PVCs and anxiety - SVT with aberrancy

[madgrad92]

Good morning. I'm a 35-year-old female. 2 kids. 110 pounds, 5'3" - relatively active. I run sporadically - maybe once a week. Low BP: 100/60

After about 13 years of "what's my chest doing?" I found a Dr. who did all the tests - event monitor, stress echo - the whole 9 yards. Found one run of what LOOKED like v-tach (13 beats) but which 3 cardiologists are sure is SVT w/ aberrancy. I was free of the SVT for about 10 months while on Toprol XL 25mg. Had one recent bout of the SVT in middle of the night (was anxious that day about work and couldn't sleep) and this seems to have set off about 3 weeks worth now of many PVCs. Doc checked me out again - 24-hour holter showed 186 PVCs in 24 hours. I feel about 40 of those. Said "Everything's benign. You're totally fine." Didn't change my meds or anything. However, I'm experiencing tremendous anxiety.

Questions:
1. Is it worth a second look? Is it easy to "miss" something on a stress echo,EKG, holter? like MVP?
2. Can you explain "aberrancy" and why it would make SVT look like VT?
3. Last night I noticed that the PVCs were definitely worse if I was lying on my right side...almost felt like PVCs and some short tachy, but then I would take a deep breath and it would go back to normal. Does this sound like anxiety?
4. Is it possible at my age that this could be perimenopause?
5. Will my PVCs increase as I get older? This causes me anxiety.
6. Any danger to PVCs early in a run (when my HR is increasing)? Makes me want to stop, but I power through.
7. Methods to control the anxiety? It's making me so scared.

[CCF-M.D.-MJM]

Hi madgrad,

1. Is it worth a second look? Is it easy to "miss" something on a stress echo,EKG, holter? like MVP?

Not usually in a 35 year old.  186 PVC in 24 hours is not that many.  I see many holters with PVC's in the 4-5000 range.


2. Can you explain "aberrancy" and why it would make SVT look like VT?

aberrancy occurs when your conduction system fatigues at a fast rate and usually causes a bundle branch block.  Any rhythm that is wide on ekg and fast looks like a VT.

3. Last night I noticed that the PVCs were definitely worse if I was lying on my right side...almost felt like PVCs and some short tachy, but then I would take a deep breath and it would go back to normal. Does this sound like anxiety?

That is a very subjective judgement.  I am not really in a position to tell.  The best way is with a holter.  It is possible that you have more PVCs when you are anxious and the PVCs make you more anxious.  PVCs are usually worse lying on your left side.

4. Is it possible at my age that this could be perimenopause?

In a 35 yer old -- very, very unlikely.

5. Will my PVCs increase as I get older? This causes me anxiety.

There is no way to know.

6. Any danger to PVCs early in a run (when my HR is increasing)? Makes me want to stop, but I power through.

No danger to single pvc's.  if you start feeling light headed or like you might pass out, this would be different -- but single pvc's are ok.

7. Methods to control the anxiety? It's making me so scared.

that is a tough one.  there many anxiety drugs out there.  I like the SSRI's like prozac, zoloft, etc.  Some work in some people and not in others.  It may be worth a try.  it is important that you realize that if you have a normal heart, EKG, stress test -- the likelihood of sudden cardiac death from PVC is extremely rare.  I am not trying to trivialize your concerns, but you are more like to be struck by lightning.  Knowing this might make it easier to deal with the PVCs when they come.

I hope this helps.  Good luck and thanks for posting.

