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PVC Couplet
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PVC Couplet

Hi, I had a question regarding PVC couplets.  I wore a heart loop monitor for 60 days and recorded PVC's, PAC's, sinus tachycardia and one couplet of three PVC's.  I also had a echocardiogram which was normal.  The stress test was also normal.  I am a 42 year old female with daily PVC's, but only 10 or so.  I only recorded one of the couplets in the 30 day period.  My doctor feels that it is not serious but wants to monitor me every 6 months to see that they are not increasing in frequency.  Can you tell me if couplets of PVC's are more dangerous and can they become a more serious arrhythmia?  When I get the couplet it feels like my heart is flip/flopping for 5 seconds or so, but once in awhile, this flip/flopping feeling last longer.  Could they be coming in longer couplets and how many is too many?  Thanks for your response.
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239757_tn?1213813182
larandsandy,

thanks for the post.

They are not dangerous of indicative of a more significant arrythmia. With your normal evaluation, they are benign other than the symptoms they may cause you.  You might refer to the forum to see how others have dealt with their symptoms.

good luck
24 Comments
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21064_tn?1309312333
You mentioned that a Holter monitor picked up one couplet of 3 pvcs.  I am not a doctor, just someone who has had her share of pvcs over many years.  As far as I know, a couplet is 2 consecutive pcvs.  Whereas, a run or "nonsustained VT" is 3 or more consecutive pvcs.  For me, the couplets and runs are flip-floppy in nature.  

I'd be surprised if, in the setting of a normal cardiac workup, the pvcs or isolated run would be cause for alarm.  But, follow up visits are a great way to keep an eye on things and for peace of mind : )



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Avatar_n_tn
you are probably right.  I guess I thought that a couplet meant a run of PVC's in a row without a normal beat in between which I had three of.  Thanks for your comment.  I do read this forum as I have had PVC's since I was a teenager and it helps to know I am not alone.  I know I have a lot less than some, but they are nontheless very bothersome and I feel every single one.  Thanks again.
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Avatar_f_tn
Hello, I just read your post. Im in the same situation. I had a run of three pvcs in a row three and a half years ago, that was my first one that I knew of. Since then I have had many runs of them and up to 26beats. So this is considered NSVT. Yes I freaked out alot. Although I have been to many cardiologist and ep specialest. With having a normal cardiac workup and in a normal heart setting and a good ef of 68-70 they are not worried. I have also had to ep studies. Which they could not induce the nsvt. I have been reassured many many times that this is not life threating. But I do know how terrible this feels and how scarey it is. I have actually seen four very good cardio/ep specialest and another one I spoke to who is a friend of a doctor I know. This paticular cardio/ep was very very reasurring not to mention the cardios on this forum. I have also been told that I do not need to take meds. However a year ago last January I did try three low does of toprol xl and that is when I had the 26 beat run. I had a loop recorder implanted so I was able to record it. I have also worn many of monitors as well. But yes three pvcs in a row is considered nsvt. If all your cardiac workups and test are fine then there is no need to worry. haha easy to say I know the fear is still there. I deal with it every day. anyway just wanted to share what I do know.
Take care
wmac also if you want to email me you can
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Avatar_n_tn
I loved the doctor's response...I never get tired of being reassured about PVCs!
I'd like to know how often you think a person with PVCs in a normal heart should have cardiac evaluation - holter and/or echo. I wore 24-hour holter in 2003 (tons of PVCs but no doubles or NSVT), and echo was fine. The cardio said it was all benign and didn't even suggest a follow-up! Do you guys have periodical cardiac evaluation for benign arrhythmias like PVCs or sinus tachy?

Thanks for any feedback!

Fran
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21064_tn?1309312333
Hi Fran,

For sure...never can get too much reassurance : )

I've always been checked periodically for pvcs.  I also have a leaky valve, so maybe that's why I was watched a little more...not sure.  My chief complaint was always the pvcs -- flip/flopping.  I think the doctors usually recommend a visit if you notice any change in your pvcs, etc.  I usually had a holter ordered when I would notice a new type of arrythmia, or if the frequency was increasing.  I remember one Holter in particular where I had 22,000 pvcs, fifty-some couplets, some triplets and thousands of bigeminal episodes.  Still, it was "benign" absent any changes in heart function, etc.  

Have a great day!

connie
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Avatar_n_tn
Hi Connie,
thanks for your reply. Gee, I thought my 3500 PVCs were a lot!! Actually I was surprised so few were recorded, I felt as if I had had a billion!

