PVC's/PAC's Runs...

[Rag123]

Age 36/male.  Had panic attacks/skipped beats @ 21, recently returned 6 months ago.

Tests: nuclear stress test, echo, several ekg's, xray of chest and two 24hour halter monitors all in past 6 month's, all showed normal.  The recent 24hour monitor captured my symptoms. Was told that they were 40 PAC's and 7 single point PVC's. PVC's are the one's I believe that happened during sexual arousal.  Two cardiologists said it's harmless. The 24hour monitor recorded 4 PVC's this time during sexual activity. I had a couple of occasions of intense arousal where I had what I believe to be a run of these for a minute or two.  I believe the symptoms were the same, just longer and it feels like: Skip-regbeat, skip-regbeat, skip-regbeat, etc. for the whole minute or two.  It feels as if it's locked in and will never return, then it does...  Could this continue endlessly? I don't feel short of breath or anything. When the run happens, it feels like my heart rate slows, becomes steady and consistent also.  Sometimes it will speed up a little afterward – briefly.  Otherwise I feel the occasional single or double PVC at other times.

Am I anticipating it and anxiety/adrenaline contributing to it when I feel my heart pounding?

Is it typically every other beat or can they happen every beat?

Should I interrupt sexual activity if I feel a run or continue and just hope it comes back?

Could you explain the function of why these are harmless?  It is still producing a beat?

With a normal heart structure, why would it be unlikely to have a heart attack from stress/fear?

[Forum-M.D.-bkj]

Rag,

thanks for the post.

Could this continue endlessly?

Palpitations will normally wax and wane. With your normal workup, there is no significant implication, other than the worry and nuisance they cause you.

Am I anticipating it and anxiety/adrenaline contributing to it when I feel my heart pounding?

You probably feel it. The anxiety probably increases the intensity of the percieved sensation.

Is it typically every other beat or can they happen every beat?

Depends on the underlying rhythm.

Should I interrupt sexual activity if I feel a run or continue and just hope it comes back?

I could make some pretty off color comments here!  There is no reason to specifically stop what you are doing based on the palpitations.

Could you explain the function of why these are harmless?

It's hard to explain, but in the presence of a normal cardiac evaluation, there really is no significant negative implication of palpitations.

It is still producing a beat? With a normal heart structure, why would it be unlikely to have a heart attack from stress/fear?

A heart attack is caused by a blockage of a coronary artery. Palpitations are caused by a electrical wiring hiccup in the heart.  The two are unrelated.

good luck

[tickertock]

I never had an episode of frequent PVCs in a long time, just the occasional one or even what feels like a run now and then.I'm 42 male and had the worst attack of my life just before I turned 37, if it can be of any comfort I used to have nearly constant bigeminy during sex when I had these episodes, it eventually went away, even now occasionally during sex I will have a PVC or two usually just before or right at climax.In my opinion they are definitely adrenaline driven in my case as the beta blocker atenolol has samed to help tremendously. After over 25 years of these symptoms I've learned mostly how to control the fear that can come with them and the anxiety they bring but it's a life long battle with them but you can definitely teach yourself how to handle the anxiety and fear that comes with them, like everything else one will have relapses at times but you can usually overcome these easier each time, after all we are only human. I myself have had countless of heart evaluations, all essentially "normal".Good luck and in my personal I doubt you have anything fear based on my own personal experience.

[kellebelle4]

Hello,

I am so sorry to jump the thread, but could you email me at ***@****. Having a lot tach in the middle of the night started almost 3 weeks ago. Thanks...K

[Rag123]

Thanks Doc! ...And Tickertock for your responses!

Sometimes I don't feel anything during sex and sometimes I feel the one or two, especially near climax as you aslo indicated.  I'm always concerned that if I feel a run - it will just continue... I somehow also had it in my head, that if I caused myself enough anxiety - I would give myself a heart attack.

I was finally able to capture a brief incidence on the halter, but not a long run of them.  I believe, it was the same sensations, just one right after another...

I'm afraid I might get a run of them while I'm at work during anxiety/panic or something and won't be able to calm down... to get it to stop.

Does the decription I gave in my 1st post sound similar to when you had your runs of PVC's?

When it does happen, I'm wondering if my heart is still actually pumping enough?  But the fact that I remain conscience is a good sign!

