One nsVT episode on my 24h Holter - is it really so dangerous?
I am 26. At the end of February I have started to feel some singular, strong heart beats every day. The feeling was that as if I had forgotten to breathe for a second, then had take one deep breath and then those heart beats were comming with a feeling of anxiety and scare. I have decided to go to a specialist with those symptoms. I got reffered to blood test (morphology), holter ecg 24 monitor, 24 h blood pressure monitor and hearts echocardiography.
The blood test was ok - I have got a bit too high level of sodium (146 mmol/l with max of 145 mmol/l).
The 24 hour blood pressure monitor showed small hypertension (my average day result was 141/81 when standard should be 135/85, and my averagenight result 129/69 when a norm is 120/70).
My echocardiography was ok, it didn't show anything, which could have influence on the hearts rythm, the anatomy was correct.
And there it comes to 24 hour holter ecg monitor... It has caught nsVT episode with 11 beats with fastest V-Tach 161 bpm - at 8:25. The whole VENTRICULAR ECTOPY statystics are shown below:
All VE: 118
VE Pairs: 0
Longest V-Tach: 11 beats at 20:25
Fastest V-Tach: 161 bpm at 20:25
Slowest V-tach: N/A
VE`s per 1000/per hour: 2/6
VE total : 118
V-Pair total : 0
V-Run total (V-Tach) : 1
Longest V-Run (V-Tach) : 11 beats at 20:25
Max HR V-Run (V-Tach): 161 bpm at 20:25
Min HR V-Run (V-Tach): N/A
VE's per 1000/per hour : 2/6
Ventricular R on T : N/A
And the rest:
Min HR : 46 bpm at 8:06
Max HR : 135 bpm at 8:59
Avg HR 24 hours : 87 bpm
Min HR hourly : 70 bpm at 4:00
Max HR hourly : 105 bpm at 9:00
Analyzed beat : 116365
SVE total : 0
SV-Run Total : 0
Longest SV-Run : N/A
Max HR SV-Run : N/A
SVE's per 1000/ hour : 0/1
Total aberrant beats : 0
Atrial Fib/flutter : 0.0%
ST SEGMENT ANALYSIS
Total ST Minutes Ch.1 : 0
Total ST Minutes Ch.2: 0
Total ST Minutes Ch.3 : 0
Max delta ST depression : N/A
Max delta elevation : N/A
Max ST episode : N/A
Max HR in ST episode : 0
First, I need to confess, that I am really scared after speaking with my cardiologist, when she had seen the results of my 24 h holter monitor examination - the point of her(and, from now on, mine especially) concern is V-Tach noticed on 20:25. She told me, that it is a very dangerous type of arrhythmia which can cause fainting or even death. I need to tell you that I am true valetudinarian - I tend to analyze the worst possible scenarios when I feel any ailment and to be worried about it. So when I have seen the concern of my cardiologist I don't need to describe you, what influence on me it has... I have been prescribed betaloc 50 mg once a day, and 2 magnesium 500 mg pills twice a day.
One important thing: on January and March I have got some serious issues on personal nature which was a really stressful time for me (in fact it is still), this combined with difficult situation in my job made me feel really bad at that time - I have got holter examination then so I suppose that it could have an influence on its results. Now with one more problem - being so worried about my health, I am totally down:/
What concerns me the most... is this episode of V-Tach really so serious? Am I in danger of loosing consciousness in every moment, or even have sudden cardiac death? Is it really something bad with my body, heart, psychology, my mind, so in case of stressful situations I have described, it ends with nsVT like the one caught during holter examination? I am not sure if my cardiologist did well by prescribing me strong heart medicine stright away, and frigtening me with possible serious consequences of my illness (I have been told that I am ill). When I was coming back home after this visit, suddenly I felt very fast hart beating with a feeling like my hart would jumped in into my stomach, I was in panic, for the seconds I was sure it is the end... After couple of minutes everything was back in normal. Now I know it was a panic disorder - first one in my life. I don't think it was accidence that it happen after seeing with my doctor ...
I wouldbe grateful for help with analyzing my results and telling me a bit more about nsVT episodes regarding to young people, without earlier heart issues.
