More PVC's after exercise

[MegMc]

I’m a 27 year old female, thin, a frequent exerciser, good diet, no smoking, glass of wine sometimes.  7 weeks ago I suddenly started having hundreds of PVC’s a day (I didn’t know what they were when they started, and thought I was dying).  I don’t think I was under any particular stress at the time, though I am a worrier in general.  I stopped all caffeine, but that didn’t help.  I saw a cardiologist, and had the usual tests:

Blood work – thyroid, iron, potassium, calcium, all normal
2 normal EKG’s
Stress test – PVC’s went away at high heart rate, though they showed up before and after.  Doctor said I was in good shape and it was safe to exercise.
Echocardiogram – Normal.  No “significant” MVP.  A bit of regurgitation somewhere that was said to be normal.
Holter monitor – showed 1080 PVC’s in 24 hours (I feel them but would have guessed a lower number).  Infrequent trigeminy.  Showed 1run of SVT in the evening that was only 3 beats and I didn’t notice.  Some Sinus brady and tachy that nobody seemed worried about.  The most PVC’s I had were 11/minute and 290/hour.

What worries me is that the minute and hour of highest PVCs occurred just after I finished a cycling class.  I do often notice more PVCs after I work out (though I have them before I work out too).  In light of that new study about recovery PVC’s, this makes me scared and confused.  Also, 11 PVC’s in a minute is over the limit of “normal,” from what I’ve read.

My questions are:

What does this mean in my case?

Does the “risk” involved with recovery PVC’s mean a person is more likely to die suddenly after exercise?  Or does it mean a risk for heart disease down the road?

Could my cardiologist have been wrong about it being safe for me to exercise?  I usually exercise for longer than the 14 minutes I did in the stress test.

Should I take a beta blocker to try and stop the post exercise PVC’s?  I wanted to avoid beta blockers because I’ve been hoping I’d improve on my own.

Thank you!

[Michael J. McWilliams, M.D.]

There is not an answer to this question yet.  It is true that the study showed an increased cardiovascular risk for recovery phase PVCs, but there is not study or data on how to safely reduce them and if they were reduced, is it prognostically significant.  I look at this as I do other cardiovascular risk factors like family history of heart disease -- it might be there but you cannot change it.  Focus on the ones  you can change -- don't smoke, treat high blood pressure and diabetes.  What makes it difficult is that family history doesn't remind you that it is still there >1000x per day and I understands that feeling them makes it hard to forget them.  There is probably little harm in trying a beta blocker, but there is no data to suggest that beta blockers reduce this risk either.

I know this is clear as mud, but it is the best I can say for now.
I hope this helps.

[ireneo]

What I've found (that works for me at least) concerning post exercise PVC's is to have a good cooling off/slowing down period. If I go from treadmill to dead stop, my heart protests. Even when doing weights, I sit for a moment before standing up. Otherwise my heart protests with ectopics or tachy.

When I had my treadmill stress test I did fine until they suddenly stopped it and told me to lie down for the recovery portion. I could feel my heart hiccuping all over the place and the women administering the test were not happy. Kept saying, 'You're having a lot of PVC's." I told them it was fine, they'll stop. But they didn't allow me a slow down period so my heart went wonky.

Anyway, that's what helps me the most and keeps me going to the gym.

[Michael J. McWilliams, M.D.]

Ask your doctor if exercise is ok (I shouldn't make that determination) but I would tell a patient in my clinic with normal studies that it is ok to exercise.  There is no data to the contrary.

[tickertock]

I think the study about EIVAs was on men only , though it was being used as general guide , but both diabetes and hypertension in men & women show a difference with increased cardiovascular event with diabetes the risk for women 4 times more than men and hypertension affecting men 2 times as much as women, it could be vice versa but i think I remember it correctly.It might be different in regards to PVCs but no study with women were done. Overall there was only a slight increased risk with a caveat at the overall clinical prognostic value.

[e.r.boy]

Try this link. Its actually called radiofrequency ablation. Hope its available soon.


http://www.utoronto.ca/respirology/JC0711Terry.pdf

[upbeat633]

I know you posed the question to the doctor, but I wanted to provide my opinion on seeing the EP.

I have a long history of pvcs, and like you, my pvcs go away at higher heart rates. That was confirmed on a treadmill test and I see it on my own when I exercise. But boy oh boy, I can get lots before and after exercise. I have, on average 1200/hr. every day, for months and months (unless I can get my heart rate above 120bpm.).

Anyhow, to my thought on the EP. I too wondered if there was something more that could be done or suggested. So for the first time in my 27 year history I recently went to see one. He was very nice, but asked why I was having so many tests done. They are pvcs after all, he smiled. He did suggest an event monitor so that I could capture the long strings that I sometimes get. But I suspect he's going to look at the recordings and the answer will be the same. Pvcs are benign even if you get 3, 4, 6,10, 20 or more in a row.

I encourage you to have an EP visit if you still have questions or concerns. It is the only way to get all the answers you need. It's just that mine wasn't that productive, except that he suggested a beta-blocker (acebutolol/sectral) that seems to stop the long strings and doesn't make me tired. I have been able to continue to exercise without feeling like a slug, but it is very difficult to get my heart rate up much past 110bpm and the pvcs seem to stop around 95 bpm now.

