Skipped Beats and Heart Disease

[Chris73]

Hello Doctor, Im a 31 male, 6'3 250lbs, my blood pressure is normal and my lipid panel is 193 TC, 34 HDL, 120 LDL, 193 Tri. I have been having episodes of skipped heartbeats for a several months now, they have always been at rest, like after eating. These skipped beats seems to be related to gas pressure somehow.

But here recently they have been occuring while im exercising or when im finsihed exercising.. like my heart will skip while its trying to slow down from being elevated. This is different and has me concerned.

Im worried with my low HDL and skipping beats that my heart is trying to tell me something.. I have been tired and yawing all the time for the last month and this has me worried by itself.

A few months ago i wore a 24 hr monitor that they said was normal. I had an exercise treadmill stress test last month that was normal, but the skipped beats while exercising started occuring after that.

What tests do you recommend next for me? My grandfather died of a heart attack at 56, but no other problems run in my family. With my poor HDL and skipped beats does this mean i have heart disease, im really concerned. Thank you

Chris

[CCF-M.D.-MJM]

Hi Chris,

Sorry to hear about your concerns.  I agree you HDL is low, but you need to remember that this is risk factors that does its damage over time.  I doubt it has had much effect on you yet.  I did a quick check of your body mass index (BMI) and you are in the obese range (obese is >30).  Your score is 31.  You HDL will likely increase and your triglycerides decrease if you lose some weight.  To reach a BMI of 25 or less you need to lose 50 lbs.  This would do you a world of good over the next 50 years.

It sounds like they noted the PVCs with exercise with your stress test.  In general, this is not a big concerns for your health.  Unfortunately, PVCs are more likely to drive you nuts and constantly remind you of your concern.

I would not recommend any additional tests at this point.  What I would recommend is taking your life back by getting yourself into shape.  Yawning is a sign of anxiety and increased "vagal" nerve tone.  Only you and your doctor can decide if this is playing a role, but sometimes anxeity can lead to increase concerns/anxiety about health concerns to the point of near obsession.  Please try not to let your concerns of PVCs cripple you from doing things. I would focus on healthy living, aerobic exercise and weight loss.

I hope this helps answer your questions.  Good luck.

[bigjoe2005]

hi,

I felt the need to comment as your case sounds alot like mine and I'm also lost on the subject. I'm 6'0, 230lbs, in shape, I exercise, recently I began having palpatations which I was concerned about beacuse I'm only 25. I was on hiatus for a while due to injury but started back at the gym recently and worked hard at it. Couple of months later, palpitations. I get mine at rest, and recently after I eat. I'm going to see the doctor soon, we'll sort things out from there. But in my journey's and reading I've come across possible causes for palpatations in 'otherwise healthy people' you may or may not find interesting.

Seasonal Affective Disorder.. not sure where you live but I'm in Canada. Its cold and dark here throughout the winter compared to summer so a deficiency in sunlight, Vitamin D, etc and associated vitamins and minerals has been shown to potentially lead to palpitations. Other symptoms include cravings for carbs, moodyness, depression, etc.

Also, do you ever wake up extremely tired, with headache, dry mouth, etc. even after a supposed good sleep? This is apparently called Sleep Apnea, for us big guys sometimes sleep can result in heavy snoring to the point where our airways become blocked and we sort of choke in our sleep. Sounds crazy but it happens. This can lead to waking palpitations due to the increased 'not enough oxygen' and 'catchup' signals through out the night between the brain and heart. I don't know if I have this but I've experienced these symptoms before (bad sleep, dry mouth, choking sensations) and intend to ask my doctor. Poor sleep is also associated with Seasonal Affective Disorder, possible link there.

Anyway, just some things to consider as by your post this seems to have arisen since winter began. Reading so many threads here about healthy people who experience palpitations.. just leads me to wonder about external factors that may be so far-removed from 'heart talk' we never consider them. Whatever the case I hope you're able to find a solution to your problems soon. God Bless.

[Medboy]

Yup I know that feeling ... also in Canada and my palpitations have been brutal this winter here in Toronto and I think the lack of sunlight often causes other impacts to us. Get it checked out though but seasonal depression is a cause of palpitations or at least a contributor.

