another arrhythmia question

[LynnSB]

Thank you for answering my previous question.I saw my cardiologist less than 2 months ago;again, he assured me I don't have life threatening arrhytmias -runs of pvcs,pacs,some brief supraventricular tach & inappropriate sinus tach noted on several ekgs,a stress test(last 8 yrs ago),holters and event monitor(last for 2 weeks in dec.).However,I keep having this near fainting/dizzy feeling. Keep hoping it's related to recent ear/tooth problem not heart. but I have these weak feelings associated with palps and, sometimes, not. Example:this a.m. in car at traffic light, looked left..felt heart beat not quickly but irregular beats..felt weak.. this continued only for seconds but long enough for me to think where i could move the car, get my cell phone and have it ready to call 911. by the time i got my phone opened, palps and most of weak feeling gone.IS THIS SOMETHING you hear from people who just have aggravating, nondangerous palps? at a meeting Mon., sitting for an hr, didn't notice palps at all but suddenly felt weak, dizzy (no graying out or anything). I'm so totallyconfused and scared.I always am told my heart is fine. I don't want to ignore something bad,though yet know my doc has reassured me ad infinitum. Is it unlikely some bad arrrhythmia would develop suddenly?And could having postural orthostatic hypotension contribute to above symptoms -even when seated? And why do i get more palps with bending, turning head, often after eating? Is this vagally mediated? Is that a bad sign?

[CCF-M.D.-RCJ]

LynnSB,

Sorry to read of your frightening symptoms.  I frequently see young, healthy-appearing individuals with symptoms such as you are describing: weakness, dizziness, palpitations, irregular beats, faintness.  The bad news for them is that the symptoms often persist.  The good news is that they don't die from them.  Attempting to determine the cause of these symptoms can be very frustrating for both physician and patient.  In many cases, the best we can do is to exclude life-threatening causes.

Some of my patients describe relief from their fears of dying or debilitation with consultation alone.  Other patients require more testing for reassurance.  You have already begun somewhat extensive testing with the stress test, holter monitor, and event monitor.

If you experienced your symptoms with the event monitor, and you were able to hit the record function, then you should have reassurance that your symptoms were not from an arrhythmia.  If you did not have symptoms while wearing the event monitor, you might consider a longer-term recorder, such as the Reveal recorder (details at www.medtronic.com/reveal/revealplus.html).  

The other issue you raise in addition to the palpitations is the possibility of autonomic dysfunction -- lowering of blood pressure after standing, sitting, or eating. The presence of autonomic dysfunction can frequently be detected by a tilt table test.  Most large medical centers will have a syncope (passing out) clinic or someone who specializes in syncope.

I've included some references regarding autonomic dysfunction below if you are interested.  

Hope that helps.

Ref:
Grubb, BP, Karas, B. Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: An overview of classification, clinical evaluation, and management. Pacing Clin Electrophysiol 1999; 22:798

Robertson, D, Robertson, M. Causes of chronic orthostatic hypotension. Arch Intern Med 1994; 154:1620.

[AmosDoyle]

Dear Lynn,
For years I have had the same problem as you describe of weak spells after experiencing a PAC or PVC.  What I believe happens with me is that I have a mimi panic attack in response to an adrenaline surge that I produce myself because I am so fearful of the extrasystoles and what they might portend.  As I have come to understand the nature of benign extrasystoles I have become much less fearful of them and as a result I rarely experience the weak spells associated with them.  Also as I have come to accept them and not be fearful of them they occur less and less as my nervous system calms down.  I think that when one becomes fearful of benign PVCs and PACs over time a general anxiety disorder ensues, specifically obsessive compulsive disorder with overtones of hypochondriasis.  A vicious cycle begins and it then becomes increasingly difficult to get rid of the benign extrasystoles as they become a kind of conditioned reflex, initiated originally by fear, that has become habitiuated. Eventually the symptom doesn't need a trigger anymore but occurs on its own.  The conditioned reflex is difficult to stop but I think it can be done over time with some mental effort.  Many things may help to break this symptom habit including psychoanalysis, medication, hypnosis, cognitive behavioral therapy and biofeedback among others.

[chrisr]

I also believe I have the problems and symptoms you have so clearly described. After CABG abd AVR almost 2 years ago I have remained with persistent palps or distinct hearing of every heart beat. This I understood to be caused by the mechanical St.Jude valve and the synthetic graft material used to fix an aneurysm. However several tests could not explain the PVCs/PACs attacks I have mainly at night and I assume that they are benign but have developed the panic and anxiety disorder you have described. What meds if any have you tried to help with the attacks? Beta blockers did not work and maybe made things worse for me. No luck with Cardizem also and recommended but not yet tried Verapamil. Which one of the non-drug approaches have worked best for you or which one would you recommend? Hope have not asked too  many questions but would highly appreciate your further comments as I am in dire need of help.
Thanks,
ChrisR

[LynnSB]

Hi, the way this forum works is you can post comments but to have a doc answer your questions, you have to  post by clicking on the "ask a question" button up top.. it can take a couple of days to get through!