I was considering taking Xanax for the anxiety (I don't like the idea of beta blockers and SSRI's).  I'm very anti drug right now and I'm concerned it might make the palpitations worse.  Anyone taking Xanax - positive or negative.

The other thing was that I've read so many differnt things using the search feature and heard about things like Afib and such.  I'm concerned, that maybe the long runs are something else besides runs of PVC's?  I think begimy is what it would be called if it's PVC's every other beat - is this right?

[tickertock]

Your description sounds very similiar to my experiences with PVCs. A pvc every other beat is called bigeminy and is often is confused with what many call a "run" of PVCs from my understanding. I had all kinds symptoms from PVCs only to find out it was the anxiety from the PVCs and not necessarily the PVCs themselves. I understand your concerns with beta blockers, SSRI and anti anxiety medications. I also take the beta blocker to control mild hypertension & palpitations along with another medication so i need to take them. You should be very reassured by the doctor's reply. I was basically given the exact reply by every cardiologist and EP I have consulted with.

[jeff 67]

Hang in there ... these things just wax and wane.  I have had the same experiences you describe above.

I have had PVC's for 20+ years (now 39).  Up and until 2 months ago and for the 2 years prior to that I had the best period of the PVC life.  I really felt like I had gained control of my life again and I had very few PVC's in that period.  Then, out of the blue, 2 months ago they started again with avengance. No idea why.  The last 2 months has been the worst period of my PVC life.  I have been getting PVC's constantly.  I went back to my doctor and did another holter.  I tried Atenalol and that made them worse.  I had to stand up at night watching TV because they got so bad when I sat down.  I don't know about everyone else, but what makes mine hard to deal with is the fact that my PVC's are very violent and often painful (the PVC itself, not the compensatory beat).  

IT's hard to believe that most people get these but most people that do don't feel them.  What I also find quite intriguing is the fact that most people have uni-focal PVC's (as do I, mine likely in the RVOT).  This means that most people that get PVC's were born with one part of their ventricles that originates the PVC's.  The intriguing part is why are most people born with one of these foci?  You might think that the number of foci would be random.  Strange.

Anyway, these things are frustrating but not life-threatening, so I am sure you will come through this.

[Rag123]

Thanks for your comments. Most things I read are comforting...  I did read something a bit disturbing in this post:

http://www.medhelp.org/forums/cardio/messages/34824.html

It's talks about QT time or something on your EKG, where if your time is too long, PVC's could cause a dangerous arythmia.
It sounds like it would be cause to look for some sort of heart disease, which my tests show I do not have.

My resting heart rate is sometimes 57-65, and I've been in the 30's durning sleep. Two cardiologists said that's normal during sleep and even though technically under 60 for a resting heart rate is Bradycardia(slow rate) - they didn't consider it to be.  I feel a bit concerned now after reading the long QT time thing? Has anyone looked into this?

I also take Travatan eye drops that has a rare possible side effect of Bradycardia, but I have no base line to know what my resting rate was before the resent tests.

I was a big coffee drinker until all this started - which likely had an effect on my resting rate at that time.

It's kind of funny...  I would drink several cups of coffee during the day, play serious Basketball 3 times a week, then drink a few glasses of wine a night and not notice anything odd with my heart rythem.  Now, I cut all that out and I feel these funky PVC's...

[tickertock]

Rag- Dont worry about the Qt thing too much, your cardiologist would have a good idea if you had long qt syndrome. Your Qt will vary from time to time but still be within the normal limits. Dont let PVCs distract you from activities you enjoy, once you've been checked out thoroughly.

Jeff . Sorry your PVCs are back with a vengence. Pain with PVC must be awful. It's rare but i heard of a few cases in which pain occurs with the PVC, apparently both doctor and patient alike are baffles, apparently though an added extra "pain" the prognosis doesn't change. Curiously enough my PVCs are unifocal and originate in the RVOT also, which for some reason I understand can be very symptomatic.

[Manhattan]

If you had a long QT interval that put you at risk, your doctor would have been able to see that on an EKG which I'm sure you've had. There are some drugs that can cause long QT however, like certain antibiotics (Zithromax etc.. I'm sorry to hear you are so against taking medication. The propranolol I am taking has helped me immensely. I take Xanax too occasionally, but it won't really help with the palpitations. Better to address the problem directly in my opinion. I don't know what your weight is, but 20 mg's of Prpranolol really helps to control my pvc's which is a very low dose with no side effects.

