pvc's?

[Dazzler]

Could you please tell me when pvc's are considered benign?  How many are too many pvc's?  Should then be treated?  When you get 20 a minute, do you just ignore them?  

Thanks, Di (Dazzler)

[Cleveland Clinic]

Dazzler,

Ive often thought we should have a faq about common topics here in the forum, PVCs being one of them. If you do a search back you will find alot of helpful information.

In short, in the setting of a normal heart, PVCs really carry no significance other then a major annoyance. Some medication options exist, but balace of the benefits and risk need to be taken into account.

[Momto3]

It is my understanding that pvcs in the setting of a structurally normal heart are nearly always benign. Even when I had over 20000 on 24 hour holter they were termed benign. If they begin to cause other problems, then it becomes more significant to pursue more agressive treatment. That being said, I believe it is rare for pvcs to become problematic. Beta blockers are sometimes offered as an medicinal approach to lessening their frequency, symptoms. Treatment is generally left to the patient and his/her tolerance to the symptoms. If they become too bothersome, you may wish to consult your physician for methods of treatment (biofeedback, yoga, beta blockers). Good luck!

[Gorbe]

20,000 PVCs in a 24-hour period? That comes to about one every five or six beats, assuming an 80 bpm heartrate. And that's benign? Does an increase in the number of long rests (between premature beats) increase the risk of stroke or anything?

[tessa0825]

I have read many of your post and you seem very knowledable..I wonder if you could give me any idea about what could be causing my BP to be increasing when I have recently (over last 15 months) done things that one would think would lower BP...Because of unrelated medical problems I have lost weight from 165 to 117 currently.....I have had a 31 yr history with HBP but was always controlled with a low dose diuretic until the last yr....I was taking hazaar then demadex was added, recently because of very high diastolic Toprol XL was added...My Drs. who have been kept busy because of my other medical conditions really have not addressed this other than to admit it exists and add the additional medications.....I do have a mixed connective tissue disease and im wondering if that can cause the increase in my BP? Thank you for any suggestions you might have....Tessa

[Momto3]

My Holters were recording 20,000+ PVCs in 24 hour period. LOTS of couplets, few triplets, runs, and too many episodes of bigeminy to even bother recording an exact number....My HR averaged 60 or so...It was nearly impossible to get an EKG strip that was pvc free. Fortunately, other than being somewhat uncomfortable, I had no pain and was not really bothered by them. Other than being tired, I managed OK. Even with those numbers, the pvcs were still considered benign UNTIL one of my latest echos revealed a drop in my ejection fraction.

After my doctor, some colleagues, and a couple of doctors from CCF discussed the situation, it was determined that the drop was very likely a direct result of my frequent pvcs....Lo and behold, they were no longer benign, at least in my case. I must tell you it is my understanding that this is indeed a very rare occurrence. For the vast majority of people with pvcs, they are considered benign even with the frequency I experienced. I've had pvcs for 25 years, and it wasn't until last year that things changed. I've had two ablations this year and so far, so good...YEAH!!

Don't know about your question regarding an increased risk of stroke...but, not to the best of my knowledge. The frequency did lead to myopathic changes and that is why the doctors are aggressively trying to eliminate (or significantly reduce) the pvcs.  

Remember, in the setting of a structurally normal heart...they are almost always benign.

[pandora9049]

Hi,
i was reading your post and was wondering, do u have sinus tachycardia?  I suffer from a fast heart rate too (sometimes it goes up to 120-130 bpm while Im doing nothing)  I was just wondering if u have the same type thing going on??
Regards,
Pan

[glassheart46]

Alice, I seen your post to momo3.  I understand you experience fast heart rates for no reason.  I do as well but I recently underwent an ablation and maybe mine is due to that.  Would you please post some more about your problem or email me at the following:

  ***@****

Thanks in advance!  I and momo3 communicate back and forth by email too.

Sincerely!

