PVCs and NVST

[Carol L]

Hi Doctor,
I am a 42 year old woman with noticeable PVCs during PMS and the first few days of my cycle during the last year.  My cardiologist firmly believes this is hormonally related as he treats many women for the same thing.  My PVCs occur only during this time and I have noted them regularly for a year.  My question to you is I have had all tests including a nuclear scan three months ago that showed NO heart disease.  But like clockwork during the second day of my cycle for an entire year and at the same time of day I get a run of PVCs, no more than 10, once as few as 5.  But my pulse was only in the 60s, so is this NVST?  My doctor insists it is, but with no heart disease says not to worry?  I have read about sudden death?  If my heart beats normally with no hormone fluctuation but gets PVCs when there is evident hormone fluctuation how can that not negatively affect my heart?  Almost like thyroid problems in women that are treated with meds?  But all my blood work is normal, no deficiencies except perimenopause. No caffiene, no stress, they just pop up during this time.  My cycle is also not normal as in a time span, so when I am caught off guard by PVCs I wait a few days and sure enough my cycle is early or late. But I am concerned about NVST even with 25mg of Atenolol I get them, do I even need the beta blocker if I am structurally normal?
Thanks, Carol

[CCF-M.D.-MJM]

Hi Carol,

PVCs during PMS is a fairly common complaint.  If on holter monitor or other cardiac monitor you have three or more PVCs in a row lasting less than 30 seconds, you have have non sustained ventricular tachycardia (NSVT).  It is true that in a structurally normal heart and with a negative stress test or cardiac cath, your cardiovascular risk is essentially unchanged compared to patients with structurally normal hearts and no PVCs/NSVT.

The atenolol is not to decrease the PVCs or NSVT, it makes PVCs less noticeable.  Beta blockers decrease the strength of your hearts contraction and therefore make PVCs less noticeable.  This works in some people better than others.  I would try the beta blocker and stop it if you don't think it helps after a few months.

I hope this answer your question.  Happy holidays!

[Carol L]

I also want to add that get isolated and couplet PVCs throughout my cycle, not just the one long run.  But they fluctuate off an on for the duration of my cycle, the run occurs the same day of my cycle every month.

[Jackie5910]

What is NVST?????

[hankstar]

NSVT(non sustained ventricular tachycardia) is usually defined as 3 or more PVCs in row , usually at a rate of over 100bpm, anything under a 100bpm , usually is defined as AIVR(accelerated idioventricular rhythm). Usually if no structural heart abnormalities is found it is considered a"benign" finding.

Usually in a 24 hour holter monitoring period it is believed about 5% of the population would present with this finding.

My understanding only!

Hope you had a Merry Christmas and all the best for 2005.

[Sondra Elmore]

Just wanted to say thank you for your contributions to this board.  I look forward to your comments as much as the doctors :)

[Momto3]

Hi Hank!

When I had NSVT, my Holters always recorded an average HR in the 60's and 70's, but I never heard the term AIVR?  My HR rarely went high, but it was still termed NSVT....Is it just a matter of terminology?  Just curious, not concerned : )

connie

[Carol L]

Thanks for the quick replies.  I know people get PVCs everyday and don't feel them, it's those of us that do that are living with the fear.  Thanks Hank for the info, my doc has not told me about the AVIR thing, it's not any more risky with a low heart rate? Thanks

[hankstar]

Hi,(Connie & Carol)

AIVR(accelerated idioventricular rhythm) is often referred to as slow VT also,anything below 100 bpm that is a run of 3 or PVCs in row for under 30 seconds, would be called non sustained AIVR , usually because of the rate of bpm. Maybe you could ask your doctor for clarification.Some would still called NSVT.

To: all4buggie, Thanks for your kind words, all the best to all for 2005.

[Momto3]

Thanks!  I have copies of my reports, etc and they say NSVT.   Maybe during the NSVT, the HR was higher. Oh well.  Thanks again!

HAPPY NEW YEAR!!

[Linda123]

I had dreadful palpitations when I was in peri-menopause and HRT helped enormously (and still is helping..).  You could try a light dose of HRT and see if it helps.

[Jackie5910]

What is HRT?