[wmac]

Wow your symptoms sound like mine! I have pacs, pvcs, aivr, SVT, NsVT. My longest NSVT has been a 26 beat run. Its funny that you mention svt with abberancy though. I have had many of many montiors pasted to me for long periods of time, they finally implanted a looprecorder. Although the thing is if they say its vt and then maybe svt with abberancy thats the tricky thing to find out. After all the monitors and loop recorder implanted they said well there is only one way to really find out and thats with a 12 lead ecg. Ha you tell me now after the surgery for the loop recorder Ya I was a bit upset. So needless to say the only way to tell if its svt with abberancy is from a twelve lead ecg or eps which by the way I have had two and neither svt or vt where induced. The second ep they did burn the dual av nodal pathway so if I did have svt with abberancy then I will be fixed but if its the vt I wont be. Its been since last sept 28 since the last ep and im still having problems but it can take up to six months before your all healed so im holding out and praying. My 26 beat run was at 187 beats per min. So I totally understand where you are comming from. This thing control every asspect of my life. I have had all the test mri, stress test, echo, tilt table, single average ecg etc.. they say not to worry haha right. No meds. I tried the toprol xl and that is when the 26 beat reared its ugly head so no more for me. Do you have the ecg strip of your 13 beat run? I would love to compare the two. Anyway good luck
wmac

[DebHasPVCs]

Madgrad--I am very much looking forward to the responses to your questions from the doctor.  We have similar builds, as well as low blood pressure and an increase in PVCs with exercise.

You may be experiencing peri-menopause, indeed.  At 38, I entered flow blown menopause, out of the blue (premature ovarian failure).  I never had a weird heartbeat until then.  Was diagnosed with PVCs.  Like I have mentioned in other threads, they get worse with exercise--during and after.  I get many runs of them, up to 6 in a row, for a full 24 hours after an hour of exercise.  

To control anxiety, you could try deep breathing, yoga and meditation.  For me, these do not decrease the PVCs - in fact, the yoga increases them - but they sure do work on the anxiety.  

186 PVCs in 24 hours is probably a nightmare to you, but I envy you.  :-)  

Good luck.

[madgrad92]

It's nice to hear that someone else is experiencing the same thing. Thanks for your post. Have you also been told that everything's normal (benign)? I've also heard that yoga tends to make them worse (more noticeable), but if I can find something that helps me get to the point where I say, "Eh, well, another PVC," I'll have made great strides. Have you also had runs of tachycardia or not? I just keep reminding myself to be strong for my kids. I'd love to keep talking with you. You can email me at ***@****

Dyan

[DebHasPVCs]

Does anyone have a feeling of chest congestion (like you need to cough if you inhale deeply) or complete exhaustion on days where PVCs are particularly bad?

[stlcard1521]

From the other thread

***stlcard1521, please help me understand how you got to the point of realizing that these are not going to kill you. When you get one (or two), how do you cope at that moment?***

Don't know what to tell you. Probably took me about a month after the cardiologist diagnosed me before I got use to them. At first I had trouble beleiving him (part of it was because I didn't care for him much, he seemed really wishy washy and aloof so I had trouble with trust) that nothing more serious is wrong, but you have to just stop worrying about it. I know it's much easier to say than do.

I'd say learning about them helped me the most. I'm in pharmacy school right now, so I've been reading school's collection of medical journals. We actually just covered them in class too, I wish we would have done that when I first started geting my pvcs :( But anyway, understanding the mechanism by which they work and reading several studies that basically said they you'll live as long as somebody that doesn't have pvcs helped convince me the doctor was right. Like I said before, I also use to lay on my side because that triggered them and then just ignore them and tell myself theyre harmless, it gave me a feeling of control over them. Also, I started swimming and jogging. If I'm having a spat of several per minute, getting my heart rate up through excercise seems to curb it for a few hours, and since I've been excercising regularly I dont seem to have as many spats start up in the first place. Also, I try to get a minimum of 8 hours of sleep a night, as they are worse when I havent been sleeping well. Hope that helps, I can't tell you how to get over them, you're gonna have to do that yourself. PVCs are very common, if you hooked up a bunch of people to a 24 hour holter over half would have atleast 1 PVC. Most people just arent aware of them, and youre one of us unlucky people who have noticed them. Just try your best to trust the doctors, and dont let them control you. Maybe try to stop thinking about them. I know it's easier said than done. Good Luck.

