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PVC causing NSVT and SVT...dangers?
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PVC causing NSVT and SVT...dangers?

30yo male, non-smoker, all echos and TEEs show now structural abnormality and mild MR.

I have had PVCs/PACs off and on now for over a year. I traditionally have gone through long periods with none...then I would get several days with quite a few (maybe 100-500) and the a day or two with maybe 1000-3000 max.

I decided to come off cardizem about 6 weeks ago (I had been taking it since last July following a lone bout of A-Fib, for which I was cardioverted).

My ectopics during the last 6 week have been heavy. I have been under more stress at work...but I have still been running 3-4 times a week, etc.

Anyway, during those six weeks I have had maybe 3-4 separate runs of what felt like multiple PVCs without a normal beat in between...NSVT? And then once last week I got a weird sensation in between innings of a softball game...PVC...PVC...then 6-7 very rapid beats...no syncope or dizzyness...but very scary. It went back to normal and I finished playing. I have a 30 day monitor right now (ofcourse hardly any palps since I got it)...anything concerning from what I posted above?

Thanks
Related Discussions
230125_tn?1193369457
Hi Wildcat,

This is a fairly common question.  I understand how frustrating your symptoms are and that they can have a significant impact on quality of life.

I also want to make sure that in the first sentence you wrote “now” but by context I think you meant “no” structural heart disease.

There is not and never can be a blinded and randomized study to look at structurally normal heart PVCs and long term outcome.  We have to rely on long term follow up studies of people with PVCs/PACs and from these studies there is no increased risk of sudden cardiac death.  Over the long – long term, people with structurally normal hearts and PVCs have a slightly increased risk of cardiac events, but these are rare events and the standard of care still dictates that reassurance is the most appropriate intervention.  

Beta blockers can decrease the symptoms associated with PVCs and have not been shown to decrease the number of PVCs.  If you have tried a beta blocker and stopped because of fatigue, I would encourage you to take it for several months before stopping it because these symptoms tend to decrease with time.

Depending on the clinical circumstances, I will usually perform a history and physical exam, EKG, holter (or event monitor to capture the rhythm while you have symptoms) and an echocardiogram.  If I see anything concerning, other tests may be required depending the circumstances (MRI to evaluate for right ventricular dysplasia) or a cardiac cath.

From what you describe, it sounds like reassurance and possibly a beta blocker is appropriate.  It would be nice to see the events on a rhythm strip so I would order an event monitor (what you already have on).

If all the tests are normal, do your best to move past these symptoms.  They can significantly impact quality of life.

I hope this helps.  Thanks for posting.
21 Comments
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21064_tn?1309312333
Good morning!

Just wanted to drop by and thank you for taking our heart rhythm related questions!  You'll be plenty busy, I'm sure : )

I joined the board several years ago as a patient with MR and a newly diagnosed cardiomyopathy (a result of frequent pvcs).  The medical advice I received coupled with the friendly dialogue were definite catalysts in my turn for the better.  Two ablations were performed in 2003 and my EF remains normalized!  Can't thank you folks enough!  

Welcome!!

Connie
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16292_tn?1189759421
"Over the long – long term, people with structurally normal hearts and PVCs have a slightly increased risk of cardiac events, but these are rare events and the standard of care still dictates that reassurance is the most appropriate intervention."

Well if EVERYONE has pvcs, doesn't that mean that everyone has an increased risk of cardiac events?
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16292_tn?1189759421
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84483_tn?1289941537
Basically everyone has PVCs & PACs and the risks with rare PVCs or frequent PVCs are about on par, though statistically speaking persons with very frequent PVCs are considered at a slightly higher risk for "cardiac events" not because of the "PVCs" but because PVCs are sometimes a marker for underlying cardiac anomalies that have not been diagnosed, again this is not a common occurence even in persons with a very high frequency of PVCs and persons with everyday PVCs shouldn't be concerned once they have been evaluated and reassured. This is a "grey area" concerning PVCs, but in general persons with PVCs and have normal hearts have risks on par with general population.At least this is my understanding concerning PVCs , at least this is how one cardiologist explained to it to be. Anyone can become that rare odd statistic PVCs or not and the risk with PVCs and normal heart evaluation are very very minute .
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Avatar_m_tn
yes, I did mean to say "NO structural abnormality"

Since I got the monitor on Friday I have had hardly a blip. I asked the doc to come off the cardizem and they were fine with it. I guess I'll have to see if anything shows up during the next 30 days.