PS. Sorry for some spelling mistakes - english is not my native language, but I tried to do my best so you can understand all from what I wanted to say.
Any ventricle problem is serious, the ventricles are the power pumpers, the atrium chambers play an important supporting roll, but are not needed to stay alive. I have permanent atrial fibrillation so my atrium chambers do not contribute to the loading of the ventricle chambers as they should. But my ventricles work well and that keeps the blood/oxygen moving throughout my body. I run through this just to emphasize how important the ventricle chambers are, so tachycardia of the ventricle is serious. However, a HR of 161, while technically tachy, isn't really very high. At your age and assuming reasonable physical fitness your heart could run at 160 all day and not do any harm. The harm comes if the HR goes much higher and if it goes into fibrillation - well it is all over.
I think (but do not know, you may get more inputs from knowledgeable people) you cardiologist is sharing that concern. But, I think many people live with nsVT at much higher rates (over 200) than you short 11 beat rate. Beta blockers help slow the HR down, but at some expense of side effects, some don't have much trouble with side effects. BB and I get along alright when I was not in AFib, now with reduced heart efficiency due to AFib the BB combine to give me some fatigue. Of course my age doesn't help any on that point either - I'm old enough to be your grandfather.
My problem is that I can not stop thinking about it all day long. As I said I had got some serious issues on personal nature before visiting my cardiologist, but when I have heard about what can possibly happen to me I think that I have lost control of anything - so depressed, can barely function in work, can barely live, my sofar personal issues have been put off for a while (just for a while I am sure, they are going to hit me hard again shortly :( ), because as you can see I have got another one. And those panic disorders - never had any before seeing with my cardiologist, now I have got one in 2-3 days, so difficult to fight the away just by myself...
Getting a grip on your emotions and other life pressures are a key to getting better, even is stopping the NSPVC. Sorry one of our PVC patients with lots of experience hasn't yet given you some inputs.
As for anxiety and depression, there are medication for those too, you may want to consider that with a doctor. I know people, my son for one, who has been on emotional medications over the years but is able to go medication free for long periods. He is a middle age adult now, so I don't get much from him on his health, but he is doing fine work-wise, so I suppose that means he's keeping it "all together".
A strong friend, help from a church if you have that connections, getting professional counseling from a psychologist are all tools to getting back in control.
Good luck, and just focus on getting better, coming to terms with all that is troubling - your young age is another strength you have working on your side.
1. You are not taking any "strong" heart medicines. "Strong" heart medicines are antiarrhythmics like Flecainide or Amiodarone. You are taking a "simple" beta blocker, used for everything from palpitations caused by anxiety to high blood pressure (and to slow the heart rate down for other reasons, and arrhythmias). Magnesium is a supplement, not a medication per se.
2. You may want to ask another cardiologist for a second opinion. Without by any means arguing against a doctor/cardiologist, but his comment sounds harsh and almost nihilistic. Yes, ventricular arrhythmias can be of concern, but the point is, the only time arrhythmias are of acute danger, is when the cardiac output is diminished. Typically that will only happen if the heart has suffered some sort of damage (like after a heart attack or heart inflammation) or you have some sort of congenital heart defect. Some ultra-rapid (polymorphic) ventricular tachycardias may be of concern in a healthy heart, but those are typically manifesting with heart rates far above 200. They would also usually cause "R on T" PVCs too (which usually is what is triggering them), as well as changes on the resting EKG.
3. Short runs of NSVT is a fairly common finding on Holter, and it's known most of anything to cause intense anxiety (or depression, read more about this under 4. below). Most cardiologists find them benign in healthy hearts, and as long as the echo is normal. By the way I find it extremely weird what your cardiologist has done; telling you this is dangerous and nothing more. If the arrhythmia had lethal potensial, he should have considered implanting an ICD or at least refer you to an EP/EP study. Which is the reason why I think you should bring the results to another cardiologist for a second opinion.