[stlcard1521]

A lot of people have activities that they think make them go away. I've seen people have diffrent foods or shakes they eat too that they think make them go away. I doubt many of those actually work, but its comforting to think youre doing something. I drink a big glass of water when I get them, it makes me feel like im having less. I know in the back of my head it probably doesnt help in reality, but its comforting. if you have any habits or something like that, use them when theyre scaring you.

[woodruff]

",,,186 PVCs in 24 hours"

Oh, dear, madgrad.  I'll trade ya; I get 5,000 of them a day.  This is normal for me, and has been for years.

Over many years, you've had a lot of tests, too, and your test results keep giving you the news that you're basically healthy.  This is actually true, isn't it?  You can physically do everything you'd like to do, but you are hyper-aware of your heart, and being aware of what it does scares you.  And being frightened is ruining your ability to enjoy your life.

Sounds like anxiety to me.  LIke you, I'm familiar with the old self-monitoring bit, and the only thing that being aware of what my heart does is make me more anxious.  That awareness doesn't change anything, does it?

Based on my own experience, I'd suggest that treating your anxiety will make you less aware of those darned extra beats, and as you become less aware of them, their frequence may--may--actually decrease.

For me, a visit to my friendly local psychiatrist, and a prescription for zoloft provided me with great relief.  It is good to go to a real psychiatrist, I think, because he/she will have enough medical training to distinguish between symptoms due to anxiety vs a physical cause.  You may find that you have to interview more than one shrink and try more than one antidepressant to find a good "fit," but, trust me, it's a worthwhile quest.

[madgrad92]

what a wonderfully calming, true, and beautiful post. I truly believe that my hyper-awareness is more than half my problem. I'm constantly taking my pulse. I know that when my Toprol "wears off" after 18 or so hours, I can expect to feel PVCs. Every day, it's like I wait in anticipation for them. But guess what? One day, my schedule was different (I'm a teacher), and I wasn't even aware that the hours when I normally feel them had come and gone, and I hadn't noticed ONE of them (anxiety for sure!). I am seeing a therapist currently, and she will refer me to a psychiatrist if she feels it's necessary. I'm a little wary of going on another medication, for fear it will make the Toprol ineffective, or that I'll feel even MORE PVCs...but I'm willing to try anything. These things are SCARY!

[tweek]

I just wanted to pass along an article from ¡¥American Family Physician¡¦: http://www.aafp.org/afp/20020615/2491.html

I¡¦ve been dealing with ¡¥skipped beats¡¦ (can¡¦t say PVCs, because have yet to be diagnosed as such, much as I imagine they are such) for at least 6 years.  I¡¦m 28, high BP (yes, secondary reasons have been checked ¡V I blame my parents ƒº) and didn¡¦t start noticing them until after I was told I had testicular cancer and was noticing dang near anything out of the ordinary with my body.

So, about 5 years ago, GP sent me to see a cardiologist for the skipped beats and MVP.  Did the 24 hour monitor and had an echo.  To be honest, I don¡¦t remember the results of that one, but I imagine it showed nothing too out of the ordinary as the doc did nothing and I¡¦m still here.  The echo showed minimal prolapse and no regurgitation.  I just went in to see the cardiologist for my 5 year MVP checkup and mentioned the skipped beats again.  This time he has me on what I think is called a loop event monitor -- if I feel something, hit record.  Like I said, I have high BP, which was diagnosed late last year.  Found the combo of Benicar HCT 40/12.5 and Toprol 50 work the best for me, and now my BP is perfect.  

Well, I¡¦ve also noticed that since being on the Toprol that the skipped beats are less intense and that I don¡¦t seem to notice them as much.  I¡¦ve been on this monitor for a week now, and have to say I *think* I¡¦ve caught two on tape -- never before would it have been in doubt.  Those dang things used to freeze me up with fear, like holding my breath would somehow make my heart remember to beat??  

Anyways, I just wanted to pass along the article, because for me, knowledge goes a LONG way in helping ease any form of anxiety.  I hate being in the dark about things, so finding reputable sources really helps me.

