curious case of weakness

[arthur]

About two years ago I underwent a successful rf ablation for PAF.  Several foci were intentionally left alone as they were found to only cause PACs (which generally show up 0-5/min, normal HR 45).
I am athletic, male, and 54.  I work out vigorously (sprints and long distance) every other day, and play competitive soccer.

There is a troubling symptom that I have experienced under special circumstances that I would like to describe for you.
This symptom showed up even before the ablation and appears to show up only rarely (once every couple of years).  When I play soccer and the weather is very hot and humid, I have experienced a tremendous weakness...that is, loss of energy to the point that I can only jog a few steps before trying to catch my breath.  This symptom clears up in an hour or two.  It is very much like when I had PAF, ie, extreme fatigue with even the slightest physical effort.  The last time I had it, I was careful to check my pulse and found it was fast and regular (fast because I was in a game)...so it didn't seem like AF.

So the question is, can the heat cause a symptom like this without causing arrhythmia? ... and if so, what exactly is happening to cause the fatigue if the heart appears to operating normally?

(I have had stress tests and everything short of a catheter test which indicate I have a structurally normal heart).

Thanks

Arthur

[arthur]

The quivering sensation info just doesn't seem to be written down anywhere...it's a problem with medical publications that they almost never describe symptoms or "presentations".  However, I have had extensive discussions with my EP, and email memos exchanged with several other EPs (these are really tough to get, since the EP contacted must immediately think you're looking for free advice and/or is afraid to provide any information that may be misconstrued as medical advice).  The current thinking among the several EPs that have had a chance to cogitate on the matter is that the sensations may indeed be a reflection of PV focal activity made possible either directly or through an enhancement produced by the epicardial (outer part of the heart) nervous system.  The whole region around and especially behind the heart is honeycombed with several branching nervous systems, so it's really not surprising that some people will feel a "nervous" sensation coupled to the activity of PACs.  In my case, the coupling is fairly loose, since the location of my PV foci is such that not every focal firing results in a PAC (ie, these foci are somewhat "hidden" and their ability to affect the heart is very sensitive to posture, adrenaline, and physical activity).
Add to this the subtle influence of the "vagal tone" which pretty much has a large impact on how sensitive the heart is to outside noise coming from PV foci.  The result is a general trend that when the "nervous" sensation is obvious, more PACs tend to surface.

I have noticed that over the past two years of intense exercising (minimum 60 min sprinting/jogging every other day), the internal quivering has subsided a bit...basically going from a very obvious fluttering sensation similar to a feeling of AF (2 years ago) to an occassional internal buzz (much higher frequency, lower amplitude) which dissipates within 5-10 minutes after onset (onset brought on by sudden physical movement, vivid dreams).  Thus, it would appear that there may be some nerves which have been irritated to the point of picking up the PV focal signals, that with time, have gradually been settling down.

So, for those of us who can feel those internal jitters, maybe patience is what works best.

-Arthur

[Goodgal]

hi arthur--haven't seen your posts for a while?? Are u still out there? I'd love to know where you are getting all your info from--any suggestions as to special sites to visit. im particularly interested in the electrical current theories (being associated with the cental nervous system etc)I too can feel this annoying "quievering" deep in my chest but i had actually put it down to some sort of food allery/hystamine or adrenalin related stimulation in the heart area,,somewhere..(hah--annoying when you can feel it there but cant pinpoint it)Where did you find your info?

[Joys]

Curious about your Dad.   Has anything helped?   And about how old is he.  I ask because I am just about 60----and longevity is in my family---and I know I should not feel like this.

Has your Dad had a heartwork up by a good specialist?

Thanks.

[TroubledCiCi]

I don't really have an answer to your question either. My dad is going through the same exact thing and he's been going from Doctor to Doctor trying to figure out what is wrong with him. They all don't know, and they just give him shots hoping they'll make him feel better. My dad is struggling, but he's still wondering what is wrong. I hope you find out what's wrong. *CiCi

[Joys]

I have a basic question-----for someone with a slight MVP and who had Rheumatic Fever as a child, what is the best and safest antidepressant to take that will not cause palpitations?

I went to a doc. about 6 months because of fatigue and depression.  We have tried effexer which made me drowsey and feeling fatigued---then tried effexer in combination with first ritalin, then with adderall, and then with provigl(these latter three were to counteract the fatigued feeling that effexer was giving me).   With the last one my heart went crazy and I had a fullblown allergic reaction.

