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PVCs
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PVCs

I've been suffering with exercise-induced PVCs for the past yr. I've had PVCs for 15 yrs, but the specific association and frequency with exercise has been only in the past yr. I have occasional-to-rare PVCs on a daily basis while going about my  routine--in general, those do not bother me. I've had a stress echo (9/03), stress test (6/04), several holters, and event monitor over the years. Results have always been normal: occasional to rare PVC, PAC, slight MVP, and one finding of mild aortic regurg. My blood pressure is great--92-110/65-75, and my cholesterol is ok, ranging from 190-212, with LDL=117, HDL=80. I am 38, 5'4" and weigh 111. I don't smoke. As a result, I seem to be at low risk for heart disease, but I can't seem to overcome the fear associated with the PVCs while I run. I think I could cope with them better if I understood why they were happening, and if I understood why they are benign. Can you answer those two questions? Also, what keeps them from deteriorating into something worse? Finally, my cardiologist sent me to cardiac rehab in June so that I could be monitored while I exercise. Of course, I've not had an episode like the few that sent me to rehab in the first place, which was frequent PVCs (1 every 3-8 beats) after getting my heart rate up during a run. The worst they've caught is a 7-second strip with 4 PVCs, which is similar to my prior episode, except that it went on for 4-5 min. at that rate. The staff said there was no cause for concern, even if it were to go on for minutes. Would you say the same? Could they be a marker for something serious?
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74076_tn?1189759432
Hi Monica,

This is a very common question both on this forum and also in clinic.  The source I used for much of this information is:

http://www.emedicine.com/med/topic2364.htm

However, I caution that the untrained eye reading medical literature tends to notice the more frightening information and neglect the good news.  I think the good news and take home message is that young people with structurally normal hearts on echocardiogram and normal EKGs do very well with PVCs, although the symptoms are bothersome.



1. I think I could cope with them better if I understood why they were happening, and if I understood why they are benign.

Causes of PVCs (the list is generated from the website above)

17 Comments
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Avatar_n_tn
Monica,
   I hestitate to post this comment, but feel some duty to do so. I had a similar history to yours except I was somewhat older when I began to notice exercise induced PVCs, probably 45 at the time. I first noticed them after running up a steep hill and then trying to count my pulse during recovery. PVC would be noticed as skipped beats but I could never feel them.
   I later became somewhat annoyed with them because they would keep my heartrate monitor from updating properly when I used it on the bike. Apparently a PVC is not counted by the circuitry so the interval between real beats is uneven. Since I was getting a PVC every third or fourth beat, the monitor could not calculate a rate. I notice a pattern of PVCs commencing a heartrate of about 110 and then ending at about 140. A cardiologist watching this while I was on a treadmill discounted the seriousness and said they stopped at the higher pulserate because I was "overdriving the focus". I had an echo and 48 hour holter by another cardio. I did a one hour hilly run and 50 mile ride during this time so many PVCs were noted as well a couple of runs of V-tach where 4 or 5 PVCs would occur in a row. Again, cardio saw no problem. Age is about 52 at this point.
   I was getting some transient shortness of breath at the beginnings of my runs that went away after 1/4 mile or so. Since I has some wheezing, I was after my GP for an inhaler of some sort. He put me on another treadmill while monitoring my breathing. At the higher pulserates, I experienced the normal PVCs which freaked him out. He sent me to a third cardiologist who wanted to see an angiogram. The angiogram showed a blockage of the LAD and first branch resulting in bypass surgery. I never had any chest discomfort or symptom other than the transint SOB while running. I never had any symptom on the bike in spite of vigorous riding that would get my pulserate over 180. Reason was that I had developed collateral circulation that was fairly effectively bypassing the blockage.
   The interesting thing is that the PVCs did not go away immediately after surgery but were if anything worse. All last summer after the February surgery my heartrate monitor was useless. This summer, the PVCs are essentially gone or have been reduced to the point that I can use the monitor all the time. I recently spent a week riding mountains in Colorado to 12,000 feet and had no problem.
   When I asked the cardio why he wanted an angiogram, he said because of my concern over the PVCs. I didn't think this was sufficient for insurance to pay for the expensive test, but they did.
   I don't know how I would suggest you use this information and hope it does not cause undue concern. I guess I had some risk factors you not(age and gender). I suppose I would listen to my body very attentatively and not ignore any ominous changes. One thing I might mention was that while my resting blood pressure was quite normal, the treadmill showed it to get quite high during exercise, like 220/110. My GP said the 220 was OK but the diastolic going up is abnormal. At the time, I was never sure how to use that information as people don't normally have blood pressure measure during a heavy work load. I had also had the EBCT check for coronary calcium which was somewhat high (75th percentile). That might be cheap additional check to ease your concern.
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Avatar_n_tn
Hi,  I read your post and I also suffered from exercise induced vt's  - well they started out as exercise induced and then many days I wasn't exercising and I still had them.  They got longer and longer in duration.  Then one day running in a road race I literally had the air sucked out of my lungs while racing.  I had to stop running and catch my breath.  I could feel a rapid heart beat - but it stopped within a minute - but not soon enough - as I could not breath at all.  I say this because it put a real damper in my race times - when I would have these episodes two or three times in one race.  So I know I was losing a good 5 minutes off my race time.  Other than feeling the rapid heart beat and the air sucked out of me - I felt fine.  No other symptoms.  I didn't get them every workout either.  Just maybe once a week and then they came twice a week and then 3 times a week and then I got them when I was just sitting and "NOT" exercising.  I had several echocardiograms over the years, and years and although I had alot of pvc's - I did not have the same type of "events" as when I exercised out on my own.  My cardio even sent me to the catherization lab - I had no increase in arterialscherosis.  Like runnertom - "I had collateral circulation that was fairly effectively bypassing my slight blockage."   But not enough to warrant surgery.  So, my complaints were just ignored.. for many years.  