[Gaspipe]

100/60BP isn.t low most would consider it ideal

[PikaPika88]

perimenopause : I'm waiting for the answer!
The Dr said if it is the case can give hormone but long time will cause cancer and heart attack.  How about short term? Doesn't work???  If it is the case, would the palpitation will go away?

[madgeOwens]

I am 54 years of age and female.  I have been under tremendous stress with having a loved one being treated for cancer.  I can tell you most definately anxiety plays a huge roll in my PVC's intensity and frequency. When I am stressed I have chocolate and that makes more palps.......I was using chocolate to treat menopause mood swings and it worked swell, only gave me a trillion pals.....so its a tough one.....I am on atenolol 50mg now.........after having success with Inderal it started to lose its effectiveness............good luck and stay active...thats a really big plus for you!!

[madgrad92]

Can I experience tachycardia from panic in the middle of the night? I had a run of it around 2:00 a.m. this morning (about 10 beats that I noticed upon waking - who knows how many before that!). I guess my mind things, "This is all anxiety," but can anxiety cause symptoms while I'm sleeping (and, hence, not feeling any anxiety)?

[woodruff]

Sure, you can have tachy in the middle of the night.  However, nighttime awakening is one of the absolutely classic signs of anxiety or panic that needs to be treated.  I found that on zoloft, my 4am wakeups were a thing of the past.  By the way, I didn't get the same good sleep with Lexapro.  Each drug is a bit different, just as each person is.

[LukeL]

The reason you feel your PVCs more at night is because your mind has nothing to do so you focus on your body even more so every little thing that happens seems like a major event. Also the need to cough with a PVC is very common and nothing to worry about.

You will find that the vast majority of people on this forum have the same symptoms and problems you do, the only issue is that we are told not to worry and feel that something has to be wrong because we can feel something happening. But with every common cardiac test done and 3 cardiologists reading your reports you can be almost guranteed nothing is wrong with you.

[madgrad92]

I have heard wonderful things about SSRIs - Zoloft, Prozac, Lexapro (also heard about the insomnia assoc. with Lexapro) - I will talk to my therapist perhaps about getting a psychiatric consultation for me to perhaps take one of these. However, can they interact negatively with beta blockers? I currently take Toprol 25mg. I worry (as I do about EVERYTHING!) that a SSRI, a "mood elevator," will actually make my tachy and PVCs worse. I will certainly ask a doctor, but would love any comments from others....by the way, does it usually take the Dr. this long to respond?

[madgrad92]

I'm sorry...one more thing if anyone can help...I have discovered through my hyper-awareness :)  that I actually don't feel the compensatory beat in my chest. I feel the "extra" one. I know this seems weird, but it's absolutely the truth. It's the little "flutter" feeling with the extra beat that I feel. The hard one that comes next? I feel it in my wrist or neck pulse, but not in my chest. Is that different from what a lot of you experience? Can I tell you how helpful you all are? I can't thank you enough...

[tweek]

I tend to feel it in my chest and neck.  It feels like a sudden extra beat followed by a pause -- and it's here where I usually freeze -- followed by what feels like a wallop of a beat followed by a return to what I assume is normal rhythm.  I think that's the best way I can describe my experience with them.

[upbeat63]

Hello, madgrad, hope you are having a better day today.

I know you asked in a different thread how anyone could possibly ignore their PVCs because you "feel" every one of them and thought they were ruining your life. I can empathize, I really can, I'm in constant trigeminy right now, so I feel more than a few, but with a good cardiac work-up as you said you've had, the sensation of them is just that, a sensation, like your eye twitching or your stomach growling.

It's easy to start focusing on every little change, but once you do that, you let the PVCs take over. It's hard to think of anything else. You need to distract yourself someway, somehow. A lot of people here will tell you they feel them most when relaxing or watching TV or reading or laying down, so those aren't really good methods of distraction. Activity is best. I know you can't do that all day and night, but the more the better.

