Palpitations--PVC's or PAC's???

About three years ago I started to have these skipped/missed beats.  I have been to the ER several times had numerous tests(dopplar echox2, EKG's,blood work,holiter monitor and worn an event monitor for 30 days) all with the same negative resluts.  I have been told by both my PMD and cardiologist that there is nothing wrong with my heart and in fact it is probably anxiety.  I took anxiety medication in the past but don't feel that I need to take it any longer.  When I get these "skipped/missed"beats I get a rush of adreline--I can feel it move from the pit of my stomach up to my head and then I get very flushed--it seems to happen simultaneously with the skipped beats.  Is this normal or should I be more concerned?? Is the adreline rush causing the skipped beats or are the skipped beats causing the adreline rush??  I can not stand the way they feel and I am convinced I am going to die.  Should I persue further testing??  Or is this the anxiety that I am trying to convince myself that I do not have???

[CCF-M.D.-MJM]

Hello SMC,

Did you have any of these symptoms while you were on the monitor?  The point of the monitor is to capture the rhythm when you have the symptoms -- if the timing correlates, they are related.  It is not uncommon for people to have symptoms from PVCs / PACs.

Is this normal or should I be more concerned??

If you symptoms correlate with the PACs/PVCs, you should absolutely not be concerned.  It sounds like you are having a skipped beat and then having a mini or full blown panic attack because you are afraid that you are going to die.  It is likely that "skipped beats" are causing you to panic and the panic is causing the rush.

The tough part is once people convince themselves they are going to die from these symptoms, it seems that a 15 minute doctors appointment is not enough to reverse this.  We see this commonly in clinic and have some patients that are essentially disabled with fear.

It is also a pattern that peole with anxiety like this will keep looking for second opinions even after multiple doctors are assured them that they are ok.  The problem is that we can tell you that you are ok, but it ensuring that you believe this is the hard part and I still haven't figured out how to do it.  Some people have success with anxiety medications and some people may benefit from counseling.

I hope this answers your questions.  Good luck and thanks for posting.

Is the adreline rush causing the skipped beats or are the skipped beats causing the adreline rush?? I can not stand the way they feel and I am convinced I am going to die. Should I persue further testing?? Or is this the anxiety that I am trying to convince myself that I do not have???

[CollegeGirl143]

the irrational consuming thoughts that you are dying is textbook anxiety.. Heres the bottom line. As uncomfortable as these missed beats and adrenaline rushes feel, neither one of them is causing you physical harm, so its kind of irrelevent as to which is coming first, and there really is no way to find out..Palpitations can be really scary, if you want, maybe ask your doctor about trying a low dose beta blocker to see if it decreases the sensation

[tickertock]

I'm 42 (male) had these same rushes and flushing with PVCs and tachycardia occuring simultaneosly for over 25 years. If it had been anything serious I'm sure I would have "bit the dust" by now. i know its makes you feel like its your last minute alive, but nothing bad has ever happened to me yet because of it. I think the flushing feeling and redness in the neck face and chest is from the anxiety caused by the sudden onset of PVCs or ectopics and the anxiety tachycardia that somes comes with the feelings, my opinion only.Hope you get some peace of mind, it's hard to do I admit but you have try and conquer the anxiety.

I've seen persons with serious significant heart disease and are not the least bit anxious about their problem living life to fullest knowing it could end at any moment and others with minor insignificant problems like palps and PVCs without any significant abnormalities that is crippled and paralyzed with anxiety and fear, sometime just realising that you're lucky compared to others can make one comes to grips with their own anxieties and fears, I know it has helped me a great deal. Good luck.

[woodruff]

These are the exact symptoms I experience, too.  I've often mentioned that my bouts of pvcs and the adrenalin rush happen so close together that I cannot tell which is chicken and which is egg, so to speak.

But, if your EKGs and other tests have repeatedly indicated a normal heart, more testing is probably not going to help.  When the heart is healthy, the exact cause of the evil sensations hardly matters.  What matters is your response to them, and your response is that you fear you are going to die.

That's anxiety, and even though you say you don't feel you need to take anxiety medication anymore, it certainly sounds as though your anxiety needs to be treated.

I'd recommend talking to a psychiatrist or counselor to see if cognitive therapy and meds could give you back a comfortable life.

