Palpitations long after exercise

[cheeser]

The details:

38 yr old male. 6'3". 175 lbs.
No medications, no "recreational" drugs (ever), never smoked, no caffeine, healthy diet, couple beers a week. No family history of heart problems (to my knowledge).

I've been exercising regularly for about 16 years - weight training and running/x-country skiing (in season)/indoor rowing.  4-5 times per week.  My resting HR is typically 45-50.  

The issue:

Heart palpitations that start 3-5 hours AFTER I finish exercising...most of the time, but not always.  If they appear they'll continue well into the next day (usually) and will gradually go away.  I'll exercise again, and the cycle seems to start all over.  Very annoying and a bit disconcerting.

Tests:

EKG (2)
Treadmill stress
24 hr Holter

All were normal, but I don't think much happened when I was wearing the Holter.

Question:

Should I be concerned?  It annoys me enough that I'm beginning to fear my workouts.  I feel great while doing them, but am afraid of what will happen later on.  

By the way, I have had "anxiety" issues and my wife thinks that it's more related to that than my heart.  Hard to say for sure, but the palpitations certainly feed my anxiety.

Thanks MUCH!

[Cleveland Clinic]

cheeser,

Thanks for the post.

SOund like evrything is ok. If you wanted, an event monitor wouls show you the rhythm when you were having your symptoms. If they are PVCs and the rest of your cardiac evaluation is normal (which it sounds like it was), then you really have nothing to be worried about with your exercise.  

Anxiety certainly can cause a lot of problems.  It is just as important to deal with these issues so that they dont interfere with the rest of your health.

good luckq

[andie3330]

What type of palpitations are you experiencing? "Skipped beats" (PVCs) or a fast heart rate or something different?  I'm just curious because I also have anxiety issues - which causes my heart to race at times while at rest ex 120 beats/min vs. normal resting rate about 55-60.  I also have PVCs and PACs but they are less tightly correlated with acute episodes of anxiety, rather, I tend to have more PVCs after being very anxious - maybe even the next day.

[AlisonInCanada]

Hi cheeser,
I experience much of the same.  During exercise, I don't get any palpitations, but afterwards, as you describe, they come quite often.  Mine are such that my heart rate appears to slow down to about 30bpm.  I also get them sporadically at other times, which I can't necessarily relate to exercise.

I also had ECG, holter, and stress test.  All normal.  My PVCs don't occur during exercise at all.  I also had an event monitor, as the doc suggested above.  This is what caught the ectopic beats (or PVCs).  I was then advised that they are benign, and too reduce stress/anxiety and exercise more.  But as you say, it is disconcerting, and makes me fear heavy exertion.

I think an event monitor is a good next step for you.  

My only concern with an event monitor is the fact that (at least in my case), it was only a 2 lead ECG, vs a 12 lead ECG.  Can anyone comment on the accuracy of a 2 lead ECG reading vs 12 lead ECG?  I've read that PVCs can mimic an idioventrical escape rhythm (which makes a lot of sense in my case, since my palpitations are very slow).

Regardless, cheeser, the event monitor would be the first step - you want to a least get these palpitation episodes recorded.

I think I may pursue getting mine recorded with a 12-lead ECG, and get a 2nd opinion - just to ease my mind.  If you are anything like me, the "not knowing" is the worst part of all of this.  We all hear too many stories about sudden heart attacks in seemingly healthly people.  So that 1% (or less) chance of an abnormality is enough for me to push for a definitive answer, even if I appear over-bearing or paranoid to my doctor.  My health and my family's welfare is much more important that my doctor's personal opinion of me.

Best of luck to you,
Alison

[janne]

Hi Andie
I just thought I'd let you know that I posted a response to your post from Feb. 19th.  I'm not sure if people ever go back a week later and check to see if there are any new responses to their posts, but thought I'd tell you just in case you hadn't seen it.
Janne

[Fran71]

Isn't it strange? We'd tend to think that exercise might make our palps worse. As for me, even when I have a bat PVC day, they seem to disappear when I'm exercising, which is really wonderful. Then 1 hour or so after my work out, if it was a bad PVC day they will just start again as before, but exercise doesn't always bring them up.

I think  not getting palps while exercising is a good thing; I read it on this board a few months ago.