You are very reassuring! Thank you.
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Avatar_n_tn
I have an appointment with an EP tomorrow for a consult and my cardiologist mentioned that maybe he would do an implantable loop because they are having trouble getting my arrhythmia recorded. Everytime I wear something I get no symptoms only premature beats. I really want to know what the fluttery feeling is I feel at times and the times I feel like there is a racecar zooomiiing in my chest. Then my heart rate goes up to 120-130. However to tell the truth I am scared do death about an implantable loop. Could you tell me something about it and why did you wear one?
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Avatar_f_tn
Hello, Well I had worn so many monitors and we did capture my nsvt alot, but I also kept getting a very fast faint heart racing and it was different than what the nsvt felt like. The insurance company will only allow one to have the king of hearts for a certian amount of time. I was presistant about capturing this different rhythm and the cardio had mentioned it several times but I was to chicken to do so finally I did. The loop recorder is about the size of a cigarette lighter but not as thick. They made a small insision about 1-1 1/2 wide below my left callor bone abpit 4inches below it. Then once they do that they just make a little pocket in there meaning they move stuff around and then they slip it in there and they didnt stich it they just taped it. I was sore afterwards, Im a hairdresser and it was amazing that I had a hard time lifting my left arm for a few days but then I was fine. They set the recordings to automatically record if heart rate gets to fast for istance if my heart rate got to 190 it would automatically record and if the heart rate got to slow like mine was 40 it would automatically record. It could do five of those, then I could record three of my own. They will give you a activator and you will wear it around your neck to activate your recordings. The problem was that I live 120 miles from the cardio and I was going to have to travel every time my monitor was filled up to have them download it. But the rep for medtronics had the computer brought here to my doc in my home town and had someone train him how to download it and if it there were a question he would just fax it to my cardio. So if that is a problem for you too ask for them to do that for you. The batteries are good for 12-14 months. I had mine in from oct to may then I asked them to take it out. Then my doc just went through the same insision and took it out. When they put it in and took it out they gave me versead and a local and I didnt feel a thing I was in lala land. I also kept breaking out from the king of hearts stickys. So this was a nice thing for me to have done it. They captured my 26 beat run of nsvt which is why I had the first ep done. But it does not hurt to have this done I do have a nice dent in my chest now from it though. So if they want you to have this done I would do it. good luck
wmac
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Avatar_f_tn
So you are saying that to say what...that we shouldn't take the doctor's word for it and just accept that these stupid skips, couplets, nsvt, etc. are going to kill us?  There are lots of afraid people here, and I'm one of them.  My life has been literally RUINED - it is a shambles right now because of PACs and PVCs.  These things have nearly caused my husband to  divorce me (due to the fact that I am scared of living anymore), me to go to a mental hospital, me to fail out of a top 5 law school, etc. ad nauseum.  I'm finally in therapy and it is helping somewhat (I shouldn't even be on this site...my intensive "health anxiety" therapy includes no symptom surfing).  I am young and have a healthy heart and my cardio told me even if I DO have NSVT (which he doubts) it won't kill me.  I'm not trying to go off on you and maybe I'm misunderstanding you and I'm also not one to keep my head in the sand but I don't think so many cardiologists would be lying to us and giving us a false sense of security that we are not dying when we are.
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Avatar_n_tn
Hello,

I had to get my two cents worth in here on this subject too.  I have had many different kinds of arryhthmias recorded over the last several years (in fact - over a dozen different kinds) including NSVT.  Al Dente makes a good point - what if you have v-tach but an abnormal cardiac workup?  Or, to complicate matters - what if you have v-tach but your cardiac workup is normal but really there is something wrong with your heart only the workup cannot find it?  (I know this sounds sort of paranoid but I keep hearing over and over again too that NSVT in a normal heart is no reason to be concerned.  But, you can flip this around to say - why if my heart is normal am I getting NSVT!!!).

I am probably the only oddball here with this scenario, but I seem to have some type of "undiagnosable" autoimmune condition.  I have been through an incredible amount of testing and they cannot find the problem.  My main problem is bad raynaud's that seems to affect my hands, feet, and other body areas also.  I had heart irregularities that started at the same time as the raynaud's and have steadily worsened.  I am worried that my arrythmias could be caused by a raynaud's like affect on the heart (sort of a microvascular ischemia or microvascular spasm type of thing).  Assuming this is true, I have read it can be very difficult to diagnose something like microvascular ischemia or spasm.  So, if I do have NSVT caused by microvascular ischemia/spasm but my cardiac workup is normal - do I have reason to be concerned or not?