[tarek]

I have the same exact thing. I am 26 m. Did echo, stress test, currently wearing the event monitor. What happens to me is the following (typical what the doctor said) and the monitor caught the PAC and some PVC. I am convinced that anxiety and adrenaline are a result of this:

1) I feel a skipped beat - Temporarily shortness of breath
2) I get anxious and fear my heart is out of rythm and am going to pass out
3) Huge adrenaline rush that weakens my hands
4) Heart races very very fast (monitor caught up to 180+)

I learned its a vicious circle. This scenario has happened to me like probably 20+ times, and so far no long term effects (but i want to control it with some medication so im seeing a physician on monday to give me smth for anxiety) and the doc said i can take a low dose beta blocker to relieve some of the irregular beats. Anyway i learned its common, its a vicious circle and the anxiety and the palps feed each other. If u want to send me an email its
tarek_tarek882***@****
cheers

[scareddee]

I have those EXACT things happen to me.  The "skips" and the tremendous rush of adrenaline or is it the other way around?  I can't tell.  Then comes the tachycardia, shortness or breath and the "I'm going to die" thoughts.  I have suffered on and off with anxiety and panic for about ten years and every time it happens I still freak out.  You would think I'd be used to it by now.  It has taken so much of my life, it's sad.

[tarek]

Scaredde:

I know exactly what you mean.. personally i had so far more than 30 "attacks" and each time its the same thing (i never get used to them)...3 of these attacks have ended with a trip to the ER because the heart rate refused to go down (usually my heart will peak for 2-3 min then calm down but when its more than 10 min i go to the ER). I enter the ER with a rate of 140+, BP 150/90 .. when they do the EKG and tell me its normal .. my rate drops to 70 and BP when exiting was 124/70... so i hope this story relieves some of you guys in a way that yes the mind can play very dirty tricks and that no, these so called palps and attacks statistically cannot do you harm...

[tarek]

just to be politically correct, i have to add that these palps and attacks cannot do you harm in the setting of a structurally normal heart (ie: echo, stress test were normal)

[Yuen]

Hi I start to have skipped heart beat after the second ablation.  It have been 6 months now since the second ablation.  Would anyone tell me if the skipped heart beat is the side effect of the ablation or it is other heart conduction problem  I feel every single of them.  It is very annoying.  My EP doctor said not to worry and exercise can help decrease the skipped heart beat but I am worry to exercise as after exercise I got more skipped heart beat.

[bulldog2006]

I had a stress test, blood work, and ecco done his past week. The doctor found thad i have prolapse of my mitro valve and he was concerned about me having 3 consecutive pvc's after i was on the down time from my stress test. It felt like my heart stopped for a second then beat REALLY hard then nothing i was fine. I have had this feeling before all of these tests, and it really never bothered me.  All my blood work came back okay, and the stress test was normal(i did walk/run for a full 14minutes).  Can anyone tell me if i should be worried or any suggestions about this or how normal this is?  Thanks TK.

[sb786]

Hi all, I started to have the missed beats after being diagnosed with SVT (about 3 months ago) i was having up to 5 missed beats which the cardiologist said not to worry about but since then i am now having loads, sometimes i am even having 3-4 in a row. I am really scared i don't understand where they have appeared from and why they seem to be increasing day by day.
The thing i don't understand is that everytime i lay down or lean/bend forward i will definitely get them! has anyone else noticed anything similar?

[Rich1979]

Hi

I am a 27 years old male from England, ive had ectopic beats for approx 5 years now, They still do worry me sometimes and listening to people who have the same problem as me has helped.  Ive had all the usual tests available ( echo etc ) which are very expensive and all of them have diagnosed the ectopic beats scenario.  The symptoms have increased lately and i sometimes get 3-4 in a row, ive found it helps to stay calm and let them just 'happen'.  You tend to have a busy month and then sometimes they will go away for a while, id love to know what causes them!! and yes I have noticed that if I sit to my left hand side i can be bombarded with them and if i switch to my right they almost instantly go! very strange isnt it! so as you can imagine I sit to the right all the time now! if anyone wants to chat about this or needs any kind of support then they can email me direct on ***@****

[woodruff]

You would probably find it very helpful to type pvcs into the search box here, and just start reading all the posts (and there are lots!).  You will get a very good idea of how common certain things are, how people feel about them, and what coping strategies we have learned.

[froggee]

