Non sustained VT

[BlondieCO]

Hi,
I wrote a while back before tests. PVCs started 11 days after gallbladder surgery.  Began during PMS, lasted 10 days thru my cycle and ended with it.  Went to ER they said they were benign, had couplets, sometimes 30-40 PVCS an hour for 5-7 hours straight and then none.  My GP sent me to have tests done. Echo normal (mild regurg); stress excellent; then holter.  I wore the holter during the start of my next cycle and had only one event of PVCs, this was the only event I have had since the run of 10 days.  I was at my computer and felt a big "thunk," scared me, I got dizzy for the first time.  My GP said the holter showed a run of 11 non sustained PVCs?  He told me it could have caused sudden death and scared me to death.  He has put me on 25 mg of Atenolol a day and I have a referral to a cardio.  I finally found a website that says women get frequent PVCs premenstrually and during early menopause.  There HAS to be a link, it's the ONLY time I get them.  My question is will the Atenolol keep the run from happening again, I am very scared, I have two kids and I don't know how I can get only one event out of the blue like that. I don't drink caffiene, good amount of stress, but I am scared to exercise now.  The stress test did not bring on PVCs.

[Cleveland Clinic]

blondie,

thanks for the post.  

Nonsustained VT is different then isolated PVCs.  In some people it can certainly serve as an increased risk marker for worse arrythmias.  The problem is that it still is rather common in the general population (about 4-5%) and in most not a problem at all.  What we do know is that there are specific populations that have a definite poor risk associated with NSVT such as those with coronary disease, a low ejection fraction or those with symptoms from the arrythmia.

Generally the evaluation should be a little more thorough to rule out coronary disease and structural heart disease and should include some form of age appropriate coronary evaluation and echocardiography to rule out underlying cardiac disease.  If these are normal, the general risk overall is low.

Avoidance of triggers such as caffeine are recommended by some.  The addition of a beta blocker which is an antiarrythmic should helf further decrease any negative risk.  

Avoidance of exercise is not recommended in patients with exercise induced NSVT and has been studied. In those without structural heart disease, there does not appear to be an increased risk of this arrythmia.  One of the most important things you can do for your overall health is to stay fit.

hope this is a start to alleviate your concerns.

good luck

[Abeybaby]

THat's precisely what scared the daylights out of most if not all people w/ PVC's on the forum.  I had a incident that was not caught on tape where one PVC caused a run of 4-5 of them in a row until I coughed and then they were back to normal while on my computer.  Scared me to death!  What is frightening is that you go to the cardio, get tests done, everything imaginable, and then all tests come back negative- common line: "dont worry they wont kill you, you have a normal heart and all tests are good ... go live your live etc ..."  Very hard to do that when you know it could have been fatal? So I empathize with you very much but having said that, you must go on and live your life otherwise you will be a cardiac cripple, a cardio once told me that if I wasnt careful I would fall in that category.

As for Atenenol, well I am no doctor but I was told by my cardio that Atenenol really helps kill the symptoms for some people and makes the heasrt less excited as it kills the adrenaline to the heart.  But other than that, not sure it does anything for the PVC's - it goes either way really. He said to me that whether I take it or not it will not increase / decrease the frequency and therefore rather neutral therapy.

Who knows ??? The bottom line is this- get thoroughly checked out my a cardio - a reputable one and see what they say.... after that move on with your life because if its going to happen well you cant really control it anyways.

Good luck and try to move on to better thoughts and things. As for the PVC and mentrual coerelation? Well I am sure there is something going on but they have no answers so again move on as best as you can.

All the very best!

[dafan]

Hi Blondie, Seems as tho i have almost the exact same problems as you... Except im a male. The last few days ive had episodes that usually start at around 8 in the morning and last until around noon. The beats occur in couplets a lot..... and ill have pvc's to the tune of about 1 every 6 or 7 beats.Sometimes every 4  beats. They had essentilly dissappeared over the summer until this last week when my wife had gall bladder surgery ...Stress i guess. But they have stayed with me. Went to the er last Wednesday and ive got an apt with my GP today. I want some answers to these things. I had an echo last March which was normal. This is ruining my life.

[dafan]

Thank you so much for your words of encouragement. Im really really trying to put these things in perspective. It just seems as tho it is a constant reminder, ie evertime one occurs, that something 'could' be wrong. I guess i need to see a counselor. Thank you so much.