[hankstar]

(HRT)Hormone Replacement Therapy

[Lexicon154]

Hormone replacement therapy means estrogen replacement.  These days it is recommended that estrogen be used, when needed, at only the lowest dose and for the shortest period of time.  Long-term use can cause cardiovazcular problems.

[pandora9048]

what about 3 or more pacs in row in less than 30 seconds?  is that nsvt?  or something different?

[pms_barbie]

3 or more pacs I think is super ventricular tachycardia.   Its not the same as non sustained ventricular tachycardi.  I could be wrong about this so if I am some one please help me out here.

[nymomof5]

if someone had nsvt..would having a moderate leaky mitral valve
be bad to have with it?

[pms_barbie]

I have had nsvt and have a leak mitral valve.  My ep dr said it was no big deal unless your heart was enlarged.

[Carol L]

Ladies,
I just read an article by a doc online that says women in perimenopause have hormonal fluctutations daily.  That the hormones should not cause any heart related long term problems but can certainly cause PVCs and tachycardia in some women.

[Momto3]

I have 2+ - 3+ mitral valve leak and the palps were no problem until I developed a cardiomyopathy.  I lived with thousands of them for years (with a leaky valve).  Good luck!!

Happy New Year!!

connie

[sdrlmom]

Hi there! brand new at this. Finally someone that knows how I feel!!  Suffer from pvc's since 95.Just a few now and then but the last 3 months have been awful.  All day(and night) long.  Ekg fine,stress test ok except for a few minor blips. Dr and Cardiologist say nothing to worry about.I am 37 yr old mom of 4.  Healthy(except for pvc's)  I do have problems now and then with anxiety/panic attacks but thought I had control of them.  Dr thinks these are related to anxiety. I do ahve a couple of ? that i was wondering if anyone could help me with.  Can pvc's change from a few to alot? Does anyone ever get a bunch in a row? I will get about 4 or 5 in a row. I never feel dizzy just really scared.  It seems like a have to cough sometimes when I get them?  I am up walking the floors the past few nights because they are so bad.  My hubby says I am just making them worse with the worry.(Easy to say when you do not have them!) I do not want to leave my house and some one told me that they heard those(pvc's)could kill me.  My Dr. said not to ask my friends about them.  Anyway, sorry to ramble but I am so scared and tired I do not know what to do. I just want to curl up ina corner and stay there.  Also, they come at anytime, no matter what I am doing. Dr put me on 25mg of Atenolol but I have not taken it yet because of things I hear. PLEASE HELP!!

[hankstar]

HI,

  I know how you feel about PVCs, I had those(demons)pvcs all my life, but just an occasional few that would trigger a tachycardia sometime with pvcs occuring with the fast heartrate.

  I am now 40, my first prolonged episode came when I was 27, it lasted for about 4 days to week, got hooked up to an ECG with PVCs occuring with an heart rate around 170-180 bpm with PVCs, diagnosed as sinus tachycardia with PVCs on the ECG, averaging about 12-15 pvcs a minute, NO FUN!, sent home by the doctor, a very good friend of mine, he told nothing to worry about, precribed 10mg inderal twice daily, a beta blocker, help the tachycardia , but did nothing for the pvcs. They eventually disappeared, just a few odd ones now and then some would trigger a tachycardia , others no tachycardia triggered.

They returned in Dec 1997 witha vengence and lasted til April 1998, in the same pattern, estimated in the thousands daily. They gave me a break until OCT 2001, this time they lasted 6 months non stop with episodes of bigeminy off and on all day for days . I was taking taking atenolol 50mg twice daily when they occurred at this frequency. I had an ECG that recorded the pvcs at this time , also a exercise stress test(BRUCE), a few pvcs before , during and after the test. The doctor/cardiologist assured it was nothing to worry about, I suspected it maight have been the atenolol and stopped taking it, gradually reducing over a few days, but stopping quicker than I should have, nothing happened , the pvc got less over time but it 6 months for them to completely disappear besides the odd few now and then.

Last year in August 2003, I statred to get a few odd ones that would trigger a tachycardia, went to the doc, prescribed atenolol, I was reluectant to take it again , but cozaar alone was not helping my B/P, so I started to take it, I now take 25mg of atenolol 4 times daily that is 100mg daily, this is the less PVCs I had in 12 years and no tachycardia whatsoever, I don't if has something to do with my B/P being so controlled and combined with the cozaar, but so far so good.