[pms_barbie]

I can relate to the gas pressure and pvcs.  Seems like if I hit a spell of pvcs and then I burp.  They stop.  Or if I take a zantac after about 15 minutes they stop.  I have mvp that was just diagnosed a couple years ago.  I probably had the pvcs forever and a day and just never paid much attention to it until I  found out what they were.  Just because you have pvcs doesnt mean you have heart diease.  Its best for peace of mind to check it out then maybe you can try and ignore them.  Good luck to you.

[mrbh]

Wow, can I relate to this post. I'm having the exact same problem exacerbated by enormous gas pressure in my guts. My tummy is so swollen and rumbling that everything rides up and here come those dreaded PVC's.

I should point out that my PVC's were caught on an EKG by my cardiologist, along with episodes of sinus tachycardia. Every now and then, I get a run of PVC's (a few) that sets off a brief bout of the tach. Not sure if my prescribed Inderal helps, does nothing or makes things worse. Also have my doubts about severe anxiety and depression being factors...I don't know enough to be sure and my cardiologist hedges when asked.

These PVC's are miserable, extremely upsetting (especially when you get more than one at a time) and have ruined a lot of things for a lot of people. Everybody claims they are benign, but they sure scare the stuffing out folks.

Hang in there. Good Luck!

[jennann]

Hi~

I want to say this in a way that doesn't minimize the reality of the anxiety and fear and disruption that these pvcs and pacs can cause.  I've had these monsters on and off for years, then in September they became dramitically increased, and I went to cardio, had event monitoring, was told they were benign and not to worry.  Hah!  Hard not to worry, but I tried my best.  Then in November I had a very frightening episode believed to be afib - new for me, and unfortunately not caught on monitor so afib is the best guess.  Okay - that made me wish for "only" pvcs!  Then, a doctor friend of mine questioned why they thought afib and not v-tach, which is MUCH more seriously and can be deadly.  NOW I was wishing for "only" afib!  I'm seeing an EP in a couple weeks for 2nd opinion, and now am really very scared about the possibility of v-tach and the tests they may want to do to diagnose.  So - I really do "get" how frightening the ectopic beats are, but please do all you can to trust in your physician and get your quality of life back - as freed from fear as possible.  Believe me, if I could go back to only pvc's, I'd be very thankful!  Again, I don't want to minimize your fears...they are nasty buggers to live with, but live with them you can!
Best,
Jennifer

[dquenzer]

Regarding BMI I think it's a bit overblown.  It is possible for someone to be your size and be in great shape.  It depends upon muscle mass.  I know guys who flunk the BMI index, but are built like rocks.  Not much fat on them.

As to skipped beats after exercise, this was a common experience for me during and after exercise.  I had all the tests and I did not have any heart disease.   Your heart may be telling you something, but it may not be heart disease.

More probably at your age the skipped beats are related to other factors in your life i.e. stress, depression, anxiety, etc.  Or they could just show up because it happens.  Sometimes there's really no good answer.

If you research the posts on this forum you will find a plethora of information and postings on these PVC's PAC's.  

In general most recommendations are:
1)  Evaluate life for stress.
2)  Eliminate all types of caffiene.
3)  Get a good amount of rest.
4)  Eat a well-balanced diet.
5)  Continue to exercise (lose weight etc.)
6)  Avoid certain types of foods that cause indigestion.

By the way, in order to get the proper benefit of aerobic exercise to have endorphines in your system, you need to exercise over 20 minutes and better for 40 minutes.  You do NOT have to aggressively exercise.  Rather keep your heart rate at the mid-range of target heart rate.

Hope things get better.  I trust they will

[Jeff67]

Hi Jennifer,

What makes you think you had A-fib as apposed to SVT?  How long did the "A-fib" event last?  I get a strange burst of something every now again.  I think it is NSVT, but it has never been captured and my doctor is not interested in trying to capture it.