I'm not on any meds. I go through periods where the palps are horrible, like today.. i can go for days where i hardly notice any.  I feel awful. I don't know what to do any more. this is not panic.. this is real worry about something that comes out of the blue. and yes, i've caught symptoms on a monitor but i have all sorts of palps and feelings.. and it is always in the back of my mind that I DIDnT catch some major bad arrhythmia. i'm so scared

[sara25]

is it possible to get the skipped beats from taking a beta blocker, I take altenolol for my high blood pressure and it seems after i started taking it is when I would notice the skipped beats anywhere from 10 to 20 a day, is that a lot?
thanks

[sleepless in raleigh]

I had the same symptoms that you have for months.  After seeing a cardiologist, neurologist, and an ENT they found out I have Meniere's syndrome.  I kept feeling like I was going to pass out, which made me think it was my heart.  It bothered me a lot when I was driving. I was put on a low sodium, 2000mg per day diet.  After about three months, it was gone.  No more symptoms of feeling off balance or ready to pass out.

[LynnSB]

Can you have Meniere's without frank vertigo, though? I don't have any room spinning, just feeling like I'm about to pass out. I talked to my VERY kind, patient, and smart cardiologist last night via phone -- he said he thinks , while i do have symptomatic but non-life threatening palpitations, this current lightheadedness is related to my inner ear. I do have problems with POTS symptoms too, low blood pressure, etc. I tested positive on 2 tilt table tests, last one about 10 years ago ( another doctor). I just wnat to feel ok -- i've given up on feeling good.. OK would be great.. just going through most days not feeling like I'm in danger and about to pass out. the palps are worse, though, and i don' t see how that couild be ear related.

[KayMO]

Hi Sara,

I too have skipped heartbeat from 15 to 20 times a day, some with lightheadness.  I take a topol xl but in small dose, the larger dose make my heart beat too slow and I feeling like I am not there, breathing is too shallow. The beta blocker is suppose to lessing your skipped heartbeat but I still feel them the same. My family doctor has done ECK, hoitor, stress test and they are tested benign. He told me I have extra beat, and to take this medicine if situtation becomes worst then we will seek other opinion.  This does not make me feel any better because I am deaf and have to use a special phone to call 911 for help. Needless to say, I can't use a cell phone for tyy equipment I have and I live alone with 9 year old child. It scary at time. I try to relax and not worry so much about it.  So doctor tell us is it normal to have up to 15 wo 20 skipped heartbeat within 24 hrs?

[AmosDoyle]

Dear Chirs,
You asked me what medications I have tried to help with (PVC/PAC) attacks. Well, I have tried Toprol XL which is a long-acting cardiospecific beta blocker.  For me, Toprol XL made be feel puffy, that is, my breathing seemed funny like I couldn't get a deep enough breath. I also felt dragged out on Toprol XL.  Perhaps I should have reduced the dosage but I just stopped it.  I have also tried Tenormin (Atenolol) which is also a cardiospecific beta blocker.  It was OK but my preference is the general beta blocker Propranolol (Inderal).  I started out taking it 4 times a day for a total daily dose of 40 mg. I also took Xanax at the same time and Prozac.  Xanax is a benzodiazapine commonly used for anxiety and Prozac is a selective serotonin reuptate inhibitor used for depression and obsessive compulsive disorder.  The extrasystoles were greatly helped by that combination but I still had some (many)  occasionally.  Over the years I have stopped and started these and other medications to try to stop the extrasystoles and have tried all of the recommended remedies, including stopping caffeine, chocolate, spicy foods and on and on. None of the folk remedies really worked.  Right now I have very few extrasystoles after having had many of them  for years during the late afternoon and evening.  I too originally thought that beta blockers made the extrasystoles worse, especially if I didn't take the medication regularly. But now I'm not sure.  I do think that the beta blocker Inderal helps me because it affects my entire nervous system not just the nerves of my heart.  I still take it occasionally, but not everyday. I no longer take Xanax or Prozac.   Once in a while when I don't want to deal with possible extrasystoles, I take 10mg just to prevent any annoyance.  Usually it works and I am PVC free.  If 10mg doesn't work I just take another one and usually that works.  Non drug approches that have worked best for me include anything that calms my brain and nervous system down, ie. retirement, meditation, sleep.  Relieving stress is perhaps is the most important thing one can do.  In the summer I exercise more and I think that helps. Right now I am trying a multi B-vitamin tablet daily, 50 mg of zinc daily, a little magnesium, a megadose of vitamin C (1000mg or more), vitamin E and Lycine. I also take Zocor to reduce my cholesterol.  Many of these things are recommended to prevent heart disease.   I am reluctant to say this, but I can go apparently now for several days without having any extrasystoles that I feel after having had them consistantly for ten years and sporadically for more than 45 years.  Throughout my experience with extrasystoles I have rarely felt that I was going to pass out.  I used to have low blood pressure when I was younger and felt like I would pass out when I got up from sitting or got up in the morning out of bed.  I don't have that problem now as I am older and presumably my circulatory system is stiffer.

[chrisr]

I have used Inderal before my heart surgery but for migraine headaches. Since surgery the headaches have completely disappeared but now its the PACs/PVCs. Since I am accustomed to it I will try it again. The cardiologists are unwilling to try anything but these attacks are really annoying especially at night. I will ask my general physician who initially advised Inderal for migraine to prescribe it once more.
Thanks,
ChrisR

[sara25]

Ive started having problems at night so I take tylenol pm that tends to help.

[ChrissyH]

I've experienced arrhythmias, weakness and nausea as well.  For me, they are usually related to nutritional deficiencies (such as lack of magnesium) or dehydration (too much coffee and/or caffeinated soft drinks and not enough water) or hormonal imbalances (related to menopause).

If you've seen a doctor and ruled out the possibility that your symptoms are serious, perhaps, a naturopath or nutritionist can help.