Lifelong Arrhythmia

Anyone have any advice? I have had a life long arrhythmia, (mostly PVCs and some PSVT, little atrial involvement) usually recurring in bouts, since I was 16 Y/O. I am now 50 Y/O.

I have had at least two relatively recent stress tests, the most recent 2 years ago being a Cardolite, the one before that, by about 2 or three years, with thallium. Though during the older of the two stress tests they believed that they saw an insufficiency towards the ventricular apex of the heart, they concluded that day that it was due to the length of my heart and shortcomings with the scan. The more recent one was supposedly negative.

Arrhythmia no longer substantially subsides, I have had three Holters and one event monitor in the last year to year and a half, showing nice examples of the arrhythmia. I seemed to have recently moved to a trigeminy that repeats for a few minutes, resolves, and recurs a short time later. Just prior to the beginning of the trigeminy,  I developed a swallowing induced component to the arrhythmia. For the large part, my rhythm is normal, except for recurring bouts throughout the day, especially towards evening.

Oddly enough, now, almost without fail, if I hold my breath in deeply, the arrhythmia resolves. (To recur a short time later when breathing again). Standing, especially as I tire more and more throughout the day, will initiate the trigeminy until, I guess, the homodynamics stabilize.

My Cardiologist is unconcerned. My family physician defers any such matter to the Cardiologist, but is also unconcerned. I know that I one time I was always told that PVCs while at rest, or while the heart rate is decreasing after exercise, are normal. Now I get them exercise induced as well, and the Doctors are still unconcerned. Being that the Cardiologist has a substantial amount of my records, showing historic EKGs, he feels that no ST Changes or other EKG Changes are noted. My machine interpreted EKG shows that I have had a heart attack, (it has shown this for years), but all the Cardiologists I have ever seen say that it is an artifact and not a real concern. Catecholomines from a 24 hour urine catch were normal. Electrolytes normal. Caffeine and adrenaline seem to be a substantial cause for my arrhythmia, so I avoid Caffeine, the adrenaline I am stuck with.

In addition to a host of other medications, I take Phenytek (phenytoin). I am aware that phenytoin can be used as an anti-arrhythmic, I take 300 mg bid for seizures. I have often wondered about the interplay between phenytoin with anti-arrhythmic characteristics and the Beta-blocker that I take. Too many specialists and too few Doctors willing to look at the entire being rather than microscopically at just tiny specialized parts.


Any guesses or comments?

Thanks in advance.

Artaud

[aussieman]

I also get falre ups where I get bigeminy, trigeminy quads etc.... from sunup to sunset and do know what you're going through. What meds are you on? I am on Flecainide with Tambocor beging a recent addition. What has worked for me is that when I do get these flare ups, I do know if I go back to a certain diet (eg. foods that I definitely know will not cause any pac/pvc's) the palps will subside. This bascially give me time to regain confidence. The diet I go back to is very, very bland and is akin to eating cardboard - but, it does work for me. Have you made a diary of what foods you are eating??as this could play a part in the number of palps you're getting.

[Artaud]

Hi,

Right now, I am on Atenolol and Diovan w/HCTZ. Also Phenytoin for seizures, ASA, Zocor, Paxil, Protonix, and Klonopin (as needed). I actually think that part of my problem is too many drugs.

I'd be happy to eat cardboard to get away from this arrhythmia for a little while at least. Keeping the diary seems like a good idea. The more I get of these, the less I feel like exerting myself. I probably get more because of a lack of exercise, and the cycle continues.

The Doctor mentioned sending me to an EP that would likely start me on Flecainide, but he (my Doctor) and the EP do not believe that my problems warrant it, as they are symptomatic only in that I can feel them. Anyway, this would leave me with the menagerie of drugs that I am on now, plus one more. Yuch! I wish I could find a good Internal Medicine Doctor in my area, as I need someone to consider all my health problems and prescribe from one vantage rather than many. I went to the Gastroenterologist, telling him about the swallowing induced arrhythmia, and my suspicions that it is caused by the Vagal Nerve, and he tells me that the Vagal nerve has nothing to do with the heart rate. I am thinking of finding another GI Doctor.

I feel as if I have an Autonomic Dysfunction, yet I can't find anyone willing to spend the time doing the tests.

Thanks ever so much for your suggestions.

[aussieman]

Just a correction on my last post. it should have read with Atenolol being a recent addition (not Tambocor). If it helps, this is the diet I fallback on when I get the flare ups (can take a few days for the palps to subside though, so be patient):

Breakfast: 4 x Wholegrain, organic 'weetbix' with warm skim
milk.
Morning tea (around 10.30 am): Cup of caffeine free tea and 2 x very
plain, preservative free biscuits (keeps the hunger pains away 'till
lunch)
Lunch: Green leaf salad consisting of: Rocket lettuce, baby spinach,
cooked sweet potato (keeps the carb cravings away), hard boiled egg
(organic grain fed hens), brocolli, avocado.  Any time afterwards I have
some water melon as a sweetener.
Afternoon tea: Cup of caffeine free tea and 2 x very plain, preservative
free biscuits (keeps the hunger pains away 'till dinner)
Dinner: same as what I have for lunch except I grill a fresh piece of
chicken breast, and also add in some organic mushrooms sauted in low
cholesterol margarine.
Supper: warm skim milk with 2 x preservative free biscuits.

