detecting/measuring PVCs

My friend's problem is the opposite of most people's: he does NOT feel when PVCs are happening. What instrument can he get to detect and measure them at home?  The ordinary home blood pressure/pulse cuff digital devices were not recognizing his PVCs.

His doctor used a stethoscope (under a blood pressure cuff iirc) to tell him when he was having an episode of multiple PVCs. She told him when this happens, to eat a snack high in potassium, or take a potassium pill. He is concerned not to take the potassium when he is not having PVCs, as the doctor already has him on potass supplements.

My friend is a computer tech and could probably repair any used cardio monitor, if he knew the right kind to get. But it seems to me there should be some instrument less complicated.

[Carey01]

Honestly, the best instrument is probably his finger to his neck  to check his pulse -- PVC's are felt in the the pulse easily.  I wouldnt use the thumb because your thumb has a pulse.  I can easily feel when my heart is skipping in my pulse.  I have to say though -- he is VERY lucky he does not feel them.  Just read through this forum and see how feeling them drives people crazy -- myself included!    

[riverwide]

It's true.  I wish I didn't feel them.  It's unnerving to say the least.

[skinny-mh]

I read many entries here and web-searched the term. Apparently his PVC's (the doctor was very definite that it is PVC's) are not as noticeable as those other people have. On the usual home cuff devices, his heartbeat at those times appears slow and regular, but the PVCs do show up on the hospital equipment (EKG) as well as to the doctor's hearing on her stethoscope.

The doctor explained that this is because the home cuff device is not sensing the weak beats (PVCs), only the less frequent, stronger beats.

At those times, as well as feeling dull,  he feels 'lack of oxygen' and tries to compensate by deep breathing or using an inhaler. The doctor is very emphatic that instead he should consider these feelings as symptoms of PVC and do something about the PVC (she has prescribed potassium, which does seem to help him greatly).

[maggiemag]

BP devices usually do not pick up irregular beats.  Taking your pulse can show an irregularity but only an EKG (or echo) can tell you what the rhythm is.  PVC's do not cause lack of oxygen by any means, and an inhaler could actually speed his rate up and/or make his heart more irritable.  I also find it a bit unusual for a doctor to prescribe KCL for this unless frequent bloodwork actually shows a low potassium.  Low K certainly does cause PVC's and can be dangerous but in an otherwise healthy individual there are few reasons for his K to be low enough to prescribe supplements.  Drinking a glass of OJ or eating a banana make more sense to me, as popping extra K when one is not sure by labtest that it is needed is kinda dangerous IMO!  Too high a K can also be dangerous!  I am not a doctor but I would be afraid to take it myself, and if he doesn't even feel the PVC's, then rejoice and go on about his merry way.

[skinny-mh]

This is a diabetic man in his 60s with non-ischemic congestive dilated cardio-myopathy, fitted with a pacemaker/defibulator. The lack of potassium and correlation of potassium level with his symptoms has been verified in repeated lab tests and episodes in the doctor's office. The doctor says the PVCs affect his EF, resulting in insufficient oxygen being circulated during those episodes.

Since he cannot visit the lab every time he feels these symptoms, I am asking for information on what kind of lab test instrument would be suitable for home use, as he also is concerned about 'popping extra K' without verifiying need at that exact time.

[fwilson3]

If pulse taking is not sufficient for him to detect them, a simple cardiac montor which very clearly displays them can be purchased on ebay for <$100USD, or his doctor can prescribe this.

[skinny-mh]

Thank you very much. I don't know whether his health benefits cover that or not. If he has to buy one from ebay or such, what are some key words to make sure he is getting the right thng?

[maggiemag]

If your friend has non-ischemic DCM, as I do, with CHF, then he would most likely be on a diuretic which causes loss of K.  Then he should already be on supplements.  I agree with surfgirl that there is no purpose in monitoring PVC's as they go along with the territory of DCM, esp. if he already has an ICD.  Sounds nuts to me too.

[skinny-mh]

Is this the sort of item you mean? These are much higher priced, even on ebay.

http://shop.ebay.com/__Medical-Equipment_cardiac-monitor_W0QQ_kwZcardiacQ20monitorQQ_fxdZ1QQ_ipgZ100QQ_sopZ2

[skinny-mh]

Or this? This is a handheld thing you touch directly to your chest, designed for home use. http://www.semedicalsupply.com/hcg-801.htm
Does it give the right kind of information?