hey every one, just wanted to chime in here.  i am a 31 year old male and have been having these palps (pacs, pvcs) since 1999.
they started after i had a bad heat stroke in which my potassium level bottomed out.  i started seeing a cardio cause these chest thumps were bothering me and my blood pressure was getting to be a little high.  so i told him what was going on.  after monitering my bp for a few weeks he dedcided to put me on bp meds.  he told me the palps i was feeling was normal and most people have them but are not aware of them. however this didn't put me at ease, so i told him i wanted to do a full blood work up, echo with stress test and a 24 hr monitor.  reluctantly, he ordered these procedures for me because he still thought there was nothing wrong.  after all the tests every thing looked good except the echo and halter said i had occasional pvc's and pac's and slight atrial reg.  the doc told me that this was a common problem and i shouldn't worry and would have to learn to cope with them.  easier said than done.  i go every 2 years for a full work up, stress, ekg, halter, echo, just for my own assurance and also see him once a year for follow ups and blood work.  all i can say is there needs to be some kind of study done about the occurance of pvc's and pac's and find out why they can be going full throttle one minute and then stop then come on again.  i can go weeks with out having them, then all of a sudden here they are again.  it really sucks and dealing with them is even worse.  the only thing that has helped me cope with them is relaxing, and breathing techniques.  i even quit my job, and went to a less stress full work enviroment this year.  it helped alot.  but its hard for me to do the things i use to like to do, like travel and go to concerts and stuff, i am always worring in the back of my mind.  but if there are people out there that have been living with this for decades, then i guess i might just make it, but its not going to be easy.

[bulldog2006]

I had a stress test, blood work, and ecco done his past week. The doctor found thad i have prolapse of my mitro valve and he was concerned about me having 3 consecutive pvc's after i was on the down time from my stress test. It felt like my heart stopped for a second then beat REALLY hard then nothing i was fine. I have had this feeling before all of these tests, and it really never bothered me. All my blood work came back okay, and the stress test was normal(i did walk/run for a full 14minutes). Can anyone tell me if i should be worried or any suggestions about this or how normal this is? Thanks TK.

[sb786]

Thanks woodruff! you're right, there must be alot of pvc sufferers. i'm kind of getting used to the ones that feel like a big single thump in your chest but i'm still learning to deal with the ones that make your chest flutter (assuming they are also missed beats?)and when you get 3-4 in a row!!! i don't really get an adrenaline rush with mine anymore now i just feel a sinking feeling that scares me! I'm not on any meds for mine yet, doc has suggested that if i can't cope with them then he will prescribe me a beta blocker. Is it worth trying the beta blocker? is there anyone who definitely thinks that they help with the pvcs?

[froggee]

i can say that the beta blockers helped me out, although they don't stop the pvc's or pac's completly, they do help reduce the severity, occurance and awareness. another thing to remember is that every one is different and the side effects of the beta blockers might be more bothersome to one person than for another.  for me, i'd much rather deal with side effects than having that thumping in my chest every other beat.  like most people with the problem, we have are good days and bad.  might not notice the pvc's or pac's for a day, week, or month, then out the blue they start up again.  somthings gotta be trigering them but know one seems to know.  good luck and be strong.

[sb786]

which beta blocker were you on? You're right i hate these pvcs so much that i too would rather put up with the side effects of the meds than the feeling of a kick in your chest every minute!
how long have you noticed the pvcs for? i've been having them constantly for 3 months now and they seem to be getting more. will they ever stop, even if its for a day?? what annoys me so much is that i NEVER had them before and they seem to have just appeared out of nowhere like a bad rash!! i'm not sure but i think indigestion may have some role in triggering them, though i'm not sure anymore because i haven't heard anyone else notice a possible connection.

[paulk]

I have suffered with PVC/PACs for about 4 years now,I am a 31 yo female.  I have had blood work, ecgs, echo and holter done about 2-3 years ago now.All were grand and they showed up on the monitor.  I have opted not to take beta blockers and can usually deal with them although they cause me alot of anxiety. I notice i get them when i am tired, hungry and especially the day after drinking alcohol, I know i will have to eliminate this entirely from my life, but what am i concerned about now is that i am starting to get them during exercise which is freaking me out as this was my life saver to help me cope and now I feel like I dont want to go to the gym anymore, before I start a class I get myself all wound up and instead of concentrating on the class i find myself concentrating on hoping i dont get these and of course i will end up getting them. I dont get any other symptoms, I want to know if this is dangerous to be experiencing them when your heart rate is higher than your resting heart rate, I might only get one or two but i feel weird afterwards for a few seconds prob anxiety kicking in. I dont feel i get any help from my doctor he just said they are of no concern but i never got them at that time while i exercised. I dont want to give up the gym as I love it. I am so sick and tired of living my live and these invading every area of it.

[woodruff]

I've had the darned things for fifteen years, anyhow.  If it's any consolation to you (heh-heh), the books say they tend to become more frequent as one ages.

Based on my own lengthy experience, one thing I can suggest is that if you've had your heart tests (EKG, stress echo, etc), and you keep coming up "normal," yet you feel miserable and are inclined to give up your normal activities out of fear, then you are probably futzing with anxiety on some level.  People don't like to consider that, because it somehow smacks of craziness, but I can tell you that a good shrink (and possibly a counselor) can help a lot in dealing with it all.