[Momto3]

Hi friends!!!! Allie, in answer to your question, I am doing quite well. The doctor successfully ablated a foci in the RVOT in August. Then in November, they went in to tackle a foci on the left side of my heart. So far, I am experiencing very few pvcs. I cannot believe how different it feels to have a rhythmic heartbeat...I've had pvcs for so long that I was just used to them.  Not sure what lies ahead, but for now it is wonderful to be ticking "in time".  I do know that during the second ablation the doctor tested the first ablated site and it was quiet!! Great news!

Hope you continue to feel the positive effects of your ablation.

Like Glassheart, I had speed ups of HR after my first ablation. That was weird cuz I'm used to a HR of around 60bpm. I kind of startled me, but once I had the event monitor I figured if it was anything serious someone would let me know. By 10 weeks post ablation, the pvcs were going nuts again (different foci). That's what prompted the 2nd procedure...It has been about 10 days, and things are pretty quiet. Last time, the pvcs didn't recur till about 2-3 weeks after...so we'll see.

Glassheart, always good to "see" you... : ) Stay in touch and I'll do the same....

[CareBear59]

Hi there,
I was reading your post and wondering was your cardiologist ever concerned that your frequent PVC's like the couplets would turn into Ventricular Tachycardia?  That's always my big fear when they get real frequent?
Thanks alot,

Carrie

[Momto3]

Hi Carrie, Yes, my doctor was watching for runs and VT. Awhile back when I asked if I had VT, I was told, "not technically".  Yet, just prior to this last ablation, the doctor said she was glad the "VT" was under control.  So, I guess what I'm saying is that it is a matter of defining VT....Some doctors define it as 3 or more pvcs in a row, and I guess while that is not "technically" VT, it does raise some eyebrows....Hope you are doing well : )

[tessa0825]

Thank you for your reply and for your information....I can certainly understand alot of what you are going through....Im 51 and I would think at your young age this MCTD would be really hard dealing with.....Im still trying to work everyday but it is getting harder to do that...I have had 4 surgeries in the last year from all of this...Its very difficult trying to justify to bosses why you are having a surgery every few months when they dont understand how many different illnesses can be caused from a MCTD....Its very depressing.....Im sorry you are going through so much...If you would ever like to talk more about this please email me at m_catarina***@****

[rw21]

After reading you comments, I also have had a time with PVC's for years.  Three years ago at age 44, I had a mechanical Mitral Valve replacement and it seems that my PVC's have increased.  I don't have as many as you thankfully but my halter monitors have shown about 6,600 within a 24 hr. period.  Mine seem to come usually two in a row and sometimes every couple of beats which will tend to tire me if it continues at that rate.  About 2 mths ago I went into Atrial Flutter and had to have 2 injections of Ibutilide which is used to convert atrial flutter or fibrillation to normal rhythm.  The 2nd injection worked after several hours.  My cardiologist has talked about ablation and I am wondering how successful they are in the long haul.  I have been on Coumadin since my valve replacement.  I have grown accustomed to my PVCS.  This morning I'm wondering if my heart has kicked back over into A Flutter because my HR races after I make any movement from around 65 BPM to 125-150 BPM which is not normal for me unless I am doing heavy excercise.  Sometimes my heart beats so hard it feels like it is trying to jump out of my rip cage. Not sure what really causes the heart to do a switch over but I was wondering if an ablation would help to prevent it.  I have a call into my cardiologist this morning to see what he wants me to do.

[rw21]

It seems that you are very knowledgeable in this area.  I welcome your thoughts to my above post.  For further info, my last holter showed 3,526 Ventricular ectopics ( 3,411 isolateds, 1,397 in Bigeminal cycles, 45 couplets and 2 runs; 45 supraventricular ectipics (43 isolateds, 1 pair).  Avg. hr is 72.

