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PVCs during and post exercise

Hi

I get regular bouts of chest pain and PVCs.  I have a had a full cardiac workup including a normal angiogram as well as gastro tests etc over the past 4 years.  I have a great GP (National Health in the UK) who is still trying to figure out why a fit 33 yr old male is suffering from these symptoms.  I am not anxious or depressed but the PVCs and chest pain do make me more anxious.

The questions I have are:

1)  I get PVCs regularly but not always post exercise (e.g after a 1 hour run)- the GP tells me to continue but I read on this site that post exercise pvcs can be dangerous.  In a otherwise structurally normal heart with normal angio - should I be concerned and look for yet further cardio tests?  My cardiologist said "whatever the pain is, it's not your heart".  So is this overkill?

2) In a regular pulse at the wrist and neck I still get flutterings by my heart - can the wrist pulse, neck pulse and heart be different or are they always in sync?

3) How does anxiety related chest pain present itself?  I am exploring this as an option even though I don't feel anxious or stressed.  I get pains with every heartbeat for about ten minutes at 3am.

4) Do you have any further advice about any further discussions/tests I can request from my doctor or do I accept this and get on with life.

Sorry for the ramble but any advice will help.

Regards

Alf

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Avatar universal
Dear Alfred,

PVCs do not portend a poor outcome in the setting of a structurally normal heart.  However, PVCs post exercise have been associated with some increased risk.  Remember risk is a relative term. When looking at the population as whole you are in a low risk category.

You have a normal echocardiogram and a normal angiogram which suggests that the discomfort you are experiencing is not a result of blockages in the heart arteries. The fluttering you experience may be in the muscle of the chest wall and give the sensation of being in the heart. Also, anxiety can potentiate all of these symptoms. I think you should continue to exercise and lead a normal life without any restrictions. Your doctor may consider adding a beta blocker which is great for controlling PVCs.

Thanks for your question,


CCF-MD-KE
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jdm
I have posted several times about my post exercise condition.  I am now 53 but it started at about your age.  Absolutely everything normal but after a one hour run at moderate pace with no pain my pulse would stay in the 120's for hours. If I did a 5 or 6 hour hike the pulse would stay 125 for hours at rest and then gradually come down over 12 hours.  Normal rhythm just fast.  Don't know about PVC's.  I pretty much gave up my life in my late 30's due to this.  Hope you get your problem diagnosed properly.  My HMO docs never really cared.  Either told me to ignore the tachycardia or just stop the recreational aerobic exercise.  Some even announced to me that it was a mental problem not physical.  That's when they have no clue I guess.  Problem with that hypothesis is the times my wife checked a pulse monitor several hours after my exercise ended
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jdm
....while I SLEPT and my rate was 125.
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Avatar universal
This board is so well informed on Heart Health.
I suffer with pvc's,pac's and have had a increase this past year, Posted here often for feedback. I am 34 and follow all my doctors heart health ideas. The skips and extra beats can be in the hundreds. Is it hard on our hearts to continue ignoring these symptoms ? Trying a beta-blocker is a option, But I too with my mvp, heart murmurs have low b/p and heart disease risk in the family. I want to do all I can to live a long healthy life and if our hearts change symptoms ? I too want to know where there beats are originating from ? The tilt table, echocardiogram, cardio-beeper said what occurred But not where and why ?
Want to learn more .
Thanks alot
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Hi, thanks guys for all the valuable info, I really don't know where I would be without this board.  I've been having a bad day today with the PVC's, and no reason that I can think of.  I've been doing everything right, tried new vitamins, drinking soy milk, just things that I've read are supposed to help.  I had a pretty good day yesterday, and was excited about that, and then right from the start this morning, I had a bad day.  I was in the grocery store early this morning, and just had them the whole time, and then they continued throughout the day, like my heart was really irritable.  The thing I notice, I was wondering if any of you could relate to, is that if I go home and lay down on my left side, I hardly get any at all, they go away.  But, if I'm up, even typing on here, or driving, and anything else, then they come on.  So, it's not that it's exactly 'exercise induced' because I'm not really doing anything to get my heart rate up, it's just a difference in position.  Laying down really helps.  I was thinking that could mean maybe extra weight in my abdomen might be bringing them on when I sit up, and things get more squished up (?) or maybe some kind of leaky valve or something, I've read about that.  But, I've had echos, although these were a while ago now, and recently had a holter moniter, and the doctor said I was having benign PVC's and PAC's.  Next week is the treadmill test, maybe I should request another echo??  Anyway, thanks again, I was just wondering if anyone experienced something like this.  Thanks, Val
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Avatar universal
I would like to add my two cents and will probably confuse everyone. I have been a very heavy exerciser for 30 of my 54 years. I have been aware of PVC's for at least the last 7 or 8 years. Although I don't feel them, I would notice them as skipped beats when I would try to take my pulse during exercise. More recently when wearing a heartrate monitor, I have noticed them because the monitor does not update while I am having them (it can't figure out what the real rate is). They have also been documented on two treadmills and 24 hour holter monitor. The pattern is that they start at a pulserate of 100 or so and end at about 135. Cardio described phenomena as "overdriving the focus". I was sent to another cardiologist by my GP this February mainly because of his concern about the PVC's, even though the two previous cardiologists had determined them to be benign.

