PVCs when sprinting

[JamesAA]

I'm 38, no known heart problems and have had PVCs on and off since age 19.  There are times when I have none, and times when I get a lot.  I have read that they are more likely to occur in a slower beating heart.  But even in times when I'm not experiencing PVCs in a my daily routine, as soon as I do my high intensity drills where I sprint or do dynamic squats (jump up and down for 20-30 seconds), which takes my HR to 90%+ of my heart rate max, I ALWAYS throw a few PVCs.  If, however I'm doing steady state biking at even 165 or more bmp...no PVCs.  They seem to happen when I go from 150 bpm to 170-175 bmp, in other words the ramping up phase of my workouts....going from standing still to a full sprint (even though my HR is 150bmp when I'm "standing still.")

It just seems like when I go "all out" I throw PVCs at the higher heart rates.  It happens when I hit about 12 reps in squatting too.  Also noteworthy, I usually throw them immediately after I stop running, or stop squatting.  I'll throw a few, then a few seconds later my HR gradually decreases and the PVCs stop.

So my concern is the fact that they are happening at high HRs, when I've been told they are much more likely to happen at lower HRs.

Is this dangerous?

[gothic_beauty]

Aw, thanks, James. We do indeed seem to be PVC twins, and I'm so glad that we can help and support each other and stop these issues from ruling our lives!

Have a great week ...

gothic_beauty

[JamesAA]

Wonderful analysis GothicBeauty.  We are peas in a pod w/regard to our PVCs...my story is identical.  Truly appreciate your reassurance and thank you for sharing your knowledge.  My brother-in-law is always telling me how nice Canadians are (he's a Montreal native).  I'm beginning to see his point.  

Hope all is well, north of the border.  :)  

[gothic_beauty]

Hi James,

With my increasingly extensive knowledge of PVCs, PACs and other heart arrhythmia, I don't think that you have anything to worry about at all. I have been told time and time again by my cardiologist that in a structurally normal heart, as yours has been proven to be, such occurrences are perfectly benign. You may have heard that PVCs are more likely to occur in a slowly beating heart, but I can tell you from my own experience that I am every bit as likely to feel them when my heart is beating fast as when it is beating slow. There is really no rhyme or reason to my arrhythmia, and I've stopped trying to find one. They can happen anytime, and all I can do is remember that I don't need to worry about them. I remember that when I was having my stress test done, I felt a couple of PVCs when my heart rate was high, at about 160 bpm, and I mentioned to the doctor doing the test that I had felt my heart skipping and was scared. She just shrugged and said that she had observed it as well on the monitor, but that it was nothing to be concerned about. That was very nice to hear. I continue to feel skipped beats as I exercise, and I continue to reassure myself that I am going to be alright. With regards to the PVCs happening when your heart rate is slowing down after exercise, I also remember my doctor telling me that this is actually quite normal, even in individuals who don't normally experience PVCs. As the heart rhythm is in a period of change, as it is when it is transitioning from a rapid exercise rate, especially a rate that is approaching the maximum level, as yours is, to a normal resting rate, it is not at all uncommon for the heart to drop a couple of beats in order to get itself back on track.

In conclusion, I think that you are completely healthy. If you still feel like something is wrong, or if you are in need of further reassurance (which I completely understand!) you can certainly talk to your cardiologist about these issues. Just remember that you have been through all the necessary tests, they have demonstrated that you have a nice normal heart, and that a nice normal heart is not going to let you down in a hurry!

Take care and keep exercising ...

