PVC's, PAC's and current cardiologist's advice

[RRH]

I'm a 29 year old male.  I eat well, and get a lot of cardio exercise - 5 times a week for 1.5 hours a time at high intensity.  Height 5’10”, weight 170.  No family history of heart disease.  I was told I have PVC’s 2 weeks ago.  I am starting to question this, which is the purpose of this post.  My family dr did an EKG, holter monitor, and stress test.  All came back normal.  At this point, my complaint was sensation of a skipped beat.  I still complained, so my doctor referred me to a cardiologist who did and EKG and then sat down and talked with me at length.  He told me that he was so confident that i was having PVC's that he didn't need to do any other tests and explained to me what they were and that they were benign in a healthy heart and to forget about them and just ignore them when they happened.  

Now I'm questioning the doctor's assumption (he never actually caught anything) and think that I'm having PAC's most of the time, with an occasional PVC.  The reason i say this is becuase i can barely feel it when it happens, and i actually thought it was gas for the longest time.  Until i had, what i'm sure now was a PVC, which scared me to death at which point i went to see the doctor.

My questions are: 1) Martial arts are a very important part of my life.  Is it still safe for me to practice?  2) Are PAC's more dangerous that PVC's? 3) Am i more likely to develop heart disease/other problems in the future becuase of this? 4)Is it normal for my chest to be tight/sore before or after having them? 5) Should i get a check up every year?

I'm very worried. Thanks!

[CCF-M.D.-MJM]

HI RRH,

1) Martial arts are a very important part of my life. Is it still safe for me to practice?

Yes


2) Are PAC's more dangerous that PVC's?

No


3) Am i more likely to develop heart disease/other problems in the future becuase of this?

based on the information given, I would say no.

4)Is it normal for my chest to be tight/sore before or after having them?

I am not familiar with chest tightness or soreness after PVCs.

5) Should i get a check up every year?

Not for this, unless your symptoms change.  Your doctor is probably right.  The differences between PACs and PVCs is not clinically relevant based on the symptoms you describe.  It has more to do with the timing of the event....how soon after the previous beat that makes them feel different.

Based on what your written, I would not worry.

Good luck and I hope this helps.

[tickertock]

i personally know  black belt karate expert and trainer that has had PVCs for the past 12 years averaging 6-10 thousand on a daily basis, he feels them , but fortunately he can ignore them and go on with demonstrations , training and such. he admits they are a pain and he suffers bigeminy and trigeminy throughtout day, after 12 years my guess if it was anything to wipe him out, with the what he does he would have been gone a long time ago. hopefully you can be assured to continue your martial arts training once everything checks out fine.

[jennann]

My understanding is that pacs are preferable to pvcs, because any irregular activity originating from the atrium is much better than from the ventricles.  I've been through this too, and have recieved the same assurances from a top cardiologist.  If your md tells you they're benign and your heart is healthy...go with it!

[gdeniseg]

I agree with your Cardiologist that you are more than likely suffering from PVC's.  They are hard to catch on an EKG because an EKG only lasts a few seconds - what are the chances that the PVC is gonna happen during those few seconds that the EKG is running?  Also, from my understanding, PAC's are less worrisome than PVC's.  
I wore a Holter monitor about a year ago and it showed I was having over 100 PAC's per day.  My cardiologist only wants me to follow up once a year (because of a condition I have called SNRT - not because of the PAC's).  So, I think you are fine, especially since you are in such good physical condition.

[Jeff67]

You sound just like me with # tests and findings.

When you describe your PACs and PVCs, are you saying that with your PACs you feel the ectopic beat followed by a pause then a compensatory beat, whereas with the PVCs you do not feel the ectopic beat but just a pause then compensatory beat? Have you ever had and SVT or NSVT?

[RRH]

Hi Everyone,

Thank you very much for your comments and answers.  They are making me feel much better.  I know even though the doctor told me not to worry, I can't help it.  I always like second opinions.  And I'm very analytical, so I'm sitting here thinking about my heart all day, which is not good.  I'll get a grip soon and learn to ignore this to the best of my ability i guess.