[cincin76]

Thanks for writing....I too read something about a procedure on the bronchial tubes..it was done with hot water...and they go in and burn them in a way that dialates them....don't know if that's what you are talking about....if you have it can you give me the website for the study...it always gives me a little hope to read things like that.....I would give anything to have some kind of new procedure to help us...all these drugs...I'm sick of them...and you are right we can't take beta blockers because they make our asthma worse...and those are the drugs that are less dangerous...the ones they offered me have more complications to them...so I won't take them....my PVC's have settled down just a bit in the last few days...but they can start acting up any time...I feel like it's a double whammy, asthma and heart issues...it's just not right...hope you feel better..keep it touch....Cindy

[e.r.boy]

I too have asthma and PVC's. In the next 5 years they may come out with a procedure where they ablate your bronchiol tubes to reduce or eliminate the spasms of your airways. Studies suggest you may reduce or eliminate your meds. We will never get better if we have to take bronchiol dilators daily. They do the complete opposite of beta blockers.

[MegMc]

I don't know if you will answer this question, or if I need to post a new thread.  I'd be grateful for advice from anyone.  As I said in the first post, I have had a treadmill test, an echo, and a Holter to determine the significance of my PVC's, and they all indicated that they are benign.  

I have seen a cardiologist but not an electrophysiologist.  I have not had a stress echo.  Should I see a cardiac electrophysiologist or have any more tests?  How would I go about finding a good one?  I'm in NC.

[Runman]

Interested in your post...I'm 62, avid distance runner...have pvcs for over 40 years but sometimes I get them post running....they do tend to come when I stop quickly like you said....but not always....I can go weeks w/o any post run pvcs and then they suddenly appear after runs....do you find this to be true for you also....I've had every test known to man and they say i'm fine.....when they are post running it's scary because I try to stop them by coughing, sitting, etc.....wonder if any of you try and stop them by doing these things....I know I should "cool" down.  they do to not appear as often if i do....thanks for your post and keep running....take care

[cincin76]

Thanks for your kind words...I agree knowing we are not alone makes a huge difference for me...and I agree if PVC's were horrible...we'd all be dying and I never hear of people dying of PVC's.  I'm in a pulmonary exercise class(for people with lung issues), mine aren't as severe as some of the people in there(older people with emphysema), but my Dr. allowed my to go into the class...but I like it because they can monitor me and I can exercise...I admit I'm afraid to go out and do it alone with the PVC's all of the time.  Yesterday they hooked my up to the heart monitor while I was on the treadmill and I had 3-4/per minute...but not every minute...and they told me they weren't concerned about them at all..and believe it or not I only felt a couple..and felt good until last night, and my heart was a little wacky, more racing, then PVC's into the 115 range...but that hard when you are trying to go to sleep.  But I must admit....this time when the PVC started up this week...I immediately started reading about them and everyone, on all kinds of sites complaining about them...and I have felt much better about them....before when I would have them...and not have anywhere to go or to talk to anyone about them, that's when I just let my imagination run wild, and I felt even worse....I am just starting a meditation CD and am looking for a Yoga class...I realize I need to mellow out about them.

I'll keep in touch...please let me know how you both are doing.

Cindy

[MegMc]

I feel your pain!!!  It is nice to know that we are not alone, isn't it?  I hope you feel better soon.  I'm still having a lot of skipped beats, but I have been more positive today.  Today I was reassured again by a doctor that in a structurally normal heart, PVC's are basically harmless, and the risk of sudden death after exercise is not really any higher than in a person without PVC's.  I know there's some conflicting information out there (have you read the post with 35 answers?).  But if people were dying from PVC's, we would know about it!  Doctors would not tell a person with a dangerous condition to "try to forget about it," like they do with people who have PVC's.

Have you tried yoga?  I have been doing that lately, and while I haven't really had a reduction in PVC's, it is a good way to stretch and get some gentle exercise.  It makes me feel very relaxed.  I was just reading the other day how yoga can lower your blood pressure, which is great for your heart!  You could start with a beginner class if you've never done yoga before.

Megan

[cincin76]

I'm having a lot of PVC's while exercising too...I get them at other times...but they increase when I exercise.  I am an asthmatic, so I take albuterol...and unfortunately that stimulates my heart and makes them worse...but I came on this site to get a little comfort about these episodes.  I have had pvc's for years...I've had over 1000 a day, like you, and they scare me and then I don't want to do anything.  I did start taking Ativan when they were at their worst and it helped greatly, but I don't recommend it..because it is addictive...and brings on its own problems...now that I am tapering down from the Ativan I feel that the pvc's are worse too.  I read what the Dr. said...that sometimes we just have to take care of the things we can...but that still makes me miserable when I try and do the thing that everyone says is so good for you...EXERCISE!!!!

I'm sort of a wreck right now...and I think the stress I feel about it is making it a little worse,  but the anatomical issues are still there despite the stress.

Cindy

[MegMc]

So It seems that I should continue exercising, because that would reduce my overall risk for heart disease?  

In other words, recovery PVC's are not a sign of exercise itself being harmful, and stopping exercise would not remove the risk?