Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Heart Disease (Expert Forum)
Various PVC related questions
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Various PVC related questions
by CraigAAA, Nov 10, 2004 12:00AM
Hello Doc, as always thanks for allowing me to ask a question.
As a 29 year old symptomatic (chest pain, dizziness, nausea) sufferer of frequent PVC's (10-30\min) with mild hypertension for the most part controlled by 12.5 mg Atenolol daily, but with an apprantly stucuturaly normal heart could you offer an insight into the following;
1) My understanding is in general PVC's that are supressed on exercise do not pose a problem, but PVC's NOT supressed on exercise can?
A recent stress test I had, when compared to one taken some 18 months earlier showed that whilst my BPM were taken up to about 170 the PVC's were no longer completely supressed, at one point I was getting 15\min with the only notable symptom being dizziness. Though in the computers words no complex ectopy (At rest I can enter long bouts of bigeminy)
2) A lot of respected websites state that in general 6 or more PVC's\min do require treatment, if so, what is the prognosis for one getting the rate of them that I do (as high as 30\min at worst, average 15\min) Can the irritable focus develop over time ie. like water running over stone over the years if you see what I mean. So that sooner or later, a pathway may be completed which could change the situation.
3) In my case, after recording triggers for my PVC's I have noted the following inflame them;
Eating food, any food, and taking fluids (hot, cold or normal)
Sudden bouts of activity ie. becoming mobile from being at rest.
Coughing
Sneezing
Or no reason in particular, away they go
Eating food is particularly agitating, because I eat le
As a 29 year old symptomatic (chest pain, dizziness, nausea) sufferer of frequent PVC's (10-30\min) with mild hypertension for the most part controlled by 12.5 mg Atenolol daily, but with an apprantly stucuturaly normal heart could you offer an insight into the following;
1) My understanding is in general PVC's that are supressed on exercise do not pose a problem, but PVC's NOT supressed on exercise can?
A recent stress test I had, when compared to one taken some 18 months earlier showed that whilst my BPM were taken up to about 170 the PVC's were no longer completely supressed, at one point I was getting 15\min with the only notable symptom being dizziness. Though in the computers words no complex ectopy (At rest I can enter long bouts of bigeminy)
2) A lot of respected websites state that in general 6 or more PVC's\min do require treatment, if so, what is the prognosis for one getting the rate of them that I do (as high as 30\min at worst, average 15\min) Can the irritable focus develop over time ie. like water running over stone over the years if you see what I mean. So that sooner or later, a pathway may be completed which could change the situation.
3) In my case, after recording triggers for my PVC's I have noted the following inflame them;
Eating food, any food, and taking fluids (hot, cold or normal)
Sudden bouts of activity ie. becoming mobile from being at rest.
Coughing
Sneezing
Or no reason in particular, away they go
Eating food is particularly agitating, because I eat le
Doctor's Answer
by CCF-M.D.-MJM, Nov 10, 2004 12:00AM
Hi Craig,
You are partially correct. Exercise induced PVCs are associated with a 3 fold increased risk of cardiovascular death. However, patients with resting PVCs were excluded and the median age in the study was 43. You are significantly younger than this.
There is not a study that I know of to discuss your specific situation. I know this may not sound reassuring, but the positive spin on the situation is this:
PVCs are very bothersome to those that have them and they tend to seek medical attention often, for concerns similar to your own. We don't see this population with a high incidence of sudden cardiac death. If we did (like LONG QT syndrome or hypertrophic cardiomyopathy), we would recommend a much more aggressive treatment algorhythm including ablation and ICD.
2. There is not good data on what happens to PVCs over time. Many of the posters on this webs site mention the waxing and waning episodes of PVCs. It sounds like you are having them incessantly. The best I can do is say that people with structurally normal hearts and frequent PVCs (baring genetic syndromes like hypertrophic cardiomyopathy and long QT syndrome) are not a substantially increased risk of future events.
3. I think your post got cut off before you could ask the third question.
Good luck and thanks for posting
You are partially correct. Exercise induced PVCs are associated with a 3 fold increased risk of cardiovascular death. However, patients with resting PVCs were excluded and the median age in the study was 43. You are significantly younger than this.
