Strings of Palps following Aggressive Exercise Without Cool down

Good morning. I'm a 34 year old male and I've had palpitations (PACs - singles and strings) for more than ten years and have made great strides in learning to deal with them - tough as that can be.  I've had multiple stress tests, color echos, holter monitors, event monitors and even an MRI scan of my heart.  All normal structurally though PACs have been evident.  I exercise 4-5 days each week - cardio and weights. Two bits to my question if you don't mind. 1.) After an aggressive workout (HR 150 for 40 minutes) if I don't cool down properly I will have intense strings of palps (no dizziness or breathing problems) for about twenty minutes straight. They begin to diminish after an hour. 2.) Similarily, if I really push a workout, my pulse will recover more than 20 bpm in the first minute after stopping, but my pulse sometimes stays elevated 100+ bpm for a couple of hours afterward.  In light of my testing - most recent echo 6 mos. ago - are these significant?  I do notice that as I age the strings of multiple palps are more frequent.  Any light you could shed on this would be appreciated.  Thanks. A.

[CCF-M.D.-CRC]

Dear archie,
What we have learned in the last few years is that most premature atrial contractions (PACs) come from the pulmonary veins.  The foci that cause the PACs are sensitive to adrenaline and increase with exercise and high adrenaline states.  A heart rate recovery of 20 beats in the first minute is very good and it is normal for the heartrate to remain slightly elevated for a few hours afterwards.  Be sure to drink plently of fluids and replace electrolytes after working out.  In regard to the frequent PACs you may be a good candidate for an ablation procedure and you may wish to discuss this option with your doctor.

[arthur]

I am 54 and play competitive soccer.  About two+ years ago, for reasons unknown, I developed PACs/PVCs and an exercise-initiated PAF.  This was cured by ablation, leaving me only with PACs which occur anywhere from 0-6 per minute depending on the phase of the moon.  I work out several times a week, very intense for 40+ minutes.  During the workouts, PACs are in evidence occasionally, however, right after workouts, for periods of 10-30 minutes, I appear to be susceptible to PAC attacks (>6 per min).  My guess is that the adrenaline left over from the workouts is sufficient to stir up the foci responsible for the PACs.  It may also be that the nervous system (sympathetic, parasympathetic and autonomic) plays a significant role in combination with raised adrenaline levels to kick up the PACs.  It is a complicated matter, and might best be studied under the watchful eye of an EP/cardio during a stress test.

For what it's worth, I have also noted a drop off in these attacks lately...I have been careful to add a 5-10 minute walk to the end of these intense workouts and it seems that this procedure avoids the PAC attacks.

[jan]

I know the dr. won't answer, but I wanted to post this to the ppl anyway. Too bad we can't post to one another somehow, in addition.
Anyway, during my 2nd TTT it was evident that something was going on although I wasn't told what it was. Twice when they asked if I was ok, I could only mouth the words, no voice was there. The tech read my lips and I never clued her in that I was trying to speak.
This happen'd again last night while travel'g with my husband. I was singing and got this funny sensation and then lost my voice, just for a few words. It happen'd twice in just about a minute's time.
Has anyone else ever experienced this? If so, do you know what caused it?
Thanks.

[arthur]

To those of us who are acronym-challenged...what is TTT?

[jan]

Sorry, it's Tilt Table Test.

[wilson-wilson]

I Found this on a Newspaper's website and I thought it may be interesting to those of us who think it could be GERD producing PACs/PVCs.

--------------------------

Doctor testing for reflux

People who might have gastric reflux no longer have to leave Lawrence County to determine the cause of chest pain.

Dr. Ramesh Kalari, a gastroenterologist, started about a month ago using a test to determine the cause of chest pain after heart problems are ruled out.

Kalari, who performs the procedure at Dunn Memorial Hospital, has been placing about two patients a week on a monitor that measures stomach acids and movement of the esophagus for a 24-hour period.

