PVC'/PAC's and bigeminy - harmless?

[Rag123]

Other post: http://www.medhelp.org/forums/cardio/messages/36226.html

I keep hearing with a normal cardiac workup PVC’s/PAC’s are harmless. Please define typical series of tests. I had normal echo, nuclear stress, and ekg’s. Holter showed some PVC’s/PAC’s.

I heard long QT times and certain ventricle disorders/disease can make them harmful.  Are these things that would have shown on my tests?

*medical articles talk about PVC's throwing off clots or causing more harmful arythmia's - is this a certain type of PVC or with a heart problem? Please be specific.

http://www.americanheart.org/presenter.jhtml?identifier=4695

http://www.americanheart.org/presenter.jhtml?identifier=565

How do I interpret articles?

I have a resting heart rate of 55-65 sometimes, told it’s not Bradycardia. Would you agree? And is this ok with PVC’s/PAC’s? My heart rate during sleep sometimes in the 35 range/told this was normal. Is it? I take Travatan eye drops – rare side effect of Bradycardia.

explain why heart won’t stop?

People have days of constant bigeminy. Think I had it just a couple of times for a minute or two during sex. Is this safe with a normal workup? Even if BP is elevated during bigeminy?  During a PVC is the heart pumping a decent amount of blood?

Explain effects of Adrenaline?

Can they cause VTAC, my heart only goes up a little/sometimes, afterwards.

If anxiety is causing skipped beats, is Xanax safe? Do certain med.’s cause harmful long QT times to be concerned about?

Will a cold/flu/etc. make PVC’s/PAC’s something to be concerned about?

[Forum-M.D.-MM]

Hello,

I will do my best to answer some of these questions but to be honest, to really talk about all these issues I would probably use several clinic visits -- these are very indepth questions.  Without trying to belittle your questions, I am concerned that you are trying to over analyze the issue.  Sometimes reading about all the things that can go wrong only creates more fear.  Not all PVCs are the same and not all VTs are the same, but very few articles will discuss the difference. The importance of seeing a good electrophysiologist or cardiologist is that they can determine what type you have and your risk and let you know.   The problem with reading too many articles is that you may stumble on one that does not apply to you, yet feel unnecessary fear and anxiety as a result.  Let your doctor do the reading and if you need a second opinion, the get one, and if they agree, try to believe them.

Please define typical series of tests.

In truly varies by the patient and situation.

EKG, sometimes holter, echo, event monitor, plus other tests if indicated.

I had normal echo, nuclear stress, and ekg’s. Holter showed some PVC’s/PAC’s. I heard long QT times and certain ventricle disorders/disease can make them harmful. Are these things that would have shown on my tests?

Yes

*medical articles talk about PVC's throwing off clots or causing more harmful arythmia's - is this a certain type of PVC or with a heart problem?

If you have a normal heart, this is not a concern.

I have a resting heart rate of 55-65 sometimes, told it’s not Bradycardia. Would you agree?

Don't get caught up with defintions.  The real questions is does this rate concern me and the answer is that this is a very normal heart rate.

And is this ok with PVC’s/PAC’s?

Yes

My heart rate during sleep sometimes in the 35 range/told this was normal. Is it?

Yes

I take Travatan eye drops – rare side effect of Bradycardia. explain why heart won’t stop?

Not sure what to say to this.  Your heart will not top with eye drops.

People have days of constant bigeminy. Think I had it just a couple of times for a minute or two during sex. Is this safe with a normal workup?

Yes

Even if BP is elevated during bigeminy?

The beat after the pause will generate a higher blood pressure than the premature beat.

During a PVC is the heart pumping a decent amount of blood?

Depends on how early the PVC is.  It all depends on the filling time.  There is no way to quantitate this.


Explain effects of Adrenaline? Can they cause VTAC, my heart only goes up a little/sometimes, afterwards.

If you haven't had VT, I would not worry about VT.  My question to you is why worry about a problem you don't have?  I am concerned that your real problem is anxiety and the anxiety is driving your fear of sudden death and other things that people with normal heart PVCs just do not have.

If anxiety is causing skipped beats, is Xanax safe?

Xanax is a very addictive medication that personally will not prescribe.  I believe in medications like SSRI (prozac, paxil, etc) for anxiety and perhaps xanax for bridging.  I have seen too many people become addicted to benzodiapines.

Do certain med.’s cause harmful long QT times to be concerned about?

If you do not have long QT, you should be safe.  

