need to put my feet up and rest exaughsted especially if I try to do anything when my heart is fluttering...

This time after a couple of EKG's, a lot of blood work and about an hours worth of constant monitoring, I was told I was having PVC's, PAC's and trigeminya decision was made to admit me with telemetry, serial EKGs and blood work (including blood gases), and a pulmonary test to be done over the first 48 hours. The doctors told me that all of my tests looked "fairly normal" and that the abnormal rhythm I was having was "completely normal" even though the nurses the night before had serious concerns about the rythms coming up on the monitor and made me stay in bed and take ativan hoping it would help. I"m no dummy but I am still unsure how "normal" equates to having to spend a week in the hospital on constant monitoring!  

In addition to the inpatient tests I have also had an echocardiogram and a stress test. The doctor supervising the ETT said that overall my test itself looked normal in the fact that, even though I had to seriously push myself, I met the target heart rate before making them stop and that I lasted the base time set for this test. He was however "intrigued" by the fact that prior to getting on the treadmill and starting the test, I had numerous PVC's and PAC's yet the higher my heartrate went after starting the test the more they seemed to decrease... Then when I was at rest after the treadmill stopped they picked backed up again right away as my heart rate came back down. At the time of this test he had not reviewed anything from the echo so he did not have any answers "in regards to any possible structural anomolies/abnormalities".  I go back to see my primary care doctor on Monday and I am hoping to have some sort of idea about what to expect. My husband wants me to reqest a refferal to a cardiac specialist and I am inclined to agree at this point.

A bit more background on me, I have also been diagnosed with osteoarthritis, sjogrens, mixed collegen vascular disease (one dr. said there might be a connection between the heart issues and the mcvd) and fibromyalgia... the only medications I take are plaquenil (200mg bid) and cymbalta (60mg qd). Between the conditions listed above and the heart issues, I feel like I am in constant pain and always tired. As a young mother with small children, this just doesn't work for me so I am open to any ideas or suggestions anyone may have!
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19 Comments Post a Comment
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63984_tn?1385441539
I can't comment about PACs/PVCs, I have some but they don't bother me or cause any other symptoms than an irregular heart beat that messes up my Polar heart rate monitor when I exercise, but your comments of having osteoarthritis, sjogrens, etc makes me wonder if you have been checked for Ankylosing Spondelitis.  Almost everyone with that auto-immune disease finds themselves in the hospital at some time with chest pain when the sternum starts to freeze up.  It commonly is a problem at about 30 years of age.  I have it, but it long since quit hurting me, which is normal for the disease (I'm an exhausted rooster, age 66).  I'd mention it to your doctor and hopefully an artritis specialist. I'd google Ankylosing Spondelitis (AS) and check the information.  Just a thought, good luck to you.  
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223126_tn?1189759422
Thanks for the thought, I will definitely check it out and ask my regular physician when I see him on Monday! Thanks again.
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84483_tn?1289941537
I can surely understand why Flycaster might have mentioned a connective/autoimmune disease such as ankylosing spondylitis. You mentioned sjogrens and such, as I am sufferer of ankylosing spondylitis. I suspect that when i was first suffering with the disease my palpitations were at peak. I rarely have them anymore probably around 30-60 a month that I'm aware of compared to bigeminy and PVCs in 1000s daily about 5 years ago.

a cardilogist definitely told me there is a connection due to the inflammatory process of such diseases and palps, the good news these diseases(most of them) though very debilitating and life altering are rarely life threatening.Good luck , I can surely sympathize with what you're going through.,
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Avatar_n_tn
Was this is in the States?  Was it a rural area or a big city?  I find it very unusual for you to be hospitalized last year based on what you said.  PVC's and bi/trigeminy are very common even in those with *normal* hearts.  It is also well known that in some patients, exercise will obliterate the PVC's, while in others exercise makes it worse.  Was the monitoring cardiologist board certified?  There can be a connection between connective tissue disease and right heart problems.  Your echo will look at that and see if you have elevated pulmonary pressures.  I can see why you would be so fatigued and have pain with the fibro.  I also agree with your husband!
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84483_tn?1289941537
I just noticed you said you live in Alaska( in your profile), believe it or not, cold weather is not good for rheumatological(sp) rheumatism like illnesses, it can aggravate the symptoms of these diseases, even living here in the Caymans where it is basically warm all year round, the slightest drop in temperature during the winter months will aggravate my symptoms.This might not apply to you or your condition , but its just something I thought you might find of interest.
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Avatar_f_tn
For anyone who is interested:
There is a new study published recently in which they put a 24 holter monitor on approximately 600 people. They did echos on all of them to ensure they had a normal heart and measured the incidence of pvc's, bigeminy, couplets and vtach in this healthy population. I can't remember the exact figures to the decimal point but bigemeny and vtach were found in approx 3.5 % of people. even in young patients under 30 years of age. Obvioulsy they only caught the arrythmias that occured on that particular day and I am sure if they had recorded for longer the percentage of people with vtach etc would have been much higher. I think the incidence of couplets was about 4%. I have the article here somewhere so I can check the details if anyone is interested.
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16292_tn?1189759421
Hi! I'd be very interested in more details! Where can I find the article?
Thanks!
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16292_tn?1189759421
Hmmm...that's interesting.  Let's try this a different way.  The email is my first and last name, no spaces, with a prefix of Ms.  and it is a hotmail account.