The third cardiologist wanted to see a cath because the treadmills could have missed a problem. Suprise! I had a 95% blockage in the LAD and another in the first bifurcation. This was bypassed surgically on Feb 14 (got my heart fixed on Valentine's Day). I recovered quite quickly and am now "back in the saddle" running 20 miles per week and riding about 100.

The irony is that I still had the PVC's after surgery as badly as before and they seemed worsen as I progressed from early walking back to biking. They no longer stopped at 135 pulserate and were at times dropping into bigeminy. The EKG monitors in my rehab class showed that I was in trigeminy most of the time when my pulse was above 120.

After reading a number of papers on exercise induced PVC's in various medical journals, I began dietary supplementation with magnesium. It seems to be working. I have been doing this for 3 weeks and during the last two, the PVC rate is 90% improved and continues to improve. I realize that my case may be purely anecdotal to this discussion, but it may prompt someone to look beyond solutions such as beta blockers. Beta blockers were no help to me.

At this point, I guess I have to be thankful for the PVC's in that even though apparently not related to the blockage, they did get me into the cath lab where the very dangerous blockage was found. Since I had no other symptoms even with very heavy exertion, my first sign of trouble may have been sudden cardiac death.
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Avatar universal
OK, now that is really scary!  That's just what I'm afraid of, that my PVC's could mean some kind of blockage.  It's really the only symptom I get, and I've been getting them for about 10 years now, but they got really bad during menopause, and then really diminished after I went through that.  I thought they were gone, and now they're back again for no apparant reason.  I am through with menopause, even though I'm only 43, so it's not that anymore I guess, and so now I'm thinking that these new ones could be something more serious like a blockage.  I'm taking a treadmill next week, but I've read in a couple places where those can miss blockages.  I know my cholesterol is kind of high, as are my triglycerides.  My glucose level was also very high when I went into the ER with heart palps.  But, you don't think your PVC's were related to the blockage?  Wow, lots more things to discuss with my doctor!!  Thanks, Val
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Avatar universal
so here's my ten cents...

PVCs and PACs are premature beats that are often caused by signals emanating from foci.  Foci are islands of electically-active cardiac tissue located in inappropriate areas of the heart and/or pulmonary veins (typically).  We all have them...it's just one of those things that evolution didn't squeeze out because they're just not significant enough to affect procreation.  So, premature beats occur at a rate determined by at least a couple of factors, namely, how close the foci are to the normal pacemaker pathways in the heart and how easily their signals can reach those pathways.  So some folks have a lot of "skips" and some just now and then.

