Post Exercise PVC

[bm38]

I'm a 38 year old male with a 16 or so year history of "noticeable" PVCs.  They weren't particuarly frequent (maybe a few per hour) but annoying.  My doctor tried beta blockers (Toprol, Atenolol) and a calcium channel blocker (cardizem), none of which had any effect on my PVCs.  ECGs and an echocardiogram were all normal.  I eventually learned to live with them and for the most part ignore them.  

About a year ago I was experiencing some chest pain so I had a cardiac workup.  I'm a mild asthmatic (well controlled with Advair) and I thought it may be related to that.  A holter, stress test, ECG and echocardiogram all were normal.  Around the same time however, I also noticed that my PVCs seemed to be getting more frequent.  For the past six months, I've really noticed they are quite frequent after I exercise.  My exercise tolerance is great.  I'm a very active cyclist and don't seem to be limited in any way by the PVCs.  My max heart rate is approximately 195 and I routinely will ride for 3 to 4 hours with an average heart rate of 150 to 160bpm.  However, my real concern is that I've read some recent information that PVCs post exercise (recovery PVCs) may be indicative of CAD.  I also still have random unexplained chest pain.

My primary care doc and the cardiologist I saw a year ago both think my heart is perfectly fine and suspect the chest pain is likely either related to my asthma or is musculoskeletal in nature.  I guess I'm just looking for some insight into the relationship between PVCs and exercise and whether the PVCs are likely significant or indicative of an underlying issue.

One other piece of informaiton is that I'm mildly hypertensive (140/90) and have recently (2 months ago) been prescribed felodipine to control this.  My blood pressure is better controlled now but this hasn't seemed to have any effect on the PVCs (not that I expected it to).  

[bm38]

Thanks for your comments.  I've certainly come to accept the PVCs as part of my everday life.  The reason for the calcium channel blocker (Cardizem) was primarily because I didn't like the side effects the beta blockers were having on me (decreased ability to exercise, lethargy) and they weren't controlling the PVCs anyways.  He tried the Cardizem, but that ultimately had no effect either.  He reassured me that the PVCs were not life threatening so I just learned to deal with them rather than continue to try different meds.  

[fizzixgal]

My EP told me that PVCs are sometimes triggered at a certain HR. He was talking specifically about RVOT PVCs but they are one of the most common kinds of "normal heart" PVCs. If the critical HR is below your steady exercise HR then you might get them during as you're warming into your routine, then they disappear and start again when your heart slows down.

I'm not aware of a relationship between BP and PVCs though there might be one.

PVCs can be really scary -- I suffered with them for 2 months at over 8000 a day. One cardiologist threw me out of his office because he was sure from my Holter that they were "normal heart PVCs". I don't mean to be discouraging but I think that with the workup you've had, most doctors will tell you that yours are too. It might be reasonable though to ask for another Holter, if it's been a year since the last one.

Was there a reason your doctor tried Cardizem specifically? From what I've read some work better than others for some kinds of PVCs, and my EP thought verapamil was the best one to try for mine --- and it worked. Everyone is different though.

Here's to nice, steady PVC-less heart rhythms!