4. Your depressive symptoms is normal with this type of health anxiety (which by the way is very understandable after the comment from your doctor). You get sort of a "I think I'm going to die anyway, so why bother" sensation, or at least "this is more important than anything else in my life", leaving your life empty, feeling meaningless and exhausting. The thing is, you are not "really" clinically depressed. Just think, if you knew that your condition was benign, your depression would lift in minutes. This is anxiety - manifesting in a bizarre way.
See another cardiologist for further follow-up. You can't live your life like this - especially when you probably are a completely healthy young man.
I agree with Is Something Wrong. VT can be dangerous but if you only have extremely short runs that do not sustain and are not causing symtpoms and your heart is healthy then you are not likley in any more danger than anyone else. I think that the most important thing you can do is work through your depression and anxiety because those very well may be contributing to your pvcs and nsvt. Work through the emotions that are causing the ectopic beats to flare up and help eliminate the beats. Regardless so long as you try and maintain a heart healthy lifestyle you will like find yourself dieing from something totally unrelated to the heart well into your old age. So do try and address your emotional issues and take control of your life. Put your heart and mind to it and you will find that inner strength you need. Stay strong and maybe do as was suggested and get a second opinion. We are here if you ever need to talk.
Thank you very much, what you have written gives me some relief which I need so much. I really appreciate it. Thanks to you somene in the world (greetins from Poland BTW) can have better day.
Sad thing is that I get down with anxiety disorder almost strightaway :/ Got several attacks since meeting with my cardiologist (really one of the most terrible experiences in my life), got constantly higher BP (never got it before) at evening it can be about 190/110... I am so embarrassed that I am not able to deal with it like a man, but I can't help seeing myself fainting or even dying in the middle of the day, at work, at home... All I want is everything to came back to be normal. I was taking betaloc for one week, but felt totally exhausted after, so I decided to stop, maybe this is the reason of my BP so high, but taking medicines is difficult one for me, as it prooves my serious illness. I am afraid that my behaviour is making it all much worse for my heart, but I just cant act in different way, it is much stronger than me , I am so scared that I won't be able to go trough it :(
You are very welcome. Thank you and greetings from Norway :)
Again, it's very possible that you don't have a serious illness. That's why you should consider asking another doctor for a second opinion. If you search for NSVT under this forum, you will see lots of people with the same problem.
Of course no one wants their hearts to be less than perfect.. I know. But taking beta blockers are not the same as being seriously ill. I'm taking beta blockers just for premature beats.
Your blood pressure reflects your stress level and is another sign that you should see a doctor pretty quickly to get this all sorted out. You must be extremely anxious - and there is likely no reason to be. If you really are in danger from this, efficient treatment is available.
I too have had NSVT found on two separate monitors. One was a 4 beat run and the other was a 5 beat run. At first cardiologist was a little concerned so he sent me to an electraphysiologist at a large university hospital. They did a cardiac MRI and told me as long as there was no scar tissue I didn't need any treatment. So they released me from their office and told me I didn't need to come back unless it starting lasting over 30 seconds or made me pass out. So I would recommend a second opinion and possibly the MRI....
You should really never stop meds that were prescribed to you without first consulting with your doctor. You could have dire consequences as a result as some need to be weaned off. I would say your high bp may be a result of stopping the meds but do keep an eye on it as you should not let bp rates that high go unchecked. Over time it could damage your heart. That said, please do not be embarassed about your issues. Anything with the heart is very very scary so you are not alone in your fears but do try to remember that the heart is a very strong muscle and it can handle a lot and find all sorts of work arounds to keep us alive so do your best to work on your anxiety and you will surely see an improvement. Stay strong.
Thanks guys, I am trying to do my best. There are better moments, like these, when I am reading your posts, when I think I am able to handle this, but there are also the worst ones. I have been forbidden to take part in team games, but I hope that soon I gonna be able to play some football with my friends. It seems my BP came back to normal, at least this one is ok.
Again, thank you very much. You can't even imagine how much you are helping me. I am so glad, that I have found this place in the web...
I agree with everyone above. I had a 6 beat run caught on my monitor after I took a diet pill. Seems my heart reacts poorly to certain medications. But I do also have single beat PVCs and PACs. I have seen to EPs and a cardio doc all of whom are NOT concerned about this. They say this happens to many people and they do not even realize it. That our hearts are healthy and strong (as per the Echo) and it can handle it. That unless I do pass our or unless the runs last over 30 seconds, that I never even need to come back. I have choosen to see my EP yearly just for reassurance and a follow up.