Will a cold/flu/etc. make PVC’s/PAC’s something to be concerned about?

They sometimes make the pvc/pac's worse, but again, if you have a normal heart, this is not a concern.

I hope this helps.

[jutah]

HI
I read this site with quite a lot of relief. Also noted another thread with Chest pain issues etc. I am 37, 88KGs, and considered fit. However recently I went through a somewhat stressful situation at work and now have chest pains (left side ribs) get shortness of breath and feel my heart beating loudly while at rest. I went to see my Dr and the ECG was OK. He reccomended getting Cardiac Thallium Stress test to confirm my heart was OK. For a couple of reasons I have not done this yet. This has been persisting for a couple of weeks now. I also went to the ER in the local hospital where they also did an ECG and it was normal as was my blood pressure. The first Dr also gave me some XANACS when I suggested maybe a lot of this anxiety was brought on by my own mind. On reading it is addictive I will stop taking it. When I exercise I generally feel an easing of the tightness. What exactly is PVC and given my condition seems to be common (to a degree) what is reccomended to aleviate the issue?

Many Thanks

[Rag123]

Thank you very much!!!

I know you will likely not respond again, however, the eye drops were just a reference to see if you thought it could have anything to do with the resting heart rate.

And the blood pressure was in reference to having a panic attack while in Bigeminy.

One of my biggest fears is that I will be in Bigeminy due to stress or excitement and it will turn into something worse if I get more stressed or excited or panic and my blood pressure gets high.

I don't have high blood pressure, but obviously when your anxious or panic your blood pressure can get high.

I think there was a post specifically stating that PVC's/Bigeminy don't turn into more harmful arrythmia's in a structurally normal heart...

I'll have to search for it.

Thanks again.

[mariop]

Good questions, and I'm not wholly satisfied with the answer the doctor provided.  I'm not wholly satisfied that the medical community doesn't have a kind of FAQ on PVCs considering that everybody asks about them.

In my own case, I wear an ICD, which has zapped me 6 times, and has provided pacing therapies numerous times.  On each occasion I never felt the arrhythmia.  However, I get PVCs that sometime go on for 24 hours a day for 2-3 weeks. Sometimes I get about 40-50 PVCs per minute.  They end up traumatizing the whole apparatus.  My chest muscle, my left side throat, my head, my diaphragm all pay a price.  It can get so bad that I pray for my ICD to go off so that my heart gets reset.  The question that hasn't been answered:  How long can the heart tolerate a barrage of fierce PVCs, before damage is done to the heart muscle and the arteries?  

This has nothing to do with anxiety, or other dismissive concepts that medical professionals use to get rid of the patient.  And if anxiety does contribute to the problem, has anybody in medicine actually been able to measure that contribution?

Meanwhile, thanks for asking the doctor some very clearcut and pertinent questions.

[--__]

You are correct. Bigeminy in a structurally normal heart, normal EKG is not a concern regarding sudden death or dangerous arrhythmias.  I am absolutely not saying that it won't cause symptoms -- because we all know that PVCs do cause symptoms.

Panic attacks and PVCs are a frustrating combination and I understand it is very scary.  Thanks for posting.

[Rag123]

Thanks. You sound very confident. Are you a physician by chance or have just done your homework like a lot of us?

I get concerned that when I do get bigeminy, which is usually only during sexual activity and more likely when I'm in an anxious mood approaching sexual activity, that it will turn into a harmful arythmia - like couplets (back to back PVC's or Salvo's - 3 or more right in a row).

I think this has been clarified in another post.

I'm trying to find it...

I think a very detailed FAQ would be great!

[Forum-M.D.-MM]

Not sure why it came up as --, but that was my response to your question.

MM

[tickertock]

I must say I have the greatest respect forum MD MM to the take the time out to offer reassurance in a follow up question. Needless to say the next time I have a bad prolonged episode of arrhythmias and PVCs, I know where I'm headed, though I hope there is never a next time. Best regards and respect.

[Rag123]

Yes, great thanks for the follow up to my questions!!!

[LukeL]

One thing I will say is that doctors don't write in journals to describe the common disorders or course of a disease or condition, they want to write about the ultra rare and uncommon disorders and manifestations of a disease which will only effect a small amount of the population. Also these journals while online were meant for professionals and not for the common layman. If multiple doctors tell you, you are okay than you probably are.

It is always good to do your own research and be in control of your healthcare but it can get out of hand if you don't know how to analyze the information you are reading.