PVC

[medking]

Dear Doctor:

I understand some PVC's are more dangerous than others. With a normal heart structure and normal echo's, ekg etc ... the incidence of PVC's are rarely a problem or considered benign?

Second, I read last night that depending upon depolarization of the PVC's can be a predictor for VT or V-fib? In a normal heart without no underlying heart disease is this still valid? Meaning that the person is still at risk of Vtach should his PVC occur on the T wave also known as the vulnerable period of ventricular repolarization may precipitate into VT or VF? Does this still mean people with normal hearts have high risks should this occurr?

I was told I have benign PVC's even though they sometimes ocurr in couplets but 99% of the time they are isolated. Am I reading too much into this? I have been told to ignore them ..not so easy to do. My cousin is a top cardiac surgeon at Sunnybrook hospital in Canada and he says its not your heart that will kill you but your mind thinking of this.

Does PVC's increase with age always? My father has LVH due to high BP, and he has PVC's does this mean I would get LVH without having High BP- I am 38 now? I am just worried about how predisposed I am to all of this because my PVC's came after our first child and they never went away after that although the frequency is not very high. Usually, every 4 months I get 200 or so and then the odd thump here are there.  All tests normal each yr. Finally, my cardiologist is saying that I really dont need to see him yearly ? Should I insist? Many thanks.

[CCF-M.D.-RCJ]

medking,

Thanks for the post, your highness.

Q1:"the incidence of PVC's are rarely a problem or considered benign?"

In a general population of persons with structurally normal hearts, there is no good epidemiologic evidence to suggest that PVCs affect the longevity of the populace.  Individuals, however, with PVCs may feel badly from them due to palpitations.

Q2:"Second, I read last night that depending upon depolarization of the PVC's can be a predictor for VT or V-fib?"

Some PVCs may indicate that a person has ARVD, a very rare condition.

I think that you would agree that a cough is a fairly benign symptom? However, uncommonly it may indicate cancer or TB.  Similarly, PVCs can indicate essentially nothing, like a cough, or rarely may indicate something wrong, like a cough.

Q3:" Am I reading too much into this?"

All I can say, is that in a population as a whole with structurally normal hearts, PVCs have not been shown to increase mortality.

Q4:"Does PVC's increase with age always?"

No.

Q5:"Finally, my cardiologist is saying that I really dont need to see him yearly ? Should I insist? "

Most patients with PVCs don't need to see a cardiologist.

Best of luck.

[medking]

Sorry about the post, I just remembered not to post for 2 months. I will stay away re: posting after this last one.  I will comment but not post. Thanks and sorry!!

[medking]

Just looking at one of my past ECG's and it showed the following:

Vent, rate 118 BPM
PR interval  164 ms
QRS duration 104 ms
QT/QTc 328/459 ms
P-R-T axes 47  - 16 - 18

Sinus Tachycardia
NonSpecific T wave abnormality
Abnormal ECG

What does this mean??

[medking]

I have another ECG on hand:

Vent Rate 117 BPM
PR Interval 160ms
QRS Duration 100 ms
QT/QTc 288/398 ms
P-R-T axes 51-42-36

Whats up with this. The cardio never eluded to any abnormality re: Prolonged QT?

[medking]

Can you comment on the two ecg data provided?

Thanks,

[bigmick]

Hey my friend,

I need a little of your input as regards the results of my last echo which I just got (done 9th May 2002):

All that was measured were as follows:

Left Ventricular Diastole 42mm as against range 37-56mm

LV posterior wall (diastole) 12mm as against normal range 6-11mm

Intraventricular septum (diastole) 14mm as against normal range 6-11mm.

I'm a big (6'4" 220LB) and quite fit and healthy 43 yr-old white male. The echo report also stated normal LV cavity size with good contraction, and LVH. My GP says he'd expect LVH in a big fella like myself: I favour agreeing with him, but am nonetheless left wondering why the LV diastole is quite low in range.......... my HR is quite slow whilst at rest and maybe the contractile force is - in the setting of a 'fit' heart - quite low (low LVD) even with LVH???

I'd REALLY appreciate your views on the above.

Best wishes,

Mike F.

