episodes of heart palpitations unable to pick up on holter monitor

[ozguy42]

I have been suffering from episodic bouts of heart palpitations over different periods for a few years now and they are recently becoming more frequent and as I am a naturally anxious individual, they are creating panic to me especially as they seem to be worse at night. My sleep is becoming affected and I have attended the emergency dept at hospital on many occasions and have worn holter monitors, consulted cardiologists last year and each time I have been at hospital, the symptoms completely dissipate which is frustrating and makes it difficult to diagnose. A cardiologist has advised me that I am possibly experiencing Supra Ventricular Ectopic episodes - my heart rate is only around 64 beats per minutes when these occur- so there is not a fast heart rate, but my blood pressure is elevated ( possibly due to my anxiety when these are occurring). I am waiting to get access to a 30 day event monitor so I can possibly catch these episodes when they occur. Could you please give me some advice on this disorder. The emergency doctor has reassured me he feels that they are not dangerous but when I experience them, I feel that my heart will go out of rhythm or stop completely which creates more anxiety for me.

[CCF-M.D.-MJM]

Hello,

It is true that supraventricular ectompic beats are not dangerous and nothing that you describes above puts in you in any high risk category for dangerous arrhythmias. The only way to figure out what is causing these sensations is to correlate the symptoms with an event monitor or holter monitor.  If they are frequent, this shouldn't be that difficult.

How to treat them is another story.  If you are reassured enough after the monitor,  you may not need any medications.  If you want to try medications, a beta blocker is the first step, but they often make people feel tired.  You will have to decide how much they bother you.  Good luck with your test.

Thanks for posting.

[matty_boston]

I would recommend an event monitor. This is similar to a holter monitor, but you only record the "event" when it happens. You just press a button when you are experiencing something and it will record it for you (actually will record even before the button is pushed). You can wear this for a month if you want or until the time is that you record the event or events.

I had one and it wasn't too much of an inconvenience. It actually caught my PVC's

Good Luck!

Matty

[talylor]

I wore a holter monitor for 24 hrs. Doctor said it showed Normal Sinus Rhythm with rare PACS. I had tons of symptoms all day and wrote them in the log and he said even though PAC's showed up, he didnt think they were causing my symptoms. How he cant tell me that by matching my event log to the EKG at that time is beyond me. I have to make sure he clears that up for me when I see him for my follow up today. I was even in the hospital for a few days for an unrelated thing and they watched my heart and I would hit the button any time I got a symptom and they always said it wasnt the heart. Thing is...I get this real STRONG ONES that send me in panic mode...but only get those a day here or a day there. Get the small ones all the time. I told my doc and the hosptial that none of the monitors captured a STRONG ONE and I was told me it didnt matter cause they arent' cardiac related. How can they be sure????? I am on the verge of asking him for another monitor or an event monitor until one of these STRONG ONES are picked up cause I read so much here about PVC's and I think that is what I am getting.

[LukeL]

Some people with IST or Inapropirate Sinus Tachycardia, and other such disorders will feel palpitations when they are in a normal sinus rhythm. It could be this is what you are feeling. While I am not a doctor, I would think the next wise step would be an event or loop recorder.

As the doctors here have said if you ask long enough you can get any medical test you want, but you need to be aware of the risks involved in having multiple medical tests.

I have had 5 EKGs in one year and they have showed things ranging from a right bundle branch block, to left axis deviation, and a possible hemiblock, all of whihc I am told are normal variants at my age but even still they have caused me many hours of lost sleep and undue stress which have affected my quality of life.

[matty_boston]

Hi Luke,

You mention risks of having multiple medical tests. Are you referring to using an event monitor? I am not aware of any risks associated with wearing this.

Thanks,

Matty

[jan]

My sis and I have had palps for a long time and just ignored them.  She had a harder time ignoring them because of her anxiety/panic disorder.  Funny thing is when they diagnosed and treated her hiatal hernia and gerd hers went away, they probably weren't cardiac at all in her case.  I had IST,PAC's, PAT's, I can't remember what else.  But we both described the same feeling for the palps.

Maybe yours aren't cardiac related, either and you should check into some other possibilities.  I don't think palps have to be strong to be picked up.  I never knew I was in tachycardia, because I didn't have palps with the IST and yet it showed up on the ekg's and holters.