"Symptoms such as heart pain, palpitations and shortness of breath may be transient and can be difficult to record by conventional devices.
With the OMRON® Portable ECG Monitor HCG-801, a recording of about 30 seconds can be made when symptoms occur whether at home or away.  These recordings can then be shown to the doctor, who can examine and use the information to assist in correct diagnosis of symptoms.
...
ECG data can be examined on the direct on-screen display without printing or downloading.
....
Home Care Situation - The device can be prescribed for home self-monitoring.  The data recorded at home will clarify patient's concerns and also help physicians assess the necessity for secondary care for patients"

[fwilson3]

Here is a simple device that enables you to see your heartbeat.

http://cgi.ebay.com/Hewlett-Packard-78352C-ECG-Monitor_W0QQitemZ230145313545QQihZ013QQcategoryZ100006QQrdZ1QQcmdZViewItem

Something about the story does not add up though.  I know of no doctor who would trust a patient to read his/her own EKG and initiate potentially hazardous treatment based on that interpretation.

[skinny-mh]

Here is a $175 item; I wonder if it does the same thing.
http://cgi.ebay.com/CorDigital-Rhythm-Check-ECG-EKG-Recorder-Monitor_W0QQitemZ220124270154QQihZ012QQcategoryZ67589QQtcZphotoQQcmdZViewItem

[skinny-mh]

Just got this reply from the seller of the Used LIFEPACK - 5 Cardiac Monitor (160129774465): The monitor will display all rhythms viewable in "Lead 2".

Does "Lead 2" include the rhythms that are called PVC's? Actually for his purpose, I suppose the important thing is the length between normal beats, not the details of the 'preventicular contractions' that come between the normal beats.

Btw, there could be much confusion between what his doctor told him, what he told me, my description posted here, other people's reading of my post. I don't want to clutter this thread by trying to speculate about all that. I'm just helping shop for some hardware; the rest will be up to him and his doctor.

[fwilson3]

That is the point.  There is no way to seperate the two.

The type of equipment is completely interrelated with what the doctor wants to do.  For the sound of the original post, it is to let his symptoms be the guide.

Just as an example, if it is not known what "Lead 2" is, how would you or he identify PVCs on the monitor?  In genreal many of these monitors do not automatically distinguish between PVCs and normal beats.  They simply display them.

And for heaven sakes, please steer clear of the LIFEPACK monitor you showed.  It includes a defibrillator, and you definately do not want to be accidentally defibriallting yourself or him.

Get a clear doctor's prescription for medical equipment, and that will guide what is needed.

[skinny-mh]

Right, no defibrillator!

As for PVCs vs normal beats, isn't that read by looking at the height and shape of the graph? Maybe for his purpose the point would be to see the normal beats on the graph and look for gaps longer than normal between normal beats.

Like, if you get bu-bump, bu-bump, bu-bump, bu-bump, bibbitybo, bu-bump, bu-bump -- for him it's the distance of that gap that matters, not the details of whether the gap is filled by biggityep or bibbityoo or whatever.

[maggiemag]

This is EXACTLY why there are doctors; so lay people don't go trying to interpret EKG's when they have NO knowledge of what they are looking at!  Your friend needs a new cardiologist stat.  Is this for real?

[skinny-mh]

I'm not going into detail, but some posters here seem to be inventing quite a fantasy of the situation. It might help to read my actual posts. Or, if you don't have constructive info for my actual question (about hardware), to spend your time on some other threads.

[FLBrat]

My friend's problem is the opposite of most people's: he does NOT feel when PVCs are happening. What instrument can he get to detect and measure them at home?  The ordinary home blood pressure/pulse cuff digital devices were not recognizing his PVCs.


Out of curiousity, what is the importance for him to detect the PVCs that he cannot feel?  How would he know when to hook up the monitor?  Who would read it for him to know what the monitor recorded?

[skinny-mh]

I've already given this information but I'll try to put it more simply. He is occasionally seriously hampered by episodes of lack of oxygen to the brain. His doctor* says that because he has a serious heart condition, episodes of PVCs which would be harmless to normal people are temporarily lowering his EF so that not enough blood is pumped to the brain during those episodes. She says his PVCs are worsened by low potassium, so she has put him on potassium supplements and is still increasing the dosage to find the right level. In the meantime she has instructed him, when he feels a need of 'deep breathing' for no apparent reason, to consider it a sign of PVC and take a potassium snack or pill. (6 otc potassium pills of 99 mg would be the equivalent of one banana.)

He is very conservative about taking pills (and sometimes is not hungry enough for snacks) so he would like to check during that sort of episode to make sure PVCs are present, before taking the drastic step of having a banana or a can of V8 juice, or taking an otc pill that is the equivalent of 1/6 of a banana. :-)

The doctor has not mentioned home ECG testing; that is his own idea, and we are researching so as to bring it up to the doctor in an informed way.

