More questions about PVCs

[deedle1976]

Dear Doctor,
Dear Doctor, Could you answer these question please. The questions belong to Michael who is very worried about PVCs.  His questions require a more technical knowledge of the heart than a non medical person like me would have. I will send him here for the answers.

Here are michael's questions.

" 1.i'm 34 and had panic disorder my whole life never felt pvcs except for like maybe one pvc a year. how how all of a sudden at the age of 34 i started to feel them more? is this normal with everyone here? i notice most people writing that they have had it since childhood

2. Do they get more frequent as time progresses? i mean i only get like 15 a day now but how bout like a couple of years from now is this a slow progression where i will get thousands later on?

3. if PVC get more frequent does this not increase our chances of developing V-tach?

4. How about the dreaded PVC on T wave phenomenon. i read somewhere that if a PVC falls on a T-wave then you can go into Ventricular Fibrillation and i'm sure we all know what that means. So what is that like a roulet wheel ? hope out of all the PVC one does not fall on a t-wave? how is that not dangerous?

5. And whats the deal with people writing that they can longer work out, what happens if we get them working out and don't stop working out will they get out of control and go into v-tach or something. i mean this is freaking me out i want to join a judo team and i'm scared to go all out and fight and then go into a dangerous situation .i'm sorry about the million questions its just that all this stuff is so confusing to me. On the one hand we are told that its not dangerous on the other people seem to have limitations from them i'm just really confesed about the true facts of this condition "

Thank you very much.

[Michael J. McWilliams, M.D.]

Hello Michael,

1.i'm 34 and had panic disorder my whole life never felt pvcs except for like maybe one pvc a year. how how all of a sudden at the age of 34 i started to feel them more? is this normal with everyone here? i notice most people writing that they have had it since childhood.

I see patients with both scenarios.  I treat both situations the same -- I make sure they have a structurally normal heart.  This is includes an EKG, echo, and history/physical exam.  IF there is any question from the previous tests, additional studies may help like a stress test or MRI.



2. Do they get more frequent as time progresses? i mean i only get like 15 a day now but how bout like a couple of years from now is this a slow progression where i will get thousands later on?

There is way to know for sure how it will progress. My current approach focuses more on making sure there is not a structural reason for the PVCs.  There is no way to know if they will progress or not.



3. if PVC get more frequent does this not increase our chances of developing V-tach?

This is a common question.  There are some people with a structurally normal heart, PVCs, and VT.  The VT tends to be monomorphic and amendable to ablation.  This is a rare though.  Some people also have non sustained VT (more than 3 or more PVCs in a row).


4. How about the dreaded PVC on T wave phenomenon. i read somewhere that if a PVC falls on a T-wave then you can go into Ventricular Fibrillation and i'm sure we all know what that means. So what is that like a roulette wheel ? hope out of all the PVC one does not fall on a t-wave? how is that not dangerous?

If this happened frequently, we would be putting ICDs into everyone.  This is just not a common event -- we just don't see it.



5. And whats the deal with people writing that they can longer work out, what happens if we get them working out and don't stop working out will they get out of control and go into v-tach or something. i mean this is freaking me out i want to join a judo team and i'm scared to go all out and fight and then go into a dangerous situation .i'm sorry about the million questions its just that all this stuff is so confusing to me. On the one hand we are told that its not dangerous on the other people seem to have limitations from them i'm just really confused about the true facts of this condition.


I think the reason they don't want to work out with PVCs is because their adrenaline is already up and a PVC during exercise is that much more noticeable.  If they are nervous about PVCs at rest, exercise PVCs can be more noticeable.  In a structurally normal heart, there is not reason to stop exercising.

Your questions are filled with serious concerns and I am concerned that you are too worried about this.  We see this in people with anxiety disorders sometimes.  Are you taking anything for anxiety? It might help.  I am not saying that anxiety is the cause of the problem, but the PVCs may be making your anxiety worse.  Just my 2 cents.

