PVC's during exercise

[XploZiV]

Had a frightening experience today. After doing a 30min workout, my heart suddenly skipped a beat, and another and anoter...I felt very cold and I fainted briefly. The whole thing happened in just 5 sec or so. Went to the ER and they ran some tests like ECG and bloodwork and a chest xray. All came out ok. Should I be afraid now?

[XploZiV]

Hi, you are right, I don't know what I had, but what I do know that the moment it happened, I felt my pulse (neck). Gloves are really sensitive so it's not that I had a distorted feeling. My normal HR during a race is about 160-180. Depends on how heavy the race was. So I presume before it started it had to be something like that. Then it felt my heart made a "hiccup". Then I felt my pulse and what I felt was a pauze, I think maybe 1 or 1,5 sec, then 1 beat (again I felt that through the artery in my neck), and then again a pauze. So basically I had a very slow HR then. I presume because my body was in real
need of oxygen, that this was the reason I passed out so fast. I had a camera mounted to my helmet so I got to see the footage and I wasn't gone very long, just 1 second. Then I checked my pulse again and my HR was up to full force (160 or more).
So maybe because I felt a beat during the episode, I can presume it wasn't a PVC, nor V-Tach?
I have to go back next Wednesday for a Holter, but also to have an ECG when riding a bike.

[is_something_wrong]

First, I don't know how you know for sure that you had PVCs. What you experienced could be almost anything, PACs, PVCs, atrial fibrillation, supraventricular tachycardia or even ventricular tachycardia. We don't know and you don't know. Which is why it is important to investigate what happened.

Second, gokart racing will probably get your heart rate up, but mostly from the adrenaline rush, which may trigger arrhythmias. Having arrhythmias during this type of exercise is different from having arrhythmias while jogging or running. PVCs usually stay away or at least reduce in amount during aerobic exercise. PACs and supraventricular arrhythmias are far more likely to happen both with aerobic exercise and adrenaline rush.

Some skipped beats is something everyone may experience after stress/exercise/adrenaline rush, but your fainting is concerning. You may experience fainting for two main reasons

1) Cardiovascular syncope (fainting) due to low blood pressure
2) Neurological syncope (fainting) - for example epilepsy, head trauma, etc.

If we forget 2) which is likely not relevant, cardiovascular syncope can again be divided into:

a) low blood pressure from dilated arteries (like when standing up quickly) - benign.

b) low blood pressure from reduced cardiac output (arrhythmias) - possibly malignant.

If you experienced palpitations (as you did) before the syncope, you should get tested fairly extensively to rule out any malignant arrhythmias. Not saying this to scare you, but you should not just accept a resting EKG and a chest Xray as normal and move on with your life. A Holter test can provide valuable info, but only if you have symptoms during the test.

[XploZiV]

Can't deny my 30 min workout is rather intense, as it is an extreme sport; gokart racing. But I've never had anything like this before. Nor during the race did I feel I was pushing it. It's not my first time. I've been doing this for over 17 years now, and I started when I was a kid. Everything went fine, my condition felt fine, and right after the finish, it's like I relaxed, and out of the blue there it came. It clearly started with an extra beat. The ones you feel don't belong there and then your heart pauzes a bit. I think I probably got a few in a row which caused my BP to drop, and since my body was in need of oxygen I fainted quite rapidly. The fainting itself didn't last long, just a few seconds, nothing more, because my heartrate shot up again. I do remember feeling extremely cold for a short while.
The only thing I can say is that I found it extremely terrifying... I have had extra or skipped beats regularly, but never during sports.

The ER did an ECG, which was ok. Chest Xray was ok and initial bloodwork was fine too. I have to go back this week for a Holter and a stress test.

My biggest concern is why I got the extra/skipped beats, because they triggered the rest. Let's hope its just stress.

[MichelleP_3811]

It is normal or at least benign to have pacs or pvcs during the cool down phase of a work out if the heart is healthy and free from disease.  That said, they shouldn't cause you to pass out.  Passing out is a concern.  It is possible you just pushed yourself too hard and your bp went too low especially if you do not hydrate or nourish yourself well before you workout. But the fact you did pass out or if these happened during your workout it is important that you go and see someone to get checked out.  Have your general health fully evaluated by a GP to make sure there aren't any underlying health issues like hyperthyroidism or electrolyte imbalances and have your heart fully evaluated by a cardiologist to deem whether or not your heart is health and you are safe to exercise.  Take care and do keep us posted on how you are doing.