Jeff67 -- you had a couple of questions for me.  I'm new to this, (just found out like two weeks ago) so I'll try to give the best description i can.  There have been 4 times where I have about come out of my seat due to the beats -- and yes, it felt like a pause then a hard, really, really hard beat -- i mean i could feel the blood rush to my extremities it was so hard.  It scared me out of my mind, i was on the verge of crying.  I'm assuming this was a PVC, not a PAC.  However, a few times a day, I have been feeling more of a flutter, or light skipping of my heart beat.  Not hard at all, like the other 4 times, but very very ligthly.  As i mentioned, i honestly thought this was gas until i got on this forum and read about PAC's.  My doctor said nothing to me about PAC's, only PVC's.  I'm still learning here.  

Your other question was in regards to SVT or NSVT.  I'm not entirely sure what this is, as I'm still learning about all of this.  But one time (only once) I had one of these four really hard beats (PVC i think) when i was on an airplane a few weeks ago.  I got so incredibly scarred (this was before i saw the cardiologist).  Right after the PVC my heart raced for a few seconds -- now, I don't know if this was related to a heart issue, or my anxiety.  The cadiologist said it was most likely anxiety, but I really don't know.  Becuase when the PVC happened, I really got scared.  But then my heart calmed down and i felt normal again, but nevertheless I was incredibly nervous and anxious until i landed.  Does that answer your question?

[Jeff67]

The two quick beats you refer to are probably what is called a couplet - two consecutive ectopics.  You can have a couplet of atrial or ventricular origin.  Yours could be either.  Did you say you have a compensatory pause after the two quick beats and prior to the hard ventricular beat?

Yes, supra-ventricular just means above the ventricles (which includes the atria and the pathways that connect it to the ventricles).

I believe you can tell the difference between what you feel because after 20+ years I certainly can.

[I'mallheart]

hey all.. i am not sure if i have pvc's or pac's.never was really told..just had the tachycardia for sure and take 25 mg every other day of atenolol.. what is this then: i can feel my heart like flip flop..or clicky feeling.. especialy when i lay or lean to the left.. is this a pvc or pac or somthing else? i also do suffer from anxity and all. like most of us.. just been coming on today stronger, these wierd sensations... any help would be great
dave

[Barbara]

I can see the doctor has not responded to your question yet.  I sometimes wonder if they really know what to say.  I am a lot older than you, and I can tell you I have suffered with these skips for 25 years at least.  From the time I get up until I go to bed, I have them.  They are either bigeminys or trigeminys, or whatever.  I feel everyone.  Been to emergency rooms, had all tests, watched what I eat, stopped smoking, tried yoga, even went for counseling because they said it was nerves.  Nothing helped.  I am on atenolol twice a day, that has not helped either.  You are so young, I hope you can get help.  If I could only have one day free of skips, it would be a miracle.

[dquenzer]

I can assure you that PAC's and PVC's are benign.

If you are just having them occassionaly I wouldn't do anything about them.  I wouldn't take meds or anything.

Having said that may I say something you might not want to hear (no doctor told me this either).  It has been found that PAC's do sometimes develop into AFIB.  That's what mine did.

I was 38 when I started to have PAC's.  The doctor told me not to worry about them.  I was having them quite often but I continued to run.  I had been a runner all my life, and had been pretty well conditioned.

At age 47 I developed AFIB.  After looking into it I found that PAC's often develop into AFIB.  AFIB wasn't chronic, but would come and go.  Thankfully it converted on its own.  I tried a couple of meds and they didn't work.  Finally I went to an EP specialist from Mayo.  He said that highly conditioned athletes often develop AFIB.  He said tracks atheletes (which I had been), hockey players, and basketball players have the highest incidence of AFIB.  The theory was that the hearts get larger and the pulmonary veins get stretched resulting in areas that get irritated and may cause extra beats and finally AFIB.

I had a pulmonary vein isolation ablation and it has worked quite well and I've been AFIB free for over a year.  Also took care of most of the PAC's.