Bottomline if your doctor has prescribed atenolol, don't be afraid to take it , it might take weeks to see a change or it may make difference a lot sooner, if it doesn't work you can tapper off it.The study released on atenolol was for its use as a first antihypertensive, nothing to with arrhythmias as i understand it. It is a very safe medication.The vast majority of persons tolerate it well, the biggest side effect being fatigue, the key is to keep going, the benefits of taking beta blockers has been well established.

Your doctor gave you some good advice, don't read or listen to stories about PVCs and sudden death, that's old news, but some still can't get the grasp of it, thats not saying they are not hell and frightening to live with.

The are basically"harmless" in a structurally normal heart without coronary heartdisease or other "cardiac syndromes".

Be assured you are not alone in your struggle with PVCs, just read about those that had them 20-40 years(that is the stories you should read) and nothing bad has happened to them yet.

Hope you get relief soon and all the best for 2005.

[sdrlmom]

Hi Hank!  Thank you for the time to answer my essay!! It is nice to know that i am not alone.  I called the Dr today and spoke to the nurse who is very kind.  I told her about the string of them in a row and she said sometimes that can be a cause of concern but not to get anxious about it.  She said TAKE YOUR MEDICINE!!(IN a nice way).  I sure hope I can get some peaceof mind and some sleep soon.  Again thanks and God bless!

[pms_barbie]

Hun I know the boat your in.  Hankstar is right its best not to take to heart all the stuff you read.  Many drs have told including my ep dr at the Cleveland clinic that in a structualy normal heart pvcs are harmless.  I have a mitral valve leaking but they say my heart is still structaly normal.  I know the fear sometimes gets over whelming.  Last year at this time I let the pvcs keep me in bed.  Utterly afraid to even get up and go to the rest room.  I wont say that they dont still scare me, because they do.  The biggest thing about the fear is knowing your heart is doing something weird.    Hang in there hun and may 2005 bring you many pvc free days.

[uptowngirl]

Hi.  I echo Hank's comments about the atenelol.

  I've been on atenelol for almost a decade (moderate MVP, SVT). I even took it  a couple months during one of my pregnancies and have a very healthy, rambunctious kindergartener now!  Yeah, it made me a little fatigued at first.  The thing I most appreciate about atenelol is that it is cardiac selective, just works on the heart muscle.  I am not a physician, but my cardiologist told me this. I have very few arrythmic heartbeats anymore.
  Also, I've tried a couple other Beta-Blockers which were not as friendly (ie. encountered shortness of breath, GI complaints etc.).  Anyway if your Dr. prescribed the med. I would consider giving it a shot.

We are glad you found us on this site.  Keep us all posted.

Uptowngirl

[Momto3]

Hi and welcome aboard!!

Oh boy do we know how you feel...You will find many nice people here and lots of good suggestions.  Until last year, I was a chronic pvc'er also. Had them for nearly 25 years, and they really went nuts in my late 30's and early 40's. Went through 3 pregnancies and no problem. I was having thousands per day and they were still considered harmless. What's important is finding the right balance between getting checked out and accepting what your trusted doctor tells you. I took Inderal (beta blocker) on/off for about 12 years and it generally worked well for me. If you try the RX and find that it does not agree with you for whatever reason, your doctor may try another one. There are several different beta blockers on the market that your doctor may suggest.  You may find great relief with the medicine and if you're lucky you'll sleep better too : )

Many of us also suffer with anxiety-type disorders. Although there is no direct correlation, there is definitely a prevelance of anxiety among pvc-ers.  Try not to let the pvcs control you.  Once the doctor runs the standard tests (EKG, echo, stress) and assures you that you have a structually normal heart, feel free to set aside your fears (that may take some practice) and try and forget about them.  Your pvcs may come and go in varying patterns with no logical explanation.  For the past several years, I would get very frequent pvcs (thousand per hour) so I definitely understand what you are feeling.  It took me years to BELIEVE that they were actually benign.  Yep, I used to get runs(3 or more in a row) also. In almost every case, they are harmless. Let your doctor run the tests and rely on his experience and judgment to assess your situation.  Do NOT listen to the people that tell you pvcs are dangerous - trust your doctor.  

Connie