There is not a study that I know of to discuss your specific situation. I know this may not sound reassuring, but the positive spin on the situation is this:
PVCs are very bothersome to those that have them and they tend to seek medical attention often, for concerns similar to your own. We don't see this population with a high incidence of sudden cardiac death. If we did (like LONG QT syndrome or hypertrophic cardiomyopathy), we would recommend a much more aggressive treatment algorhythm including ablation and ICD.
2. There is not good data on what happens to PVCs over time. Many of the posters on this webs site mention the waxing and waning episodes of PVCs. It sounds like you are having them incessantly. The best I can do is say that people with structurally normal hearts and frequent PVCs (baring genetic syndromes like hypertrophic cardiomyopathy and long QT syndrome) are not a substantially increased risk of future events.
3. I think your post got cut off before you could ask the third question.
Good luck and thanks for posting
Related discussions
-
Skipped Heart Beats (PVC's § PAC's) (52 replies):Hello Doctor, I wanted to take a moment to thank you for...[more]
-
Getting constant, but asymptomatic PVC's - is it worth s... (28 replies):Hi there and thanks very much for taking my question. I ...[more]
-
true definition of v-tach (11 replies):Hello, First of all I had a run of three pvcs in a row o...[more]
-
PVC cause and resolution? (26 replies):Recently had extensive physical with EKG, Stress Test, B...[more]
-
PVC's are now constant (122 replies):I have had PVCs, PATs,and Vtach leading to SVT since I ...[more]
-
pacs/pvcs and normal activity (25 replies):My question is in regards to pacs/pvcs. Since they are b...[more]
Thanks as always
Regards to all
Craig
Sry it did fit before :)
I had a comment. I know the Dr. will answer later.
I noticed that you are taking a very small dose (12.5) of atenolol. Check with your Dr., but perhaps you could consider increasing the atenelol to give more coverage from the PVC's, if your Dr. would allow. Atenolol has helped me alot. Are you on any other meds.? I take 25mg daily, but my cardiololgist said I could go up to 50mg if necessary. I have a different cardiac issue, but I do get PVC's occassionally, and the atenolol knocks them out completely. What I really like about atenolol is that it is cardiac selective, so it doesn't contribute to shortness of breath like I've experienced with a couple of other beta-blockers. I better stop, or I'll soulnd like a Drug Rep. (and I'm not), I'm just echoing my cardio's words. Thanks.
I'm looking forward to the CCF Dr. response.
All the best.
Uptown
I just ate -- and there they are again -- bumps..
This day was a good day.
Until the food went down.
So something gets irritated down there.
What the heck is it...?
~~
Bye - Ianna
Hi,
Man , I feel your pain regarding PVCs as i had them before in the same way you are describing, they are hell to live with when so frequent and so affect the quality of life, but apparently not the quantity( in other words your lifespan is rarely affected).
With all respect due to respected websites, 6 PVCs or more a minute do not warrant treatment in all cases, except for extremely symptomatic patients. PVCs are considered"benign" regardless of the quantity per minute in structurally sound heart and doctors are now even swaying away from treating symptomatic patients as apparently some benefits don't out weigh the risk involved with certain drugs.
Ablation in alot of cases are apparently becoming a quick fix for symptoms only to return again in alot patients, some do well, the field of ablations for PVCs is advancing from my understanding so this might eventually become a standard route to take for PVCs , such as in most SVTs.
One things for certain, PVCs appears to be the bane for most who visit the forum, I guess til then reassurance and coping skills are the best treatment , until other therapy is perfected at a satisfactory level.
These are personal observations and opinions only.
Hope you get relief soon.
I also take 100mg of atenolol daily in divided doses(25mg every 6 hours) and cozaar 50mg daily for ultimate B/P control. I usually take the atenolol 15-30 minutes before meals to avoid tachycardia and PVCs. I must say I rarely get PVCs anymore, don't know for certain if it is the meds and I am lucky not suffer any side effects, again tolerance of medication varies from person to person. Good luck and always check with your doctor before doing anything with your medication.