Jeff

[jennann]

Hi Jeff-

I've had SVT since childhood (I'm 38 now) and that's always a very clear event for me...sudden rapid heartbeat, scares me but doesn't make me feel faint - just panicy, and I can feel the fast pulse.  As a kid, I didn't know it was abnormal and did nothing to try to stop it, thus it continued sometimes for perhaps an hour or more.  Now I immediatley bend over, deep breathe, and it stops after maybe a few seconds and has been captured twice on recorders, so I do know that's SVT.  However, I had an episode in Nov. while driving where my heart suddenly flipped into some bad rhythm and I immediately was beginning to pass out...darkness coming in from the periphery, that feeling of losing consciousness.  A very scary part was that I could feel NO pulse (very low b.p.??) , and I'm an expert at quickly feeling my pulse from all the years of SVT.  I made it out of my car to the curb and was taken to ER, but it lasted only perhaps 30 secs, so they caught nothing.  Had to pee like crazy afterwards...a symptom of afib but maybe other arrhythmias too.  Anyway, it happened less than a week later while in my cardios office (not hooked up though :(  ) and he felt my pulse to be very fast and irregular, leading him to suspect afib.  I've had recent echo showing only mild mitral valve prolapse - no heart disease, structurally normal heart otherwise.  I fear VT though, because my symptoms were SO severe, and it seems that all the afib stories I read and hear are nothing like what I experienced, and some VT stories are like mine.  I'm on beta-blocker, but am having horrible horrible nightmares each night, so he may pull me off (already tried 2 different ones).  
So - that's my story.  My MD only felt my pulse for a few secs in his office - it was another very brief episode - but I guess he was probably accurate in his sense of what he felt.  The other thing I think is extremely relevant to my story is that 10 minutes prior to the 1st episode, I had an enormous enormous fright and was shaking more than I would have thought possible - clearly a huge adrenalin flood.  I'd love to believe it was all due to that, but my cardio is more pessimistic.  Can't wait for the 2nd opinion!
Best,
Jennifer

[Jeff67]

Jennifer,

Thanks.

Your story is similar to mine ...

I am also 38.  I have had PACs, PVCs, etc for at least 20 years (I know I had stuff before that, but I never focused on it). I have become more and more focused on them over the past 20 years and have been eliminating triggers ever since (and there are many!).  They have always bothered me because so many of the ectopic contractions for me feel so weird ... some are very painful with the pain taking seconds to fade away, some kick violently, some flutter and on some I can feel the contraction take forever to ripple through the heart.  Then I started to get the occassional burst which I think is NSVT since I have always felt that it is more likely that beats conducted abnormally through the ventricles are more likely to feel violent, painful, etc than a beat conducted abnormally through the atria.  My cardiologist says it is impossible to tell. I have also noticed if I take my pulse during these events that it kicks harder than normal beats.  Not sure if this proves anything.  If anything it might disprove my belief as cardiac output is much lower when beats are conducted abnormally through the ventricles and therefore you would expect a weaker pulse, not stronger.  Who knows.  I have had many tests and like you have MVP and trivial regurgitation. My holters have only ever shown PACs (normally conducted and aberrantly conducted) and PVCs.

Take care.

Jeff

[kellebelle]

Hmm, I can relate I think. About 2 months ago  I experinced a strange feeling in my chest. It felt like my heart begin to flutter/quiver and this caught my attention....soon after my heart began to race for just a short time. About 45 minutes later I felt this feeling again , I actually could feel the flutter when I touched my chest. I have had panic attacks for 10 years but the pvc's started over a year ago.I have had all tests and am fine the cardio says...in fact he told me to quit worrying about dying!! I was rather shocked by his statement and explained to him that I do not sit on the couch all day counting my pulse, though am very aware of how my heart feels. Anyway in a nutshell I never did get a clear answer for my event. My dad has had afib/flutter since he was 38. I take a beta blocker now and meds for anxiety.Thanks for sharing it helps to know you are not alone.

[fpd3hm]

Just wanted to hop about the palpitations bandwagon.  I am 33-years-old and a recreational runner (although I have above-normal blood pressure for someone of my age and conditioning level). I also suffer from pvc/pac-induced anxiety that, while not debilitating, is certainly distracting.