[PikaPika88]

The triage nurse yelled at me "You're lying to us!"  Honestly, Other Dr all said nothing wrong "Go home wait and see." I felt my pulse runs like a "train stops all stations" and the chest like an "elephant sit on it".  

The cardio told me, the palp and tightness is caused by anxiety.  Pacemaker didn't catch anything since Feb 2005.  The tech told me the pacer "pick up 2 beats late" in Oct 05.  Cardio told me, I didn't have PAC and PVC so what is that 2 beats?  Not counted or no name?  I think about privately order a holter to catch what are they?  But my GP.. didn't want to write one for me.  Now, I see what you're saying, may be it is a waste of time and money too.  Probably won't catch anything either!

I feel everything inside my body are falling apart!  I suppose I have to live with it for the rest of my life!  

Pika.

[ozguy42]

I know exactly how you feel and sometimes it does seem like life is falling apart. There have been so many nights that I wake at around 3.00 AM experiencing palps and think to myself " This is it, my heart is going to stop"
the two beats you are referring to I believe could be called a Couplet as I remember this being noticed on one of my holter monitor results.
whenever I have attended the hospital, I end up feeling like I have wasted their time as the symptoms are not apparent when I am there.
Pika you must tell your doctor that you want the event monitor and if they refuse again, for your piece of mind - find a new doctor who is willing to listen to your concerns

[LukeL]

By dangers I mean of invasive tests like going to the cath lab. Also like I said above when you have multiple tests done you run the risk of having false positives as well. But sometimes peace of mind is worth the risk for many people.

[msmma]

Ah, the joy of PVC's....not  : )  My PVC story is interesting..

I'm a 30 year old male, and I quite accidentally first discovered PVC's around 3-4 years ago.  I was just sitting at my desk at work one day and happened to feel my pulse.  Right when I did, it felt like this:

beat.beat.beat.........BEAT.beat.beat.beat

I immediately thought it was very strange, and the more I checked my pulse, the more I noticed them.  Afraid, I had made a Dr. appointment.  My regular doctor was out of town, so I saw one of the other doctors in the office.  She made me feel like a total idiot, and didn't take me seriously at all...she essentially said, "you are a 26 year old male with no major symptoms of heart disease, and don't worry about it".  That seemed to do the trick because for the next 3-4 years, I didnt feel them anymore.

Then around the end of March of this year while battling a cold, I suddenly noticed them for real.  I would intermittently feel a single heavy THUD in my chest, then nothing.  It would just do that on and off.  I had taken some nasal spray (active ingred Oxymetazoline), and some alkaseltzer to help.  It was after I started these that the palps came back.  So I checked online for possible side effects of Oxymetazoline, and sure enough, one of them is "irregular heartrate".  I immediately stopped the meds, and called my doctor.  They saw me that same day (not my regular doc because it was Saturday).  The doc that saw me was very nice, and was able to feel the palps while taking my pulse on my neck, after I told her I was still feeling them.  She thought that this was a condition I have always had, but was aggravated by the cold meds.  She ordered a Holter Monitor for me.

I wore the Holter for 24 hours, and when the results came back, I went and saw my regular Primary doctor about it.  He went over the results, which did not show any PVC's, only one "late beat", which was in the Superventricular Ectopy section of the report.  He said my results were perfect, and not to worry about anything!  My blood pressure was 188 / 75, which he also said was fantastic.  I left there, and felt great.  The palps actually went away for about three weeks.  

After a bad day at work, they came back one night, and that was almost three weeks ago, and I've had them daily ever since.  I made an appoint with the cardiologist, who felt that I also had nothing to worry about, but to be "extra sure" ordered a stress/echo.  I did that, and during the initial startup of the treadmill, they were actually able to see my palps on the EKG.  Diagnosis?  PVC's.  I get my actual results of the stress/echo this Thursday, but my impression from talking to the nurses while doing it was that everything was great.  I was able to read on the paper, "No MVP", and I asked about that and she said it meant "No Mitro valve prolapse".

So, where do I go from here?  Reading about others that have this surely helps, but I'd be lying if I said that I wasn't disappointed with the fact that Medically, there seems to be no doctors who can find a surefire solution to these.  Sure, they are benign, but the emotional toll can be terrible.  

After reading about it online, I had started to take around 500mg daily of Magnesium, and whether its in my head or not, it seems to be helping.  I'm taking Mag Oxide, which from what I've read is the worse one to take (least absorbable).  I plan on buying Magnesium Citrate and will take the same dosage daily.  Anyone else have Magnesium experiences and palps?