Good luck.
It was discussed with my Cardio and other docs about the possiblity of increasing the Atenolol to at least 25mg (infact when my cardio prescribed them he said his aim would be to take me up to 50mg), it was decided not to increase from 12.5mg, mainly because my Heartrate will dip to between 30-40 at regular periods in a day(not just in periods of sleep)
Funny thing is I've been on that dose of Atenoolol for just under a year, and they dont do anything for my PVC's, they obviuously slow my rate and control blodd pressure, but help my PVC's? No chance!
Possible anti arrythmics may be considered (propafanone hydrochloride) in the next month or two (Cardio)
Trouble is, in this coutry (United Kingdom) Ablation procedures are like gold dust :( much more difficult to gain access to EP or the like here. Not that I dont trust my Cardio, he is very knowledgable etc but, when I mention things to him I read on this or that website which are or could be relevant he doesnt like it, maybe it seems like I'm trying to teach him things -which I'm not, I just want to try and get to the root of my problem, like everyone else here.
As an extra - does anyone on Atenolol find the give you terrible indigestion? Coz I think it does with me :(
Regards to all
Craig
The reference for the article I mentioned above is.
Morshedi-Meibodi A et al. Clinical correlates and prognostic significance of exercise-induced ventricular premature beats in the community: The Framingham Heart Study. Circulation 2004 May 25; 109:2417-22.
Selzman KA and Gettes LS. Exercise-induced premature ventricular beats: Should we do anything differently? Circulation 2004 May 25; 109:2374-5.
If you read the article, remember, this excluded people with PVCs at rest and probably doesn't apply to most people on this forum.
I would just like to mention that ARVD(arrhythmogenic right ventricular dysplasia) and Bruguda syndromes are also genetic disorders in which exercise indued or frequent PVCs maybe of more concern or medical significance.
ARVD is found more in persons of Italian or Mediterrean ancestry and Bruguda syndrome are found to be more prominent in the far east such as Thailand, Phillipines, in those parts of the world, but it can affect anyone regardless of one's ethnic background.
Gypsy
Yes , I exercise moderately, I suffer from ankylosing spondylitis which makes vigorous exercising difficult for me. I don't get short of breath, only on rare occasions when i get an anxiety attack or feels anxious , i have this feeling like i need to think to breathe and can't get enough air into my lungs, this is as close to experiencing shortness of breath that I can think of , but I know it is anxiety related.
And take a guess what , I have exercised induced pvcs on occasions, other times not, but I also experience them at rest, but rarely post exercise, at least not in the immediate period after exercise.
One should always try to exercise, if no more than 30 minutes of brisk walking at least 5 days a week. Exercise is very beneficial to ones overall health and can help keep diabetes and hypertension under control and at bay, which are major contributing factors to cardiovascular disease.
If you are given the green light to exercise by your doctor, do so by all means, it will only benefit you in the long run and might even add to your longevity.
Take care.
On another note exercise , along with being deconditioned and anxiety thrown is a recipe for tachycardia and hyperventilation syndrome.
Learn how to breathe properly and gradually increase your endurance, if you are afraid , you might wish to start this in a cardiac rehabilitation setting until tour confidence and anxiety is reduced, just a thought!!
Good luck.
To get copies of the two articles that CCF-M.D.-MJM cited requires either a subscription to the journal Circulation or that you pay a fee of $15 an article (http://circ.ahajournals.org/cgi/content/full/109/20/2417). So be prepared to pay a few bucks unless you have ready access to a nearby medical library. It might be worth getting copies so that you can show these to your cardiologist at your next appointment. In any event, there is also an earlier article by Dr. Lauer and associates at CCF on the same subject that is available for free (after registration) at the New England Journal of Medicine site (http://content.nejm.org/cgi/content/full/348/9/781 ): "Frequent Ventricular Ectopy after Exercise as a Predictor of Death", Joseph P. Frolkis, M.D., Ph.D., Claire E. Pothier, M.S., Eugene H. Blackstone, M.D., and Michael S. Lauer, M.D., NEJM, volume 348: 781-790 February 27, 2003 Number 9. This article inspired the other two as I recall and can provide you an idea of what the clinical studies revealed.