[medking]

Just spoke a cardiologist out of NY- he was a cheif of staff at one the majors in NYC. Actually, he is my best friends father. I faxed him everything I had and he said: I have no R on T, no Long QT syndrome, just unifocal PVC's and probably most predisposed to this due to an adrenogenic response (anxiety) causing much of this.  In any case, all is normal nothing to be concerned about.  Told me to take the atenenol for a while till I feel better - he said 12.5 mg per day is less than a childs dose and even suggested going to 25 mg to have any real impact. In any case, I feel much better and thanks for your support. Much appreciated !!!!!!!!!!!!!

Thanks Friend,

Abe

[nmc]

Hi Hankstar: I am significantly smaller than BigMick (5'7", 135 lbs - female), but have almost identical LVH values (13 mm for both septum and posterior wall). Given that men's hearts are bigger than women's, are there any gender-related norms that are used to quantify the degree of LVH? I mean, do my values also suggest mild LVH? Probably should have asked my doctor, but I obtained a copy of my echo independently and have never discussed with it her. Do you have any information?
Would appreciate your input,
Nancy

[Paule]

I have to say that I'm concerned (& I hope I'm not alone but fear that I am) at some of the threads on this board.  I have been reading some responses, in particular, those from a "Hankstar." It seems that Hankstar dispenses what appears to be "credible" sounding medical advice (in fact, seemingly close to practicing medicine) to clearly concerned "patients" after "patients."  In this recent thread, someone types out some details of an ekg and it gets immediately interpreted as a possible Long QT Int Syndrome on the basis of "number!"  I'm sure the brief anxiety that was created on the "over reading" of a "portion" of one's ekg (without the benefit of knowing if there were other factors such as electrolyte imbalance or even seeing the actual strip)was anything but helpful--and in my opinion, dangerous.  In fact, it was even neccessary to have a physician contacted as a precaution. This is not helpful and a waste of medical resources, and at a minimum, totaly avoidable.  Additionally, blurting out medical mubo jumbo and then trying to balance it with "By the way, I'm not a doctor" is not appropriate fair balance.

There are plenty of doctors today that over read ekg's for LVH and other begnin findings, the world doesn't need more.

Hankstar, you may already know this but you seem to have a very unhealthy preoccupation not only with your own health, but with this board and, in my opinion again, "practicing" medicine.  I also don't think your a doctor as a doctor wouldn't reach conclusions you seem to do so quickly without first seeing their patient.  In the future, if your not able to keep yourself from reading every thread, try to think about the possible anxiety you may cause before resonding--and the implications of that anxiety (possible increased medical costs and second guessing qualified physicians)--in the long run even though "patients" may appreciate your responses in the short run.
Translation: before scaring a person to death by telling them they may have Prolonged QT based on partial reading of an ekg, try to resist writing your interpretations until you do rec' your med degree.  And pls discard your copy of Dubins EKG Interpretation..it's not healthy.  I can't say that I blame the forum staff as they don't monitor the patient-to-patient comments.

[pandora9048]

hi,
if you were to red thru many of the posts in this forum, u would see that more often than not hankstar is asked for his opinion by others on here.  
pandora

p.s.  to medking,
normal heart rate is between 60-100 bpm so anything below or above this will read abnormal on computerized ekg.  if its 59 or 101 bpm, simply because its not within the range, it says abnormal, thats what i was told by my doc.
pan

[michi]

like you may not have noticed, the doctors throw here and there comments in after they read what we write. that shows that the comments are overlooked. i am sure if someone would write something totally wrong it would be corrected. the forum is a support for all of us and i am sure a lot of us feel reassured either way. if you get better informed about your problems you can give helpfull tips etc. and that is all what hank is doing.

[trrtrix]

I agree 110% with your comments.

[medking]

Beating on Hankstar is getting out of hand. We are free to read and free to make our own decisions with out beating on someone for an oppinion. I guess I am guilty of this too. Frankly, I must admit I have found more answers to my questions through Hanks direct questions of the doctors than most of the questions I see on the site.  Lets attempt to be civil here. If you dont like what you see ignore it. If you care to ask Hank for assistance then take it with a grain of salt after all, as he states he is not a doctor ....which is ok.

So my advise to all on the forum take it easy before we all get too excited and we start suffering from one cardiac issue or another.

Have a calm weekend!

