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Bigeminal PVCs and Triplets
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Bigeminal PVCs and Triplets

I was discharged this afternoon from a local large hospital's cardiac care unit.  There was some disagreement between a couple of doctors as to the significance of these rhythms.

I understand that a PVC by itself is nothing, and even a short term Bigeminal or Triplet series is nothing to write home about.  However, I was admitted 2 days ago, after a multi-hour stay in another small hospital's ER while they monitored a very long non-stop series of these beats.  I was eventually transferred to an unfamiliar hospital's care.  During the hour-long ambulance ride, these same arrythmias continuously occurred... sufficient to raise the eyebrows of the EMTs and the receiving hospital's ER team on my way to the ccu.

I should add here that I have a history of hypertension, high cholesterol, and a typical rhythm of sinus bradycardia.  I am trim, in my 40s, male, and have a family history of heart disease and hyperlipidemia (among other things...).  I am currently on Toprol XL, but I don't know if that is best for this situation.

I have been researching this issue and there seems to be a lot of contradictory information.  The doctors themselves seemed to diagree with one another.  One cardiologist said that these rhythms in my case are significant, and another from the same group said that they were not significant, that the heart is healthy and forget I was even told these results in multiple facilities by different professionals.

The doctor who seemed to think that the condition should be treated was talking about medication and if that does not work then possibly an ICD.  The other doctor wouldn't even talk about the rhythms saying that they were normal.

I was given nitro after a stress-test today, and this seemed to control the beats for about 3 hours.  
Then they slowly started again.

Now, I am not ignorant about my health and my heart.  I know what is normal, and this was definitely NOT normal.  I would not have bothered going to an ER over one or two PVCs.  This was hour-long+ periods accompanied by shortness of breath and some pressure and mild pain.

Unfortunately, the physician who ordered my transfer to his hospital is the one who doesn't think there is a problem (he viewed the ER ecg and other tests before he authorized the transfer).  He was also the one who discharged me three hours ago.  I spent 2 days in hospitals only to walk away with a very big question.  What should I do next?

I am not interested in playing doctor against doctor.  All I want to know is which one was more likely to be right so I can pursue that course of action.  Some information on the net supports both opinions!  It is hard to decide what to do.

If I do choose to ignore this problem, are there any warning signs that I should look for with these multiple pvcs that should not be ignored?  My usual warning signs are already there... chest discomfort, shortness of breath, palps, etc.

If I do not ignore the problem and seek treatment, is it likely that the medication and/or ICD can shorten my life-expectancy as some doctors (on the net) claim.

Now, only after 3 hours following discharge, I have spent two hours of them same arrythmias and some tachycardia.  Not only do they not seem normal, they are annoying!

Thanks in advance for your advice.
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257552_tn?1404606154
Hi,

How well did your ♥ heart rhythm function during the Stress Test, normal Rhythm or otherwise?

You mention Bigeminy and Triplet, these are two significantly different rhythms. One is a PVC every other beat, the other is three PVCs in a row. (I suspect you know that, I am merely tyring to be sure that you weren't referring to Trigeminy ;-)

Did you have an Echo Cardiogram and/or Echo Stress Tests? How about Cardiolte or Thallium Stress Tests done?

I was traveling along the highway years ago, and developed a rhythm where my heart felt like is was all over the place. I made my way to a small hospital’s ER, and onto the EKG monitor I went. Although my rhythm was restored by that time, my EKG says that I have indications of an old Myocardial Infarction. The Doctors looked quite serious about it, and they phoned the Internist whose care I was under at that time. They sent the EKG to him, he compared it and said “give him a little more Inderal (my prescription Beta Blocker at the time) and send him on his way”. They looked shocked. There can be quite a bit of disagreement between Doctors.

Ignore the EMTs’ raised brow assessment. They are invaluable (the EMTs), yet they are not Cardiologists. After suffering increasingly from PVCs one day at work, I had enough and phoned for the In-Plant Ambulance to take me to the Medical Center. Before they arrived, I realized that my resting pulse was higher than normal, and I took ¼ of an Atenolol that I keep in a pill case on my Keychain. Oh well, before they arrived and had loaded me onto the Ambulance, my heart rate was already dropping. While taking my Pulse, the EMT looked like he felt something wrong, but I could not feel any PVCs. I asked him if it was ok, and he replied that my pulse was “weak”, scaring the hell out of me. By the time I got to the Medical Center, I had no PVCs to be seen when they hooked me up on the EKG. I felt like such a schmuck. (I was glad my rhythm was normal again).