[Momto3]

Hi RW! It was kind of a dejavue to read your story...like looking in a mirror! I am 46 and facing the possibility of mitral valve repair/replacement at some point. WOW! My pvcs were picked up when I was in my late teens and I've had them on/off since that time. Also diagnosed with MVP/MR back when. Pregnancies (a LONG time ago) really kicked the extra beats into gear, but they remained benign. Since the 1980's I have gone for periodic echos to keep an eye on the leaky valve. In 2000, when I went for a checkup, the leak appeared to have worsened. TEE at the Cleveland Clinic came back OK...normal EF, etc. and "not a candidate for surgery". After 2 subsequent follow up echos, EF showed a continuous drop...down to 40%. Lots of cario docs and more tests indicated that the drop was very likely due to persistent, continuous pvcs...Tried a couple of antiarrythmics, and although they helped with the pvcs, the side effecs were crummy. In the past when I asked about ablation, the doctor said it was not necessary for heart health, but that if the symptoms were very bothersome, we could consider it. After I tried the RXs, the doctor suggested the ablation, this time with more conviction. I have had 2 since August, and I'm here to tell ya, my heart feels incredibly different! It is ticking so beautifully...

I would love to hear about how your MV replacement went. What was the surgery/recovery like? One of the CC doctors said that it is likely I will need repair/replacement at some point because of the longevity of my situation. Right now, my doctor is watching with a careful eye. I am bummed that you have experienced an increase in your pvcs since your valve replacement. OH NO! Do the doctors correlate the two events?

By the way, my latest holter (October) showed 6000 ectopics and only 54 couplets (previous one had thousands of couplets and bigeminal events) so there was definite improvement. You are right, that can be exhausting. It has only been 2 weeks since the second ablation, so time will tell on that one, but so far....it's working! AND, atrial flutter...eee gads! The doctor mentioned the possibility of that, but I'm hoping it does not occur. I'm glad to hear the medicine worked for you. Keeping my fingers crossed.

I would be interested to know what your cardiologist has to say about the HR speed up. When my HR sped up, it was only up to about 120, but that was high for me...Sorry to hear you are experiencing those uncomfortable symptoms.  Has your doctor mentioned an ablation to prevent the "jumps" or pvcs? Good luck to you...connie

[rw21]

Thanks for your response.  Sorry I'm just now getting back to you but Thursday when I wrote to you, I later was taken to the ER because my HR starting to increase.  Anytime I started to move around it would go from a normal 65 BPM to 150 BPM.  They said I was back in A-Flutter and tried some medication but it didn't work.  I spoke to the EP surgeon and he felt that I should consider an EP study and if he found anything to go ahead with an ablation.  10 minutes before I was to go into the EP study my heart flipped back into normal rhythm.  They decided to still go through the EP study so he had to work to get my heart back into A-Flutter and then found 19 areas that he had to ablate.  He feels that this was 90% successful so we will see how it goes.   To answer your question about mitral valve replacement, it wasn't really that bad.  My biggest problem was that I was too healthy which sounds weird.  He said since I was young, thin, never smoked, no alcohol and no drugs, I had about 100% of my nerve endings working which caused me to feel the highest degree of pain.  It took me about 4 weeks before I could sleep in my own bed.  But after that I felt fine.  I understand there are some new procedures being done with you own human cells that they graft into a valve which will keep you from coumadin and should last forever from what I have read.  I think this is still fairly new but I remember reading about it.  I had PVC's before my surgery but I think the surgery caused me to notice them more.  I was put on a beta blocker but that slowed me down too much and made me worse after about 30 days or so of taking it.  I stopped it and just deal with the PVC's.  It really is mind over matter with the PVC's.  If I dwell on them, I find myself going crazy.  If you want to send me an email or anything, feel free at ***@****.  Take care!!

[wmac]

I saw your post and you said that you three pvcs in a row and some runs, did your doctor tell you that you have v-tach?? Im just wonder because I had a run of three in a row and they consider that non sustained v-tach.
wmac

[Momto3]

Hi wmac, When I asked my doctor if I had VT, she said..."No, not technically".  But, prior to the second ablation, the doctor said, "At least we've got that VT under control".....It is my understanding that some doctors refer to 3 pvcs in a row as VT, while others do not.  So, I would say I had NSVT, but that it did not seem to be the primary problem....For me, it was the frequency of the pvcs that resulted in the ablations.  

Just curious, does your doctor treat NSVT?