[kate38]

Hankster has responded to people and is trying to be helpful. He has never claimed to be a doctor and I have noticed he always tells the person to confirm things with their doctor.

This is his opinion and is usually classified as such.

A forum is a place for people of differing opinions to come together and discuss ideas for the common good of all. The forum is designed to support all ideas and opinions. Not everyone agrees on everything in this world. It would be unnecessary to have a forum of this type if everyone always agreed on method of treatment or diagnoses.

Respect of other person's opnions even though they differ from yours is necessary to promote exchange of ideas and advice.

Please respect other people's opinion even though they don't match yours as we respect your opinion.
:-)

[mmfd]

I agree 110% with heartwise, trrrix, and paule.

You others are defending Hankstar so vehemently, but are not listening.  This is not Hankstar's forum!  He doesn't need to comment on everyone's comment or comment on a comment!  If someone doesn't agree with him, that doesn't make him right, and them wrong!

I have been appalled on occasion by the *medical* advice he depenses so freely.  As a medical professional and someone with REAL and very serious heart disease, I know that it is critical to watch exactly what you say to patients.  Those, like Hankstar and many of the regulars, who are so preoccupied with their hearts (even though they deny it, it is so obvious), are very susceptible to fear and will pick on anything they think might apply to them.  Their fear is real but many times unfounded.

I will say that Hankstar is always polite and reassuring, even after inappropriately dropping an diagnosis.  That is why they like him so much...he feeds directly into the neuroses.  It becomes self-perpetuating.  Maybe he needs the forum more for that.  It is nice to be wanted.  On the other hand, I made one quick non medical comment suggesting a great website message board to Guenter and got blasted!  You can't win.

Maybe the solution is for Hankstar to start his own board!!!!

[bigmick]

OK, whilst reluctant to become embroiled in the issue of whether or not Hankstar rightly or wrongly 'dominates' this forum, I nonetheless feel compelled to comment thus:

1. Firstly, at the risk of sounding slightly arrogant (which is NOT my intention), I speak as a well-educated person with a BSc, a MSc, and a PhD, as well as other professional qualifications;
2. I am a relatively fit and generally healthy 43 yr-old male who most definately is anxious about cardiac issues. I have had noticable ectopy for 20 years, and AF for the last 5 years (5 short nocturnal episodes - I am not on any meds). I have accordingly met and consulted with a variety of docs and cardiologists.
3. Having become convinced that it is more often than not a case of 'patient heal thyself', I have rigorously applied my own research abilities to investigating issues connected with cardiac health, and can surmise with no small degree of confidence that the advice dispensed by Hank is IMHO generally considered and sound........ and MOST helpfull and reassuring in the vast majority of cases. But as the old saying goes, you can't please all of the people all of the time..... My own general paractice doc is a great doc as they go, but he freely admits that I know far more about ectopy and AF than he does. My first cardio tried to give me flecainide for the occasional PVC..... He also gave me digoxin for vagally-mediated AF (he did not even recognise/acknowledge a distinction between vagally and adrenergically mediated arrythmia.....). Further to investigating the situation for myself, I took none of these meds, and am glad I did not. As incidentally is my current (younger and far more open-minded and knowledgable) cardiologist (and EP) who was a bit horrified at the aforementioned suggested drug therapy for myself.
3. Hank is CLEARLY an intelligent individial who has - as a result of his own undoubted anxiety and obsession over his own cardiac issues (no offence Hank mate) - spent a great deal of time learning all he can about heart health and heart ill-health. I myself accordingly regard his presence here as a valuable resource to be drawn upon PROVIDING one realises and appreciates that:
a) Hank is NOT a doc;
b) Hank is - in common with ALL docs - NOT omniscient;
c) One takes Hank's advice IN CONJUNCTION with ones own deductions and ones own docs advice/input.

Believe me, I am no fool, and I regard Hank's presence here as a valuable addition to that service provided by the CC Docs. Illustrative of this is the fact that I noted down Hank's email address a couple of days ago in case he stops commenting/participating here (sorry Hank fella!!). Whether Hank maintain his presence here on this forum or not, I will be grateful to continue to have him on board (directly as opposed to via this board) as a valuable information resource... and friend. And you can take THAT to the bank.