[Erik36]

Ask your cardiologist for an EP study. If the they cannot induce Sustained VT then you should have nothing to worry about. NSVT is harmless in a structurally normal heart. Peace of mind is the most important thing. You shouldn't have to worry all the time. I know how you feel. Best of luck!


Erik

[dafan]

Erik, I just made an apt. with an EP this morning. I was getting no where fast. In your understanding, even if they can induce a VT in an otherwise normal heart then I suppose they would do an ablation? I never thought I would get to this point with these pvc's but they are taking over. With every one of them im reminded something could be terribly wrong. And, I am becoming a cardiac cripple. My question also, I have had bouts of nsvt although not caught on monitor. Im sure that is what they were. I dont know with a normal heart whether to request a study, and are they normally carried on insurance?

[uptowngirl]

Hi. Sorry to hear of the VT.  It sounds like you have gotten some good words from bkj and others.

I have taken atenelol for almost ten years and it has been a very good med. for me. As far as the female cyclical connection between the PVC's/misbeats I've read several commentors on this forum say that there is one.  I have very few palps/PVC's anymore,but if I do get them it is in the time frame you describe.  Like I said the meds. have made a profound difference in my life, though I have a different cardiac situation than you describe.  I also like what Erik said about the EP study which sounds like a good direction to consider.

All the Best
Uptown

[dafan]

Does anyone have pvc's that come in patterns? Mine have been coming in the mornings from around 8 to noon and then they really decrease in numbers. I dont know what this means.

[pms_barbie]

Its my understanding that a dr can make anyones heart do vt during an ep study.  When I had my ablation done back in August I was thrown into vt.  I didnt have to get shocked out of it it stopped on its own.  I remembered going into it and asked the dr about it he said the caths triggered it not to worry about it.

[BlondieCO]

What is an EP? Do they make your heart go nutty while you are awake?  That would scare me to death.  I see a cardio do tomorrow.
Has anyone gotten non sustained VT like mine?  It really does scare me.

[Erik36]

Barbie. You are exactly correct. An EP study can induce VT in almost anyone. The important thing is that the VT isn't sustained. The fact that your VT terminated itself means that it it is very unlikely you would have a sustained VT now which is great news. That's why I suggested that dafan seek an EP study for peace of mind.

dafan. Most Health Insurances should cover the EP study and any subsequent Ablations (if necessary). They may not be able to induce Sustained VT in you at all. The Beta Blocker will reduce the chance of you having any problems in the interim. I know they're scary I've had short runs of what I think was NSVT and it scared me too. I've never had more than 5 or 6 beats at a time and I've never had an EP study. I've have had a few stress tests that did not produce any arrhythmias. My Doctor said that if a stress test didn't induce VT then it would be unlikely for me to have an episode of Sustained VT. I haven't had any problems in a while. You should keep exercising, however, as this will reduce the likelihood of having any heart-related problems. Best of luck!

Erik

[BlondieCO]

Erik,
Can you read my question about what is EP? I guess I will know tomorrow if I am getting that done. Sorry, I am just nervous, I thought I was ok.

[hankstar]

To all concerned about NSVT, I had a 5 beat run in 1987, back then it was taken a bit more seriously , yet a EP doc told me it was nothing to worry about, I did not feel it , yet I was awake when it occurred so I know these things that can happen and you don't feel it. It is nothing to be concerned about once all your test come back normal, it is a rare patient with NSVT without structural heart disease or abnormalities that requires and EP study and even more those that qualify for ICDs.

  Just about anyone can be thrown into VT, a-fib,and even V-fib, it is not an end point, it is are few that mee the criteria for an ICD without any structural abnormality.

In an EP to investigate atrail arrhythmias, you starts with the ventricles, to investigate ventricular arrhythmias one usually starts
with the atria, one would think it would be the other way around.

To dafan , usually my episodic PVCs act up in the morning myself,probably usually to due to some change in autonomic tone I suspect , everything gets to overdrive when upon awaking, maybe this is what is happening to you.