Some people have good results with beta blockers, and I think they're worth a shot.  Some people, including me, get better results with SSRIs (in my case, zoloft works best).  Shutting down a faulty alarm system (which is part of the problem) does seem to decrease the frequency of pvcs.

One poster here, collegegirl, reported that her life, her marriage, and her relationship with her children were being ruined by fear of these irregular beats. In several of her posts, she mentioned that a course of intensive treatment for anxiety, part of which involved actively facing and acknowledging the pvcs, freed her from terror and improved her life immensely.

[paulk]

Thanks so much for answering, i know i have anxiety to a certain degree and i do feel that is where my PVCs originated from, my sister died 4 years ago and I developed severe anxiety as a result and had this for about 6 months before i started to notice the PVCs. But I feel over the last year I do not feel the debilitating anxiety i used to but the PVCs have remained if this makes sense. I started to control them(what I thought anyway)through exercise, if i worked out I would not experience any at all that night and perhaps for the week, but they always started again at some stage. The only thing the doctor gave to me was sleeping pills to take if an episode got so bad during the night, i could take one to calm me down and continue to sleep, I dont take these regularly maybe once a fortnight and only half a tablet if i do. But are you aware that if you get them during high intensity exercise is it any different or more dangerous than getting them at rest, I know it is prob anxiety and fear before i start a class that is making me experience them nevertheless i am, and would like to know if they can be dangerous. My doctor felt my heart rate was low enough and didnt want to start me on beta blockers which i felt was fine as well as i heard of the side effects etc...

[woodruff]

"I started to control them(what I thought anyway)through exercise"

Unfortunately, we don't get to "control" pvcs in quite that way.  If your heart is otherwise normal, it's more a matter of accepting that you have kind of a twitchy nervous system, and sometimes it takes medication and talk therapy to achieve that.  

"But are you aware that if you get them during high intensity exercise is it any different or more dangerous than getting them at rest... would like to know if they can be dangerous."

You need to go back to your doctor and ask these questions.  Given your age and sex, and the fact that just a couple of years ago, you passed a very thorough workup, you're probably fine.  However, your pvcs with exercise are more recent, so make the appointment and get the word based on some newer tests.

That said, if you are told that your heart is in good shape (as will probably be the case), I advise you to accept it, accept it, accept it.  I've seen several people here run themselves ragged, desperately trying to find heart disease where there is none, because it's worse--of course--to need psychological help!

Oh, and don't be afraid to try beta blockers if your doc suggests them.  Some people feel very good on BBs, but if you turn out not to be one of them, you can quit taking them.  You won't suffer damage from a trial.

[paulk]

Thanks alot for your comments, I think i will go back to the doctor and see what she has to say, i feel i prob need help for the underlying problems i have and if i get the all clear i will try to accept them, thanks again.

[froggee]

the beta blocker i am taking is labetalol.  it took a couple of trys with other beta blockers to find one that helped me.  it's not a cure for pacs or pvcs but it  helps me deal with them.  they are alot more easy to deal with than before i was on the drug, but they still come out of hidding and hit me when i least expect it.  i also asked my cardio to give me script for my anxiety, which i usually have when i start to feel an onset of the "thumps".  the zanex (i think thats right) helps alot when the "thumps" are around.  helps keep my focus off my problem so i can concentrate on other things, another thing to do is to try to train you self not to focus on the "thumps".  when you have an episode, try to work through it by staying on task with what you were doing.  it hard and not always successful but it does help.  it is a scary thing, and apparently alot of people suffer from them, we are not alone.  also, track what you eat, some people notice a correlation between sugar,caffine etc. and their pvcs and pacs.  keep your head up.

[sb786]

Thanks frogge, have you ever been prescribed a beta blocker called bisopropol/zebeta? thats what my doc wants me to take but i'm just concerned what its going to do to my already low bp (90-100/55-60) and my low resting heart rate (50-55bppm). i guess i really should be on a beta blocker because i suffer from svt as well as the stupid, annoying pvcs!!!

[froggee]

i have not tried that one before.  however most beta blockers are the same, however some people react differntly to each one, so it might be a trial and error senario until you find one that works well for you.  you say you worry about taking bb because you have an already low bp and pulse rate.  just try to remember that the doctor is not going to give you anything thats gonna harm you.  however, remember to keep an eye on yourself while trying new drugs.  try to eat right and drink plenty of water.  from what my doc has told me and what i have read about beta blockers, it is good to not consume to many foods or supplements with potassium in them because some beta blockers increase potassium levels in the blood and consuming even more potassium might raise the levels to a dangerous level.  ask your doctor about the coralation, in fact ask him as many questions you can think of, there is no such thing as a dumb question when it comes to your health.