Cheers

Fran

[upbeat63]

I'm pretty much in constant trigeminy, but during exercise (treadmill), I have, on occassion, decreased to a PVC every 10 or 12 beats, which for me is heaven, so exercise helps me.

It is very disconcerting to have any strange rhythm during or after you have exercised but if you've been given the "ok" by your doctors, I'd second that and say keep on exercising.

Sudden death from cardiac arrest is a very scary thing. My mom and dad both died in their 60's from sudden heart attacks, and my brother had heart surgery at age 42 to correct a faulty valve. BUT, if you are low for all the known risk factors, taking family history and your own health history into account, then you are ahead of the rest of the pack, by miles. There are no guarantees againt SCD with or without the best tests.

I am actually more frightened by motor vehicle collisions--even knowing my family history for heart attacks and myself being in trigeminy. I am however, on the watch for cardiomyopathy, which is the only thing cardiologists have been able to say "may" happen with high frequency PVCs. You've got to be a good consumer of your own health care, so keep on looking for answers until you are satisfied.

[andie3330]

Thank you for the reminder and thanks so much for your comments - you were correct that I had not looked back at my post until just now.  I see my cardiologist next week and plan to ask about a cardiac MRI. I'm doing ok, but I am a little afraid to exercise because if I get symptoms I start worringing again.  You mentioned you didn't have any risk factors except smoking - If you don't mind, could you elaborate - Chol, BP, etc. The reason I ask is that my doctors seem to completely rule out CAD based on my lack of risk factors - even though I have unexplained pains. Sorry to take up room on this thread.

[janne]

Hi Andie

I don't mind at all that you asked about my risk factors.  Although I do not know the exact figures, I was told  my cholesterol was excellent (I'm lucky in that no one in my family seems to suffer from high cholesterol, so I guess it's not in my genes). Despite my good cholesterol, I was put on lipitor to reduce my LDL even further than it was.  When I had my blood checked, I was told that my HDL was excellent and my LDL was so low it was almost undetectable on the blood test. I'm not so sure that's a good thing being so low, but I have been told that lipitor also has some physical benefits for my heart.

My blood pressure has always been within normal limits, with the exception of when I was pregnant or on the birth control pill, then it was borderline high.  

There is no one in my family that I am aware of who has heart problems. I have one brother with high blood pressure.  My dad passed away at 46 but he was a big drinker. My Mom passed away a few years ago at age 64 from lung cancer.  My grandmother will be a 101 in May and still going strong.

I was a smoker when I had my first heart attack, however, I had quit previously for 11 years and had only been back at it for a few years (stupidly under stress I started back).  
I always felt I was overweight, but I was told I was only about 7 pounds overweight.

The only thing I was really told to do was to reduce stress in my life (which I have). Along with some personal issues, I also was in a high stress job in engineering and development (which I have since quit and gone back to school full time).

No one can tell me where the 90% blockage came from if I don't have high cholesterol.  The restenosis was caused from scar tissue, and the angiogram after the second heart attack showed my arteries completely clear.  

I have been told it is very usual for a woman to have a heart attack at 39 and again at 41 with no real risk factors, but it does happen.  I cannot say I can completely blame the doctors for thinking it was in my head because I passed all the cardiac tests.  What else were they to think?  

I think that it must be very difficult for doctors in these types of situations because there are people who have anxiety issues, and although I had no history of anxiety problems, with all of the stress in my life at the time, it would be reasonable to think I had developed anxiety.  However, as I have heard from the docs on this forum, anxiety should be a diagnosis of exclusion.  Until my family doc mentioned it, I did not know about Prinzmetals angina or variant angina...I really started believing the symptoms were in my head, so much so that I refused to go to the hospital until I was absolutely sure I was having another heart attack...I didn't want to waste anyone's time.

Good luck with your appointment next week.
Feel free to ask me more questions if you need to.
Take care, Janne

[Fran71]

Hi Upbeat! Nice to see your post. I was thinking of you and wondering if your trigeminy had improved. I also thought of you because I had praised Inderal so much that you said you'd give it a try and I praised it too soon...Last night I was having constant bigeminy for hours; took 20 mg Inderal which usually does the trick immediately and nothing happened. Took one more 20 mg, nothing happened. So I went to the ER! It's the very first time I go to the ER for tachy and PVCs. I was monitored all night and ECG only showed tons of bigeminy, no NSVT it seems. The wierd thing is, the cardio said he saw PACs, not PVCs. Weird. I always only had PVCs in my holter taken 2 years ago. Could the doctor see wrong from the ECG? anyway, he discharged me saying the same old wonderful story, i.e. that they're really nothing to worry about. He just ordered a new holter to make sure the medeication works. He prescribed bisoprolol instead of Inderal. Has anyone ever tried bisoprolol? He said it's a new kind of Betablocker. I was very disappointed with Inderal, which I was praising as the miracle cure!
I guess it much depends on the situation, on our general health, etc. So far Inderal had been fantastic for me. Let's see how this new one works.