BM

[sheryl1945]

Personally, I think we need Hank!  I have derived immeasurable comfort and reassurance from him so stop picking on him!  If you don't like his posts, just ignore them...but let others like me continue to read his posts; I do not want to lose touch with this man. He is respectful, compassionate and knowledgeable and I think he's a tremendous asset to this forum.  He always defers to the dear doctor and makes it clear he is not a physician, so what's wrong with that??

[lmroswell]

Definition of 'forum':  A public meeting; any medium for public discussion.  Enough already.  If you don't like comments from hankstar, don't read 'em.  In this day, a person with a medical condition should empower themselves with as much information as possible on their condition.  One great way to do that is via this forum, whether it be info from the good doctor or anyone else who wishes to add their comments.

[Linda123]

Re Hank
Hank's participation on this forum is an extra bonus for all of us and we should think ourselves very fortunate to have him, I know I certainly do.  He is always helpful and compassionate with all those who write in.  Obviously Hank has a great understanding of heart issue and this is an enormous plus for us all.  It is also very comforting to know that Hank experiences what we all experience so understands only too well what we are going through.  
More power to your pen, Hank (or computer keyboard.....).
Hope you are well and chest pains abating, it was kind of you to keep on writing on the forum to help others when you were unwell.
Best Wishes, Linda

[medking]

Hank, I took 12.5 mg of ateneol for two days. One dose per day and it settled the PVc's and I decided not to take on the third day. Is it normal to get withdrawl from this? ie: nervousness, elevated heart beat ? How long would it last for? Also would PVC's become worse if I suddenly came off? Of course two days dose is hardly addictive to the body?

Pls advise,

Abe

[medking]

Hank, I dont have your email: mine is:

abe-***@****

Send me yours lets stay in touch.

Abe

[bigmick]

Great forum, but it will be significantly less of a resource as far as I am concerned without Hank present and actively participating. I've probably learned all that I reasonably can here anyway - virtually all posts pertaining to anxiety over PVCs and short runs of NSVT etc in an otherwise healthy heart receive more or less the same replies from the docs here. Furthermore, I'm now very well aware that there are many thousands of individuals out there who have the same arrythmic manifestations and concerns as myself and whose future outlook in terms of their health and longevity appears to be more or less the same as any other Joe out there- it's great to know one is in good (and healthy) company (-:

So I won't be hanging around much either - better to get on living life as full as one can than pouring over every post to this forum.... as I've already said... duplicity becomes an increasing issue the longer one is around here. I'm the first to admit that I spend FAR too much time lurking on this and one or two other cardiac arrythmia forums, and I think that the time has well and truly come to spend less time hunched over my PC fueling my anxious and obsessive nature and more time out wandering the wild and magnificant coastline right outside my front door here in NE England (UK). And better to leave the forum free for those who are in the early stages of learning and seeking reassurance.

My sincerest and best wishes to all of my fellow arrythmia sufferers for a healthy and happy future.

I'll be in touch HS,

BM.

[michi]

hi bigmick,

i have a couple english questions, i will stop in london in juni. i give you my e-mail ***@****.

thank you,

michi

[netrox]

Hankstar said over and over that he's not a doctor so stop picking on him. It was very simple and I don't know why you bother to take him literally.

Doctors are sometimes WRONG that can cost people's lives! That's why we all should ask for a second opinion. I would ask people like Hankstar what he thinks and then talk with more people of similiar education.

In case with PVC's, not long ago, PVC is viewed as an omen and doctors would treat it with drugs. Now, we have a study showing that people who take medications for benign PVC's are much more likely to die than those who don't take medications for it.

Doctors used to dismiss fish oil as a snake oil. Now, we have evidence that it is as effective as many heart drugs in treating venticular-related arrythmias thanks to the power of omega-3 acids.

When my mother was pregnant, my doctor prescribed amphetamines because she was too fat (huh? She wasn't!) and he told her that I should be drinking formulas instead of breast milk. That was a horrible advice because formulas have caused me to develop allergies. Now, we all know that breastmilk is the best milk for infants and formulas should NOT be used over breastmilk.

Even to this day, I've done research on a certain blood "abnormality" and my doctor said, "You need to drink more water.. that's really nothing tho." While he's right that the "abnormal" result is really nothing, he failed to realize that my abnormality is caused from too much hydration (I drink a lot)!