I developed "extra beats" in my early- to mid-twenties, triggered by all the things discussed here (exercise, eating, stress, caffeine, sleep-loss).  I went through all the medical drills, but still find myself preoccupied with my health and well-being.  

I encourage you to get off caffeine for good.  Also, exercising in the morning prior to ingesting any food or drink (besides water) has been greatly beneficial in reducing the frequency and severity of my palpitations.  

Exercise, in and of itself, is of GREAT importance in reducing my long-term stress level and boosting my overall physical and mental health.  Ironically, it can be an incredibly hard thing to do, especially when the palpitations are present.  My advice: Get the necessary tests done and when they come back negative (as they already have and almost always will) get out and hit the pavement or the treadmill!

Good luck!

[jennann]

Kellebelle -

Your experience sounds much like mine.  I also experienced my heart as quivering, or fluttering - not pounding or beating normally, and as I said, I couldn't even find a pulse.  Did you also feel about to pass out immediately?  Your cardiologist and mine are at opposite ends of the spectrum...mine seems to be more of a doom-sayer and has really just increased my anxiety without giving me any real answers.  How long did yours last?  Had you been very anxious or anything PRIOR to it happening?  I think the adrenalin connection MUST matter.  I used to have panic attacks when I was late teen and early 20's...sorry you have them, they're awful.  But, real heart things are real heart things, and panic attacks can't explain away every symptom!  Especially if they happen in the absence of the panic attack.
Thanks for writing!
Jennifer

Jeff - so you do have vent tach ?  How do you experience it?  
Thanks,Jennifer

[tickertock]

from what i gather nsvt or vt would usually be pulseless or only a weak rapid pulse present, whereas a-fib would be an irregular irregular, erratic beat conducted at rapid, sometimes not so rapid irregular intervals to the ventricles.

Vt is regular though usually pulseless and a-fib is completely irregular, pacs and pvcs are usually felt as brief pauses in the pulse, though when frequent can be confused with a-fib.

this is what i gather from reading about vt, pac, pvcs and a-fib, rely on your tests and your doctor to provide an accurate diagnosis.

[pms_barbie]

I get confused about pacs.  I thought pacs were still conducted through the ventricles like a regular beat.  Therefore causing what seems as a double quick beat.  All these beats get confusing.lol

[tickertock]

from what i understand about pacs they are conducted normally to the ventricle just as in a normal heartbeat even though the atria contracts prematurely the same amount of blood is pumped by the ventricles as usual, even though the ventricles might beat prematurely and there is a slight delay or pause before the next normal beat though usually there is no complete compensatory pause as what usually occurs with pvcs, in pvcs the ventricles beat prematurely before the atria initiates the normal process, therefore the ventricles pump very little volume of blood and there is usually a full pause before the next normal contraction of the ventricles, in which the ventricle full with an extra volume of blood to make up for the little volume pumped by the pvc, this is what is perceived as a skip or thump. in general that is why pvcs are more symptomatic than pvcs, but both can basically feel the same.some people don't feel pvcs, yet feel pacs and vice versa, just goes to show we are all different in what our perceptions and feelings are. these are only my interpretations from what i read regarding pac and pvcs, only your doctor or cardiologist could provide with accurate information regarding these troublesome ectopics beats.

[pms_barbie]

Thank you very much for you explanation.  I think I tend to feel the pacs more than the pvcs now.  LOL I guess its always something.  Anyway thanks again

[Jeff67]

pms_barbie,

To answer your question:

PACs typically do conduct normally through the ventricles, but not always.  With a PAC the impulse that originates in the atria reaches the ventricles earlier than would be the case if the impulse had originated from the sinus node. The ventricles may still be in a refactory state after the previous beat and if this happens the impulse conducts aberrantly through the ventricles.  Hence, the beat is not conducted through the ventricles normally. This is apparently a common EKG finding and is known as the Ashman Phenomenon. I often have these aberrantly conducted beats as they have been captured on a holter monitor.  The earlier the PAC the more likely it is that this will occur (which makes perfect sense when you think about it).  This phenomenon also makes it difficult sometimes to distinguish between SVT and VT since an aberrantly conducted SVT looks very similar to VT on the EKG. In a way I take some comfort from this phenomenon since maybe some of my weird feeling stuff is atrial in origin after all, but just aberrantly conducted.