[Rag123]

It's interesting that you mention different medications could cause something like long QT times. Especially considering almost everyone has some PAC's/PVC's even if they don't feel them. I know it's probalby an unlikely side effect, but doctors seem very care free about precribing med's... I mean, if I went in to see the Dr. for something that required an Antibiotic and explained about the PVC's - they would probably tell me that it would be highly unlikely that anything would happen, but I would likely be very intimidated by taking the meds...
I have a lot more worry about PVC's than PVC's themselves, that's why I was considering Xanax. I see a psychologist for panic/anxiety and he doesn't prescribe meds. He has helped with most things, but not so much the fear of the skipped beats.  He's taught me to face my fears, but putting myself in anxiety provoking situations becomes difficult for me with the skipped beats.  Anxiety of course can make them more frequent. It's weird that it seems like I get the bigeminy PVC's sometimes during arrousal, but when I'm at work in a stressful situation or something I might just get single ones and maybe panic without any.

[LAflipflop]

I've been dealing with arrythmias since I have been 17 (I'm now 48).  SVT's in my teens and 20s, A-fib in my 30's, and PVC's in my 40's.  Always negative cardiac work-ups, and presumably no cardiac defects or disease. Although we all wonder, I know, that if we believed we weren't defective, we shouldn't be having these damn things.....Anyway,  Some days/weeks/months/years I am fine, and other times I have palpitations of which I feel each and every one.  I keep xanax with me at all times, "just in case."  Although I may not take one for an entire year, when I feel those aberrant beats, I self medicate.  Xanax doen't stop them from happening, it just lessens my reaction to them.  Rather than going into a full blown panic, I just stay a little calmer and ride them out.  I can continue my activity when the Xanax is on board, rather than stopping and "freaking out".  The drug really does help me get through the palpitations and continue my life.  As I mentioned, I only take Xanax PRN.  It does tire you a bit, but it has always helped me.  I take a .25 mg tablet. and sometimes I even cut the dosage in half.  I don't like taking drugs, but I'd rather go on with my life than constantly panic when the episodes happen.  Good luck.  

[sb786]

manhattan: Does the propanolol get rid of all the pvcs or just some? I also am on a low dose beta blocker and it really helped at first but now 2 months later its not as effective

LAflipflop: I am 27 and have had the svt since my teens. Don't you get svt anymore? How long and frequent were the svt attacks and how did you control them? YOu said you got the pvcs in your 40s, did you not have pvcs when you were diagnosed with svt? Thanks

[Rag123]

TickerTock:

Did you experience bigeminy outside of sexual activity, such as work or other stressful events?
When you had bigeminy that lasted for a while, did your heart rate remain slow regardless of physical activity or did it speed up as it should - only with the skipped beat every other beat?

LaFlipFlop:

What is Xanax PRN? Did you take it while in the midst of PVC's/Afib?  Could you describe the difference between Afib and PVC's or bigeminy(PVC's every second beat)?
Is Afib harmless like PVC's/bigeminy?

Bigeminy is also harmless, even if it lasts for a period of time?

Does Xanax have any effects on the heart such as lower the resting rate? Or any of those QT times as described above with Zithromax?

[LAflipflop]

Don't you get svt anymore?

I haven't had svt since my late 20's.

How long and frequent were the svt attacks and how did you control them?

  I would have runs of 200+ 2-4 times per year.  I usually wound up in an ER where they treated me with IV Verapamil.  I first tried the valsava manuever (carotid massage), and also dumping my head in ice water, but neither every worked for me.  I have no idea how or why I "outgrew" them.
  
YOu said you got the pvcs in your 40s, did you not have pvcs when you were diagnosed with svt?

I wore many holter monitors in my 30's, and they rarely picked up a pvc or even a pac.  The frequent pvc's started in my 40's, but they definitely wax and wane.  I could have several hundred a day for several months, and then I won't have them for another few months.  There is no understandable pattern for their arrival or disapperance.  The problem, as we all know, is that we feel them and get scared (understatement!)

Good Luck.  It takes lots of time and effort in being able to cope, but eventually we somehow decide to stop worrying and start living. Someone once posted a 12 step program in dealing with PVC's.  I wish that I could remember it all, but it was terrific.  If anyone has it, please post.

