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.

[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?

[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...

[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

[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.

[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.

[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]

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]

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.

[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

[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.

[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.

[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.

[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

[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

[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.

[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

[VikingColumbus]

Thanks, Mr. H

I also copy on your caveats.

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]

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

[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.

[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)

[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

[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.