My biggest fear is that these are going to get worse, and worse as I age....what do you know about this?

Anyways, sorry for the superlong post, and God bless.

--Mike

[fearfactor]

You are right on!  I have been through almost all these stages - I'm at the pissed off point right now!  :)

[dodgybeats]

Brilliant chart - I have been at #9 for a while, although days like today I am back at #4

[Momto3]

I went for my semi-annual checkup and asked if there is a difference between the information obtained on a stress echo and a "regular" echo.  Yup!  The "regular" echo gives more detailed information, pictures, etc.  OK, if I got this right, the tech said that the regular echo gets more detailed pics and values for the chamber sizes, valves, etc.  

For the last 3 appointments, I have been in NSR, but this time, guess what?  Yep....pvcs.  The doctor was listening and she looks at me, and I said, "Oh gosh!"  She said, "it's just bigeminy...and we know you have to have a LOT of extra beats to cause trouble."  Whew!  She was relieved it was "just bigeminy."  I've had quite a few episodes the last couple of days but I think b/c I was a bit anxious about the echo.  Turned out to be a GREAT report!!  Hooray!  Back to NSR I hope : )

[skippyheart]

If you are indeed having PVCs, PACs, or other ectopics, take heart (no pun intended) - they are harmless. But it's typical to go through the following phases:

1) You are sure you are going to die, and every beat brings about other symptoms like light-headedness, breathlessness, high-blood pressure (all anxiety related).
2) You go to the ER a few times. They bring you in right away, then send you home telling you there's nothing wrong (they're right)
3) You go to a cardio, get a full workup (and pass with flying colors)
4) You don't believe the doctors, keep having anxiety attacks, read everything about PVCs on the internet everyday, become agoraphobic, and try to isolate every trigger (there is no one trigger except anxiety)
5) You try to will them away (you can't cause you're still thinking about them)
6) You become anxious thinking your PVCs are going to get worse (and they do, since anxiety is the one common denominator)
7) One day you get pissed off, and go about your life regardless of the PVCs, figuring who cares if they kill you since you're at your wit's end anyway (you live)
8) You start to realize nothing bad ever actually happens to you while having pvcs, start going about your normal life, and start ignoring them and forgetting about them (they don't go away yet)
9) You start really forgetting about them (they never go away completely, but occur much less often, and you don't care about them anyway)
10) You troll the forums to help other people :)

There are exceptions of course, but judging from my own experience (about 8 years now, averaging 10 an hour a few to 8 hours a day at peak), and from others on forums, this is how it often goes. Mine come on during periods of stress (usually delayed a few days or a week). While they are occuring, cafeine does NOT bring them on, and meditation does NOT make them go away . But there is nothing (exercise, sleep, etc.) you cannot do while they are occuring. It's a matter of will.

BTW, I've yet to see one person on the forums write "Well, if finally happened, I had to be defibrillated. I was right!"

If you've had a cardiac workup, just skip right to 9. It'll save you years of misery.

-Skippyheart

[woodruff]

Right on, skippyheart!  If your heart is structurally normal, this is an excellent description of the timeline you go through with these things.

[refugegirl]

I have been dealing with excessive PVC's for a number of years and have even quit coffee trying to stop them - no luck.  I do have one question that I haven't really seen answered . . . . do PVC's eventually cause damage or fatigue to your heart?  I did experience some relief while taking Toprol XL (25 mg), but stopped taking it during the testing done by the Cardiologist and haven't resumed taking it.

[tickertock]

I am not a doctor, but as fellow sufferer of very frequent PVCs when I do get an attack, which thank goodness have been well over 4 years now I have asked this same question many a time to numerous cardiologists and electrophysiologists and have always got the same reply, on very rare occasions they can lead to cardiomyopathy, but they have to be extremely frequent in the range of 15-20 % of your total heartbeats for quite a number of years or even decades for this to occur usually with some underlying cardiac anamoly in conjuction with the PVCs.

An echo is usually required every 1-2 years if it is possiblity of this happening, other than that they are a mere nuisance with a normal cardiac evaluation. In extreme cases an ablation maybe recommended, generally this is not the normal avenue in dealing with PVCs. Take care and good luck. Rely on the advice of your doctor or cardio with these concerns.