[LAflipflop]

What is Xanax PRN?

PRN= take on an as needed basis

Did you take it while in the midst of PVC's/Afib?

Yep!  It takes 15 minutes or so before you can feel the effects of the Xanax.

Could you describe the difference between Afib and PVC's or bigeminy(PVC's every second beat)?

A fib is a regularly irregular rhythm which originates in the atrial part of the heart.  PVC's originate in the ventricle and are irregularly spaced, however, bigeminy is a PVC every second beat.

Is Afib harmless like PVC's/bigeminy?

Afib requires you to be anticoagulated (blood thinners), so that you don't form clots.  The rhythm itself won't kill you, but a stroke might.  You need to speak with your MD about this.

Bigeminy is also harmless, even if it lasts for a period of time?

Depending on the cause of the bigeminy it may or may not be harmless.  Again, speak to your MD.

Does Xanax have any effects on the heart such as lower the resting rate? Or any of those QT times as described above with Zithromax?

No, xanax doesn't affect the heart directly.  However, it lessens the amount of stress hormones that may affect your heart.  And I don't think Xanax is associated with prolonged QT.  Again, speak with your MD to be sure.

[tickertock]

When I had my attacks of PVCs, I could have bigeminy at any given time with or without a stressful situation, though I remember sex as a definite trigger of bigeminy, usually it occured intermittently during the day lasting from 1-10 minutes at a time.

My heart rate responsed during bigeminy was normal or fairly "normal" , even though with a pause every other beat it makes your heartbeat appear to be slower than it should, more like a rollin over feeling not really a steady beat.It's a nasty feeling. Hope this kinda explains it.

[Rag123]

LaFlipFlop:

"A fib is a regularly irregular rhythm which originates in the atrial part of the heart."

Could you be more specific? A regularly irregular rhythm sounds like it could be a variety of things... If you've experienced PVC's/bigeminy and Afib - could you contrast the two based upon how it felt?

Interesting that you mention the clotting with Afib - never new that. I've been getting periodic, light blood splinters under my finger nails. My cardiologist didn't think anything of it because I don't have MVP. And my Primary care physician said it may just be signs of stress coming out due to anxiety and panic attacks. I think I had them when I had panic attacks when I was younger, but it's tough to recall the timing...

I would thing that if I had Afib at some point it would have showed up on one of my halters? Are there specific symptoms/sensations unique to Afib?

Is it safe to exercise on Xanax?

TickerTock:

Your explaination of bigeminy sounds familiar, although I've only had it during sex.

The normal echo and nuclear stress test is what is required to determine if PVC's/bigeminy is harmless for someone, correct. I believe, if PVC's are caused by some sort of heart disease/structural problems that would be the only indication of danger - which is the heart disease itself, not so much the PVC's/bigeminy?

Is this how it was explained to you?

Did your heart ever speed up slightly after a single PVC or a period of bigeminy.

[LAflipflop]

A fib is a regularly irregular rhythm which originates in the atrial part of the heart."

Could you be more specific? A regularly irregular rhythm sounds like it could be a variety of things... If you've experienced PVC's/bigeminy and Afib - could you contrast the two based upon how it felt?

In A-fib when you feel your pulse it is all over the place---not a regular rhythm.  For me, a PVC feels like a quick pause---like an elevator dropping or almost a quick pound in the chest.  Bigeminy feels like the skip,or pound, or elevator dropping, every other beat.

Interesting that you mention the clotting with Afib - never new that. I've been getting periodic, light blood splinters under my finger nails. My cardiologist didn't think anything of it because I don't have MVP. And my Primary care physician said it may just be signs of stress coming out due to anxiety and panic attacks. I think I had them when I had panic attacks when I was younger, but it's tough to recall the timing...

The concern is for blood clots to the brain.  Your fingernail stuff sounds unrelated.

I would thing that if I had Afib at some point it would have showed up on one of my halters? Are there specific symptoms/sensations unique to Afib?

It would have showed up on your holter monitor if you were wearing it at the time of the abnormal rhythm.

Some people have a-fib and don't feel a thing.  I always know when it happens because I feel the irregular rhythm going on in my chest, even without taking my pulse.

Is it safe to exercise on Xanax?