Please take care and thanks for posting.

[deedle1976]

Just to add Michael I remember you saying that you have had normal echo, thallium stress test. Your holter only showed 8 isolated PVCs, not very many at all. Studies have been published in which about 21% of the population had more than 24 PVCs per day and 4 or 5% had more than 300!!. So your risk of any sudden cardiac event is no higher than anyone else you pass on the stress i.e. EXTREMELY low. You are way more likely to be hit by a bus (not that you should be worrying about getting hit by a bus!).  In fact your risk is probably lower than the average person you pass on the street as you have had all these investigations done and passed with flying colors.  Most people have never had an echo! Most people I know have never even had an EKG.
Also have you tried cutting out caffeine and cigarettes. Mine decreased from about 100 per day when I was a teenager to about 1 per day in my 20s after cutting out tea ( i drank alot). They only came back with avengance ( every minute, every day) when I got pregnant due to hormones and the haemodynamic strain of pregnancy.

[Michael J. McWilliams, M.D.]

Hormones can definitely do that to you.  Michael, your friend is right.  If you really want to help yourself, stop smoking now.  Cutting back on caffeine, tea, and getting more sleep may help..... good luck.

[Michaelccc]

thank you both for helping me with my concerns.

So i understand there is no way to know if pvc will get more frequent as time progresses. a couple of more question if you are still here doctor.

1. can pvc's happen without "faulty" or "extra wiring" in the heart? can they happen just with panic attacks without any sign of "faulty electric" or "irritable points" in heart?

2. how does one rule out any chance of having  VT  . my understanding of VT is 3 pvc's or more in a row . Sustained would be over 30 seconds. i remember about a month ago driving and i felt my heart beating. i can't describe it i literarly felt the contractions and pumpings in my heart at the same time i thought i would either literarly die or pass out. i'm not sure if this pass out feeling was intense fear of the feeling the heart beat or VT in effect. This was obviously never captured on a holter but it freaks me out to this day.

3. One time on my holter monitor a few weeks back i had 3 pvc's very close together , seconds apart. This happened during sex, i never have these feelings if i'm not having sex. My concern. If i'm having and do not stop or slow down will this not increase the chances of these pvcs coming closer and closer and closer together and eventually becoming pvc runs and VT?  I had a stress test and during running my pvcs were not present but i feel like sex produces PVC's in a different way. Any ideas about this?

4. Final question. What exactly are "late beats"  i had 2 "late beats" show up on a holter. under "Superventricular Events" section.  No dropped beats but 2 late beats with a    1.2    Seconds   R-R interval .   Thank you Doctor and Deedle

[Michaelccc]

[Michaelccc]

i would like to add that i had a holter, thallium stress test, EKGs, Nuclear Echo tests done after the incident i described with the passing out feeling while driving in my car. Just to rule out a few things you may or may not suspect due to that description

[deedle1976]

Remember I'm not a medical doctor  so Dr Mcwilliams can give a much more reliable answer than me but here are my thoughts.

How long did the sensation you had in the car last for? If you were having a dangerous sustained arrhythmia I don't think you'd have been able to drive, which suggests to me that you were not haemodynamically compromised  and your heart was still pumping blood around your body efficiently.
Also, I might be wrong, but I think I remember you saying that you got some PVCs just before this incident. It's highly possible that you were in normal sinus rhythm but the panic caused by the PVCs created an adrenalin surge that made your heart beat harder so you felt it pumping and contracting hard as you describe. In VT the contractions are weak so I don't think they'd be felt as you describe.  
As for the feeling that you would die or pass out this is usually caused by panic. I have experienced this and I know how real the feeling of impending doom is.
As you the PVCs during sex I don't know what causes that (maybe adrenalin from the excitement).I don't think they do stress tests for that!!

The docs don't usually answer follow up questions on the same thread (understandably) due to time constraints although Dr MJM very kindly does sometimes. If not you might have success posting another question around 1pm British time. It hasn't been full at this time whenever I have checked. (don't know what time that is where you are).