I've checked my pulse many times, I've listened to my heart with a stethescope, we all, at some point "watch and listen". I guess you need to do that every so often, but the longer you do it, the more you will notice. It's a catch 22. Hope your therapist can help you with even more suggestions to distract yourself.

[madgrad92]

HOLY MOLY!!! What in the world is a bundle branch block, and why might I have one??? Talk about increasing my anxiety!! I just had about 10 PVCs in the last minute after having read that. I'm definitely going to see another cardiologist ASAP. I can't imagine anything having to do with a "block" during a tachycardia episode is good....oh, this just sucks!! I'm sorry, but this is truly the most difficult thing I've EVER been through. I'm young, healthy, active, I've been through childbirth twice, and I can honestly say that my life is AMAZING aside from this *%&$#^ heart issue...it's just overwhelming at this point.

[bama jane]

Pika
I promised I would let you know after I had the endoscopy.  I know you are concerned about it and your heart as I was.  I didn't feel a thing, they put me on an iv and after the dr. said give her 20 mlg I felt a little relaxed, then she talked to me for a few seconds and told the person giving me the drugs to give me 20 more and the next thing I knew I was in a recovery room and it was over.  I do remember a little choking sensation but just briefly and they were so nice and reassuring.  I asked how my heart did afterward and the nurse said fine.  I was a little groggy and unable to concentrate for a while but it was so much easier than I had imagined. As in anything medical the key is a good team of people doing the procedure and I was fortunate to have that. Like most people with heart arrhythmias I was concerned about the procedure triggering the arrhythmia.  Everyone is different but for me it wasn't nearly as bad as thought it would be.  Hope this helps you.

[Bromley]

Hi. My understanding is block happens when number of beats is too fast for a spot somewhere along the conduction path. It can be a response of normal tissue to fast heart rate.  The result is a conduction delay, maybe in the left or right bundle branch, which creates a "wide QRS complex" on an ecg.  

I suggest working on getting the right perspective on all of this.  A lot of people go through this.  Having SVT is not all that unusual, and its pretty easily treated these days. Its normal to experience some anxiety over such an important, but difficult to understand topic, when you dont understand.  So keep asking the questions. And dont worry...

-B

[Fran71]

Hi there,
when I had my holter done I scored 3500 PVCs! :-). Fortunately that was taken when my symptoms were at their absolute worst so I hope everything was recorded. I've never felt that bad afterwards so I guess I've never gone beyond that limit, though I think it's already a lot, also considering that my average HR then was 120.....

Good luck!

Fran - Italy, 35

[D. Kreg]

Thanks to one and all for your comments and input--it all just depends on your history.  Anything less than 1000 PVCs per day for me, and I would go back to church, he he!

My new anxiety this week has to do with dizziness--yes, I am at the tail end of a cold, BUT! the dizziness has occurred during a period of PVCs, making me wonder if enough oxygen is getting to my brain, which of course, re-petrified me!!  And, I COULD NOT sleep two nights ago "feeling" my heart until 3 AM, and then worrying that if I went to sleep, my heart might stop....arrrgh!

What really helps for me?  Exercise and some form of focusing or meditation.  At this early point (2 years of PVCs) exercise usually eliminates them for a couple of hours--today has been great, and I am thinking happy thoughts for tonight's sleep!  I am otherwise generally healthy and happy, no smoke/drugs.

BTW, does smoking really increase PVCs?  I am just curious, and NOT thinking of smoking :)

[PikaPika88]

BamaJane,
Thanks. How you feel now?  Did they find anything?  Mine gastroscopy still in the waiting list.  I'll let you know after I get that done.  I probably will get a panic attack if I see any needle or tubing thing.  Plus I'm not on any medication.  

madgrad92,
I'd right bundle branch block since I was 15.  Now I'm 48.  Apart from that, they said I have wpw as well.  I had a post with this forum before which is under RBBB.  

"when your conduction system fatigues at a fast rate and usually causes a bundle branch block" I'm also first time heard of this.  My pacer cause the LBBB for me.  I'm wondering, is my pacer pacing the rate too fast also?