Upbeat, I'm very sorry to hear about your parents. Anyway you're right: the danger of dying in a road accident is much greater than dying from SCD, regardless of our family history.

Take care and happy arrhythmia free day everyone!

Fran

[Mel22]

Check your electrolytes. I was getting PVCs hours after excercise and found out later my potassium was bottoming out. I didn't have symptoms until after I sweat and lost even more potassium.

[tictock]

couldn't post on other thread closed. Just wanted to say that i just emailed my cardiologist to let him know that bigeminy rhythm slowing up but i still want them to try and provke them and ablate if they can. I don't think they would not atempt it if they didn't think there was a chance they could do it, a chance i'm willing to take. with all the medication i have been on these passed 6 week make me wonder that when these buggars decide to come on they do, and when they decide to stop they will. in my case i don't think meds has helped much as i'm just back to my 80mg a day what i was taking for years. Just finished vacuming and guess what? (THEY ARE BACK)It's nice looking at all of your post keeps me same being i'm off work at the moment. I'm in London England so with the time difference don't know if your awake or asleep ha ha. take care you all.

[upbeat63]

It is frustrating that you can't predict when, or if, the bigeminy will be there, but I'm glad to hear you've gotten some relief.

Do you still have PVCs when you don't get the bigeminy? Are they very many and do you feel them? You don't get the chest pain with the periodic PVCs just the bigeminy right?

I wonder about meds for PVCs. Beta blockers may or may not work, and it could be a matter of which one, so you might have to experiment with your doctor. Toperol may have stopped a bigeminy period for me, but does nothing for the trigeminy! I must say though, that it does work to reduce the sensation of PVCs and luckily it hasn't changed (too much) my heart rate or BP which are just fine. I was worried about being a little tired from the BB, but that seems to have stopped. Anti-arrythmics scare me a little, but are an option for some people.

Have you heard of a date for your ablation yet? Maybe you already posted that. Knowing that your ablation is scheduled is like a type of medication itself isn't it?

[tictock]

yes wish i could predict when they would come on they have a mind of their own. When i don't have the bigeminy rhythm i have pvc's now and then some days more tham others don't usally bother me. 26 years ago when i just gave birth to my daughter i had VT went on for some time but it terminated by it's self doctors wasn't too bothered, they said it was the stress of the birth and for months after i was getting bigeming on and off then it weaned off and i was left with pvc's again which like you i lived with them all these years.in all i've lived with these buggars for 36 years.i haven't got a date yet but i think it maybe soon, (i hope). I am scared to have the ablation again but i've got to the point where i say kill or cure. funny enough when it gone for awhile i'm my old self again. sound like you have had your fair share of them over the years, have they ever stopped you doing anything?.well i'll give this one more try and if it don't work i'll ask the doctor to try me on some other meds. it's so nice coming on here just to see what others are dealing with.The cardiololgist that done my ablation before said that this arrythmia is not coming from the site that he ablated years  before, so straight after he done the ablation another foci took over that was already there i quess.well... we live to tell the tale.  take care upbeat.

[Fran71]

Guys, do these benign arrhythmias always worsen with age or can they improve? After being at the ER with bigeminy now I'm scared to death - not scared that I will die or anything, just scared that I will feel so bad again. I only had bigeminy for a few hours...I hear some of you have it for weeks. I'm so worried these days I realize it is limiting my activity. Whenever I feel a PVC I go crazy...I've had them for years and I've always ignored them. I don't want them to rule my life!