Look at it like the U.S. has an estinmated population of about 300 millions person if I iam not mistaken, about 350 to 500 thousand are estimated to suffer sudden cardiac death from arrhythmia, usually on autopsy about 80-90% are found to have severe undiagnosed coronary heart disease, the rest have HCM, ARVD, long qt or some other cardiac syndrome(rare) such as Brugada syndrome. That is is roughly two tenths of 1%, of the total population.

The chance of dropping dead from NSVT in a normal heart are just about nil, the same as the average population in general, of course it can happen to anyone after we are only human, but the chances are almost nil. Don't let "alarmist" doctors frighten anyone. I would say Dr, BKJ reply should be most reassuring to those that suffer with this.

[hankstar]

The first paragraph should read and even more rare is those that qualify for an ICD.

The second paragraph should read in an EP study just about anyone can be thrown into a-fib , VT, and even v-fib, it is not an end point.

[Gaspipe]

Please remember posting limits

[BlondieCO]

Thanks Hank,
I have to admit going about my daily life is crazy now that my doc mentioned sudden death. The crazier part is my 24 hr monitor showed that one event of 11 ectopics in NSVT and NOTHING else.  I am just floored that this can all happen and that there are not enough concrete answers. Thanks, I wish you all luck with your PVCs.

[hankstar]

I know how you feel , I had palps all my life I am now 40, and only within the last year or 2 have I learn to cope with them.

I know this sounds blunt but we are fighting a battle that one day we will all lose. Life is uncertain and death is for sure.

I know these arrhythmias are alarming and uncomfortable to those aware of them. Some person are incapacitated by minor insignifiacnt arrhythmias , while others with severe life threatening arrhythmias can be completely unaware of them.

If a Ep study is recommended, then get one for a peace of mind, but the chance  of something  going wrong with invasive testing , though I admit  it is sometimes necessary is much higher than anything happening to you from an 11 beat run of NSVT.

Good luck, best wishes and let us know what happens.

[Cleveland Clinic]

Blondie,

Not all people with NSVT require an EP study, which is a invasive study mapping the electrical activity in the heart.  What they do require is a thorough evaluation looking for factors that associated with an increased risk of bad outcomes associated with the NSVT.  

If you have a normal cardiac evaluation there may no need for an EP study.

See your doctor discuss all of your questions with him or her and try not to get too worried by all of the comments you read in the responses to your questions.

good luck -- keep us updated

[wmac]

HELLO I JUST READ YOUR POST. IM SO SORRY THAT YOU HAD A RUN OF 11 NSVT BEAT. I CAN TOTALLY RELATE. I HAVE HAD A 3,5,6, AND 10 BEAT RUN OF NSVT. AND A FOUR BEAT RUN OF AIVR. ALL THE DOCTORS WHICH I HAVE SEEN THREE EP DOCS ALSO CARDIOS, AND MANY MANY OTHER DOCTORS THEY ALL HAVE SAID THAT ITS NOTHING TO WORRY ABOUT WITH A NORMAL AND STRONG HEART. HAHAHA. EASY FOR THEM TO SAY RIGHT. BUT THE PROBLEM I HAVE IS THE "FEAR" THAT IT WONT STOP OR GO INTO SUSTAINED VT. I HAVE MANY MANY TEST WAS EVEN SENT DOWN TO THE UNIVERSITY OF UTAH WHICH THEY TESTED ME FOR ARRTHYMOGENIC RIGHT VENTRICULAR DYSLASIA WHICH THANK GOD IT WASNT THAT WAS A BAD WEEK. I AM NOT ON ANY MEDS THEY JUST IMPLANTED TWO MONTHS AGO A LOOP RECORDER IN ME I ALSO HAVE A RACING HEART WHICH FEELS TOTALLY DIFFERENT THAN THE NSVT BUT WE CAUGHT IT AND IT WAS SVT. THANK GOD. ANY HOW IF YOU WOULD LIKE TO TALK I WOULD LOVE TO CHAT WITH YOU. YOU CAN EMAIL ME ANYTIME AT
***@****  THAT WOULD ALSO BE OF COMFORT TO ME AS WELL. GOOD LUCK AND ILL BE THINKING OF YOU.
wmac (Wendy)

[pms_barbie]

I have documentation of 4 and 5 beat runs of nsvt.  Even after my ablation sometimes I feel like I still have some vt.

[VikingColumbus]

Greetings, cardio guru :)

Can you clarify to the best of your understanding
how one may detect that they are in NSVT?