Now there's not much one can do about where the foci are located, however, the ease with which their signalling reaches the pacemaker circuits can be modulated.  One major factor here is the state of the autonomic nervous system surrounding the heart..basically, when it's turned up, the signalling travels quite well (ergo lots of PACs/PVCs), and when it's turned down, the signalling is significantly inhibited.  So, if you are one of those individuals that has foci located at just the right distance, you may experience a significant reduction in "skips" by just lying down because your autonomic nervous system is turned down when you do that. I have experienced exactly this phenomenon.

There are no doubt other means to clobber the foci signalling (which include certain drugs).  But of course, if you are unlucky enough in that the foci are located very close to the pacemaker circuits, then you may not experience a nervous system attenuation at all.  

Note that foci fire all the time.  Every sleeping and waking moment, they are firing away at a pace that generally reaches 100s/min.  When you exercise or make a sudden move, these critters go into overdrive (much like your muscles would when exposed to a sudden rush of adrenaline)...during this period you may experience an increase in "skips" simply because the foci are firing more rapidly and at a higher amplitude.  Luckily this lasts only for 5-15 min, long enough for the adrenaline levels to drop down to normal.

These are my ten cents, which means these are notions of a single individual with years of research in the area.  I am not a doctor of medicine, but I am a doctor...and what I am reflecting in the above comments are opinions garnered from MDs, EPs and the scientific literature.  In the end, these are my notions, and you should definitely pursue your own research and discussion with your own MD/EP to reach conclusions about your own condition.

-Arthur
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Avatar universal
Calm down! My post was not meant to scare you. As I wrote, my PVC's were apparently not associated with the blockage. On further reflection, I think the basis of my doctor's angst was the pvc's in addition to an abnormal EKG he had taken of me in a previous visit. This abnormality (ST elevation, it think) was not repeated in either of the last two cardiologist's offices. Also, the pattern of my pvc's were a bit more ominous than normal, in that the holter caught a number of couplets, triplets, and short runs during or immediately after vigorous exercise.
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Thanks for the comments guys and what a great service on this site.

I'm going to carry on and try to forget about these bothersome symptoms.

Cheers

Alf
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Avatar universal
HI,

I so appreciate everybody's input on this site. I have PVC's and PAC's. Sometimes when I am resting I feel my heart beat fast for about 5 or 6 beats and then it goes back to normal. Anybody know what that could be? I have had holters before, but this was never recorded. I was kinda thinking it might be PAT.
One person mentioned to take 500MG of Magnesium twice daily. I have a bottle that has 250MG, which I take once a day. Do you think I can take it twice a day or is that too much?
I really need some help. I don't want to take a Betablocker because of the side effects. My husband is in the military and our life is very stressful with at times deployments, frequent moves ( which we are getting ready to right now). And when I get stressed my heart goes bananas and I get very anxious and can't function.  
Thank you!
Anja
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Avatar universal
Unless you are experiencing your rapid heartbeat on a daily basis, the Holter is probably not the best instrument. An event or loop recorder is worn for longer periods and does not record until you activate it by pressing the button. Then it records the previous 20 seconds or so.

Some of the studies I read were dosing as much as 5 grams per day of magnesium, so 500 mg does not seem like a lot. The adult requirement is in the 350 mg range. My concern would be that by treating yourself with magnesium you may be wasting time in finding out what the rapid beats are. They might be something that should be treated.
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Avatar universal
Hi,