The gist of these articles, as I understand them, is that the PVCs themselves are harmless. However, when they appear at a rate >6 PVCs/min during exercise as well as during the immediate recovery period following exercise, they indicate that something may be going on within the heart that leads to increased mortality risk; i.e., people displaying these ectopies have 2-3 times the age-adjusted death rate of the general/normal population even though their hearts appear to be structurally normal. What that something is, the cardiologists don't actually know. Rather, the authors consider the rapid PVCs during/after exercise as a 'predictor of death'. Of course, these are just averages and at your age the normal death rate is very small anyway. So I wouldn't get too upset.
Rather I think you (and also Gus who was having 30 PVCs/min)should use statistics like this to motivate you to undergo a lifestyle change as needed. If you need to lose weight, then do so asap. Same goes for lowering cholesterol, exercising, adopting a healthy diet, reducing stress, etc. An analogy would be a cardiolgist telling you that your LDL/HDL ratio is at 3 times the average risk for heart disease. In that case, you would try to lower your LDL and raise HDL, perhaps by taking meds and/or by diet change. Just my thoughts (and I'm not a doctor).
As CCF-M.D.-MJM also said, these studies don't apply to the usual PVCs that many people on this Forum experience.
Best wishes,
Tony
I am 43 years old and very active and do get frequent PVC's at rest. My PVC's seem to be triggered by smoking. I smoked one cigarette or tw a day for 20 years and a month ago, I started having these PVC's. My echocardiogram came back wonderful. I did not have PVC's duinrg the regorous excersise. I was on the treadmill for 12.5 minutes and my pulse went up to 170.
I do get frequenet PVC's, about 30 - 35 per minute on a bad day. I could go on the treadmill in the Gym for an hour and I was a powerlifter in years past. I do not have athlete's heart.
I would certainly appreciate an elaboration on your statement.
Gus
Why is it that when the doctor says, "[T]he best I can do is say that people with structurally normal hearts and frequent PVCs (baring genetic syndromes like hypertrophic cardiomyopathy and long QT syndrome) are not a substantially increased risk of future events[,]" some of you completely miss the point? He/she is trying to reassure each of us that in the VAST majority of cases, there is no need for concern. This is not to say that the symptoms are not bothersome (I know they are), but there are effective medicines and therapies for treating the symptoms. Beta blockers have proven to be safe and helpful in many, many cases. If you have a headache, you reach for Tylenol...Why treat this any different if the doctor suggests medicine?
I am not familiar with the two studies that the doctor pointed out, but he/she is trying say is that the study did not include people with PVCs at rest and therefore probably doesn't apply to most people on this forum. Also, I believe the average age of the participant was 43...meaning that the study inculded many older people who may have had other related cardiac issues.
As for the third study mentioned by va_tony, I am familiar with that one. I was a patient of Dr. Lauer's during the study, and even when I was having 22,000 pvcs in a day, he was NOT at all concerned.
I think that focusing on the things that we can changes is a much better path to a healty heart and happy life. Focus on the doctor's positive comments rather than trying to single out one phrase to induce yourselves into panic.
I believe the AHA suggests:
No smoking (CRITICAL for healthy hearts)
Alcohol in moderation
Keeping your BP under control
Eating a balanced diet
Keeping cholesterol at optimum levels
Serial checkups for those who have other heart conditions
Find a doctor who you trust and by all means, listen to him/her. They see this stuff every day. Once the baseline tests have been done, relax and live your lives. If you still cannot get beyond the fact that pvcs in the setting of a normal heart, will NOT harm you, consider talking to a professional.
Good luck to everyone who is bothered by these darn things! After dealing with pvcs for over 20 years, I am hear to tell you, in nearly all cases, they are benign. Settle for treating the symptoms once you have been checked over.