Beta Blockers are not major drugs, they also help with anxiety. Have you tried it yet?
Yes, I tried it for about a week - I found my heart extra calm then, however felt so tired through all day... I have spoken with my cardiologist, and then she told me to take 12,5mg of betaloc instead of 50mg, and after some break I am going to start it again. Now I feel about 10 times more of PVCs that before... some of them in series of 7-8, which may be nsVT. My doctor still states that its very dangerous arrhythmia and it requiers treatment. Told me only to calm down - as if it would be so easy, after what I have been told about my condition at my age. What makes me worried is the number of my nsVT beats - its 11, as I read most of the topics here, the benign nsVT in most cases was 3 to 7... I have just read about ARVD and Brugada Syndrome... seems I am reading too much lately :/
Well it has been over 1,5 of a month since I have shared my story here. As you suggested me then I had seen to other cardiologist for the second opinion. I was lucky to live in the city where I could visit I belive one of the best EP specialist in this part of Europe (as from what I have read). Usually when someone wants to register for a visit in his office there is 2-3 months time to wait, but again I was lucky to register for an earlier appointment as someone had to postpone one. Obviously I had to pay some amount of money which was not a small one, however as it comes to my health there is no point of putting my money by.
I have there two times so far. At first visit he has calmed me down a bit, which I needed so much, however he reffered for another holter monitor a 12-lead one this time to see where my pvcs are coming from even if there wouldn't be any NSVT runs on it.
I have also decided to go to my first cardio. When she saw me, my mood and behaviour and how much I am worrying about all this stuff, I think she has understood she have overreacted at the first time. She has also started chilling me down, and reffered for another holter monitor. So during short period of time I habe wearing two holter monitors.
On the normal holter I was totally clear - 1 Pac, 0 PVCs, no couplets, salvos, bigeminy, trigemniny etc, however I was feeling that this was a good day. "Luckily" when I was wearing 12-lead monitor I was heaving really bad day with panic attack, I was sure there would be some NSVT on it, as I felt lot of hard pvcs and some of the slow runs of them. It showed 80 pvcs with 5 episodes of bigeminy which I felt very clearly (they appeared right after panic attack).
My first cardiologist was really optimistic about it (totally different as on our first meeting), and told me these are great results, and not to worry, but still she didn't want to reffer me to stress test (I think it is necessary).
My EP specialist after seeing these results was wondering what to do, and asked me if I want to have 30 day monitor with constant control by phone from their medical center, or simply to do an EP study (however he has told thet there is possibility that they would not be able to induce anything). I have decided for EP study. I am still waiting for EP study appointment (in my country there are long queues for it, but when EP specialist saw my anxiety he ordered a urgent study so I will not wait long).
I have chilled down a bit, now when I know that I will have an important medical examination to exclude possible serious issues with my heart. For couple of last weeks I feel good, just a few of pvcs a day, there are days I feel none of them. Cant wait for the study and I am dreaming of beeing alright after it.
How do you think, should I be reassured with my two lates holter results? Do some of you also feel this creepy bigeminys with one by one pvcs so hard that they cause shortness of breath (as mine often do)? During some of my "strong" PVCs I can feel very creepy sensation of backing up into the jugular in the neck for a second or two. Is this symptome normal as for PVCs? I have read that it may happen when a PVC fires while the tricuspid valve is shut, however I am not sure if I have understood it correct...
Now I am on 12,5 mg of metoprolol and 10 mg of escitalopram for my depression and panics attacks (yes I had to visit a psychiatrist :/ ). Is it safe to combine these two?
I have ectopics that have been documented as pacs and they feel much like you describe on the strong ones. Quick loss of breath and feeling of back up into neck. Ectopics can feel way different depending on where they occur in the beat cycle so I don't believe those sensations you're feeling are any concern.