thanks for your info. The fast heartbeat only happens once in a blue moon. I think it might be PAT, but I don't know. I guess trying to wear the long term holder would be hard, because three months might pass before I feel it again.
I did make another appointment with my doctor for next week and I will ask him about taking more magnesium.
If you have any more info, you can also email me
***@****
Thanks
Anja
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Avatar universal
Hi, I just want to thank arthur and everyone for their comments, it's just so helpful!!  arthur, that makes me feel so much better that this could be a "normal" thing.  Anyway, I went to the doctor today, and told him that my palpitations were bad the last couple of days, and I had a treadmill scheduled for next week, but he decided that I should have a myocardial perfusion stress test, I think it's also called a thalium test and moved it up to tomorrow.  So, I can't wait to get it over with, but I'm very nervous about taking the test.  I'm worried that maybe he thinks I might have a blockage since he decided on this test instead of the treadmill.  He did explain he just likes this test better cause it has like a 90% rate of detecting blockages, as the treadmill has only about 70%.  Do you think this is kind of a common test to have?  I hope I do ok, I haven't exercised in quite some time, so I'm nervous that my heart won't take it.  Also, with the frequent PVC's I'm having, I am worried that they will go out of control on the test.  Wow, do you think all this anxiety could affect the test?  (ha ha)  Anyway, I was wondering if any of you knew anything about the test.  My husband was concerned as to why he would order this particular test, he thought it sounded serious.  Well, thanks again for all of your valuable advice, I really don't know where I'd be without you guys!!!  Thanks, Val
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Avatar universal
Hi again -- I had the myoview stress treadmill test which is identical to what you will be having except the difference is the type of tagging agent injected.  Thallium is a common agent.  Mine was an isotope (which is radioactive) -- I think thallium is radioactive too. Keep your sense of humor!

They put an IV in your arm and set you up to accept the thallium.  Doesn't hurt.  I am ultra hypersensitive so I could actually "taste" the isotope once it was injected (kind of like the smell of a dry cleaning store).  That freaked me a bit but if they had told me ahead of time what to expect, I would not have been so nervous about what I tasted. Silly doctors!

Your doctor is doing the right thing.  I am very glad my doctor ordered the myoview instead of the regular treadmill stress test.  As long as your insurance is going to pay for it, you might as well get the cadillac of stress tests. It doesn't mean he saw something.  My cardiologist ordered it because he thought I said I got dizzy (I do but it's all from my sinuses clogging my ears).

Once injected, you wait awhile for the "dye" to circulate and "tag" areas of your heart.  You then go for pictures (don't forget to smile!) where they take images of your heart to see if it is functioning properly and at the right level, etc., etc. You must lie still or I guess the pictures are blurry (?).

Then you do the treadmill test.  The doctor and nurse will monitor you the entire time. Try to finish the test.  The more minutes you put in walking, the more tape they can read.  My heart rate got up to 180 bpm and I was so out of breath but I did it! And remember, once you get off the treadmill you will feel a little lightheaded or dizzy -- this is normal!  Right before you get off the treadmill, they will inject you again with the thallium.  You may have to wait awhile again too and then it's off for some more pictures!  They want to see how your heart recovers from exertion, to follow the blood flow, see any blockages, etc.

If at all during this process they see anything of life and death concern, you will be told to stop the test; otherwise, you will get a follow up call or visit to your doctor.  I was told over the phone I had PVCs and that they were benign.

These tests are to help you so please go in with an open mind.  They are done every day to all kinds of people with all kinds of worries and issues and others with no problems.  It's the unknown that scared me.  Knowing what I know now, if I had to take another one of those tests, I would not be as nervous.  I had myself on my death bed!

Good luck and let us know how you do.  Okay?  Be brave -- you'll be fine.

Beth
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Avatar universal
It's ironic how many of our symptoms are similar yet different in this thread and previous threads on this topic.  We can each relate to a piece of the other persons experience.  In a post a while ago, a Dr. discounted the "positional" effect on PVC's, saying that they are just more noticible at rest.  But mine clearly kick IN when I lay down, and Val's go away!  No wonder they can't figure these things out!  I can't accept the "psychosomatic" explanation.  My chiropractor had an interesting question about whether the cause of PVCs is within the neurological path, that perhaps the nerve supply to the heart gets "pinched" so to speak in certain body positions.  The body is not static, so these things come and go in some cases.  Arthur's summary lends credence to that idea.  Has anyone asked a neurologist about their PVCs?  Does anyone know about any other studies on that angle of this problem?
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Avatar universal
You know, I've been dealing with these suckers (PVC's) too. Actually for about 4 years now. I get them during exercise sometimes. I've been racking my brain like the rest of you to find causality. I believe position may be implicated, but from my personal experiences, I believe the GI contribution is more important. For instance, when I have heart burn, I notice more PVC's. When my stomach is upset, I notice more PVC's. Early todya I drank soup that was far too hot...it caused PVC's. Many times after a particularly strong PVC, I will burp. Almost as if the gas in my stomach was applying pressure in such a way as to cause a PVC. This perhaps is related to positional occurances mentioned by other people.