Sorry to babble on so long here but the point I am trying to make could be applicable to any of us with NSVT.  Is the real question whether our cardiac workup is normal - or is the real question whether our heart is normal?  (There could be a difference).

Hope this makes sense.  I will look forward to hearing what others have to say.

-Mr. J.
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Avatar_f_tn
Sorry about the previous post...I shouldn't have "spoken" to you like that.  I realize you were talking about people with heart disease, but still, there was no cause for that.  I'm just having a bad day.  I've been suffering from palpitations for 1 1/2 years and they've ruined my life, it is true.  I just get VERY frustrated sometimes because I have everything to live for and live like an 80 year old shut-in because my heart decides to act up.
I apologize.
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84483_tn?1289941537

Great debate I'm sure everyone is making a very valid point. Defining normal can surely be difficult is some cases. I think the doctor/cardio looks at the complete picture and makes an educated judgement call,one of the first questions a cardiologist will ask is if anyone in your immediate biological family died suddenly at a relatively young age, this almost always raises a red flag.

I personally don't believe(my opinion only) that anyone's heart is completely picture perfect, but still falls within the limits of what is normal. The biggest problem is doubt. There is widespread concensus in the medical institutions in these later years that most of these arrhythmias including those ventricular in nature are benign in the setting of a normal cardiac evalution. Are things missed and overlooked? Certainly it happens after all we are only human, but for the vast majority that is given the all clear they can rest assured that they will be just fine.
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Avatar_n_tn
If every single cardiologist we ask basically says the same thing - that these arrhythmias are benign - it must be true, they can't all be wrong! I too get scared, I have read everything I could find on the subject and I never found anyone who doubted PVCs were benign. I'm talking about PVCs in a normal heart. What defines a normal heart? I'm sure the cardiologists know. Sure, there may be a mistake, or a missed diagnosis. But this can happen in anyone, with palps or not. My friend's brother never had any palpitations and one evening had cardiac arrest and it's a miracle he's still alive. He has a right ventricular dysfunction he had never suspected. So people who don't have symptoms are also at risk of SCD - maybe even more so since they won't even have a cardiac evaluation unlike those of us with palps.

I too get scared and I can relate to everyone's feelings, I just want to believe that the doctors know best.

Fran
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21064_tn?1309312333
Hey Al,

Your situation definitely puts medical professionals into a tailspin, I'm sure.  

Speaking only for myself....I had significant pvcs for about twenty-five years. I also have MVP and mitral regurgitation (therein lies the "abnormality" in my case).  Even with very frequent pvcs, there was no cause for concern UNTIL my heart muscle showed some signs of changing.  Fortunately, I get serial checkups (primarily for the valve) so I was made aware of the cardiomyopathy fairly quickly.  For me, that's when pvcs became the topic of the day.

I'd say if you have ANY other underlying cardiac problems, it is probably best to keep an eye on the whole picture (CAD, lipids, CM, valve disease, etc).  Can't be too careful.

For those with pvcs and no underlying heart disease, I think you should obtain consults periodically, and certainly whenever you feel the personal need.  That being said, once you have been given a clean bill, and maybe a second and/or third opinion, it's probably best to just keep an eye/ear/heart out for anything new.  This is just my personal opinion, of course.  Everyone is different, and some of us, me included, may need extra reassurance.  That's OK too!  Whatever makes you comfortable.


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21064_tn?1309312333
Looks like we've researched the same guidelines.  The ACC website is full of great information.  