My point is that if the PAC's increase over time (which mine did) it may be a sign you could (not will) develop AFIB.  You probably won't have it happen until you are around 40 or so.  At your age they will have a host of treatments.  And even now they can take care of much of the AFIB.

If I were you I would keep working out.  AFIB is not heart disease.

[RRH]

Thanks again for all comments everyone.

Dquenzer -- thank you for the advice to watch out for AFIB.  I had to look up exactly what that was, I'm still learning about all of this :).  This may sound like a stupid question, but when you have an episode of AFIB, can you distinguish that it's not several PVC's or PAC's in a row?  I'm guessing from the definition that it would feel completely different.  Just curious, so if I ever experience anything different, I might have an idea.  

Also, I know I mentioned this in an earlier thread, but some of you with more experience than I on this may be able to offer an explanation -- one time I had a PVC on a plane flight.  This was before I saw my doctor, so of course, I'm thinking that I'm about to have a heart attack in mid air.  I think that was the most stressed I've ever been in my life, I honestly thought I was about to die.  Well, immediatly following the PVC, my heart raced for a few seconds, no irregular beats at all, but it felt like i had been exercising.  It just beat fast and hard for a few seconds and then calmed down.  I told my cardiologist that and he said, under the circumstances it was probably anxiety caused.  But, since it was immediatly after the PVC I'm still wondering if it's a sign of something else.  Anybody ever had that happen?

[Jeff67]

If you put a holter on everyone in the population there are very few people that would not have PACs and/or PVCs.  I think there is more to the AFIB than just a history of PACs.  When you say you were 38 when you developed your PACs, is that just when you became symptomatic? What were your symptoms when you first noticed them?

[desi000]

On the subject of a-fib and PACs-- I specifically asked my cardiologist about this since I was currently diagnosed with unsustained sinus tach and PACs- about 600 per day.  He actually chuckled and ASSURED me, after all the usual tests came back normal for me, that PACs do not lead to a-fib.  He sais bouts of A-fib are most commonly accompanied by heart disease or other heart conditions. He said that for a normal heart, there is no cause for concern.  Then I read a post like the one in this thread and I start to question what my doctor said. Additionally, this is not the first place I have read that PACs can lead to a-fib.  Can anyone else shed some light on this issue?

[jennann]

Rrh - when your heart raced on the plane after the pac or pvc, did it have a definitive end to the racing, or did it slowly return to normal?  I have SVT, which can be an IMMEDIATE increase to above 200bpm for as little as 10 beats or so - then IMMEDIATELY back to normal - no slow increase or decrease, just a "light-switch" effect.  That might help determine what yours was...anxiety or something else like a brief run of SVT.  
I too have heard there's a relation between increased pvcs and pacs and afib.  All I know is...for about 3 mos I had markedly increased pvcs, very disturbing, then one day I had what we think may have been a brief (seconds long) afib episode.  VERY hard for me to believe there's no relationship, no matter what any MD tells me.  Something changed w/ my heart, then 3 mos later, something else changed - I know correlation isn't always causation, but...come on!  Anyone else?
Jennifer

[tickertock]

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

read it. it might help answer some of your questions.

rgds.

[pms_barbie]

My God I couldnt imagine being able to do that in bigeminy.  More power to him though.  Anyone that can handle that has to be one tough cookie.

[dquenzer]

What I was talking about was not just a few PAC's a day.    I'm talking about 3 to 4 PAC's a minute.  There would be times that I would actually have a PAC every other beat!  I am not talking about a few here and there.  Everybody get's those.

I'm sure I had them before, but one day after working on my house I noticed that I was having them about every minute.  After a week or so they went away entirely for a few months.  Then they came back, I would have them occassionaly.  Then as I got older they became more and more frequent as I mentioned above.

What I was suggesting is to be aware if they start to significantly increase in frequency; especially as a person gets older (in the 40's and 50's).  For example I couldn't sleep late the morning because my heart would just be skipping beats all over the place.  It was horrible.  If I would have gone to the doctor they would have sent me home and just said it was benign PAC's.   But one morning I woke up and something was different.  My heart was very erratic and I felt kind of weird.  That was the first time I was in AFIB.  My wife just thought it was PAC's like normal.  But I felt it was something different.  She was actually kind of angry at me for fixating on my heart rate.  I actually waited about 6 hours before going to the ER to get checked out.  Sure enough it was AFIB.