Now, I know that the vagal nerve innervates both the heart and the stomach. I'm wondering if this is somewhow the relationship that can somehow transmit stomach issues to my heart? Anyone got any insight on this?

SR (33 yo male)

Y'all keep on fighting!

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Hi, thanks so much for all the comments and help, I don't know what I would do without you guys!!  Anyway, I did go in yesterday for the nuclear test, and it was not easy, but I did get through it!  Jaz, thanks so much for the extremely helpful letter, I actually kept thinking of your words "be brave" as I was laying there taking pictures, having tons of PVC's, and it really helped!!  Thanks!  Anyway, I did the treadmill ok, I had PVC's during it, but when I had the most PVC's was the first set of pictures.  The second set, after the treadmill, seemed to calm them down a bit.  He injected me with that stuff while I was on the treadmill, and then when I was done, we went back to the table to lay down, and he waited a bit before taking the pictures again, does that sound right to you?  I thought the pictures were supposed to be done right after you got off the treadmill.  He kind of kept talking to me, and we didn't start the picutres for a while.  Anyway, they called today, which made me nervous at first, cause the guy said they wouldn't call unless someting was abnormal, but the nurse said my test was normal, and didn't show any signs of blockages or MI.  I was very happy about that, and you would think, if my PVC's are due to anxiety, that would have helped calm them down, but I've had a really bad day with them today, just nonstop.  I want to lay down all day again cause that's when I feel better.  The only thing that's really left to do is the blood tests, and beyond that, I don't know if I'll ever figure out what's causing these.  One question, do you guys know if there are any negative effects from the isotope (or thallium, whatever it is??)  I was wondering if that could have aggravated the palps, I'm just having such a bad day.  I'm sitting here typing, having tons of them.  Do you ever notice that some days they seem less hard, like today I feel like my heart is really irritable, and the PVC's seem more demanding, and harder, if that makes any sense.  Well, thanks again so much for helping me through the test!!  One more thing out of the way!!  Thanks, Val
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Avatar universal
Hi Val -- glad to hear you survived your test!  Told you!  And you were brave!

To answer your first question: after they inject you, you have you wait awhile before taking pictures.  This waiting period is for the tagging agent (thallium/isotope) to circulate and "tag" areas of your heart.  The imaging unit picks up on these areas. At my cardiologist's office, after the injection, I (and about 10 other people) were seated back in the waiting room for 30-45 minutes.  Then brought back in for pictures.  So what was done to you sounds accurate.

You were lucky you heard back so quickly for your results.  My test was done on a Thursday and I didn't hear back till Tuesday!  Pins and needles the whole weekend.

So you got the big B ("benign").  You now fall into that category like a lot of us including myself.  No reason for PVCs; just there.  We're all on the search for an answer.  Just keep reading everything and trying everything.  I do think you focus a lot on them and I know for me, that will trigger those little buggers!

Deep breaths.  You've been checked out.  Now you face the task of learning to cope.  Yoga, meditation and slow walks calm me down and dancing helps alleviate any extra adrenaline. Good luck! Let me know what works for you.

Beth
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Avatar universal
The test you metioned in the last post , Was this ordered due to your pvc's on a ekg ?
Finding out the cause, location of these pvc's is so important and I too like to know what is going on within my heart and nervous system. When I first started noticing pvc's,pac's over 7 years ago, they were alot less in frequency , Since then other medical issues came into play.
Do you have low b/p, heart murmurs, mvp, cardiogenic syncope ?
At what age did you start seeing a cardiologist ?
Thanks,
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Avatar universal
I'm not sure if you're directing your question to me or not, but here's my answer:

I first was seen for palpitations when I was 17.  Back then (I'm 44 now) they didn't say what kind they were and I was to young to know there were "kinds." Doctor's response: normal.