Thank you!
Laura Gill
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Avatar_f_tn
The article is
Cardiac Arrhythmias and Atrioventricular Block in a Cohort of Asymptomatic
Individuals without Heart Disease
In "Cardiology" 2007;108:111–116

You can find the abstract here however it doesn;t give any detail.

http://content.karger.com/ProdukteDB/produkte.asp?Doi=95950

You have to subscribe and pay to download the whole article. I have the article in pdf format and could email it to you. Alternatively I could copy and paste the relevant results section here.
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16292_tn?1189759421
Hi deedle! My email address is ***@****.  Thanks!!!!!
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Avatar_f_tn
Study Protocol
The study was performed in a general outpatient clinic at a
tertiary care university hospital dedicated to cardiology that also
provides primary and secondary levels of care. Patients were enrolled
from April 1997 to October 2001.
Asymptomatic individuals with normal clinical examination,
electrocardiogram and chest X-ray were eligible for the study.
Laboratory work up included treadmill electrocardiographic exercise
stress test, echoDopplercardiography, hemoglobin, hematocrit,
leukocyte count, serum glucose, cholesterol, triglycerides,
uric acid, TSH, creatinine, and urinanalysis.
Arrhythmias and atrioventricular block were evaluated relative
to clinical variables (age, sex, body mass index, systolic and
diastolic blood pressure) and to laboratory variables (total cholesterol,
HDL-cholesterol, LDL-cholesterol, triglycerides, heart rate
on resting electrocardiogram and maximum oxygen consumption
estimated by treadmill electrocardiographic exercise stress
test).

Inclusion Criteria
Asymptomatic individuals older than 14 years with normal
clinical examination, electrocardiogram, chest X-ray, echoDopplercardiogram
and treadmill electrocardiographic exercise
stress test.
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Avatar_f_tn
The results are in the form of a large table so I couldn't copy and paste it into any readible form. I have copied the datd for the overall incidence of each ventricular arrhythmia. (This is further broken down by age in the original table.

Below is the nu,ber of subjects having each arrhythmia followed buy the percentage of the total population.

Total subjects 625
ventritricular ectopic beats 398 (63.7%)
Isolated ventritricular ectopic beats 392 (62.7%)
Paired ventricular ectopic beats 55 (8.8%)
Bigeminy ventricular ectopic beats 20 (3.2%)
Polymorphic ectopic beats 186 (29.8%)
Nonsustained ventricular tachycardia 21 (3.4%)



It doesn't give data regarding the average number of PVC's etc. Just the percentage of people that had them. The only thing it mentions is the following:

"We detected in a 61-yearold nonsmoker woman 24,900 isolated ventricular ectopic beats. She denied symptoms and is asymptomatic after
a 4-year follow-up"
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Avatar_f_tn
Would you mind pasting the results here?
Thanks!
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Avatar_f_tn
Have just sent you the article.
Denise
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Avatar_f_tn
Have posted the overall results above. Sorry for all the typing errors. I typed it one handed while holding a baby. LOL.
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Avatar_n_tn
Hey deedle is the whole thing posted or is that it?  I would like to see the whole article.  I will send you my email address if you have more info?
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Avatar_f_tn
Thank you!  I often type holding my baby, too!  :)
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Avatar_f_tn
There's alot more than that ....6 pages, although most of it is about atrial arrhythmias and heart block I think. If you send me your email address. I can send the pdf. I don't think you can post your email addy on the forums as it blocks it out but maybe you could hint to me as Laura did above.
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223126_tn?1189759422
Thanks for all of the helpful comments. I went to see my doctor this morning who told me that my echo was again, "fairly normal", with the exception of seeing some minor mitral valve regurge and a ton of PAC's with some PVC's... I have a half sister with mitral valve prolapse... Can this be a possible precurser to this condition? I am not really knowledgable about heart conditions other than I know that heart disease runs hard and fast in both sides of my family.

In response to the comments about the autoimmune disorders, the doctor did say that he had rechecked my ANA again while I was hospitalized and compared it to when I had seen a Rhuematologist in March. He was surprised enough by the findings to call the Rhuematologist today at his home (I live on an island and this Rhuem. lives on mainland) while we sat together in clinic to go over the findings with him. In March, my ANA was 1:80, last week it was 1:640!!! He said that he is fairly certain that the MCVD (which is of course a connective tissue disorder) is the culprit behind my ongoing heart problems and previously unexplained chest pain. Ironically, he doesn't believe in the fibromyalgia diagnosis, even though the rhuematologist he is working with on this case is the one who diagnosed it! He feels it is a "wastebasket term applied when no other answer is readily available".

To answer your question maggiemag, no, none of the dr.s I have seen to this point over this are board certified cardiologists... mostly family practice. I did ask for a referral to one today though and they are setting up something for me to see a cardiologist the next time one comes in! In the mean time, they continue to tell me that everything is fine and that all the tests look normal with the exception of the elevated ANA, but at the same time have decided to move my next appointment with the Rhuematologist from next summer to the beginning of September (thats when I will get to ask about AS). In the mean time I have now been prescribed prednisone (qd) and metoprolol (bid) and ativan (prn- "to keep stress levels down") with instructions to follow up with my primary every 3 weeks...

Am I losing my mind or does this seem to be a bit much if everything is so "normal"?!
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