Jennifer,

Not sure what else I can add than what I put in my last comment.

Jeff

[tickertock]

TO: pms-barbie/jeff

jeff is right is his explanation regarding pacs also, some are conducted aberrantly to the ventricle and can be very difficult to distinguish from pvcs.

afib with aberrancy and svt with aberarracy as i understand can be very difficult to distinguish from Vt and sometimes can truly only be identified with an Ep study.

in any case an aberrant beat is supraventricular in nature, once it is identified as aberrant beat.

in any case no matter how bad pacs , pvcs , nsvt may feel, it quite obvious by looking at the posting of persons that have dealt with this for nearly half a lifetime that with a normal heart or a heart without significant abnormalities that these palpitations are harmless and benign even though they might make you feel like you are on your last.

[pms_barbie]

Thank you both for your input it was greatly appreciated.

[~*CaMeO*~]

I thank you also as those were easily understood explanations concerning conditions that are unbelievably frightening to those who experience them.

[Jeff67]

Thought I would add one other thing after reading some of the comments above. PACs normally reset the sinus node which is why you do not get a pause (or at least a full pause) after the ectopic beat.  This is probably why so many people who get PACs have no idea they get them. PVCs normally do not reset the sinus node and that is why you get the full compensatory pause after the ectopic beat.  That is what normally or typically happens.  However, there are times when the PAC does not reset the sinus node and therefore you do feel the full compensatory pause after the ectopic beat, and there are also times when a PVC will reset the sinus node and therefore you do not get a pause (or at least a full pause) after the ectopic beat. So, sometimes when you think you had a PAC it might actually be a PVC, and sometimes when you think you had a PVC it might in fact be a PAC (I like the latter!).

[sunnygirl]

Just a comment on atrial fibrillation for those of you who were talking about it - my dad had it when he was alive and you can discern it from the pulse - it is not regular, contrast that with tachycardia which is fast but regular, boom, boom, boom, boom(in the absence of other arrhythmias). Of course if it is fleeting like Jennifer's then she would not be able to detect it from her pulse, but if she had it all the time, she would.

[Catmon]

I'm a 37 year old male that has recently been diagnosed with PVC's.  I first noticed something when I was approximately 23, but I never could catch it in the act.  I would wake up in the middle of the night thinking my heart was stopping, but when I felt my pulse, everything seemed normal.  At 27, I lived in Arizona, drank Pepsi, and was under a bunch of stress.  At that point, I started really noticing what I thought was my heart skipping beats.  Of course, I never followed up with a doctor, and they eventually went away for years (probably because I gave up the Pepsi).  Now over the past 5 years, they have been getting worse.  They never used to happen when I was standing, but they started to around 6 months ago.  I finally went to see a cardiologist and he diagnosed me with PVC's and literally dismissed me like they were nothing to worry about.  I could go months without issue, but I've noticed when I eat or drink things high in Sodium Benzoate or other preservatives, I'm stuck with PVC's for weeks.  The usual suspects that I hear about are MSG, Caffeine, and Alcohol.  I have had issues with all of them, but not even close to the Sodium Benzoate.  If I feel my pulse when the Sodium Benzoate induced PVC's are occurring, it literally feels like I'm skipping a beat non stop.  If my beat is supposed to be 70 BPM, then when this is happing, it's 35 PBM.  Again, this will last for 2 weeks after I ingest Sodium Benzoate, but there are usually 2 or 3 days that are impossible to get through.  No sleep, as they drive me nuts.  During the 2 weeks, I can't even drink water without it bringing them on.  Obviously I try my best to avoid Sodium Benzoate, but as most of you know, it's in almost everything we eat and drink these days.  I'm usually caught off guard at a restaurant or something.  Please let me know if any of you have experienced anything similar and if you know of anything I can do to stop them sooner once they start.  Anything that would help, I can't go on this way!!! Thanks!!

[gs714]

A related discussion, MISSING HEARTBEATS & HEART FLUTTERING/QUIVERING was started.