I saw a cardiologist again when I was in my early 30's due to palpitations.  Again, I didn't know what kind they were. Doctor's response: slight reguritation in right tricuspid valve, innocent murmur, irregular heartbeat -- normal.

Saw cardiologist last year for BAD episode of palpitations.  Many thorough tests. Doctor's response: same as previous doctor except I ASKED what type of irregular heartbeat -- PVCs -- diagnosis was normal.

Beth
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Avatar universal
Sorry -- I forgot to mention:

I have low blood pressure.  Had a general doctor's visit due to sinus problems.  BP read 104/60.  The average is 120/70 which is actually "high" for me!

My myoview isotope test was ordered due to my cardiologist thinking I said I got dizzy -- I do, but from my sinuses clogging my ears.  Not all the time. PVCs showed up on EKG and echo, but all was benign.

I don't faint nor do I ever feel like I am.
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Avatar universal
hello everyone:
I just found about this forum, and I was reading about PVCs. Actually I went to a cardiologist the first time in my life this year. I have been having many "skipped beat" feelings, and i wanted to see a doctor. I wore a heart monitor for a month, and they found out that it is nothing to worry about, just early heart beat. they also did blood tests. However, I decided to get ready for triathlons and adventure races I have been running much more than I do for the past 6 weeks. now I run 3ml/day for the past week and i have had the worst week ever. there are no triplets or even doubles. I just feel one skipped beat. but today it happened almost 10-15 times. my mom also had them all her life. she is now 55 very healthy. I am 29...
do you think I should call me doctor again? or just forget about it, get some more magnesium and continue with my runs and training? i get worried when it happens while I am running. I don't smoke for the past 5 years, I don't drink coffee, no tea, no meds. I might have some stress though.

thanks for all your support. it is at least comforting to hear that other people also have it.
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Avatar universal
Thanks again for all of the help, and Beth, thanks so much for the encouragement, I really don't know how I would have done it without you!!  This board is literally a life saver!!  I am so glad I finished the test, because when I first laid down to get the first pics, I was having so many PVC's, I really thought I wouldn't make it through the whole thing, and then wonder forever if it would have shown something.  But, I kept thinking "be brave" and just tried to calm myself down.  It's weird, it's not like I have less PVC's when I try to calm down, it's just that if I don't let them bother me, they seem less demanding or something.  I really could feel them hard when I was laying there, though.  Do you ever have some times in the day when you get them, like a couple or a few a minute?  I get like that sometimes.  I am staying here in Reno right now with my Mom, cause my Dad passed away, and tonight I had to drive my older daughter over to Carson City (about an hour drive) and I was so worried about the drive, and then I just did it.  Afterwards, I felt so good that I had done it, so it seems like if I really try to not limit myself, and just do anything with these, then it's like you win over them or something like that.  I know that sounds stupid, like what's the big deal with a one hour drive, but that's a big anxiety thing for me when I'm going through a time with alot of these PVC's.  So, now that I've had the nuclear test, and a holter, does that rule out any serious thing with my heart?  From here, do I just try different things like vitamins, and maybe go to some other type doctors, like acupuncture or something?  I was thinking that I still have some blood tests to take, and beyond that, I could go get my hormone levels checked or something, and then I heard something (maybe it was on this post) about chiropractors, and the connection between your nerves in the back, and your heart.  I was just wondering if there's any other test you think I should have.  I guess it wouldn't hurt to do another echo, the one I had was years ago, and I suppose things could change.  Well, thanks again so much for all the help, I wish I could do the same!  I am such a hypochondriac, I actually thought the call from the heart doctor saying my test was normal was a crank or something.  I sat there thinking, something is not right....anyway, thanks again!!  Val
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