Quite frankly I am very fatigued and don't want to have another experience such as with the provigl.

Sometimes I feel like we are treating the wrong thing----that the depression is a symptom of another problem----maybe even heart failure as I feel so draggy and tired.  

Thanks for your response.

[JR]

i used to be able to throw PVC's "on command" by bending at the waist! ANd every once in awhile i could induce PSVT in the same manner....it blew my doctor away the first time....

[Alfred]

Hi Arthur

I have experienced this weakness after playing tennis in hot conditions, but not quite as severely.  I also play soccer but in the UK it never gets hot in the soccer season!

Cheers

Alf

[arthur]

Re. posture and PACs/PVCs...
I am not aware of any research/papers discussing this odd correlation between foci-driven events like PACs and posture. The information I obtained is anecdotal, ie, I got the info from people like us and from EPs who see this kind of thing quite often.  As I understand it, for a foci-driven PAC to show up the focus energy (in the form of ions) has to get to one of the normal pathways in the heart (atria)...in cases where the focus is not always in a good position to do so, when you change position you may slightly shift the relative position of the focus making it easier or harder for that electrical noise to interfere with a normal beat.  Slouching may simply push up on the pulmonary tissue/cardiac tissue and allow that to happen more easily.  Some (including me) report that when the PACs appear active, PACs seem to show up on the intake half of breathing, just when the lungs push up against the back of the heart.  

It's both disquieting and somehow comforting...disquieting since it's a pain in the arse and comforting in that it's not particularly serious as one can always get up and/or shift position and change the way those PACs show up.  You might even come up with a posture which inhibits them (for me, that's simply lying down).

Pain in the chest has also increased PACs for me...shortly after an operation to remove my xiphoid process (a small chunk of the bottom of the breast bone), PACs were firing incessantly and increased by simply applying pressure to my abdomen.  So, I am sure that pain in the chest area (or back) could translate to a heightened nervous system response all around, including the emergence of PACs...it's clear that firing foci alone are only part of the story in creating a PAC.. there's plenty of evidence that a nervous system interplay is at work as well.

Re. 3D doppler echo ... I am definitely not an expert, however, as I understand it, the doppler echo is designed to determine blood flow rates and volumes, and to note whether there is any appreciable back flow from leaky valves.  I don't think I would rely on an echo test to determine whether my heart was completely sound (there are other tests), however, a good result with the echo does suggest things are likely to be fine...the only thing missing is to know how those arteries are doing (heart catheter test being the gold standard here).

Good luck with your back!
-Arthur

[stillkicken]

i really dont have an answer for your question, i know i am slightly anemic and sometimes when it is really hot outside and im a little dehydrated i get VERY weak, to the point that i just want to lay down and go to sleep, but ive never noticed any shortness of breath along with it, although anemia can cause that also.

anyhow i had a question for you, i noticed in a earlier post you mentioned that pac's and pvc's which in a structurally sound heart are caused by active or over active foci, could be agitated by certain body movements specifically posture (i.e. slouching).  is there any research to show this and would that have anything to do with the spine in the upper back.  i went to have my back adjusted about a year and a half ago and ever since that time if i sit slouching in a chair for a long time or sleep an uncomfortable way at night and my back is acting up the next day i know its going to be a bad day with the ol' PA&PVc's.  also do you know what the accuracy of an 3d dopler echo picking up any form of heart failure, there are times when i too feel short of breath in the day time, just at various points in the day.  not really short of breath but i feel as though when i breath in deep that i just don't get that good breath and i feel a pac or pvc at the end of the inhale which seems to stop the breath???  i have no other symptoms like swelling or SOB when laying flat or anything like that, and the echo i had a couple of month ago said everything was fine and dandy in there just those annoying premature beats??

sorry so long, just thought i'd through those questions at you.  I hope you get a better answer to this question than you did the last one you posted about the vibrations.  hang in there science is advancing rapidly, so a few more years and they'll just go grow you a new heart from you own tissue.

[CCF-M.D.-CRC]

Dear Arthur,
You symptoms sound very much like those of heat exhaustion.  This is usually seen on a hot and humid day when the wet bulb-globe index (measure of heat and humidity) is greater than 28C. It is not related to heart arrhythmias.   The core temperature of the individual can rise to 40C and it may progress to heat stroke if exertion is not stopped and cooling measures taken.  For individuals with heat exhaustion cessation of activity, fluid intake, moving to a cool place and adequate ventilation are recommended.