The important thing is to secure the data, Thallium or Cardiolite Stress Test, Echo Cardiogram, Holter Monitor, Blood Work, etc. Only this was can they be sure that your arrhythmia is not caused by a structural problem with your heart. They can be very confident at that time that they feel your rhythm is stable (not necessarily normal in terms of nice uniform beats).

The Best for the ♪♫♫ Holidays ♪♪♫ and the year through.
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Avatar_n_tn
Thanks for the reply.  I understand what you are saying.  

I did have a stress echo and a Thallium injection (they were out of Cardiolite).  I requested a copy of the results because of the confusion I had, but some of the information is a bit vague.

The stress portion says, "...widened P wave with bigeminal and trigeminal PVCs and PAC triplet...."  I should mention here that neither of the physicians ever said anything about PACs to me directly.

The echo portion mentions, "...mild thickening of the right coronary cusp and blunting of the LV septal wall...."  This was never told to me either.

The thallium scan results discusses, "...heart rate out of normal range requiring frequent test pausing."  I knew about this, since the tech explained that the alarms I was hearing was periods of bradycardia and tachycardia during the test.  She said that the scan was longer (an hour or so) than usual because of the temporary pauses in the scan.

I am, of course, picking small phrases out of the entire report.  Much of it discusses functions within normal ranges, and the general impressions were... "essentially normal."

I can quote in much more detail than this, but I don't know if it would be any more help.

So far today, I have only had a very few arrythmias.  I did, however, schedule a followup with my personal physician.  I have been under his care for years, and I will bring him a copy of your post.  Perhaps a 24 holter monitor isn't a bad idea.  That would give him a full idea of the heart action during a normal day of activity.  I will ask him about it.  I see him on Thursday.

Thanks again for your reply.  I hope that you have a very merry christmas season and a happy new year.
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525600_tn?1213032448
I would look at sick sinus syndrome as a question for your doctor (Hopefully a EP) I can relate to them no mentioning your pac's a simliar situation happend to me. I also noticed with beta blockers controlling heart rate they also send your bradycardia into a slower beat which in my opinion results in pauses and more pvc. It feels like my heart is jumping trying to make up for the loss of pace. Not a doctor just suffering for years myself. Good Luck
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Avatar_f_tn
Well, I sent you a message Squirrellyticker, but I'll tell you here that I have Ventricular tachycardia and it sounds an awful lot like what you're describing. I won't begin to analyze all this heart stuff, but you've got two doctors with two different opinions and this is your heart, not whether you should go to Harvard or Yale. Do you instinctively trust one more than the other? Maybe you should get a third opinion. In my case, I only saw one electrophysiologist and he conferred with his practice colleague and they came to the same conclusion. Personally, if one doctor told me something was serious and another told me it wasn't, I'd probably ere on the side of caution. I have an ICD. It's really not all that bad, unless what you're saying about life expectancy is true and I hope it's not. I'm only 34.
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Avatar_n_tn
I can relate to what you are describing.  The past year I have had the same bigeminal problems, along with severe chest pressure, mild pain, shortness of breath, palpitations and general malaise.  I work full-time in a very stressful job, and doctors kept saying it was stress. After a couple of trips to the ER, my cardiologist considered starting me on Tambecor, IF my heart was completely healthy other than the conduction problem.  I had a heart cath (no blockage), stress test, echo, etc.  Everything was good, so I started the Tambicor.  (By the way, in the ER, my bigeminy caused my pulse to be 20's to 30's. I felt AWFUL.  On the monitor, my heart rate was 50's, but the PVCs did not perfuse, so my pulse was half my monitored heart rate)

The day after the first pill, I could feel the conversion, and I never have felt better in my life.  That first weekend, I cleaned out closets, put in a new sink, started cleaning out the attic, gardened, and felt better than I had in years!!  Since then (four weeks) I have almost totally redecorated and renovated my house!  I hope it lasts!

There are a lot of side effects possible with Tambecor (have to go back to doctor every two weeks for a while to monitor my QT intervals on EKG) but so far, I haven't experienced any.  It's amazing the difference you feel when your heart beats properly!!

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