Have you heard anything back from the CCF evaluation?  Hoping for good news.
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Avatar_f_tn
I am just as guilty as the rest of you about freaking out about all of this. I have had palps since I was 19 and now 42. I do have mvp but then again only sometimes depends on the echo and the person doing the echo and the postion. Big debate there as well one report says mvp with reguritation other times no regurg and others no mvp. So there you go. But if you read my earlier post I listed how many cardio/ep docs I have been too and every single one of them have told me that in a normal heart you will not die with nsvt and that includes the mvp. The ep I spoke to from Portland Oregon helped me the most he was very sympathic and understanding instead of just sending me out the door with oh your fine. He told me that I have had my heart looked at from the inside and out and that should be reassuring although some of you may not have had as many test as I have he said if the echo is fine then dont worry. He also saw all my ecg strips epstudies and read my reports. Unless you have something wrong with your heart heart disease, heart attack scaring or part of your heart has died no sudden death in your etc... then your fine. Yes people just die from scd but all those people have heart problems that they dont know about. Just think your better off than the general population cause you all have had the heart workups etc.. That is not to say none of us wont die from scd or heart attack years down the road nothing in life is 100%.Things change as we get older as we all know. I asked my cardio "can you honestly tell me that having two ep studies and not being able to induce nsvt or svt, that im really ok"? He said Yes with out hesitation. He said the worse thing that can happen is your heart will get stuck in vt and I said that is what I worry about he said well that is so unlikely your chances of that are no greater than anyones. So in a nut shell we are probbably better off than the average joe. He also told me that if everyone wore a monitor almost everyone would have pvcs, pacs and even nsvt at some time. He said noones heart beats perfect all the time just some of us feel it and others dont. Good luck to all I hope I have helped. Let me tell you all I have been going through this for almost four years with nsvt and Im finally beginning to start to calm down and live my life. The cardio also said you just need to go on and except it.
wmac
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Avatar_n_tn
Wow, great thread, hope I can jump in and add something useful...wanted to let you know that from age 18 when I first went to a medical doctor because I was getting "more than usual" PVCs, until the age of 30, I hadn't been recommended any tests at all, nothing.

At age 30, a 24 hr holter recorded 10,800pvs. Did the stress test only. But was never recommended any follow-up and never did any.

Age 42 I noticed "more than the usual". 48hr holter records 22,000 and 28,000pvc with lots of couplets, bigeminy runs etc etc. It was me, me, me, who asked for more tests. Echostress, normal. I've was not recommended any follow-up. None.

I've learned from good folks, like, oh, just about everyone on here, that more has been done for less, so it's up to me to watch out for my own health care.

PVCs=not life threatening, but they sure as heck are life changing. Fear factor, don't let that happen to you. You have so much to live for. We all do. We just need to be reminded every so often, when and if we get a break from all the worry over our situations.
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97628_tn?1204465633
Frankly I just don't believe that all people are treated equally well. I think younger people are brushed off. My father had his first heart attack in his 30's, my aunt died of a heart attack in her 30's, previously mentioned cousin died in his 50's ("normal" heart, no clog, with history or arrhytmias), my grandfather was on digitalis through my mother's entire childhood, my mother just had an abnormal ecg, and her younger brother died of mitral regurgitation. So they can give me all the statistics they want that's fine. I don't have a high level of anxiety about dying or anything. I just get tired of having stupid symptoms for what appears to be nothing. It makes me feel ridiculous. So I guess my disatisfaction lies more in that goofy self esitmation than in my projected lifespan. However, if they can't tell me why I'm dizzy and having chest tightness and flip flops it does undermine the credibility of them *knowing* it's harmless LOLOL
As the actress in the Bicardi and Cola ad says "Whyyyyyyyyy?"
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Avatar_n_tn
When I was first diagnosed with PVC's it consumed me , I was here so often or I would sit and cry something horrible was wrong .. I had a monitor , I had Bi's , Tri's  and Quads ( I dont know what these even mean or ectopic ) all I know is that the heat beats  Atrium to ventricle , why my heart would do this I dont know but I suspect its my thyroid disease and my diabetes and my periods at 44 I think I am peri but hey .. my body is the Orchestra , fortunatrely  I never went Tachy though , my heart would add that extra beat and that was it ... like spomeone tok the wind from me

There are so many times that like in another post one Dr said they can be none for a while or be fast and furious for a while .. its true .. I want someone to say to me LOOK SOMETHING IS WRONG ..... heck my PCP wont advise me to see a cardiologist because they are just PVC's .. but they are changing , sometimes I feel light headed and it seems the same time at night mine happen .. is this the heart or coincedence ..... I think we all know the answer ......  Stress .......  

its very scarey and its like we are free falling and no one see's us ......  but we are , we are heard here and the Dr's here are cardiologist , they are specialist and in my final sentence for this post ... my mother would always say if its not broke there is no need to fix !!!


good luck everyone its been a bad month for me

cheryl
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Avatar_n_tn
Kitcurious, that's well put, not much faith in a doctor who can't tell why I, (we) are dizzy or having symptoms and the only thing "abnormal" are the PVCs, except that the standard line is "it's normal to have PVCs they don't mean anything". !!