AFIB felt different for me than PAC's.  However some people don't feel anything.  That may sound strange, but some people are very unaware of their heart rythmn.  So what I am suggesting to rrh is that as he gets older he should understand that if they start to significantly increase he should get educated on what AFIB is.  

Having said that I want to assure rrh that at this point in his life having a few PAC's and PVC's is not significant.  He probably will never have AFIB.  I am only saying there is evidence that people who have frequent PAC's do have a statistically higher probability of developing AFIB.

[Jeff67]

dquenzer,

Understood.  Thanks for clarifying.

I wanted to ask you something about your PACs (I have aksed a few people this question lately as I am trying to understand what others experience). Do you find that most of your PACs have a compensatory pause? I keep reading that typically PACs reset the sinus node and you get no pause (or at least not a full compensatory pause).  I always get pauses with my ectopics and I know I get far more PACs than PVCs, so I am not sure I can differentiate between PACs and PVCs based upon this.  Most of my ectopic beats (not the compensatory beats) feel painful or violent or strange in other ways.  Did you notice that with your PACs?

Thanks.

[dquenzer]

My PAC's had two symptoms.

1. There would be as you say a compensatory pause.  It felt like my heart skipped a beat, but the next beat would be hard. That is the beat I could feel.  The doctor said it was because the ventricle had more blood.

2.  The other PAC's I would have were a succession of quick beats.  I could feel the two quick beats.  No feeling of a skip.  

I would have both of these when I was getting PAC's alot.

PVC's have a different sensation for me.  It feels more like my heart sort of flip flops.  I don't get too many PVC's.

I still get PAC's after my ablation.  I probably have about 4 to 5 times a day that I can feel them.  Much better than before when I was constantly having them. The fact that most of the PAC's left after my ablation probably indicates they were coming from the pulomary vein areas because that's the kind of ablation I had.  The other spot they were coming from was too risky to ablate.  

Also I could tell when I was going into AFIB because my PAC's would start getting worse.  It seemed like the PAC's were a trigger.

[Linda123]

My A-fib Experience ....
I had a-fib the day after I had been extremely stressed at work.  I woke up that morning feeling fine but whilst making breakfast I had two consecutive whopping pvcs which sort of stunned me a bit but I shrugged my shoulders and carried on with what I was doing.  Over the next hour I kept getting quite regular mainly singular pvcs.  I went out in the car with my husband and as we walked to the car -bumpf - another pvc, we set on our journey and as I started to talk -bumpf pvc - and then just like that, my heart went into a-fib and it went on for a good half an hour.  Whilst it was happening I wanted my husband to stop the car so I could walk about but of course he couldn't because we were on a motorway, when he did manage to pull in I got out of the car and walked about a bit and the a-fib stopped by way of a series of irregular beats.  Immediately it stopped I had a rush of pins and needles into my hands which I'm told happened as a result of over-breathing.  I felt very drained after this experience and went to bed when we returned home.
Looking back I am quite certain that the pressure I had been under at work the previous day had been the cause of my a-fib.
Regards.

[dquenzer]

How do you know it was AFIB?

[Jeff67]

How do you know it was not VT given that you were getting PVCs at the time?

[suesday]

i have had palpitations for 30 years and have been told they are ok. Five years ago I had a atrial fibutlation episode and I had to go to the hospital overnight. It went away. Since then I have had ekgs, stress tests and echo tests. All normal, but I still have palps, and an occational fib every now and then. The fib only last a few seconds. I think about this constantly and am told that this is a benign condtion but I am afraid to go anyway far by myself for fear of this. It feels like it's destroying my life. The doctor says that as long as they only last a few seconds it's ok. I take 100mgs. of Toprol XL twice a day. I think I need to hear from someone out there who has the same fears. Sue

[annetteamc]

A related discussion, heart pvc -pacs was started.