Always ask for lab results and do your research at a library or on the Internet. Doctors don't really know everything, trust me!

-jeff

[netrox]

"There is evidence that stress can raise the risk of abnormal heart rhythms."

http://www.cbsnews.com/stories/2004/03/08/earlyshow/contributors/emilysenay/main604529.shtml

-jeff

[smiles45]

Hi, This may sound funny but in Oct I started feeling funny in my throat, I went to the doctor and they set me up to look inside they went down my throat with a camera, they told me I probully had reflux, well it turns out I was fine nothing wrong, so that even disturbed me more because I was sure there was something wrong because I was having fluttering in my throat, it made me so nervous all I could think about was I just knew something terrible was wrong with me, so on top of that I was having panic attacks that sent me to the emergency room three times the first two times they said the same thing reflux that was before the test I had, then the third time the doctor said before even checking me he said you have pvc, then he gave me a ekg which came out good but when i was hooked up to the machine at the emergency everytime i experianced the feeling it showed up on the heart monitor, now since then I had the heart halter, and the stress test, I am on 25 mg once a day of atenlol, I still feel my heart alittle but not like I did, has anyone experianced the feeling in the troat? is it normal? and sometimes I feel like my heart is going to jump out lol, what are some of the symptons, are mind normal?

Thanks for letting me vent,

Smiles

[hopenprayers]

HI
My first post after reading archieves for hours last night.
I am female 53 & have had many test ( ekc, stress thalium EPT even angiograms)done on my heart over the years. All have been ok except for pvcs and an ocaasional fast rate once while wearing a holter monitor. I have had ocassional pvcs for some 35 yrs. Cardi prescribed diltiazem about 5 or 6 yrs ago and all was well untill a few months ago. The pvcs seemed to suddenly get worse, much worse so i went to a clinic that did an ekg. THey said i was having them about every two beats &  if it got worse to go to e r
which I ended up doing. There they said the pvcs or skipped beats were every other beat.
I could feel them and it made me very nervous. They put me in hospital to observe overnight. The next morning my cardiologist came in and said "Go home, thy should not have even put you in here" So i did. I have had several episodes since & last night from 4:oo pm untill 11:50 pm my heart was beating so irregular that I almost went back to E R.
It got "in sinc" at 11:50 just as suddenly as it started going nuts at 4:00pm. WHat a relief that was for it to suddenly decide to start beating normal.  This morning I felt like I had been ran over by a mac truck... Just tired and sore all through me. I guess from so much stress & holding tense for those 8 hrs of misery. ( i can feel every missed irregular weird skipping beat flopping in my chest) That would eventually drive a person insane i DO believe. My pulse was so irregular that WHOLE time. Like 2 normal baets a skip, one normal beat a skip, then 3 normal then 1, then stayed at 3 normal and 1 skip for awhile, then real irregualr agian.
I tried to get mind off my self But it was impossible. I called the nurse this morning to tell her about this episode & told the doc had mentioned another kind of monitor if the pvcs worsened. She set em up to go in today(without talking to doc) to get a 30 day event monitor. I have never worn one of these. Can someone that has tell me what to expect. Also has anyone out there had an episode such as or simiar too  what i just described?
In the past the irrigeular feeling beats would only last a few mins then a break of mins or even hours....but last night it was continuous skipping flopping and irregular beats for almost 8 hrs.
Thanks!
hope

[Momto3]

Hi Hope!!

Yep! I can definitely relate to the all day flutters. It can be exhausting at times. Fortunately, my pvcs were not painful, just frequent.  

I have had the 30 day event monitor a few times for frequent pvcs. Yep, they can drive you nuts! When you have a pvcs every other beat it is called "bigeminy"; every third is "trigeminy"' and every fourth is "quadrigeminy". The event monitor is really helpful in identifying exactly what type of arrythmia you are having. The doctor or someone on the staff will hook up a couple of leads to your chest. They will be connected to a small tape recorder like device (mine was about the size of a pager). The recorder can be hooked right onto a belt loop or clipped onto your slacks. At night I used to lay it beside the pillow, just so I wouldn't get it tangled.  Anyway, the monitor may have a "red" or "black" button that you will push when you feel the pvcs. The monitor I had constantly recorded my heart beat, but it is recorded in a "loop". In other words, it records a couple of minutes and then keep recording over itself. So, when you push the button, it will retain the last 30 or so seconds and record somewhere around 1 minute. You will hear it recording (loud tone). When it is done, you can send it over the phone line to the technicians. Mine could hold up to 4 recordings at a time, then I would have to send them. The technicians will print out your recording and ask you to wait on the line until they are sure they got everything. Then they tell you how to reset the recorder and off you go.  GOOD LUCK!! connie

