PVCs on T Wave---Sudden Death

[JamesAA]

I just got back from my general MD and I am totally FREAKING OUT.  I need help.  Ok so I'm plagued with what Kaiser is calling "benign" or "safe" PVCs despite have many a day, every day (for over 1 year now).  I'm 37, healthy, exercise a lot, eat well, don't smoke, no drugs, only drink on weekends.  I have had tests: ECG, stress test, echo...everyone says I'm fine.  It's odd to me that I have PVCs all of a sudden, though and it sure feels like something must be wrong.  

Anyhow what totally freaked me out is when my MD said that if a PVC occurs on a T wave it can cause sudden death (from ventrica fib. I believe (some type of fibrillation...can't say I totally remember which one)).  Point is it is VERY dangerous of PVC occurs on T wave.  So how likely is this to happen???  Because I probably have way more PVCs in my life than the average person does this mean I'm more likely to have one fall on a T wave, thereby resulting in disastrous consequences??  

Is a PVC more likely to fall on a T Wave during strenuous cardiac exercise?  I ask because I run often and during sprints my heart rate reaches 90%+ max heart rate.  Generally my PVCs are minimal during this type of exercise but I still can and do feel 1 or 2 during a cardio session.  

Thanks for any help,

A very stressed out James.  

[Mom2four85]

The only way to know is to get your test results, write down any questions and go to a cardiologist for a full cardiac workup - sometimes things may not be seen on one ekg that may be on another and sometimes what one dr says is normal another may not.

For example - I've had ekg's since 2004, complained of shortness of breath, fatigue, chest pain and arrhythmia's at different times and been told I was stressed, out of shape (even when exercising an hour a day 4-5 times a week) overworked and even nothing was wrong.

One ekg would show "normal" usually just simple stuff as bradycardia, then the next ekg would show other things such as Very frequent pvc's, IRBB, Bradycardia, Tachycardia, Short QT, Long QT, and both Unifocal and Multifocal Pvc's etc....

My cardiologist and EP, considered ALL that normal and said nothing was wrong.  Just a few short months before I was dx with something dangerous and malignant - I had an EKG that showed NOTHING wrong except Bradycardia! I even did a sleep study 3 days before I had an ablation for over 50,000 (yes fifty thousand) pvc's and their monitoring and ekg's showed NO arrhythmia's...

My echo was considered "normal" nothing really to point to anything major wrong, minor MVP, TR.... I felt the pvc's, but I did not feel like I had anything seriously wrong with me and even sought a 2nd & 3rd opinion when they told me I could develop cardiomyopathy; heart failure or die - I didn't believe them and my testing was "normal" sans the 50,000 pvc's.

I don't know if they told you how many pvc's you're having 24/hrs? but most dr's say they're nothing to worry about unless you have structural heart problems, very symptomatic or they're more than 15% over you daily heartbeats or about 15,000+ in the normal heart that beats 100,000 time daily.

r on t phenomenon can happen in ventricular tachycardia or ventricular fibrillation, but it doesn't sound as if you have VT? if you do, that's more of a reason to get a full workup from a cardiologist.  I had VT but was told it was ok and nothing to worry about - but during my EP Study my EP found I had Polymorphic ventricular tachycardia and I went into Vfib 3 times.
P-VT is very rare, but it does happen and sometimes there are no pre-warning signs.

don't rely on your PCP/GP - go to a heart dr and get checked out just to rule out anything - there's a 95-99% chance that what you have is "benign", better to have things checked out just in case

[is_something_wrong]

Good question. I don't know. The only thing I know for sure is that you don't notice them as heart beats (but most PVCs will feel like skipped beats so this isn't helpful).

Remember, this is an issue with existing heart disease and especially LQTS (Prolonged QT). In this case, R/T PVCs can trigger an arrhythmia named Torsades de Pointes (sort of a mix between ventricular tachycardia and ventricular fibrillation).

I don't understand why on earth your doctor would scare you with this stuff. It's not relevant to your situation at all it seems. :)

[littlegreenman1]

Your cardiologist said, "Don't worry about it."
Your daily doc said, "T Wave blah, blah, blah."

Trust your cardiologist and his insurance company are the only people that don't LOVE you who would be so upset to see you die.

Call Dr. Cardio, ask about the "T Wave blah, blah, blah." See what he says. Based on what you said the Cardiologist said... I'm betting on "You won't die... any time soon."

[yarrow]

"How would one know if his/her PVCs are of the R on T type? "

Call the doctor back and ask.  EKGs tell the tale.

[JamesAA]

Thank you very much for your insight.  You made me calm down quite a bit.  I really appreciate your reaching out.  

How would one know if his/her PVCs are of the R on T type?

[is_something_wrong]

Relax! :)

You're referring to the so-called R on T phenomenon.

R on T usually occur in the setting of severe heart disease, because some damaged points of the heart repolarize slower than other. When the healthy part is repolarized, it can release a PVC and you have the phenomenon. In healthy people the chance is much less, because the so-called relative refractory period is a lot shorter.

Even with R on T PVCs, chance of ventricular tachycardia or fibrillation is really low. But, if you have hundreds of R on T PVCs a day, you need treatment, because these PVCs are less benign than the others.

I know this is really scary stuff, but you pull it way out of context. We all do, if we read about it. I've done that. I still do from time to time. But it's something we all need to live with. But please be aware that chance of v-fib in healthy hearts is almost nonexistent.