What did show something - years later - was when I had another echocardiogram - interpreted by a 'certified' cardiologist reading echos.  I had only had a 'regular' cardiologist reading my echos and he never detected that I had a moderate to severe mitral valve regurgitation.  :-(  Which evidently I had, had for many years.  I would suggest when you have your echo that you have it done as a 'stress' echo (exercise) (which CCF had suggested to me) and not a regular sitting echo.  

I had suffered from rheumatic fever when I was a baby and I was in intensive care but I was "never" told it was rheumatic fever -instead I was told that it was pneumonia.  

My surgeon who replaced my mitral valve - said my valve was diseased from rheumatic fever.   All these years and my leaky mitral valve was never diagnosed and I was seen time and time again by a cardiologist - just not a very good cardiologist..  My complaints were all ignored and I was told that my situational pvc's were benign for almost 10 years !!  My new cardiologist is much better - but he's from a high volume hospital center and not the low volume I had gotten my previous care from.  

None of this may apply to 'you' - but if your pvc's get worse and you get no satisfaction - go to a bigger teaching hospital center.    

Good Luck and Best Wishes
Konopka1955
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Avatar_n_tn
Hi Arthur,

I posted a question to you under the thread 'a flutter sensation under the left nipple', and forgot to put your name up in the side-line.
Will you try and answer my question about A-fib?
Thankyou.

Regards, Ianna
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Avatar_n_tn
I answered your question under your original posting.

Again, sorry I can't be of more help.  For my two cents, ablation is the best approach for paroxysmal afib.  Drugs are a shot in the dark.

-Arthur
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Avatar_n_tn
Please, writers give the whole name of your problem.   What are PVCs?  (I know pvcs as a plastic pipe to run water through. ) But I guess, by reading your letters, that PVCs must be a heart flutter.  Is this right?
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21064_tn?1309312333
PVCs are premature ventricular contractions
PACs are premature atrial contractions