Yes, I think you should be reassured, but just do as your EP tells you to, get a 30 days event monitor to be on the safe side. Your monitorings sound great! :)
As to your Metoprolol and Escitalopram, the answer is; yes and no. Escitalopram is boosting metoprolol concentration by inhibiting an enzyme (CYP2D6) which metabolizes Metoprolol, meaning that your effective dose is somewhat higher. Still, 12,5 mg is an extremely low dose and even with your Escitalopram, it's likely equalling no more than 25 mg, which still is very low. It's possible that your dose is this low because your doctor knows about this interaction.
Just keep that in mind in case your doctor decides to increase your Metoprolol. Most SSRI's have this side effect (inhibiting this enzyme). If it gets problematic, an SSRI without this effect is Zoloft, and a beta blocker not metabolized by CYP2D6 is Atenolol.
Again, I want to say THANK YOU for your time and help, can't find the words to explain how much it helps me. Now I feel better, but in the beginings of my story I doubt I would be able to handle it without a support I have been given here.
@is_something_wrong. I am really impressed by your cardiology knowledge. As I look on my first holter (the one I wrote in the first post) I am bit worried about growing number of PVCs from the mornig till v-tach appeared on the evening, heres what it looked like:
I remember this this day very well, it was a very stressful one. I was waitng for important call (which was really important as the future of relationship with my girlfriend was going to be cleared, and I was sure I would be the end of it - that was the base of my serious personal issues :/) at the evening as you can see on the numbers - the closer was time of call the more pvcs I had which has ended in v-tach. It really concerns me that my body reacts on stress in this way I still cant help thinking I suffer from Catecholaminergic Polymorphic Ventricular Tachycardia. Despite the fact that my cardio told me that this nsVT was monomorphic one, I am afraid it could have "potential" to becomy polymorphic one. My second holter didn't catch any NSVT but caught 80 PVCs with 5 runs of bigeminy as I previously wrote. There was 11 "forms" of PVCs which I suppose meant that they were multifocal ones, I am scared that having multifocal PVCs may mean that there are svereal places in my heart which can cause arrythmia and more likely polymorphic VT. Do these facts may mean I am in danger of suffering polymorphic VT (From what I know I don't have any family history of SCD at young age, nor fainting episodes or being hospitalized in young age because of heart issues)?
You do not have CPVT. First, CPVT will not manifest with monomorphous VT, second, it will only happen during intense exercise or very rapid heart rates. Polymorphic VT can have several forms, depending on the cause, which is almost always genetic malfunctions in the "streams" of various electrolytes in and out of the heart cells (usually too much calcium within the cell). Depending on the mechanism of the abnormal heart beats following this, the arrhythmia can either be "short-coupled" (torsades de pointes, caused by LQTS) or "long-coupled" (bidirectional VT, caused by CPVT). In any case, polymorphic VT would likely cause heart rates above 250 bpm.
Stress, anxiety, fear, anger, despair, almost any negative emotion, can cause and/or worsen premature beats and tachycardia. Do not, by any means, think that you'll have to have CPVT for adrenaline to trigger an arrhythmia. Your pattern of PVCs follows your stress level, which is very normal and very common. It's not at all unheard of that PVCs may cluster up in bigeminy or even short runs of VT.
Are you in danger of polymorphic VT because you have multifocal PVCs: No, not more than we all are.
Monomorphic and polymorphic VT have completely different causes, and one cannot "morph" into another.
Again you have put my mind at ease and I am really grateful for it.
Finally I have been told about my ep study date. It is scheduled on 12th of August. Of course I am a litte afraid of it as it is quite invasive type of medical examination, however I really hope to get some relief after. I am wondering what can I expect - would it be a good sign if they wouldn't be able to induce any arrhythmias like nsVT, VT. What counclusion after this type of examination my EP can draw? Can he know after if my heart issues are benign or malignant?
I do my best to think positive through last weeks, and I think it goes well, however last week I have had some nasty experience of very hard PVC which made me dizzy, it has happen only once before, I was scared it might be NSVT, but I was suremy heart didn't started to race with very fast rhythm, it was just really strong PVC. Then I had strange felling of cold wave going through my body form my neck to the feet, some dizziness, malaise, felling like presycope, but everything got back to normal in very short time. Can PVCs produce these kind of symptoms? I have read somewhere that how people feel them (if they feel them) is related to the moment of heart beat cycle when they occur. Is that true? In the end I feel normal, I feel PVCs rarely, but some of them can hit me really hard...