But, I have had them since I can remember (my sister used to ask me to stop shaking the bed when we were taking naps--she thought I was doing it on purpose and got mad at me--little girls don't know anything about PVCs). So as the years go on, and the PVCs keep increasing I have to admit that still being "here", gives a little support to the standard line about PVCs.

And I don't think anyone needs to apologize for having a bad day, or week, or month, we've all been there. I hope it changes for you. I was going through the same thing and I think today is the first day I've felt myself for a long time. Hang in there.
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Avatar_n_tn
I've had pvc's 35 years and lived with them the best i can, had most test even had ablation 8 years ago it helped but no cure. Still i carried on untill 6 weeks ago when i started to get bigeminy rhythm continuously, i've had this rhythm before and loads of single ectopic's but didn't use to last long. Why i ended up in the ER was because when i was getting bigeminy all i could do was sit down because when i was walking while in this rhythm i was getting pains in my chest and it was the pain that stopped me.(Do anybody else get pain when they have this rhythm?)They just told me to increase my sotolol to 80mg twice a day. I was able to find some peace from this rhythm only when i'm resting but not when i'm walking.even though they say these things are harmless i am now housebound because of them. i am now waiting for another ablation which i hope will be soon as i can't stand this any more i'm 52 and feel like 82.The Dr has asked me to increase my sotolol yet again to 120 twice a day to see if that would make a difference with pain when i'm mobile, we have yet to see. It's nice to know i'm not alone.
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Avatar_n_tn
I have been reading this forum off and on for a few years, and I finally decided to post.  I know there are a lot of people who are very anxious regarding PVCs.  I don't know if my story will help, but here it is.

I am male, 39, good health.  Back in 2002, I hadn't been to a doctor in over 10 years, mostly because I never found one I liked or trusted.  After my wife nagged me for months, I finally found a doctor and went for a routine checkup.  I had felt some "skipped beats" over the years but didn't think much of them.  The doc noticed palpitations and sent me to a cardiologist.  To make a long story short, after months of tests (24 hour holter, stress test, echo, etc), several visits to an electro physiologist, and several rounds of beta blockers and calcium channel blockers, it was determined that my 33,000 PVCs/24 hrs were benign.  I was told not to worry, was taken off the medication, and was told to live my life and to see my doc if I noticed any changes.  Was I worried?  Yes.  Did I do a lot of research?  Yes.  Did I let it ruin my life?  At first, but then I realized I had probably had PVCs for a long time before I was diagnosed with them.  I decided to take my docs advice and try to address some of the issues I could control (weight, diet, exercise, etc).  I started riding my bike a lot more, started eating better, started spending more time with my family, and started enjoying life more than ever.  And I have been back to my doctor once a year.  I recently had another 24 hour holter and stress test, and have a follow up visit with my doc in a couple weeks.  I still have the PVCs, but I try hard to not let them control me.  Sometimes it is very difficult not to think about them, but most of the time I just focus on other things.  

I know everyone's situation is unique, but I just wanted to let you all know it is possible to live with these things.  My advice to all of you is to just try to get on with your life.  Life is short.  Don't let PVCs control you.  I know this is easier said than done, but just stay positive and keep going.
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97628_tn?1204465633
Very well put "I Live". I appreciate what you have to say. It is important to continue with life and I admire that you are able to do so with so many PVCs. I am going to school, working and caring for family, I exercise every day and do volunteer work in my community. My point is that I don't understand why and it makes me feel bad about myself, not panic-stricken or unable to function. It's affecting my self-esteem because when I start to sway I try to hide it so no one will know I'm apparently a  goofball.I had been getting symptoms for I guess about 6- 7 months or so before I went to a cardiologist who says I just have a redundant mitral valve.  To reiterate a past post, I believe this benign condition is congenital, which begs the question why did it take over 30 years to give any symptoms?
I don't entirely blame the doctors. They are busy, they have many critical and obviously ill patients and if I could pass a patient off with stats I'd probably do it too.
The truth is that my observations of how other people have been treated by  medical professionals has kept me away from seeing the cardio again because I have similar symptoms all the time. Reading about other people's fights for their own health care exhausts me LOL. So I sit here quite transfixed by other people's courage to demand to know as much as possible, but not actually going back with furthter complaints. I feel that it would be futile because it has already been determined that I have a statistically "safe" condition and am uninteresting  :-)
I admire all of you for having the spirit to pursue a diagnosis  under some of these circumstances.
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