[refugegirl]

Thanks.  :-)

[upbeat63]

I'm trolling the forum to see if I can help!! Thanks skippy girl.

Actually skippygirl is right on, except that I've had PVCs for 22 years now, and I can tell you there are times when you get to the end of her list, only to start it all over again. I just have never been to the ER.

Last year a holter recorded the PVCs at 20% of my heart beat. And since that time it has been higher. Constant bigeminy for weeks, and recently constant trigeminy for a couple of months. But a cardio just told me it still doesn't matter, risk of cardimyopathy is still rare, and he did not recommend periodic echos of any sort. However, he did recommend a transthoracic echo to get a "better look", so I've since decided that's unnecessary (what is that #8 or #9 of skippy's flow chart?).

Anyhow, there are still days when I wish it were different and I don't feel very well AT ALL, but I have to recognize--it's not the whole day, and it's not every day and all the rest of the time life is GOOD!!!!!!!!!!!!!!!!!!!!!!!!!

[upbeat63]

very sorry, it's skippyheart and refugegirl, I hope no offenses committed.

[ozguy42]

What you have written is so true and hopefully I am heading to the end of the list.
Today I am going to see my doctor, who has been very dismissive regarding my search for an answer and demand an event monitor.
I have done some research and where I live in Australia the only long term heart monitor I can access is a 7 day event monitor.
I am hoping that by wearing one it will finally catch the palps and give me a definative answer on what is happening.
I have been trying hard to ignore episodes when they occur, nighttime has been the most difficult time especially when trying to go to sleep. Funny enough mornings are bad for me but during the day symptoms are minimal.
Thank you all for your posts and suggestions

[skippyheart]

I am, in fact, a skippy-guy (no offense take upbeat63 - lol)

A correction - when I said I have 10 an hr I meant 10 a minute. You gotta get to the thousands-a-day club before you're really having fun :)

Good luck to everyone!

[megz22]

I've had PVCs for about one and a half years now, and I'm 22. I went through a period of about 6 months where I was barely getting any, and now they're back with a vengeance. It just seems so unfair! I cant concentrate or do anything when they're around. I just want to know what people do to distract themselves from these little buggers? I'm finding it all so difficult right now!

And I know there's nothing wrong with my heart so I dont actually have those anxious types of feelings. It's more a case of how to try and ignore them when they're around because at the moment they're impossible to ignore! They just make me feel so useless and hopeless.

I've tried beta blockers with not much in the way of results...I tried flecanaide with results but shocking side effects. I went to a pscychologist which did help tremondously at first but now even when I dont feel anxious I seem to get them. They just pop up out of the blue.

I ask you....what is a girl to do??? I feel like I'm so young and healthy and I've got so much to live for! They just frustrate me so much!!!

If anyone has any advice or comments I would really appreciate it. Here's hoping for a palp free day for all of you! :-)

[Momto3]

LOVE the list!!  You've really captured the true affects of the anxiety behind the pvcs!!  Have you contacted your publisher? After YEARS of dealing with pvcs, I'm sitting on #10...breathing normally and FINALLY believing : )

Thanks for sharing the list...You've got Letterman beat on this list!! LOL

[jwinst]

I feel your pain! I am a 23 yr old female and have been battling with these for the last few years! The PVCs got real bad after a real stressful time in my life and I really started to panic after that! I am so thankful that this forum is here so I can see that I am not alone! I too feel like I am so young and this is just not fair! I should be out enjoying life instead of worrying about this darn things! I do go through phases of anxiety, worry, anger, etc, but I really try to not let them get the best of me (MUCH easier said than done!) My biggest fear is that they will get worse over time! That is why I am trying to destress as much as I can and eliminate anxiety! Walking has seemed to help me. So grab a friend, a boyfriend, a dog, whatever, and start walking! We cannot let the palps stop us from living! Good luck to you!

[talylor]

I was told by andie3330 to read your post because i have been dealing with this for 4 months now. Your words have been very reassuring to me as have andie3330 and woodruffs and many others. I truly hope I can get tru these 10 steps and get back to enjoying my life again. I have never panicked enough to go to the ER so I am grateful for that. But I have panicked enough to pick up the phone to call my mom, my sister, my doctor, etc...always ask me "how you feeling now?" and I say "fine bu they scared me" and they said "i am sure they are but you are still here".