[wmac]

When I was first diagnosed with nsvt, the cardiologist and my regular doctor wanted to put me metoproal, I said no! They said okay, it was mostly for the symptoms rather than the problem in its self. I was kinda freaked by there response because everything have read said v-tach was so serious. I have done alot of research on this and even the medical book i got said its better to not treat, that the meds could cause worse problems even death. So Im very glad i didnt. I have gotten alot answers from the cleveland heart clinic and it varies from doctor to doctor what they consider v tach. some say 6-10 beats some say five but most of them and including the medical book
(I got the book from a nurse friend) say a salvo meaning three beats in a row with no normal beats inbetween is nsvt! I was bummed. So I often wonder how many actully have nsvt, I have read of so many people have tons of pvs and I dont really get that many. And I have nsvt?? So do you supose most people have nsvt and just dont know it??
wmac

[wmac]

Your awesome!!! Are you some how connected to the medical field?
I guess Im just freaking all the time because my cardio just said " you have nsvt" and that was that, I had read enough about all the heart arrythimias before and said "WHAT"! Oh its nothing to worry and that was that, so now i freak all the time I have since talked to her more about it, but all i can find on the subject is basiclly how bad it is. Its just nice to hear not that I wish it upon anyone else but it is nice to know other people share the same feelings as I do. Thanks so much also do you ever get the painfull pvcs???
wmac

[Momto3]

Hi wmac!! I agree with Hank....There are not many people who don't have some kind of variation in their heartbeat at some point in their life.  I've had pvcs for what seems like a thousand years...hahah...Actually, it's been about 25! Two to three years ago my holter picked up 22,000 ectopies (25% of total QRS complexes) and my doctor said it the extra beats were bothersome I could take a beta blocker.  Like your doctor, she would be treating the symptoms, not the heart.  It wasn't until my EF dropped that the pvcs and runs of them became an issue. So, unless you have other problems (CAD, cardiomyopathy, congenital defects, etc), your doctor will probably continue to treat the symptoms (if you want to) and periodically check on you. I used to go for annual echos for MVP/MR, but now I'm going in about every 3 months. My first ablation targeted an RVOT foci and this one got an area in the wall of the left ventricle.  I cannot believe how strange it feels to have a NORMAL heartbeat.  I get an occassional pvc, and I notice it cuz it is like getting one hiccup every day or so....nice!!!

My doctor decided to ablate because my EF was dropping (general concensus among many docs is because of my very frequent pvcs). So, I am anxious to see if my heart function is improving...I'm inclined to believe it is improving since I am feeling better...and I noticed I don't get winded going up a flight of stairs!! It's awesome!!  

[wmac]

So your EF was dropping due the ammount of pvcs? Did you always feel your pvcs? Where they thumpy? What was your EF again?
Wmac

[Momto3]

wmac, Over a period of a year or so, my EF was declining. I was first diagnosed with the pvcs around 25 or so years ago. I took beta blockers (mostly Inderal) off and on for a number of years. The beta blockers were strictly for the pvc symptoms. The medicine was never mandatory. In 1998, because I didn't really think the BB was working as effectively as it had been in the past, and because I thought it could be contributing to the increased frequency of the pvcs, I asked my new doctor about stopping the medicine. No problem since my heart was OK and they were only for symptom relief. I am lucky because I can take a 20mg Inderal on an "as needed" basis, as opposed to many others who must have the RX in their system all the time. Anyway, after I stopped the BB, I still had the pvcs, but they didn't really bother me (no pain, and I knew they were benign). Still only took Inderal as needed (rare occassions). All that changed in 2002 when my annual echo came back with an EF of 40%.

Doctors wondered if the drop was because of my MR, but all tests pointed to the frequent pvcs. So goes the story..hahaha....Initially, I tried anti-arrythmics, and after 3 months, my EF had improved bo about 10%....Unfortunately, I didn't like the side effects. I tried a second anti-arrythmics and still didn't like them...Now, 2 ablations later I am feeling great!

Are you having frequent pvcs?  Has your doctor suggested beta blockers? They work for so many people in alleviting the symptoms...Good Luck!!