Kalari installs a catheter tube in the patient

[alexawesome1]

Hey Archie, I was reading your post and wanted to ask you a few questions if you don't mind (all comments welcome). Did you're palps get progressively worse from the time they first started or have the remained the same?  I also exercise 3-4 times per week with weights and cardio (27, 5' 11", 190LBS Male).  I find that my heart rate increases easily from resting 46-52 to around 80-90 from walking. It's hard for me to jog because of my weight and large frame so I'll speed walk at a pace of 6.3KM/H for 25 minutes for cardio or cycle or kick-boxing/punching bag.  After maintaing a HR or 135-140 for 25 minutes, it will stay after cool down at around 80 for an 1-2 hours before it goes back down to around 50 (hope that answers your question). I'll get a skip occasionly 1-2 per month after a workout, and if I push my HR close to max I'll get a skip as well during the workout.  I just hope that with age they don't increase. I too have learned to deal with them even though it sucks! I always cool down at least 5 minutes after cardio or until an HR of 80-90 before I stop.  email to: alex_dolgonos***@****

[Sam R]

I think there is a correlation between exercise & PAC's but I haven't figured it out yet.   As a runner, I find the PAC's disappear entirely for several hours after a run. The longer & more intense the run the longer the PAC's stay away.  Has anyone had a similiar experience or have any ideas on the relationship between PAC's  & exercise?

[Niecey]

I was wondering, have you ever had your heart skip so bad that it sometimes feel as if it has stopped briefly?

[arthur]

I workout intensively every other day, 1 hr of jogs and sprints. I also have PACs.  These go away after the workout and stay away for 3-6 hours, even though the HR is down to normal (40-50) within an hour or two.  In my case I know the PACs are generated by a partially concealed PV focus (probably not unusual).  These foci are located near the vagal and other nerve bundles.  The process of inducing skips due to the focus is complicated and can depend on the activity of the focus, the vagal tone, and other factors like blood chemistry and levels of adrenaline to name a few.  So the answer to why we get a nice break in PAC production after working out is a bit unclear.  The facts are that (1) the vagal tone is increased, (2) the PV foci are irritated and fire rapidly (perhaps too rapidly to cause skips), and (3) the HR is slightly elevated.

In my case, I can sense the PV foci firing and know for a fact that when they slow down to normal the PACs will begin again...coincidentally, this takes 3-6 hours to happen after working out. So, some of us are trapped into working out as much as possible in order to enjoy several hours of peace afterwards.

[davem44]

I too am a runner, 58 years old, and run 20 to 25 miles a week, along with weight training twice a week.
I notice pacs disapear for a few hours after a workout
A long slow run will give the longest relief.
Weight training will usually give the most severe episodes of pacs when they return.
I also notice the more exhausted I am after a workout the more likely I am to have pacs in a couple of hours.
Dave

[Sam R]

From what books or web sites did you get your knowledge of PAC's ?  It is almost impossible to find anything on this.  Most health books devote a small paragraph at best to PAC's  and docs I have been to consider PAC's to be a minor annoyance.  I would like to read something in depth on this subject but can't find anything. Thanks for your help.

[arthur]

Sam R - Here is a partial list of articles that you may need to request through a university/medical library that have a reasonable discussion of PACs.  The AF articles also include such detail.  I agree with you re. medical texts.  Unless they were published in the last couple of years, they will not be able to explain the origin of PACs in great detail.  It was only after the discovery (notably by Haissaguerre) that PACs (and PAF) are usually due to overactive PV foci, that any real scientific advances were made...this discovery is actually only 5-10 years old.

I used medical libraries and the Web for more references (search terms like arrhythmia, atrial, pulmonary vein).  The company I work for has a Web access to Medline (capability of directly searching the medical journals).  However, I am sure that your public library should have some access as well.  I found many of the articles loaded up with jargon, making it difficult to wade through...just give it some patience and have a medical dictionary handy.

Good Reading!