I understand what's involved is a 'run' of PVCs.

OK, so is a run in the form of a tachycardia?

Or are PVCs 'countable' as they go by?

And, are there different tempos to an NSVT?

Appreciate you frequent perspectives. In lieu of
getting a shot at a question to a CCF Cardio.

VC

[hankstar]

I'll try to remember all you asked as i did not print out the questions, I may miss some.

   Usually one can detect NSVT if you can feel your pulse in time , there is usually no pulse felt with NSVT, then again it happens so quickly it is hard to tell, usually it ends witha big thump such blondie described, but also can isolated PVCs.

NSVT can occur at a slower tempo , usually between 60-110 bpm is usually referred to as AIVR(accellerated idioventricular rhythm)although most would consider anything above 100 bpm a tachycardia, so in reality a "run" does not mean true tachycardia(AIVR) is also called slow VT.

I imagine once you feel it and it has been captured on a holter , one remember the feeling again, of course sometimes the same PVCs feel "different at time so it can be hard to really tell without a tracing.

Usually 3 beats in a row would be considered a run, some EP refused to recognized this as true NSVT and basically called it a run of PVCs, 5 or 6 is often referred to as a "salvo", anything above that is usually recognized as true NSVT.

Remember I am not a doctor this my understanding of NSVT and even opinions vary among EP and cardiologist, so who am I to make the final call.

Always trust what your cardiologist/EP tells you regarding NSVT, if in doubt get a second opinion.


Note: Sometimes Low junctional wide complex tachycardia is often confused with VT and can sometimes only be distinguished in an EP study.

  My understanding, not grounded in stone.

Kindest regards.

[VikingColumbus]

Thanks, Mr. H

I also copy on your caveats.

VC

[uptowngirl]

Just briefly, I'd like to thank you for the good instructions last week about how to increase your chances to post a question. It really helped me, even though it took alot of persistance I got one posted a few days ago!  I have only been able to post twice in the last year and a half since I found the forum, but we all thank you for the helpful hints. I have learned alot from the archives in the meantime.  I do admire the helpful, selfless person you seem to be.
Thanks,
Uptown

[hankstar]

Thanks for the kinds words. I might have mentioned many times that PVCs and AVNRT same to hand in hand in many cases.

Read this rare documentation for reference, I just came across it today. Very interesting.

http://www.ipej.org/0402/pirat.htm

Apparently RVOT VT and SVT can initiate and support the other though rare, the key sames to able to ablate the RVOT VT,  first, then procede with the abaltion of the AVNRT to completely cure the palpitations.

Maybe this might actually be a more common condition than thought and be responsible for alot of PVC/SVT symptoms that apparently does not resolve by ablation for AVNRT alone or vice versa, just a thought.

[VTBen]

Hi Blondie,

I have non-sustained VT all of the time.  I'm a 28 year old male.  I started with PVC's and couplets and bigeminy.  Ocasionally my heart would miss over and over like yours and I would get a dizzy spell.  Holters showed it was non-sustained V-Tach.  I never get runs more than 10 to 20 beats.  It is a scary feeling though.  I take 100mg of atenolol a day. I've had 5 EP studies and FIve ablations to try and cure the VT.  I have what is called Idiopathic Right Ventricular Outflow Track VT.  I go to the Mayo for treatment, and they state, as well as everything else I have read, that this condition poses the same risk of sudden death as the rest of the normal population.  The condition is benign.  After you get your cardiac work-up, stress test, echo, etc. and if your heart comes out OK, then there is a good chance that you have VT that arises from your right or left Outflow track.  All the studies show that non-sustained VT in a normal heart is benign.  This condition also can be cured by ablation.  If i was you, I would go to a very good electrophysiologist from a place like the mayo or cleveland clinic and get an abaltion.  There is an 80% plus chance you'd be cured.  So if your heart is normal relax, you won't die from it.  I know better than anybody that that is easier said then done.  VT is a very bad feeling, and I still get extremly nervous every time I have it even though I know it won't kill me.I'd have to say however, that bigeminy is worse than the VT.  Hope all is well and you can relax.  Ep studies and ablations are not bad.  The worse part about them is the Foley catheter.