Thanks for listening

Fran

[tictock]

Hi Fran, most people and doctors say that pvc's do increase with age i know mine has. i get them off and on when i've got a virus or if i'm tired i notice them more. on the whole i try to carry on best i can and not let it take over too much of my lifestyle. But the (BIG BIGEMENY RHYTHM)is another kettle of fish for me this time i hate it it's so uncomfortable and gives me pain and breathless, never did before.  it's hard to say if yours will get worse you might find it will go just as quickly as it came mind has in the passed and it's going now i've had it for 5 weeks and upbeat has his most of the time. try the different meds it's seems to be trial and error, what works for you may not work for another. good luck!

[Fran71]

Thanks tictock,
I can manage with PVCs very well. It's the constant bigeminy that I dread! After the night at the ER Monday they haven't come back. It seems that BBs generally work for me. They seem to eliminate the most part of PVCs, only that night at the ER they weren't working...Even if they increase with age, I hope they don't get more noticeable, or maybe less?

Let's all hang in there! The best of luck to you for your ablation.
Thanks again

Fran

[tictock]

Hi Fran I'm happy for you that your bigeminy has gone, I was trying to explain that rhythm to my husband but unless you have it your self no one can know what it feels like. all i can tell him is that it feels like my heart is limping along when i'm in bigeming.at least bb works for you. with mine i get the feeling that even if i don't take bb which sometimes in the passed i didn't it will wean off eventually to what is normal for me.i'm just glad i've found this forum.If there is anything that you want to ask me feel free to Fran. take care.

[upbeat63]

I guess a body will get used to just about anything, over time.

The trigeminy that I'm in right now has been going on for so long I can't remember when it started, it's been a couple of months for sure, before Christmas some time. It has become my "normal" rhythm, I just expect it.

I think I am used to it for the most part, EXCEPT when I am: tired, dehydrated, low-blood sugar, eaten MSG, haven't exercised, overly stressed, and maybe too much coffee (more than one cup). Then I get frequent dizzy moments, feel short of breath and wonder when the dang PVCs will stop because they drive me crazy!

I think (I hope) I have begun to watch the PVCs less but I watch my habits more. Got to be good or else the PVCs definitely clobber me, bang, bang, bang. Hang in there, sounds like you've gotten some relief from the bigeminy, lets hope that it lasts. Enjoy it now, and deal with whatever comes up tomorrow--tomorrow!

[Fran71]

Hi guys and thanks so much for standing by me!

Upbeat, what you say is so wise...We will deal tomorrow with whatever we need to face tomorrow, right? Since my ER visit last Tuesday I am on the BB daily and I hardly get a PVC at rest. Still I feel so scared the bigeminy will come back! I want someone to tell me this might decrease with time...but I usually hear otherwise LOL.

Upbeat, I can’t believe you’ve been in trigeminy since Christmas. Were betablockers never very successful with your symptoms or did they work before and have now lost their effect? Also, have you ever considered ablation? If I had trigeminy for a long time I know that I would. I apologize, I’m sure you have written this info in previous posts.

Tictock, yes my kind of arrhythmia seems to respond great to BBs, though the night I went to the ER the BB did nothing – the very first time it did absolutely nothing to my symptoms. My tachy and PVCs also can disappear without a BB. After having my first bad arrhythmia in 2003, I took no meds and was basically fine with no scary episodes for nearly 2 years! Only some tachy and PVCs now and then. But when symptoms become aggressive I can’t really bear them, and a betablocker does help.

Again, thanks a billion, guys, for your kindness and huge help!

[upbeat63]

Last spring I did a 48hr holter that showed 20,000+/pvcs/day and my GP Rxd toperol xl. I was resistant to taking any meds at all because I've had high frequency PVCs for so long, and a cardiologist 10 years ago said BB may not work and might make PVCs worse. So I didn't take BBs.

That was until I went into bigeminy last summer and I couldn't stand it anymore. So I took the toperol for three days and the bigeminy stopped. But then I stopped taking the toperol because I was just so darned tired on it, and it wasn't doing anything for the high frequency, that remained.  

Now, with the constant trigeminy the toperol isn't working to stop that......but I must admit, I don't feel the PVCs so much. And that's good enough for me. I still sense them every day, but believe me, the less I am aware of them, the more of the day I have to get on with things.

Ablation is an option, I know. So if it ever gets bad enough, I'll pursue it. But for me, for now, I'll live with the PVCs. Geez I've been researching another procedure--Lasix surgery for a long time also, but there is still a 5% chance that your eyesight could be worse so I figure glasses are ok for me until they can predict a 99% success rate!