I've lived with pac's and pvc's and non-sustained vt's and sustained vt's and I have an ICD and I've been 'shocked' 6 times from my ICD - do you want this to happen to you?
If you insist on perfection - you just might not like what it brings.. Good Luck to you all and 'please' be careful what you ask for - you just might get it and if you want to insist on perfection - I'm sure some doctor 'somewhere' will give it to you.. :-( Just keep searching :-( But when you do think your going to finally get that perfection - you might worry about getting shocks.. Think twice about what you ask for.. Believe me - you don't want to 'rush' the process - but, I'm sure you'll get there in due time - especially for some who persist at it..
Runner
Please check out the archives of this forum under Topic Area- Arrhythmia Subject- Significance of PVCs during and after exercise (reply by CCF M.D. RCJ on 5/22/04) I asked this question under the name of nickname of pluto. Read the doctor's reply it might give you some reassurance as this is still much a topic of debate and confusion and only leads to anxiety for the patient.
This is my understanding sometimes when working out or doing exercise, adrenaline levels are still high in the body after the activity, occasionally this will irritate an already irritable focus and trigger PVCs.
If you experience PVCs at rest, during, or after exercise, apparently you are at no increased risks, PVCs that appear only after exercise, usually within the first few minutes, usually in complex forms , usually runs of NSVT, couplets, 7 or more PVCs within a minute, usually there appaears to be a marginal increase in risks, probably not because of the PVCs, but of some other underlying factor, in other words the PVCs may serve as marker for the risk, but not the direct risk in itself.They(PVCs) may serve as wake up call to get more extensive testing, this is usually found within the age group that is already susceptible to heart disease.
If you had all the necessary testing done and are given the green, then i wouldn't worry regardless of when they occur. Remember in this life nothing is 100% guaranteed, but if you spend 99% of the time worrying about the 1% that is uncertain, you will have lived life with no enjoyment at all.
Take care.
thanks
Dave
And please don't run around seeing five different ones, wasting money on unnecessary tests, and taking addictive drugs. Cardiologists see patients with benign PVC's every day, every single day! And yes, these doctors also have occasional PVC's, like everyone does. So it's not a matter of *they don't understand b/c they don't have them*. That's not it.....they just ignore them as they know the PVC's are harmless in a structurally normal heart. When I found out that I had non-sustained V Tach, years ago,I was quite anxious, as it was considered a forerunner to Vfib in those days. I saw an EP who sat down, took my hand, looked me in the eye, and told me I was not going to die from the NSVT. I BELIEVED him and never gave it another thought, despite being in bigeminy and having couplets and runs and all. I was told that I did not have a heart problem, I had a little electrical problem that was nothing. I had a choice to get on with my life, despite the annoyance of the PVC's. And now that I have dilated cardiomyopathy (unrelated to the previous arrythmias0, and after undergoing a failed ICD implant, I STILL can sleep at night, knowing that I am doing all that I can, and the rest is up to the Lord.
Very , very inspirational post and so true.May the Good Lord bless you in every way.
Take care and best wishes.
I am a runner too (4 years junior to you if I am not mistaken), and after ablation of an accessory pathway several months ago have occassional epsisodes of Non sustained VT and narrow complex PSVT. We have considered the possibility that the site of the ablation on the left free wall may somehow be responsible for both arrythmias. In any case, the NSVT seems to come to me at rest, after several weeks of fairly light training (less than 25 miles per week). It also seems to wax and wane in the sense that once I have pushed past a previous limit, I tend to hear from it more, while when I am training at my average mileage, I experience less --- almost as though some stretching of my heart is responsible for its appearance and disappearance --- or who knows, maybe I am just imagining it --- or on the other hand might it become something more sustained if I continue to push?
Your statement about wanting perfection has got me thinking. Running has been a part of my life for a long time. I have run in many beautiful places over distances that previously seemed unattainable to me, and experienced the joy that goes with all of that. Ablation of the idiopathic NSVT seems like an exciting possibility, but is a questionable, possibly risky approach. I dont know enough about your situation or history to know whether this is a good question to ask, but would you have any insight about this? If not, dont sweat it --- as I say I dont mean to pry, or to necessarily draw comparisons where situations may be drastically different...