Good Luck,
Ben

[VTBen]

Thanks for the link.  I am actually one of those people who had both SVT and NSVT.  My NSVT or the PVC's arising from it would always be the trigger for my SVT.  I did get the SVT ablated however in my first ablation.  FOur more ablations and 36 burns later however and still can't ablate my NSVT.  Epicardial Ablation is the next step.  Very interesting article for me.  Thanks
Ben

[hankstar]

I thought many would find it interesting, apparently the real success or trick is to get(ablate) the RVOT VT first.Then the SVT is apparently quite easy to get at, at least that is the way i understood it in this link.

I agree bigeminy is the worse feeling one can have, I too am on atenolol 100mg daily in divided doses 25mg 4 times daily , very effective that way in controlling the palps, no significant discomfort in nearly 3 years.

Good luck on your next(ablation) attempt, I hope it meets with success, but even if it doesn't despite the discomfort you can look forward to long life.

Look like one the biggest risks now is being in the wrong place at the wrong time.

Good luck and let us know how it turns out.

    hank.

[BlondieCO]

I just saw my cardio.  She was great, lots of info.  She told me she does think there is a correlation between dips in hormones and PVCs for "some" women. She treats more than a few of them.  She told me my GP should not have told me I would drop dead from NVST.  I did have one run of 11, and no other PVCs during the 24 hr test.  She told me that the Atenolol should help if I get anymore, but I will get a cardiolite stress exam as well. She told me women can have normal regualr stress tests, but to be accurate I need the dye in me to see if there is any chance of CVD.  My echo showed my heart pumps strongly which takes away another risk factor.  She has ordered a holter during my next cycle (sorry guys) as she thinks there is a correlation.  She also told me that because I seem to get PVCs only during that time that she feels that lowers my risk from anything happening with NVST.  I hope she's right.  Thanks to everyone who gave input, I'll take the 25 mg of Atenolol and hope for the best.

[Erik36]

Sounds like your on the right path. Good luck!


Erik

[oakroom]

Reading everyone's comments, I feel like such a novice in this arena. I'd appreciate any thoughts on this....I'm a 45yr old woman, no high blood pressure, no high cholesterol and just lost 30lbs over the last 6 months. About 3 weeks ago I went to the ER because I felt some chest pressure and short of breath. Chest x-ray was ok and no blood clots but was told to have the nuclear stress test the next morning. After horribly failing the treadmill (EKG was going nuts), I was sent back to the ER. They did a catherization and found no blockage. I was put on calcium blockers and told to come back for treadmill test in 5 days. Failed again and put on 50mg of atenolol and referred to an electrophysiologist and for an MRI. Side note- my father died of a heart attack at age 47 and without an autoposy, no one knows with 100% certainty it was his arteries (tho that's what was thought). Anyway - had an echo done and another treadmill and still having irregular heartbeats. The specialist put me on 75mg of atenolol and am wearing an event monitor. So now it's been 2.5 weeks with medication and i still have good and bad days (i've recorded slow heart beats and PVC's on the monitor). 1 cardiologist seems more concerned than the other and i'm stuck in the middle of not knowing anything. 10 days and no MRI results given to me. With all this info - are these PVC's still with atenolol concerning or not? would love to hear anyone's thoughts on this.....tks.

[Gaspipe]

Hi I think you need to find out why you "failed" your stress tests. Your heart cath ruled out CAD so why did you fail? If it was an arrthymia what type? Why are you taking the meds your on? Why is one Doc more concerned than another?What's the game plan your docs have in mind? Good Luck

[hankstar]

Sorry to hear of your ordeal, if you had a cath  and showed no blockage , then you have to no coronary heart disease or any significant blockages. That is good.

Sometime PVCs are more frequent with a slow heart beat and vice versa. Taking atenolol and still having PVCs is nothing to worry about , probably will keep your heart from going erratic anyhow if even an increase in PVCs.First did they tell you what your heart showed on the stress test, what kind of rhythm, a-fib, SVT, NSVT or very frequent PVC or PACs, you should know what the rhythm was for discontinuing the test.

A recommendation of a MRI and and EP would suggest they are probably checking you for ARVD (arrhythmogenic right ventricular dysplasia) fatty  fibrous tissue in the right ventricle that can ventricular arrhythmias.

  Please note these are my opinions only and might have no relationship to your problem. I am not a MD.

Good luck.