[Michaelccc]

i'm not sure how long it lasted maybe 30 seconds or so. and i really felt as if i would die right there. what does haemodynamically mean? like i said i'm not sure how to describe it. i felt the actuall pumping action of the heart. like the heart pressing and depressing. filling with blood and unfilling with blood. didnt hurt.  but scared the hell out of me. does this sound like VT?

[Michaelccc]

Also curious. Any idea what "late or dropped beats" are? i had 2  "late beats" on my holter. Said longest R-R interval was 1.2 seconds

[deedle1976]

It really does not sound like VT to me. VT is usually described as a faint fluttering sensation from what I've heard.  The heart pumps less strongly than it does normally ;it has less time to fill up with blood as the beats are so close together.
Haemodynamics refers to the movement of blood around your body ie your circulation and blood pressure.  I don't know what late beats are but I think everyone has a few funky beats on their ECG that are not PVCs or PACS.
Apart from the 1786 PVCs on my holter I had about 12 'other abberant beats' although I don't know if they were late beats. I saw the tape of them and they looked liked PVCs except they were not early. My cardio said it was totally normal out of the 100,000 beats we have a day to get a few like this thrown in and noones heart beats smoothly all day long.
In fact even with my very fequent PVCs they still didn't think I needed an echo. It was only because I had several changes on my ECG (6 of my t waves were inverted) that they did it to rule out peripartum cardiomyopathy and only because I pushed them to do it as I was worried.

[mbh56]

Can taurine and L-argine help to reduce and/or eliminate PVC's?  I have read several research articles that suggest that 10-20 grams taurine and 4-6  of L arginine is very useful in reducing and eliminating both the pvc's and pauses.

Can you comment?
Thank you,
Mark

[PVC man]

Sometimes you may really think there are no normal beats between PVCs but there very well may be.  For example, I take stress echo every year...this past year I began to get PVCs during the treadmill...well the adrenaline began to max out and I felt more and more PVCs.  The doctor told me to relax and encouraged me to go on.  As activity increased, the PVCs disappeared but I STILL felt as though I had failed with multiple PVCs together.

Well I was very relieved when he told me that I did FINE and that there were plenty of normal beats between and that they had captured all the PVCs on EKG and they were not a big deal.

My point is that sometimes its possible you might think there are no normal beats but there very well might be.

I think an event moniter that you could bring home would help you so that you could activate it when you felt your worst.

Good luck and feel better...

[marcusbrian]

I had PVC's - ectopic beat for over 12 months. I tried everything under the sun.  Finally, I connected the dots from my research on possible causes and found that my pvc's could be caused from gastric reflux.  So, I quite drinking cola (was drinking about 4 cans a day), took prilosec for 14 days, and purchased a very good grade of digestive enzymes.  I take the enzymes 3 times a day; at each meal.  I have been pvc free now for 2 months.  I still drink coffee, eat spicy foods, etc.  My research indicates that the reflux was putting pressure on my esophygous and causing the pvcs.  I'm cured.

No meds (other than the 14 day prilosec), no diet changes (other than quitting the soda), and just taking healthy digestive enzymes.  

[michaelgaul]

I don't want to steal any forums but i am just like the others but im 17, i am in excellent shape and work out everyday, i have had several ekgs and echos and one short stress test aswell as a 24 hour holter monitor, im relaxed in bed and a keep having PAC's its causing my SEVERE anxiety to go crazy and i want to freak out, im so young and  i keep going back to the doctor but i dont get any help they just say its "benign" and i beg to differ. what kind of test should i do and thats all i want to know? whats the second best step to go along with this?

( I only have PACs at night or thats when they bother me , i take Ativan and i get some Very MILD chest pain when working out very hard)
once again sorry for the budge in i just want to work with yall im very young and scared i wont wake up one of these days.