One thing I can't stop thinking about is that as you know, I am young, 26 year old person, I didn't have any heart rhythm issues before. They appeared 3 months ago during very stressful period of my life. Is there a possibilty that these issues would go away or I need to be aware that from now on I need to deal with it for the rest of my life?
And... I am ashamed to confess that for about 1,5 year I smoke 1/2 pack of cigarettes a day, and lately eat poorly bacause of stressfull and axhausting job combined with heavy personal issues (It was really, really stressful time in my life - can these these things be a reason of my heart rhythm issues? Even at that age?
Yesterday I had got an NSVT. I am almost sure it was NSVT. I was climbing up the stairs, I wasn't in hurry however I was carrying heavy backpack. When approached the door of my flat and started to look for keys in backpack I felt that there comes a PVC - I got used to it, so while being prepared for thumb, I continued to look for keys. I felt the thumb but after it there came next one, and another one, and another one all with fast rate with no "normal" beats between. When I opened the door and walked into the flat my heart was beating in normal rhythm. I didn't feel dizzy, difficult to say if I got blackout as the place was in shade and I walked into it from sunny day. After few minutes I felt short run of bigeminy. That's all. I am totally dawn,feel crushed, devastated. Last month I have got less and less PVCs, bigeminys I thought I am able to overcome my problem, to be in charge of my life again. When everything seemed to be going back to normal I have finally faced NSVT in the way I was able to feel it. I am terrified :/
It can be super hard to tell for sure what you are feeling without it being recorded. It could have been a more innocent run of pacs. Most people who get ectopics get both kinds from time to time. Either way considering your heart is structurally healthy based on your echo and the fact that the runs don't last but a few beats and you are not passing out or anything more than likely nothing will come of what you are feeling. Your best bet is to try and work through the fear this is causing you and try to find a place in yourself where yo are living in the moment. There are no guarantees in life. As they say you could walk outside and get hit by a bus but we can't spend our lives worrying about what might happen because it robs us of the joy of today. And really the more you stress the worse your symptoms will be so do make a very strong effort to work through your fear and anxiety about the ectopics. You can't control when your heart will act up but you can take back control of how you react to them. Refuse to let them take over your life. You deserve to be happy. Stay strong and hang in there. It will get better with time. Take care.
I have nsvt big tri PVCs and PACs stress is by far the biggest trigger after a 30 day I could kinda tell which is which deffently the nsvt those actually kinda hurt. Another big trigger is anxiety certain foods up to a day later make my heart jump skip pound same with alcohol. I was so scared and still do but its easier after awile. It takes a lot of time I still get scared but I'm a baby and would go to er all the time. I'm sure I made a lot of errors typing this I'm sorry but your case seem kinda like mine I wanted to help out a little I was freaked out all the time. Look for triggers take stress lightly I've been doing OK so far with nsvt its been a year since they found good luck.
Thank you for your response. You are right, I can't be sure if this what I've felt was NSVT. The point is I've never felt it before - more than terrfied I was devastated bacause of it. I have learnt to live with my PVCs and bigeminy runs. I am getting very few of them daily when some people here get thousands, however I am the unlucky one who feel them very clearly, every single one. But I get used to it. I have finally accepted the fact that I need to live with it, and was OK. It is just that this new sensation has struck me hard, but being aware that I can always count on help form here puts me at ease. On 12th of August I am going to have EP study (or I am not - some people I have been spoken to say that with so few arrythmias catched on my holters the docs in hospital I am going to put myslef on can refuse to make EP study for me) and some other tests. Then I think I would be able to calm down for good. I am very grateful for your response, again.
I don't care about your typing errors, have no problem to understand you, and help you want to provide to me, especially if you have same experience to mine, is also greatly appreciated. It could be something with food indeed, as I have definitely overeaten myself in McDonald's that day. Thanks for your interest, and hope you are doing well.
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