PSVT / NSVT?

Hey there,

I've been suffering from PVC's  / PACs for about 10 years now. (i'm 26). After all tests came back find, but no capture of any of my episodes (more on that below), I kicked up a stink about not getting any proper diagnosis, I had a reveal loop recorder put in which has been listening to my heart rate for about 18 months.

My symptoms are every 2 months or so, I'll have a bad day of what I would describe as PVC's (flutter, pause, thud). I'll get 2 or 3 of these every minute for about 4-5 hours at a time. Needless to say this is normally very dibalitating. My other symptoms are an out of the blue - 3-4 really quick, hard beats (i reckon into the 200bpm range) They start and stop normally before I've even realised its happening. Its only afterwards i get scared. Like the PVC episodes, this will happen once every 2-3 months.

I'd caught both sets of episodes (or so I'd thought) on my reveal recorder. Upon getting the information downloaded, I was told by the technicians (note, not cardiologists - people just taught how to use the event recorder) that the PVC episodes were PAC's and that the fast hard beats were not showing any abnormal rhythm atall.

As mentioned above, I've had echos, ecgs, etc etc and all is showing fine, I still have worries and I'm scared that I'm going to be told that I'm being irrational in my fears having been given the all clear.

The episodes of 3-4 hard beats always has me scared that it's NSVT and that one day, itll just take off and last for alot longer than it normally is. I have a couple of questions for you Heart Rhythm gurus:

1) Could it be possible that my first set of symptoms (which i thought were frequent PVC's) are actually PAC's like the technician described? I know its not impossible for there to be a compensatory pause after a PAC, but this is normally seen in PVC's?

2) Do the 3-4 hard beats I describe sound like it could be NSVT? Could it also be PSVT? (I understand that PSVT would show a more normal ecg trace on the holter monitor than NSVT, explaining why the technicians didnt pick up anything untoward)

3) Has anyone with a Reveal loop recorder experienced symptoms that weren't picked up by the technicians / monitor even though they had marked the 'event' for closer inspection?

Many thanks to all who read this.

Will

[Bromley]

Hi, I know many people complain of these kinds of symptoms, indicating that they find them fearsome, sometimes even after they have been told that they are in the clear.

With something like this I think two things.  

First, you need your doctor's input on the diagnosis.  What a technician tells you, and what you think may be correct to a degree, but the doctors input is also important, and in most cases should override the technicians opinion, and yours. Get a second opinion if required, but listen to what the doctors are telling you.

Second, if and when the doctor gives you the all clear, you may need to validate it (second opinion if necessary) and then get over your fears.  The symptoms you describe and your response to it are common, but they are no reason to be fearful to the point that you become debilitated by your fear.

Hope this helps, and take care.

[curmudgen]

I don't care how many doctors tell me that my PAC's/PVC's are benign they still scare the hell out of me when they occur.  I recorded what I thought we very strong episodes and the recording showed only minimal PVC activity.  Sure didn't feel minimal to me.  To tell you not to be concerned won't help you feel any better during the episodes. Anxiety over them can prolong them...try and relax.  been there done that and that's all we can do sometimes.

[LindaTX]

Along the same line, I recently had a 48 hr monitor.  When I put it on I had constant a-fib for about 12-14 hrs, then NSR with some PAC's/PVC's for about 20 hrs and then finished up the 48 hrs with a constant bout of a-fib.  I know what I had...but when I got the report it didn't reflect what I had had.  It didn't show the PVC's, at least not nearly as many as i had experienced.  It called some of my a-fib tacychardia and a-flutter.  I guess it just didn't pick it up as accurately as I thought it would have.  I felt very disappointed in what I read because I have absolutely no doubt it was greatly inaccurate.

[Bromley]

I do agree. Originally, a single blip set off a rush of adrenaline. Not any more. This I have adjusted to thankfully otherwise I would react visible to them whenever they occurred (i.e. while talking to people or whatever).

Multiple blips in a row (NSVT) does give me the adenaline rush and some light headedness. This instills some fear if it goes on too long.  Single blips no, I am ok with this.  Just my unique perspective nothing more. Everybody's entitled to feel some fear.  Hopefully though we would encourage people to overcome any debilitating fear over benign PVC's.  I realize this may be easier said than done for many folks, but it is a reasonable goal I think.

regards, bromley

[Bromley]

Hi. I almost prefer a king of hearts loop recorder for this very reason.  With this device, data are continuously collected into a buffer. When you press the button, these buffered data, plus additional data collected for several seconds more are time stamped and stored.

The main thing is that you initiate data collection by pressing the button when you feel your symptoms. The data are time stamped, so you can correlate your symptoms with the measurements by keeping a written journal of the symptoms you experienced at the time and date when you pressed the button.

More costly devices use algorithms for detection and recording.  This is more reliable in some ways, as data collection does not hinge on the patient pushing a button. The algorithms are adjustable, and may be set up to ignore some events, which might be why you didn't see many of your PVC's.  However, the drawback to you may be that it is harder to understand your symptoms in terms of the event monitor traces.

You could always try one of these more manual devices.

[LindaTX]

Thanks, Bromley...I will talk to my Dr about this.  King of Hearts...I'll remember that!

[curmudgen]

I don't know what recorder I had...event monitor where I pushed the button when I had an episode... this would keep data prior to and after episode..total of 3 minutes? and then after three recordings I called the hospital and downloaded the info.  they could read the ECG recordings as transmitted and give back information immediately, if necessary.  hope this helps.

[LindaTX]

I do have a monitor like you are talking about and i do transmit up to 5 or 5 events at a time.  Even though I may have terrible symptoms they always check it and say " nothing to be alarmed about...nothing we have to call your Dr. about."   I will have that Lifewatch monitor for 2 more months...I haven't had to call in too often lately. Of course I've been on a high dose of flecainide so I haven't had a-fib to deal with since the middle of Dec.  Now if  i could just get rid of the PAC's and PVC's....

[Chris881]

I just had my event recorder removed 2 weeks ago. Had it in for 6 months. My cardiologist laughed the first time they checked the recorder and he saw what it was. He said,"Is that all?" I have the same thing pac's over and over, sometimes lasting off and on for hours. At one point I hit that little button 17 times in 10 minutes. And still the same diagnosis. Benign PAC's. I've had every heart test imaginable. Last stress test I had was one of those nuclear. Everything is normal. The event recorder was the last thing, and now the doctor says he feels it was a waste of time and money. I just need to learn to deal with it. Just had a few this morning, they make me sick to my stomach, I sometimes break out in a sweat.I was told they make me have anxiety attacks. Deal with it, easier said then done. I do notice if I don't dwell on them they seem to be less and less but I have them everyday. I am on a beta blocker which the doctor says will help, I can't really say wether it does or not. They are still there. Good luck to you. I think this forum was the best thing for me. Just to know there are other people out there with the same problem and I'm not crazy....lol

[curmudgen]

I wish I could transfer my episodes to my doctors and have them tell me they are "nothing to worry about." I agree with you that this forum has been a great help.

[tom_h]

"I wish I could transfer my episodes to my doctors and have them tell me they are "nothing to worry about."

Ain't that the truth!  I wore a 30 day event monitor, and for the first couple of weeks all  I was having were PVCs which were dismissed as nothing.  Then I got an SVT and that's when my cardiologist sat up and started to listen to me.

As for an answer to your questions:

2) As an uneducated guess, I'd say perhaps a very short run of SVT; note: very short, especially if they start and stop aburuptly.

3) If there's electrical activity within your heart, it will be picked up on your wearable monitor unless there's an malfunction with it or with the electrodes and/or their placement.