Heart "Quivering", etc. Episodes

[angelize]

I hope you can help. With a holter monitor test I have been diagnosed with PSV, PAC, and PSVT about 5 years ago. It got worse in the last year (I think because I have become very sick with chronic severe lyme disease it has affected my heart too). My cardiologist put me on Toprol 50 mg XL, which seemed to help the fluttering for a while. But now in the past month I have been having bad episodes of my heartbeat pounding fast, feeling faint, feeling pressure in chest and sweating, it will even wake me up at night and usually happens while laying down. These episodes can last from 10 minutes to hours with breaks in between. What really concerns me is that I also sometimes get that intense quivering feeling like my heart is spasming for a few seconds (very intense and scary!) this comes sometimes with the fast beat and sometimes just out of the blue with normal beating, I am getting this almost daily, sometimes a few times a day. A few times the quivering lasted longer than a few seconds and I almost passed out then it stopped, the worst one I felt that lasted possibly nearly a minute or so, a squeezing chest pain came with after a few seconds of the "quivering". I feel my heart is going to just give out one of these times! I also get episodes of very low blood pressure (89/45 or around that), especially during the "fast beating episodes" - Normal for me is 127/74. What I really worry about is the intense "quivering". I also sometimes feel a sensation in my chest just before it starts. We did not catch an intense "quivering" episode on the holter (I only had slight "flutters" while wearing that) Could a PVC feel that intense at times? It feels like erratic flopping or jerking, or quivering real fast. I am so scared of this, any ideas what this could be? Also, could alot of PVC's, PAC's or PSVT's or fast beating episodes be hard on my heart? (all of those did show up on the holter). But especially let me know what you think the quivering could be, & what you suggest.

[Michael J. McWilliams, M.D.]

There are several key elements in working up symptoms like yours.  
1. EKG
2. Echocardiogram
3. Sometimes a stress test, if indicated
4. Very important -- wearing a monitor during the period of your symptoms and being able to correlate the time of the symptoms with the heart rhythm at the time.  This the only way to truly answer the questions.

The first three tests are a matter of risk stratification and determining a list of possible causes.  It is very rare that symptoms like you describe are dangerous in some one with a normal EKG, normal ECHO, and normal stress test.  The key element is seeing the heart rhythm while you are having symptoms.  I have seen this work both ways -- someone with a diagnosis of  SVT and a normal rhythm while having symptoms and others with a diagnosis of anxiety when they in fact have an SVT.  It sounds like the next step for you is a 30 day event monitor for you to press a button to record the rhythm when you are having symptoms. It is very difficult to tell what the fluttering sensation is without capture it on a monitor.

I am going to shoot from the hip here and be pretty honest.  I have met many people with a diagnosis of chronic lyme disease and very few of them actually had it.  Most of them have had was it called "fibromyalgia" or some form of autonomic dysfuction that leads to intermittent lightheadedness, SVT which is usually sinus tachycardia and constant fatigue.  This is often the case when someone tests negative for lyme disease but they have lyme disease despite the test being negative.  I imagine you ran across these terms while you were trying to figure out what was causing all your symptoms.

I hope this answer is helpful to you.  Good luck.

[angelize]

Thank you for the recommendation on the further heart testing. I will check into that.
In response to your comment on the lyme disease, yes, I do have it and the fatigue is a result from it. Lyme is very prevalent in my area. I was diagnosed in February, although the doctors suspected it and treated me for it the year before, but I kept relapsing and getting worse with each relapse. The fatigue is a later symptom of that, I ended up with that after my last relapse - never had fatigue before I got lyme, I used to be very active. It is well known that chronic lyme can cause chronic fatigue and severe pain. I talk to many people who also suffer with the same problems from lyme in my area, and support groups. I also have many other symptoms as a result of the lyme - including the neurological symptoms such as numbness and bells palsy which has improved with antibiotic treatment, and too many other symptoms to list here! - I have more than enough lyme info. from my lyme-literate doctor & numerous other sources. I have heard about chronic lyme affecting the heart in some people, and my condition has become quite worse since the lyme - I am just hoping it is not making it too serious.
I really need to find out if these quivering episodes or PVCs can cause cardiac arrest - Is that something I may have to worry about?
Thanks for your help.
Angelize

[Michael J. McWilliams, M.D.]

If you have a structurally normal heart (echo), a normal EKG and normal stress (only needed in some people), your risk of VT/VF from PVC is the same as people without PVCs.

The chronic lyme that I was talking about is with people with negative lyme titres but are given the diagnosis anyway.  If you have a positive lyme test, that is different.