*by much testing, ECG and blood tests; and other things have been tested for too.

[maggiemag]

Temporarily lowering your EF during a PVC is not gonna cause a lack of oxygen to the brain. Do you know what a PVC is?   Why not just put him on oxygen if that's what they feel he needs?  Plus PVC's do not lower your EF unless you have sustained VT.  I HAVE been reading your posts, which is why I am incredulous!  I am even further convinced that your friend needs a new cardiologist.  It's nice you are trying to help him, but, a monitor??  Who is going to read it?

[skinny-mh]

From http://www.uspharmacist.com/index.asp?show=article&page=8_1802.htm
"Nonsustained Ventricular Tachycardia: VT is defined as three or more PVCs at a rate greater than 100 bpm and can be further classified as nonsustained VT (NSVT) or sustained VT depending on the duration of the dysrhythmia. NSVT usually spontaneously terminates within 30 seconds and is not associated with hemodynamic instability. The severity of symptoms seen with VT depends on the duration of the arrhythmia, the ventricular rate, and the degree of the patient's heart disease. Patients who have NSVT, especially those without heart disease, are often asymptomatic or have mild symptoms, such as palpitations, dizziness, and syncope.1"

We're talking about groupings of multiple PVCs within a minute or less; and repeated groupings within a few minutes, over and over within the space of an evening -- in a dilated cardiomyopathy congestive heart failure patient with very low EF to begin with. Enough of these PVC groupings close enough, and the result (if I understand the doctor) is an episode of erratically reduced blood supply to the brain over a period from minutes to hours.

The reason that during these episodes his brain feels a need of oxygen is that the heart isn't pumping enough blood up there. As for 'giving oxygen' ... there's a reason why oxygen requires a prescription and bananas (or otc potassium pills each equal to 1/6 of a banana) do not.

[maggiemag]

I know what NSVT is, as I have several episodes a day myself plus SVT, and multiple groupings of PVC's from DCM.  If s/he has a reduced blood supply to the brain from a very low EF, then they may be end-stage and it is common to put those on O2.  I am on O2 at night myself, and it made a huge difference in how I feel.  And yes, I have a prescription for it, and have to re-qualify every year.  How low is their EF?  I started at 15% myself and am now at 40%!  I no longer need a transplant eval which they ordered twice, and for other reasons put off.  So I have been there and really am still having trouble grasping what their doctor is doing, as it isn't following the standard of care.  I am not trying to upset you, you are being a good friend to them.

[skinny-mh]

You said you have "non-ischemic DCM ... with CHF." So does he, though obviously your condition and his differ somewhat (yours sounds more serious, and he is nowhere near "end-stage".) He has had two recorded SVTs: one that resulted in syncope (unconscious on the floor); the other was caught by a new pacemaker/defibrillator.

IN 2002 his EF per Echo was very low, well under 35% iirc. They gave standard meds and installed a pacemaker in Sept 2002, and in a 2006 Echo the EF had improved, though I don't think it's up to 40%.

His former doctors had him taking much Lasix: in fall of 2006 he changed doctors and the new doctor has improved his condition very much!  She is part of a large reputable hospital with very conservative standards that all the doctors are held to. Many tests are done frequently, and all his heart numbers are much better.

She is familiar with both diabetes (he was dx Type II in 2002) and the interactions of diab and heart treatments. She discovered a potassium deficiency, put him on potass supplements, told him he was "over-medicated" and should miniimize the Lasix, changed other meds, changed him from Tolbutamide to Glipizide (which relieved some 'rebound issues' with 'hypoglycemic-like symptoms" or "some kind of hypo"). Sfaik it is all well within the accepted "standard of care."

As to the current subject, the PVC problem. The new doctor is very emphatic that when he has these symptoms which make him want to take deep breaths, those symptoms are caused by PVCs and he should immediately do something for the PVCs, such as eating a banana. :-) (And when these symptoms happen in her office [PVCs verified by EKG on the spot] a potass pill relieves them.)

Now I may have been wrong in talking about actual lack of oxygen to the brain and lowered EF during these episodes; that's less clear to me. My impression was that she meant there was plenty of oxygen in the lungs but less was getting pumped up to the brain during those episodes because of the PVCs.

If you and he are getting different treatment, it is probably because your conditions are different. Have you been checked for potassium deficiency?

[maggiemag]

I disagree about the low sodium V-8.  The 5.5 oz. cans only have 80 mg. in them and that is easy enough to fit in the daily sodium allotment and I think it is really good!  I have never seen the salt free stuff, and would not even try it.  Gross!