Coincidently , I have moderate pectus excavatum(sunken chest)doctors have told me it what makes more aware of my heartbeat, but doesn't interfere with its function or the lungs, it can if it is really severe.
My 2 sons have pectus excavatum also, it happens to run in families theirs are more severe than mine , but they are not aware of their heartbeat at all. I guess everyone is different when it comes to being in tone with their body functions.
I agree this is a great forum. take care.
Arrhythmias may actually be a symptom to a larger problem. But so many dwell on the little stuff they forget about the big picture. I think they need a shrink - they're going to kill themselves with panic attacks and anxiety.
Face it - some people have a screwed up electrical system - and it not going to get all better and be PERFECT tomorrow or the next day - and it won't matter if they "do" certain things or they "don't" do certain things - the question is does it have to be PERFECT in order to have a long happy life !!!! it could be something other than their electrical system that is broken inside their heart - that's the question they should be asking themselves... There could seriously be a much larger problem..
Marilyn (runner)
Gypsy
Good Luck
Marilyn (runner)
If you don't get the positive 'testing' results to verify your 'symptoms' then I would recommend - getting to a psychiatrist and getting to the bottom of your 'feelings'.
I certainly would not sit around and dwell on the 'maybe's of life.
Good Luck
Marilyn (runnner)
Axg9504
As I recall, this is common with PVCs. In some case, the timing of the PVC is such that the atrium attempts to pump blood through a closed tricuspid valve, causing a backwash pulse, called a Cannon A wave, that's felt in the jugular. Consequently, there is a tightening sensation in the neck or even a tendency to cough. This is harmless.
Dee gee and Marilyn,
Coffee (even regular) doesn't seem to trigger my afib even though everything I've read seems to indicate it's a definite problem. Just to be safe, I've cut way back on coffee drinking and only have an occasional cup during social occasions and even then it's decaf. Funny thing is, whenever I have a cardiologist appointment, there's a fresh pot of coffee (decaf, I assume) available for the patients in the waiting room!!!! Out of curiosity, I asked my cardio if I should refrain from coffee because of my afib and he said "no, it's not a problem". Can you believe that?
Best wishes,
Tony
Incidentally, I was thrilled to be able to return to chocolate after my ablations. I had never totally given it up, but definitely watched more carefully. I took chocolate covered pretzels to my follow up appointment (post ablation) for the doctors and everyone in the EP lab....I told them I was celebrating my new rhythm with heart shaped chocolate covered pretzels. YES!!
I've even had a couple of cans of Dr. Pepper over the past year.....oooo....so good!! I hadn't had a Pepsi or anything soda with caffeine in many, many years!!
connie
I certainly would not sit around and dwell on the 'maybe's of life."> -- ?????????
I know I have ectopic beats because it showed up on my ECG taken when running on a treadmill, and I can feel my pulse miss a beat.
Richard 5 year pvc sufferer
***@**** would love to talk with any of you!
Thank you for listening to my complaints, I sure know I have drove my wife crazy when I get these pesky things.
I am also a frequent PVC and chest pain patient. I've had all kinds of tests and they say I am fine. However I have been reading alot lately about how panic disorder can cause real cardiac problems or sudden death even in healthy people. Have any of you heard this? What do you think?
Thanks
Check out http://www.pyschiatrist.com/pcc/pccpdf/v04n02/v04n0203.pdf
Hope I typed it correctly, you need adobe to access it.
Panic disorder/ attacks needs treatment, not criticism. Some just can't "get on with life" they need drug therapy, psycho therapy, etc.. Long term effects of panic disorder and attack can be detrimental to one's overall health in general.
Regards.
When studies are done about medical stuff don't the doctors read it?
I'm 61 yrs old and I've been getting PVC's during exercise or right after for the last 40 yrs and I'm still alive, and I still exercise every day. I found out that when I'm fatigue or tired I get these PVC's during exercise. If I feel fit I don't get them.