BTW...my million dollar question is...how many PVCs and how frequently before docs worry about CM?
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Avatar_m_tn
BTW...thanks for taking the time to answer my question...Thank you...
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230125_tn?1193369457
There is no magic number.  The real measure is do we see dilation in the ventricular chamber or reduction in ejection fraction.  If you pushed me on a number I would say we worry if we start seeing thousands, usually 10,000 to 20, 000 range.  
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21064_tn?1309312333
If it helps, I was having 20,000+ per day for a long time and the pvcs were still benign.  Exactly what the doctor said - when there was a change in the echo (chamber size and EF), then the pvcs were considered something to be dealt with more assertively.  As long as you're getting checkups and don't notice any new symptoms, you are probably just having more pvcs.

Good luck!  Hope the monitor is able to pick up what you're feeling so you can get a definitive dx.  

Have a great day!
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Avatar_m_tn
does that mean 20K every day for a month, year? Or does it mean 20-30K sometimes. I probably have never had more than 3-5K on my worst day...but sometimes that is 3-4 times a month. Then I go long stretches with none...and then long stretches with quite a few.
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Avatar_n_tn
I have been having over 25,000 to 28,000 a DAY for over a year now.  I have had one ablation due to RV PVC's and I am scheduled for LVA next month. (mine stopped in the right ventricle during the ablation but then started up with the same intensity in the left ventricle)  The main reason I have opted for ablation though is that with so many per day I stay very fatigued and that has severely impacted my life.  Normally the doctors can give you medications to control the PVC's but I have been intolerant of all the medications we have tried.  Therefore the ablation is my only recourse.  I would like to have an occasion "day off" from them but have not had one in over a year so I don't expect to without the ablation.  If your pvcs are only 3-5k on your worst day, your heart is otherwise "normal," and they do not "severely" impact your life I would suggest you try medication.  Good luck
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21064_tn?1309312333
I had them for at least 25 years and probably in the thousands/day for many of those years.  Over the years, I can't ever remember an office visit where a doctor did not comment on their presence.  Fortunately, for me, they were not painful.  I'm not exactly sure how long I had them in the 20000+ range, but when I had that particular holter it didn't feel any different from all the previous holters.  I was feeling more tired (than usual) and an echo showed the changes.  But, up until then 20000 didn't set off any alarms for the docs.

Gabby, I had a similar turn of events.  First, RVOT ablation, then LVOT.  Hang in there....I got great relief!!  
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116881_tn?1189759423
Can someone explain what SVT and NSVT is?  I thought they were rapid fore heart beats -- not PVC's.  Do people die of this or is it just a nuisance?  How fast does your heart have to be beating?