And skinny, don't even go there about my potassium levels!  I used to take a normal dose of 20 mg/day and after my severe hyperthyroidism, my requirements escalated for some unknown reason and am now taking 120/day and was on 160 for a long while.  And NO ONE can tell me why I now need so much! :-(  Arrgggghh.  And my thyroid levels are normal now.   So, yes, I have been checked!

[skinny-mh]

Those numbers seem a little odd. A quick Google shows around 2000mg potassium as a minimum daily requirement. 120-160 mg/day seems a drop in the bucket if someone actually had a deficiency. When my friend's deficiency was discovered, the doctor started him on about 500mg per day, which she has kept increasing (and he feels better and shows better heart numbers with each increase). He's now up to the equivalent of 4 bananas a day (at 500mg each banana). :-)

His doctor talked about diuretics and some of his other heart meds causing potassium deficiency, so requiring a greater intake of potassium than normal. Also, if I understood her correctly, his heart (and brain?) function may be unusually sensitive to lowered potassium levels; apparently his heart function (PVCs etc) varies with fluctuations of potassium level within a single day, as half a banana's worth does seem to relieve his PVCs (or at least the discomfort they cause him) immediately.

[maggiemag]

Whoops, I didn't mean milligrams, I meant millequivalents!  Meq, not mg.  It is quite different, and I take 120 meq/day now, where the usual dose for replacement from Lasix 80 mg, would be about 20 meq.  Sorry!

[skinny-mh]

I thought it must be a different way of measuring. Looking up meq / mg + potassium.... Good heavens, here's  a recommendation of " 4700 milligrams (mg) of potassium per day," which could explain a lot.
http://en.citizendium.org/wiki/Potassium_in_nutrition_and_human_health
"The IOM makes no statement whether  [the recommended]120 meq/day potassium intake ‘’optimizes’’ cardiovascular health, but it sets no upper limit restrictions on potassium intake from food, which could reach 200-300 meq/day."
Well, I must go, so I'll post this without looking up the exact conversion factor for potassium meq's to mg's.

[skinny-mh]

Okay, my friend says his prescribed potassium began at 8 meQ's (500 mgs) and has just been raised to 32 meQ's (2000 mgs).  So he has a way to go to get up to your 120 meQ's (7500 mgs?). Much less the 200-300 meQ's ( c. 15,000 mgs?) possible from food? -- Hm, well some people can have fun fine-tuning those numbers. :-)

[skinny-mh]

Okay, I was starting to agree with the poster who said that taking pulse shoudl be good enough. but my friend went ahead and got a geeky device: "Card Guard CG-5000 MiniMonitor" by Scientific Survival Ltd. Looks like it will do all the right stuff (other than interpret the readings). So learning to compare the pictures will be our next project.

[Momto3]

I just joined this thread, so I apologize if I'm repeating the comments and questions of other posters.  

I understand that your friend has a pacemake/ICD.  Does the machine transmit data to his/her doctor on a regular basis?  

Also, taking potassium supplements needs careful monitoring.  Have blood tests indicated that he/she is in need of potassium?  

Is there a danger to having the pvcs?  If so, why not an antiarrythmic?

Sorry if you've already covered this, and I've missed it.

[skinny-mh]

I've already posted answers to most of the same questions you're asking, but I'll try again to summarize:

He is a diabetic (type 2) non-ischemic DCM/CHF patient
hampered by episodes (minutes to hours) of dullness, low energy, weakness, and feeling need of 'deep breaths', which symptoms are relieved immediately by potassium. The cardiologist says these episodes are caused by PVCs and whenever he feels these symptoms he should take a snack or potassium supplement (one otc pill has the content of 1/6 of a banana).

She has been increasing his regular supplements of potassium (currentlly 2000 mg/day) in an effort to get his blood K up to the high 4s instead of the low 4s. Apparently his system is unstable and the potassium level varies or gets depleted during the day, so she is telling him to take potassium snacks as needed in addition to the regular supplements (and standard arrythimia meds etc etc, see earlier posts this thread).

He is a geeky type and dislikes pills and often feels disinclined to snacks, so he wanted some kind of geeky  feedback device to confirm he's currently having a PVC-caused episode instead of just eating a damn banana when in doubt. :-) He has just purchased a  "Card Guard CG-5000 MiniMonitor" by Scientific Survival Ltd.

His pacemaker gets interrogated every few weeks, not often enough to alert him when an episode is happening. Correlation between the symptoms, lack of K, PVCs, and relief by immediate K has been demonstrated repeatedly in ECG tests, Echo tests, blood tests, and incidents in the doctor's office.

[Momto3]

WOW!!  Thanks for the summary.  If he's the "geeky type" he'll probably love the monitor : )

Best of luck!!  Hope the monitor helps to keep things in check.

Connie