They occur when the heartbeat is out of sync. Hope that helps : )
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Avatar_n_tn
Hi,
   This post is for anyone who can help me. (Can't get question posted)
   In the past I've had an occasional pvc, with the worst episode being about 4 years ago a couple days after giving birth, where I had pvc's every other beat or so for hours.  Went to er, said they were benign heart palps and blamed it on the delivery.
      The other night I was in bed, got up to put my daughter in her bed, and after sitting back down, I had a 4 skipped beats in under a minute:(   This really frightened me and I'm terrifed it's going to happen again.  
      I've had a stress echo 8/4/04, a regular echo and event monitor about a year ago.  they were interpreted as normal.
    My question is, what the heck caused 4 pvc's in a row like that??  I was usually a tachycardia sufferer, not pvc.  since that night 4 years ago, I had only occasional pvcs.  is this sudden increase in pvcs a cause for concern?  I am a light smoker and maybe have a half cup of coffee a day.  but i was doing neither when this happened.  Thanks to anyone who answers.
Pan
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Avatar_n_tn
PVC's and PAC's are "extra" beats that are actually two quick beats, followed by a pause, then the heart beats normally again. Sometimes though, several can be strung together. They are pretty much benign but are very irritating because you can feel them and can be scary. They are the subject of many posts on this board for that reason. Many people, including myself have developed severe anxiety due to these beats. Of course, we may have been anxious to begin with, which is what may have caused them in the first place. I have suffered these since I was about 12. Sometimes they just keep going and going for months at a time. Currently I am at a point where I hardly have any. It is very weird, and you can tell by my post that we who suffer from these love to talk about it!
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Avatar_n_tn
I know this is directed to others in the group rather than a dr. I wanted to explain my things and see what others think.
I have lived with anxiety disorder for about 9 years - your basic "anxiety attack symptoms". I learned to live with it.
Two months ago my heart started diong come crazy skipping. Something I had never had before. It even hurt my chest. I chalked it up to anxiety and tried to ignore it. It got worse and worse and worse until eventually I ended up in the er. Everyone (family) kept patting me and telling me it was just my anxiety, until they saw the craziness on the screen (ekg). It was then they told me they were benign PVC's and they would not hurt me. They have me 25 mlg Toprol. The next night I was in the er again for having PVC's for over 45 minutes straight. They ran tests again but came to the same conclusion.
I will skip all the extra info, but I have seen doctors and a cardiologist and am 90% convinced they won't hurt me and I believe they are a mix of anxiety disorder and hormones (mine are a mess). I am now on 1 and 1/2 of 25 mlg Toprol which have helped greatly. I only have them occassionaly and they don't really bother me. Only thing is my resting pulse is low as 50 but I guess that's not such a big deal. It doesn't seem to get any lower when I have a couple of beers! lol
What really bothers me is that I can almost always "feel" my heart beating. It drives me nuts. When I go to bed sometimes when I am almost asleep I guess I can feel it slow down and this scares me. Eihther that or it just beats hard and keeps me up. And sometimes just little things get my heart beating hard, like if I just walk up my stairs to get something.
I am trying to ignore these sypmtoms but find they are always on my mind. Does anyone else experience these types of symptoms after being diagnosed with PVC's? If so, do you know any "tricks" to make them better or ease them?
Just FYI, I am 28 female, in pretty good health, no other problems or diseases or disorders, no other meds, no smoking, drink occasionally (sugar free beer), no caffine, had a problem with PVC's as a baby until the age of 8 and was under the care of a cardiologist at that time, all symptoms subsided by age 8 until recently. So what do you all think?
TIA!
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Avatar_n_tn
I know exactly what you mean.  When my pvc/pac rhythms get really bad I can hear my heart beat and skip and I'm always grabbing my wrist to feel them.  I usually have them about 4 or 5 per minute.  Some will tell you that isn't very much but I can tell you when they are yours, they are too many.  I sometimes put on earphones and stories or music and that seems to help.  I recently was seen by an Electrophysiologist and he put me on 50 mg of tambocor twice a day.  It seems to help a lot and definately slows my heart down. Do any of you seem to have them when you are hungry or when you have indigestion?
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Avatar_n_tn
I went to the doctor today because I've been experiencing pvc's for 2 weeks.  It's hard to sleep at night, because I feel like my heart is going to jump out of my chest.  I had some blood work done and should have the results tomorrow.  The doctor said it could be anxiety, or my thyroid could be out of whack.  I'm 54 yrs. of age and going through menopause, but he didn't say anything about that.  I have pvc's most of the day and night.  It's making me very nervous.  I've had an upset stomach along with the pvc's.  The more I have, the more nervous I get.  And the more nervous, the more pvc's.  I don't know what is causing what.  Tomorrow the doctor is putting a 24hr. heart monitor on me.  That alone is going to make me anxious. He also prescibed Lexapro for the axiety.
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Avatar_n_tn
I am 43 female and have had panic attacks for 9 years as well. Last year the pvc's started up out of the blue and they do bother me even if I get a couple. My doc said he is surprised that I feel them... But needless to say I do.Anyway I am very cardio sensitive to meds dealing with anxiety. I could not take Lexapro it made things worse, sweats, heart racing. Beta blockers have helped me alot.It is really hard for me to not be a worry wart when I am having symptoms. This week I had a bad bout with sinus tach and it freaked me out thought my heart would not stop pounding so fast.It had been months since I had a tachy episode mostly I have been bothered by pvc's over the last year.Lynda it is great that they are checking you out, thyroid etc. I feel we are own advocates and know our bodies best. Anxiety or no anxiety when it messes with our quality of life we want answers. Take care, kel