Thanks guys!
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212161_tn?1418434895
i didnt have to pay 20 for question are they charging now
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Avatar_n_tn
Just from my experiences - I'm not a doctor, it sounds like you have a similar condition to what I had.  SVT that begins with NSVT.  I lived with those conditions for almost 20 years without a problem.  Had a ablation done this year because the NSVT happened during a sleep study and never went into SVT, and so the nurse thought it was Vtach.  The words Vtach were a little scarey so I had the ablation done to make sure that I only had SVT.  Suggest doing an Electrophysiological study to see what the problem is.  The ablation was a piece of cake.  However, my PVC's are still there.........they're just annoying.  No need to fear.
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221122_tn?1323014865
Hi.  Here are what these stand for and the difference.  SVT stands for SupraVentricular Tachycardia.  This means that the rate is above 150 (100-150 is just Atrial tachycardia) and that the pacemaker is starting above the AV junction.  NSVT sounds like it would be almost the same, but actually it stands for NonSustained Ventricular Tachycardia. V-tach is a rhythm that is stemming from the ventricles.  PVCs do that as well.  But the ventricular rate, if it were to take over, would be from 20-40 so anything faster than that is V-tach.  Non sustained means that you had several PVCs in a row, but converted back to sinus or then had some sinus beats before anymore PVCs.  I hope this helps.  
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225570_tn?1191290673
Hi i saw you answered the ? about nsvt..about 2 months ago i was admitted into the hospital with chest pain while there i had a strange episode wich later i found out was nsvt..They did a nuc stress test, echo and chest x ray all normal....well the echo showed trace regurg in my mitral and tricuspid but i was told very normal my EF WAS 66% And was told that was also very good...so my quetion is since that episode i had one more a month later i never have pvc's in between these episodes..so ive only had 2 episodes...is this dangerious or life threatning and can it go away..i think mine are brought on by anxiety could this be true? Thanks Gina
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Avatar_n_tn
I have been diagnosed with PVC'S and some PAC's. I have had two doctors tell me they are benign. I have had ecco's, and ultrasound to rule out an aortic aneurysm, and an MRI to rule out rt. ventricular dysplasia. Thankfully the doctor says my heart is structurally sound. She suggests I am under alot of stress and should go on anti-anxiety or depression meds. I really don't want too. I also have HBP and am on a diuretic and Toprol (50 mg). Shouldn't the Toprol help with the PVC's. I did not really start noticing the PVC's until after I started taking the Toprol. Is this just a coincidence.  My questions are as follows: What triggers them; does stress really cause them; can HBP cause them; what can I do short of taking more meds to calm myself about them?If I do have a structurally sound heart should I really worry about them turning into something else. Should I give up all caffeine and alcohol. Even when I don't have caffeine or alcohol, I still get them. They cause me great anxiety. I guess I am looking for someone to tell me they ARE truly benign.
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Avatar_m_tn
well...I've had the loop monitor for a month now...and ofcourse I have had 3, almost 4 weeks with hardly any palps...same as what happened back in May. So I don't put the monitor on unless I think I might be getting some.

At any rate, I played softball yesterday and at one point I had just finished sprinting to third base and a guy got thrown out at home for the third out. So I am walking off the field and I got the 2-3 PVCs in a row feeling again...but I didn't have the machine gun beats following this time. Scared me again though...I kept playing and it didn't bother me.

Seems to be that when I go on my normal runs 8-10 minutes/mile pace for 2-3 miles I have NO symptoms...and not really any during most physical activity. But these weird bigemies or trigemies have come twice now after I have been running hard/sprinting and then stopped. What gives? Is my heart having a hard time coming down from the sprint.

BTW...I don't feel symptomatic during these things...but I can feel them.

Any advice is appreciated.

Thanks
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Avatar_n_tn
Hi there.  In my humble opinion (and I have had both PVC's and PAV's for 20 years now) when your heart is beating faster (as in exercising etc) there is much less time in between "normal beats"from the sinus node for any other area of the heart to drop in that "extra beat" (pvc or pac).  Mine always occur at rest - especially when lying down when the heart rate drops.  This was also confirmed for me by a trial of beta blockers which only made them worse.  Viz - the beta blockers slowed my heart rate thereby (in my opinion) giving more chance for these "additional little pacemakers" to kick in and throw in that "extra beat".  My nephew is a Professor of Electrophsiology Cardiology and somewhat agrees with my thesis.  I can't have an ablation as mine are "multi focal" meaning they come from different areas of my heart.
I've found the last 20 years wretched in some ways as I can go long periods without having any and then WHAM - they are back with a vengeance.  Like you - I rarely had an "episode" whilst wearing a monitor (why is this so???).  My nephew tells me that indeed all people have PVC's - how some people can't feel them is quite beyond me however its largely anatomical.  I have found a low dose of Lexapro (an SSRI antidepressant) has helped considerably - also keeping well hydrated, taking magnesium (double or triple doses) and getting the proper amount of sleep makes a huge difference. I too have had runs, triplets, doublets and everything in between including runs of SVT which scared the willies out of me.  However - after 20 years I think I have accepted the fact if they were going to kill me I would be long dead!!!!  Yes - they are horrid and yes they panic me every time still. But - there are worse things - and interestingly people who have pvc's and also sinus arrythmia (where the heart slows down with breathing out and speeds up with breathing in) are often statistically less prone to heart disease.  Go figure??    Chin up.  Susan in South Australia
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Avatar_f_tn
I find your posts to be fascinating. I wonder if you could post more about your history, path to a cure, resolution, where you had ablations, etc on your biography? I am plaged with different arrhythmias.
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