[oakroom]

see what i mean about being a novice. i don't know what kind of rhythm. the ER nurse told me they shock people with that kind of rhthym....1 cardio tells me it's a life threatening rhythm the other, the specialist, says he has 4 other patients like me and seems to think once all the tests are reviewed, that it'll be nothing. But I saw your note on another posting about ARVD - I am a first generation Italian. So I went and looked it up and found that an MRI isn't necessarily conclusive either. So now i'm thinking if i MAY have something that rare, that I may need to look for someone who may have more experience in this. Do you know?

[hankstar]

You sure read and remember my comments I was going bring up if you were of Italian descent, ARVD is very pravelent among that population for some reason , your dad dying at 47 with no autopsy, was your Dad Italian or your mom side of the family or both Italian.

I guess I'm a bit ignorant myself , I guess first generation Italian would mean both parents Italian. I try not mention a person ethic origin now cause sometime it can be touchy for some , others really don't care.

My guess you had a run of NSVT. A MRI can give a good idea, the next step would be a biopsy, the have certain diagnostic criteria for diagnosing ARVD.MRI will give    the clue or information needed in most cases. NSVT in a population with ARVD is a risk factor, to rule this is a must in your case. Italian school children competing in sport screening for ARVD is mandatory now from what I understand. The cause of SCD is Arrhythmia triggered by exercise. In person with HCM, long qt syndrome , and ARVD , NSVT during exercise is an increase marker for cardiac events, in persons with a normal heart and none of these syndromes, NSVT is of very little significance and usually pose no risk.

Brugada syndrome victims usually die suddenly in their sleep and is more prevalent in the Far East , singapoe , phillipines, those parts of the world , generally southeast asia.

Good luck , hope everything turns out just fine.

[oakroom]

Thank you for your feedback. Yes, both my mother and father were born in Italy. I'm starting to brush up on ARVD and Emory (I'm in Atlanta)has a study on it.I've noted the RN at Emory already. Once someone can convince me there is nothing structurally wrong with me, I'll be happy to live with palpitations!I'll let you know what happens next.....tks again.

[dafan]

Hi! just wondering if the nsvt felt like very weak beats and the svt felt like a sinus tach? When i felt what i think was the nsvt, i had a couple of pvc's then a pause then what felt like 6 or 7 pvc's in a row. thanks so much.

[wmac]

Well its hard to describe for sure. My svt feels really fast and very faint. My nsvt feels like its not racing at all when in fact it is. It feels like one hard thug then pause, hard thug pause, and so on. Kinda like a galloping heart, or like when you get a really funny twitching in your arm or leg and it wont stop and its hard kinda  like that.It for sure does not feel fast to me but it most certainly is. Here is one rolling heart, kinda like that. Its just so hard to describe. But you do know what a pvc feels like right? Well just like that but many in a row with a thump with each one. Sorry this probably isnt much help. But I tried. It will be interesting to see how others describe it.
wmac

[WPWGuy]

I can say that my short run of SVT is more of an annoyance than anything.  The short run of what may be VT feels distinctively different.  Mine starts with a light twinge of pain, immediately followed by several very uncomfortable beats, and a delayed wave of vertigo...

[cmariep]

Hi, I just read everyones' posts and was wondering a few things. I went to my GP about eight months ago because I was feeling palpitations. I wore a Holter monitor which at that time showed frequent PVCs, 21 PACs, and 1 sinus arrest. He sent me to a cardiologist who then had me do an echo and a stress test. I had lots of blood work done and everything came back fine. Doc said there was nothing structurally wrong with my heart. Good news I guess. However, I recently went back to the Cardiologist because I have been having a lot of dizziness and left-sided chest pain. The PVCs are getting worse; they used to be single PVCs but now I have episodes of NSVT and also couplets and triplets. The cardiologist prescribed a beta blocker, but I have been reluctant to take it because I already record a low blood pressure at least once a day (around 95/50 or so) as well as a slow heart rate (around 50 bpm). I'm thinking that I should do another holter monitor or an event monitor but I don't know if my insurance will cover another one. All of the tests that I had done were done at least six months ago. If my symptoms are getting worse, does that merit a reason to do some tests over? I'm not too confident in the echo that I had done (I hated that cardiologist and am now seeing another one). Does anyone know if insurance will cover these tests again and should I ask to have them again?