Brian A. McGovern, Richard Liberthson
"Arrhythmias induced by exercise in athletes and others"
Cardiovascular Journal of Southern Africa, Suppl 2, April 1996, pp c78-c82

R.S. Perry and S.S. Illsley
"Basic cardiac electrophysiology and mechanisms of antiarrhythmic agents"
American Journal of Hospital Pharmacy, Vol 43, Apr 1986, pp 957-974

Task Force of the Working Group on Arrhythmias of The Eur. Soc. Of Cardiology
"The Sicilian Gambit: A New Approach to the Classification of Antiarrhythmic Drugs
based on Their Actions on Arrythmogenic Mechanisms."
Circulation, Vol 84, No 4, Oct 1991, pp1831-1851.

P. Jais, D.C. Shah, M. Haissaguerre, M. Hocini, J.T. Peng, J. Clementy
"Catheter Ablation for Atrial Fibrillation"
Annual Review of Medicine, vol 51, 2000, pp 431-441

S-A Chen, C-T Tai, C-F Tsai, M-H, Hsieh, Y-A Ding and M-S Chang
"Radiofrequency Catheter Ablation of Atrial Fibrillation Initiated by Pulmonary
Vein Ectopic Beats"
Journal of Cardiovascular Electrophysiology, Vol 11,, No 2, Feb 2000, pp218-227

J. Marcus Wharton
"Ablation of atrial fibrillation: a procedure come of age?"
Current Controlled Trials in Cardiovascular Medicine, Vol 2, No 2, 2001, pp 67070

Ching-Tai Tai
"Role of Autonomic Influences in the Initiation and Perpetuation of Focal
Atrial Fibrillation"
Journal of Cardiovascular Electrophysiology, Vol 12, Mar 2001, pp 292-293

David Schwartzman
"Premature Depolarization Concealed in Two Pulmonary Veins"
Journal of Cardiovascular Electrophysiology, vol 11, Aug 2000, pp 931-934.

[jan]

What is PAT? It was on my event monitor report a couple of times.

[wilson-wilson]

I copied this book list to a text file.....I'll be looking them up on the net/library or somewhere.

And thank you for the "common sense" you bring to this forum!

wilson-wilson

[Sam R]

Art:
     Thanks for the reading list.  I have a need to know what causes this and I am amazed at how little the docs I've been to know about this.   Knowledge is power.  I have another question:  In your research have you come accross any relationship between PACs  and blood pressure?  Are PACs more common with high or low pressure?  Again thanks for your help.   Sam

[arthur]

Readings and discussions with cardios and EPs re. blood pressure and PACs suggest no relationship exists (although one cardio thought that very high pressure might cause PACs due to strain on the heart muscle and surrounding vessels).  The only sure thing between the two items is that one tends to feel the PACs more readily when the pressure is high.  My feeling is that if PACs owe their origin to abberant islands of electrical activity (foci) then a high blood pressure may simply exacerabate their activity but not really cause them to occur.  If your blood pressure is high or even high normal, it's probably a good idea to talk it over with your doc and go for either an ACE inhibitor (least side effects) or a beta-blocker, since high blood pressure can lead to much worse things than PACs.

[katnevada]

I have pretty LOW blood pressure and i have PAC's.

[tokyojoe]

I seem to have SVT's after exercise in an unusual pattern. That is, my rate decreases to around 100 or 90 and then quickly increases back to around 150-160 or sometimes higher (once 200). Then for a while after exercise I am very susceptible to slight movements - say if I get up and walk my rate increases dramatically. Symptoms usually disappear within a few hours.

One doctor has suggested I take Verapamil before exercising another doctor has suggested I take a beta blocker before exercising  - has anyone tried either of these approaches? Are these drugs interchangeable? Is it dangerous to just take them before exercise (usually for me I exercise at night) and not in mornings every day as I have read somewhere is normal? All my tests with cardiologist have come back normal except treadmill which showed the above strange pattern.

Has anyone any experience with all this? Frankly I feel for most doctors in this area it is a little hit and miss!!