I eat the same thing every day until the palps stop. I then keep
on this diet for as long as I can until I get the confidence to move out
of the comfort zone and try something else.

Hope this helps.

[Artaud]

Thanks again for the extensive post.

Have you identified the foods most likely to cause or aggravate your arrhythmia? I remember one Cardiologist complaining that people are the only animals that continue to drink milk as adults. I believe he was concerned about the fat in milk. I realize that some people develop an allergy to milk and milk based products later in life.

I had a coworker (who is now retired) that had various ailments. He was always in the best of spirits though. He had a heart valve replacement, knee replacement, and periodically would contract this or that ailment, some of which he had to be hospitalized for. (He was in his 50s when he retired, one could not tell by his attitude or appearance that he had so many problems). Anyway, he became sick again near his retirement and was beside himself trying to understand what was causing the problem. He got passed it one week, thought himself cured, then would be stricken again. A little introspection on his part, and one unexpected free lunch provided to his shop by a vendor, and viola, he discovered that he had a food allergy. (Confirmed by the Doctor). A food group (perhaps sea food) that he had eaten all his life suddenly was causing a serious reaction when he consumed it. Go figure?

Best of health and success in controlling your arrhythmia.

[hava]

As you mentioned, breath control helps. My suggestion is do this breathing exercise everyday. You will start to notice benefits. Your medical tests will go on, but if you do something yourself at the same time to help your body, you will feel in control.The first benefit will be better sleep.Keep a note of what improvements you feel.
Anulom Vilom - Deep Breath-in through left nostril keeping right nostril closed
then - Breath-out through right nostril keeping left nostril closed
then -Deep Breath-in through right nostril keeping left nostril closed
then - Breath-out through left nostril keeping right nostril closed
and repeat this cycle for upto 20  minutes twice a day(maximum 60 min/day).

[RC1088]

Every time I think I have a certain sequence of certain foods that help alleviate PVC's, the PVC's eventually defy it and the combo no longer works.  

I do supplement with Co-Q 10 enzyme capsules and an herbal known as Hawethorne (ground up hawethorne flowers, leaves, and berries in a capsule form).  Those two seem to help sometimes. Both claim to be "good for the heart" supplements.  

[deedle1976]

Hava mentioned breathing exercises. Here's something from the international journal of cardiology to back that up.

Effect of deep breathing at six breaths per minute on the frequency of premature ventricular complexes.

Although the effect of reflex increase in vagal tone on the frequency of premature ventricular complexes (PVC) is known, the effect of timed deep breathing on the frequency of PVC has not been reported. We serendipitously discovered that deep breathing at six breaths per minute abolished PVC in an 18-year-old female with frequent PVC, anxiety, and palpitations. In five of a series of 10 consecutive patients with frequent (> or = 10/min) unifocal PVC, deep breathing at 6 breaths/min reduced the frequency of PVC by at least 50%. This is possibly due to increased vagal modulation of sinoatrial and atrioventricular node. However, factors predicting the response to deep breathing, and the mechanisms involved need to be studied in a larger number of patients.

[Artaud]

I have been away for the weekend.

Thanks to all for your replies on this issue. I had the occasion to see my Family Doctor Friday, and among other things, mentioned my ongoing arrhythmia. He, as usual, was not concerned (he is apprised of the testing and diagnosis by the Cardiologist, I guess being the nature of Managed Health Care). I told him that if I hold in a deep breath, it stops the trigeminy. He believes that it is a vagal reflex similar to the bearing down common to people with PSVT type arrhythmias used to try to interrupt the cycle.

I will try the Anulom Vilom and controlled breaths per minute as mentioned in two separate responses. I breath like a hamster, shallow, fast and frequent.

Reading articles on Safety Topics (Safety is part of my responsibility at work, I am part of a Union Appointed Committee that assists/oversees the Safety Operations at our facility) and was surprised to find out about Oxygen (O2), Carbon Dioxide (CO2), and Respiration. In the context of Inert Gasses, such as Nitrogen, if an individual were to enter a room filled with Nitrogen, (therefore lacking Oxygen), I would have thought that they would get the feeling of suffocation quickly and be alerted to leave the room. Not so, according to my reading. It appears that an excess of CO2 is largely what produces the feeling of suffocation, as well as increases respiration and heart rate. In a room filled with Nitrogen (therefore little CO2), they won't get that feeling, and the possible danger of rooms that can fill with Inert Gasses become evident. (These room are equipped with Oxygen Sensors that alarm if the O2 drops below 19.5%).

Continued reading showed that when one hyperventilates, the lack of CO2 is a factor in the physiological response of panic and other symptoms. So, by extension, my breathing in tiny and frequent hamster like breaths (this is an exaggeration, I am trying to be humorous about rapid breathing rather than the deeper breathing with pauses at the inspiration and expiration that we usually know so well that occur just as we are falling off to sleep or are adequately tranquilized) is sure to be causing some unnatural response by my body. In addition, when I have been most symptom free, I have been aware of the deep and natural style of my breathing, yet I do not seem to be able to adequately reproduce this breathing technique to my own advantage when I am symptomatic. I am working to see if, in my case, my shallow and frequent breathing may be causing or exacerbating my problem.

Thanks again to all.