[arthur]

It sounds like an episode of paroxysmal afib...because it sounds exactly like what I experienced a few years ago (at age 53).  For the year following, I had about 6 more such episodes, each clearing up on its own within 24 hours.  You mentioned a history of PVCs which are a different kind of arrhythmia, but often folks refer to anything that kicks up as a "PVC", so one never knows for sure.

One classic feeling while in afib is the clear sensation of a purring, fluttering motor at the center of the chest.  This is caused by the atria contracting rapidly and mostly to no avail, until the ventricles pick up the signal and kick out the blood.  It's a very uncomfortable feeling, and the result is a very irregular heart beat.  If you can detect series of regularly-spaced beats, interrupted by apparent skips, no matter how many skips, then it's not afib.

The key is to record the episode when it happens so that your cardio can take a look at the tracings and give you an accurate diagnosis.  As the previous posting indicates, the monitor is simple to use and painless.  I wore one...several times...and it confirmed that I had lone afib.  This was important, as it eventually led to treatment via an rf ablation and cure.

Hang in there.  First the data.  Then the treatment.

-Arthur

[hopenprayers]

Hi & thanks so much for your replies!

What a releif to finally find that there are others out there that are going through this craziness. I am sorry that they (u), anyone has to go thru this because it is AWEFUL, but it is a comfort in a way to know I am not alone. I am SO thakful I found this site.

I went to get the monitor today..... but it has NO LEADS....(hand held) ya just hold it to your chest when having an "event" & it records for maybe 30 secs?...then I am suppose to call it in and let "them" listen to what I just recorded over the phone.
Well for evermore.... I think I got the wrong kind because my heart does not just skip & then _stop skipping, it keeps on for hrs at a time..... so tommorrow I guess I will call back and tell the nurse I want the one with the leads, so I dont have to call every minute.

Arthur I do not know what that pro? afib is, could you go into more detail?
I just got through sending "them" a recording.
I asked the guy what it showed. He said it showed irregular heartbeats that got back into rythyme, I said is that PVCS? He said "I am sorry that is all I can tell you". I don't feel a _flutter in my chest when all this happens but more of a JARING or flopping/thud that seems to even 'move' me every other heart beat or 2. ¿?..

I have also noticed that if I drink a few beers it helps..ALOT.. I am sure in the LONG run this is not a good habit to get into, but for the quick fix it has seemd to help.

Thanaks again for your replies...And any more correspondance from u 2 or others would be greatfull appreaciated.

Hope.

[Momto3]

Hi Hope,

I remember having a "wireless" monitor many years ago.  I completely forgot about that one....another senior moment...lol.

Anyway, even with the monitor I described you would have to call the service whenever you record an event. After awhile they might say, "we have enough of those". "From now on, just send anything 'different' from what you have already sent."  Hope that makes sense.

Feel free to post any questions. There are many people on this board who know what you are talking about.  Arthur can explain the difference between the way a-fib and pvcs feel. I only experienced zillions of pvcs.  Started to get them in my late teens/early twenties....until mid forties!  Had 2 successful ablations last year, and am nearly pvc-free these days. It is not normally the treatment of choice, but for some patients (like me) it becomes the best idea.  Good luck to you!!  

Connie

[arthur]

If you are getting normal rhythm interrupted by "skips" which feel like a bump in your throat/chest, then it's unlikely to be a persistent irregular beat like in afib.  Paroxysmal afib is just a term indicating that the afib is not constant...it shows up for a while and either converts back to normal by itself or is convertable.

Rely on your event monitor and your cardio to nail this bugger down...to me it sounds like a sparadic attack of "skips" that could be nuisance PVCs or PACs.  If so, they are more of an anxiety inducer than anything serious.  Again, let's wait and see what the doc says.

Good luck...and you're right, there's lots of folks with this stuff.

-Arthur