[Fran71]

If they don't drive you crazy then I agree there's no reason you should go for the ablation. I guess I'm more intolerant of this than you are.  I also often get tachycardia with PVCs. That's probably what makes them feel even worse for me.

I wonder if there are different types of PVCs, since yours seem to be rather refractory to BBs while mine, for now at least, seem to respond pretty well to BBs (of course that may change for me, I know...SIGH)

Have a great day

[tictock]

yes that's what the doctors say if symptoms don't feel bad then live with it.i can't live with this bigeminy or this life style. I have read somewhere on forum that it's not a good sign when these pvc's or bigeminy come on during exercise, mine do, i 've also read that people don't feel pain with bigeminy, but i feel so much pain when i'm in this rhythm and trying to walk i have to stop because of it. I know having ablation is not 100% but if it cuts them down enough to enables me to get back to work, ride my bike and going for long walks by the river, that's what i miss. it is a chance to take but the doctors are willing to try again.i know that ablation is not often done for pvc's maybe because of the cost for what doctors think is quite a minor arrhthmia but it can be cured. fran i  sometimes get short burst of vt for a few seconds once in awhile.i can just about do all house work but it takes me longer these days.I'm glad to hear you all coping quite well we all have to hang in there some how. My friends think i have a good life at the moment watching daytime tv, lol. take care

[Fran71]

Dear Tictock,
I sympathize with you. I've only had bigeminy for about 12 hours last Monday and I freaked out. I'm sure the body gets used to it to some extent but I know that I will go for an ablation if my symptoms get worse, and they don't have to get as bad as constant bigeminy... So far the BB is working wonderfully, but I wonder if its effect will decrease overtime.

About your PVCs and exercise, I'm not a doctor but I think you shouldn't worry. I think the prognosis is slightly worse when exercise brings them on. As I understand it, you're having your bigeminy even while you watch daytime TV (LOL), so this means your arrhythmia is not caused by exercise. Sure, when one is in a bad PVC period exercise can make them worse. For instance, right now with the BB I have virtually no PVC at rest, but if I start walking I get some. When I exercise and I'm in a bad PVC period, I notice that they first get worse, but after 10 minutes or so they fade away. That's all so strange! When I'm in a no-PVC period though, exercise will not bring them on. I think that's what matters.

The best of luck to you! If you feel like chatting just email me at ***@****.

Thanks and have a great day everyone.

Fran

[tictock]

Thanks Fran, i took you up on your offer of sending email which i did. all the best to you. Take care.

[Barbarella]

What is bigenemy?  Is it none stop skipping of the heart, none stop PVC's like skipping every beat?  I had that real bad one time for days.  I also get PVC's during exercise, and sometimes after.  Cardiologist said not to worry, but I worry anyway.  He told me worrying about PVC's can make them stay longer with you.  I can't take beta blockers because my heart rate will drop to 30 bpm, and I get so fatigue that I can't do my work, doc took me off immediately, my regular heart rate is 52-54 bpm, I exercise a lot for many yrs. If I feel several PVC's I immediately worry "what if they will stay with me again" and here it goes, and I have them for at least the next two weeks. My Cardiologist said to say to myself and the PVC's "common, do your worst, I'm not scared of you", if it was only so easy.  Only people who have experienced that themselves like you folks know what hell, what a nightmare it is. At night it interrupts my sleep, and I worry about them.  I know doctors say it wont kill you but anything that has to do with the heart scares me.

[barmat]

Hello, I am a new member. 35 y.o. male.  I am so glad I found this forum.  I developed pac's last year after some intense workouts and was a big coffee drinker.  After holter and ekg test revealed pac's, I quit coffee and exersized less thinking i didnt want to die.  They went away. Last tuesday, while lying in bed,(after workout) they came back.  "not again"  So I have cleaned up my diet, which wasn't much to clean up and started exersizing even more because like others on here they are not present during exersize. However, some time later they come and go through the next day. I am 5'10 160 lbs.  Mother had premature heart disease and died at 66, but was a heavy smoker and drinker most of her life.  Father is still healthy at 85.  Other forums have described these disorders leading into more serious ones such as, A-fib.  Just today, a new symptom appeared, small twinges of pain in top of head, anyone else.
I also want to say, it helps to know Im not the only one.  Thanks.