Except for being a little bit tired, or woosey, it doesn't have an effect on your hearts ability to work during exercise.  I do, however, take only a small dose of Xanax (.25 mg or sometimes I even cut it in half as I mentioned before)

[Rag123]

Thanks.

Your description was helpful. I never noticed a completely  wild rythem. I have felt the PVC's and bigemingy.

I've taken Xanax in the past for axiety. Have you ever noticed a PVC or a thud minutes after taking it?

Did it make your PVC's or other palps worse and just ease your mind or do they basically remain the same and just ease your mind of them?

I noticed in the past that I felt a thud minutes after taking one. I don't remember if it was every time or not. But I also become anxious after taking some medications, wondering about side effects, etc.

Has anyone been told that cold weather could have an impact on PVC's/palpitations. One of my Cardiologists stated that this in not a good time of year with the cold. I haven't noticed a direct trigger or anything, but with temps near zero sometimes - I'm a little paranoid.

TickerTock, when your had your bigemini during a stressful event - did it subside regardless of weather or not you left the stressful event or did you have to flee from the stress to get it to stop?

[tickertock]

My heartrate always tends to speed slightly after a PVC for the first couple of beats, occasionally it will race for a few minutes depending on the adrenaline rush.

Usually my PVCs Note : I rarely have them anymore "knock on wood" will calm down regardless of the stressful event, whether I avoid it or not. I have tried never to let them interfere with what I enjoy in life though they can sure be distracting and a real nuisance.

I have been explained by cardilogists and electrophysiologists that periods of bigeminal PVCs and the occasional PVC have no adverse prognostic implications in the setting of a normal cardiac evaluation.

[LAflipflop]

I've taken Xanax in the past for axiety. Have you ever noticed a PVC or a thud minutes after taking it?

If I am having palpitations, they continue after I take it.  I've never noticed a specific thud related to the Xanax.

Did it make your PVC's or other palps worse and just ease your mind or do they basically remain the same and just ease your mind of them?

It doesn't make it worse, just eases your mind which can actually make them better (at least the ones that are adreneline/epinephrine driven)

I noticed in the past that I felt a thud minutes after taking one. I don't remember if it was every time or not. But I also become anxious after taking some medications, wondering about side effects, etc.

Side effects are only tired and a little woosy.  Does not cause "thuds."

Has anyone been told that cold weather could have an impact on PVC's/palpitations. One of my Cardiologists stated that this in not a good time of year with the cold. I haven't noticed a direct trigger or anything, but with temps near zero sometimes - I'm a little paranoid.

Never heard that one.

Good luck.

[Rag123]

Thanks again.

I used to be concerned that if I was in bigeminy and I persisted with whatever I was doing - it would somehow evolve into something worse. But that doesn't seem to be the case based on Dr.'s responses and feedback from people who have experienced it.

My Dr. simply stated that the cold may constrict blood vessels which may make palps. more likely. Like anything else, I suppose we all have similar and different triggers. I think mine are mostly related to stress/anxiety...  Though I don't enjoy cold weather much because my hands and feet are usually cool, when other individuals are not...

I'm doing better with so much of the reassurance I've gotten. However, I'm still considering a mild dose of Xanax.

Do you know what your resting heart rates are?

And has your Dr's ever recommeded one type of daily vitamin over another.  Right now I take Members Mark daily vitamins and it has some herbs - Ginsing/Ginkoboloba...  I'm wondering if I should aim for something a little better.

[mariop]

When PVCs get so bad and cannot be controlled with meds, there is a procedure called RF Ablation.  An EP doctor goes into the heart, locates the point of ogirin of the PVCs, and burns them out.  There's a 70 to 90 percent success rate.

Because I get hammered 24 hours a day for weeks at a time, my whole left side of my chest is extremely sore and irritated.  This has nothing to do with anxiety;  the heart muscle after a while gets sore from the irregular beats.  That's why I'm having an ablation done.

[Rag123]

Sorry to hear your palps are so bad. Fortunately mine are not frequent and seem to be mainly anxiety driven.

I hope all goes well with the procedure. Let us know how it works out. I've heard about those procedures and I heard a little about a "Foci" or something...

It's intersting to hear the various things like - almost everyone gets skipped beats regardless if they feel them or not and the various things that can cause/trigger them.