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Heart Disease (Expert Forum)
Palpitations--PVC's or PAC's???
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Palpitations--PVC's or PAC's???
by smc123, Dec 15, 2006 12:00AM
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???
Doctor's Answer
by CCF-M.D.-MJM, Dec 15, 2006 12:00AM
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???
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???
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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.
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.
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
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...
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?
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 ***@****
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.
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.
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.
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.