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Avatar_n_tn
Hi everyone! I am new in the group since I have just discovered this forum. I am a 45 yr female. I was diagnosed to have nonsustained VT coming out from abnormal focus in RVOT by an electrophysiologist in just about 6 month ago. Just like everyone with similar problem, this diagnosis scared me so much but my doctor says not to worry. It is a benign condition and will never become sustained VT, but I am still not convinced though. I always worry that it will become sustained VT and VF and so on..... would it ever? I hope not. It has affected my life though since I have missed a few oversea trips because of the worry. I have been put on verapamil since then, and managed to control the symptoms untill recently when I had too much excitement over meeting old school friends. I had it even on verapamil and an EPS was scheduled but was abandonned when no VT
was induced with isoprenaline and atropine, except for a few PVCs which originated from LVOT. Again, I am advised not to worry and I try to but the moment I feel the missed beat, the feeling is still the same...scared... I have tricuspid incompetence but again told not to worry...Help me... Angiogram was not done as my stress tests were normal and my angiogram abt 10 years ago was normal. I am obese, cholesterol borderline high around 6mmol/L and I have a benign tumour, angiomyolipoma of my left kidney diagnosed about 1 year ago, again told not to worry. I guess I just want to share my worry...
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Avatar_n_tn
Hello! Me again!
I have a couple other questions for you all. As I said, I take Toprol, about 17 mlgms. (I have 25 mlgms. script and cut one in half and take one and a half).
I enjoy drinking on occasion. I only drink Mikes Light which is sugar free and low calorie. I don't drink more than 3. I only drink in the evenings. I take my Toprol in the evenings too. 90% of the time if I continue drinking after I take my pills which is 9 pm, I have such a hard time falling alseep. My anxiety symptoms really act up. I would really like to be able to have a few beers with my husband and friends after 9 at night sometimes. Do any of you have symptoms like this? Is it all in my head? Suggestions?
My next question is, when any of you try to go to sleep at night, do you ever almost fall asleep just to be woken up feeling like your heart is stopping or like you lost your breath? Or like your "fading away" and it startles you awake? Anyone have these or simillar symotoms when going to sleep at night?
And my last question I may have to ask my dr but I will ask you all anyway. I take my pills at 9 pm. I would like to take them in the morning. Do any of you see any reason why it's better to take beta blockers at night? And what is the best way to begin changing my dosing times - do I just do something like take it 15 minutes earlier everyday until I have it where I want it?
Thanks everyone!!  =0)
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Avatar_n_tn
Hi there, new here, would appreciate any help.  I'm a 26yo F, VERY VERY healthy lifestyle: Haven't had caffine for 4 years, no drugs, no alcohol.  I run for 30min 5 days a week.  I've started meditating 30-60min qd.  I eat all organic foods including organic chicken, turkey and fish.  I haven't eaten sugar in 3 years.  I haven't eaten fast food in 5-6 years.  I try very hard to keep a positive heathy outlook and i'm seeing a cranio-sacral therapist, homeopath, chiropractor, DO who does energy work along with my Cardiologist. I take Mg 200mg, omega 3,6,9, hawthorn berries, and ginko. The only hx of heart 'issues' in my family is my paternal grandfather dying of his 5th heart attack at 62.  
So, here's my problem: I've experienced at rest 'irregular beats/palpitations' since i was 16 that occured soooo rarely that i didn't bother with them till later got an echo and ekg that were nl but they continually got worse.  In this last year they have been very symptomatic: lightheaded, dizzy, very nauseated, blurred vision, 'floaters', SOB, chest pains (but we're pretty sure this is a pleruacy (sp?))And pretty much those S&S make me feel like i'm going to die and make me very afraid.  I had my last very severe and long lasting symptomatic episode about two months ago and finally went to the ER and my electrolytes were nl, my x-ray was nl, ekg had pvcs so he gave me metoprolol 25mg which i took, i was having irregular beats every 2-7 beats going into the hospital and leaving the hospital.  The medication did nothing as far as i could tell, i felt the exact same.  I saw a cardiologist, my holtor monitor said i had over 1100 irregular beats with pvs pac mostly on the right side but also on the left, my pulse went from 43 to 200 avg 73. (This was a good day for me.) He put me on 12.5 mg trenormin(atenolol) which i've been on almost a month with still NO change.  He says ablation he doesn't want to do unless i get worse, i don't know how it could get worse, though i'm sure it could.  I used to feel better with exercise, but now i feel the same with exercise.  I have good days where i get get them a little throughout the day and night and bad days or times when i get them every other beat and they wake me up at night.  I get them at all times.  My symptoms get worse with hypoglycemia, i literally need to eat q 3h or i get shaky, agitated, tense and feel like i am going to scream.  I am working on letting go of my persona as i am/was an extreme type "A" person and can be stressed when most other people are not.  However, i get them at times when i'm totally relaxed.  My cardiologist has no other help for me.  I think he figures since i'm not about to die then i'm ok.  I am very afraid of this though i am working on changing my outlook, they still are the same.  Any suggestions, advise, words of encouragement would be GREATLY appreciated.
strong healthy vibrant hearts to everyone :)
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Avatar_m_tn
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