[JamesAA]

Oh Dave....100%.  I even called them out during my stress test and I called each and every single one of the out.  It's very obvious when I have a PVC.  I know some people can't feel them, but I'm one of those that can..unfortunately.  Your post was very informative, however, and I do appreciate that.  Same for the rest of you.  Thank you so much.  Knowledge is a great thing!  :)  

[dave1726]

You say you have PVC’s, but do you really know that? Unless your arrhythmias were documented by an EKG, a stress test, a holter, an event monitor, or a loop recorder you don’t really know what the cause of your palpitations are. They could be PVC’s, PAC’s, nothing, NSVT, VT, SVT, etc, etc. With a clean stress test, ischemia is unlikely, so the timing of your PVC’s post exercise is largely irrelevant as the studies that indicate those are more dangerous are looking into them as a possible result of CAD (coronary artery disease). With a clean echo you do not have any structural heart issues, so the only real concern you might have is a cardiac channelopathy such as LQT, Brugada, or CPVT. But LQT and Brugada should have been caught on an EKG, as would ARVD most times. If you have something else like malignant ERS or WPW, those would have distinct EKG characteristics as well. So, if a doctor has reviewed your EKG’s and your echo and found nothing, plus you passed a stress test I would tend to think you have nothing to worry about, assuming the palpitations are not accompanied by shallow breathing, dizziness, or syncope. The only thing that came to my mind with your story is WPW (Wolf-Parkinson White Syndrome), which is a preexcitation syndrome that generally produces palpitations after the heart rate is revved up suddenly. WPW would be characterized by a short PR int. (<120ms), delta waves (a notching at the start of the QRS complex), and periods of extreme tachycardia due to the AV node reentrant arrhythmias that may affect the ventricles in this syndrome (HR’s up in the 220+ range). If you have none of that, I would doubt WPW, and assuming you had a good cardiologist and/or EP examine you three years ago, I would assume you have a normal QTc interval, no Brugada sign, and no signs of ARVD or M. ERS on your EKG’s, which pretty much puts you in the clear. Your prolonged history with these intermittent symptoms with no syncope or cardiac arrest history (obviously for the latter) is very encouraging and most likely means you have some kind of benign idiopathic arrhythmia. If you wish to know if it is originating from the atriums or ventricles a Holter where you exercise very hard the day you wear it might do the trick of satisfying your curiosity.

[thedude1973]

I've had pvcs forever, and have had the wonderful experiences of SVT since about 24 (39 now).  
My understanding as to the PVCs are they are completely benign unless there are underlying conditions.  The stress test, echo and electrocardiogram would give signs as to a more serious condition that the PVCs may aggrevate or have an effect on.  Since you've had those tests, you probably have nothing to worry about, "probably" meaning almost certainly nothing to worry about.  

That being said, I am always erring on the side of caution, and would recommend that you speak with your cardiologist about this issue.  

[Mom2four85]

that should read coronary ...what I wouldnt give for an edit button

[Mom2four85]

I think Dr. Borek was trying to say as someone else pointed out - you have to have one of the conditions for something dangerous to happen which most of the time can be found in a full cardiac workup.

Here's a better explanation of MA's - Dangerous/Malignant Arrhythmia's from the US National Library of medicine  & National Institute of Health.  http://www.ncbi.nlm.nih.gov/pubmed/2913541

About 5 percent of arrhythmias are serious, life threatening, malignant arrhythmias.  The MA is regularly associated with organic heart diseases such as oronary heart disease, cardiomyopathy and valvular heart diseases, but a MA can develop without cardiac disorders e.g. in long QT syndrome or WPW syndrome. (this is what Dr. Borek is referring to)
  
The prognosis of VA was very serious a decade ago, however now with application of newer therapeutical procedure the prognosis of MA is permanently improving.

(sorry for any confusion) - I was really interested in finding the answers to these same questions like this because I've had so many problems with exercise, arrhythmia's and fainting during exercise and exertion.

If I remember correctly the prognosis had to do with pvc's and exercise pointed to ischemia.

In 2008 there was a study done that said patients undergoing treadmill testing who had arrhythmias during the recovery phase had an almost doubling of mortality in the five-year follow-up period, compared with those who had arrhythmias only during exercise.  

In contrast, PVCs occurring solely during exercise have limited prognostic significance.

I'm sure if you ask different doctors you may get different answers also; anything i've read had said pvc's during exercise/recovery are widely debated.

[MichelleP_3811]

I think the key to Mom's post is that you also have to have one of the underlying conditions as well as the pvcs to fall into a dangerous rhythm.  And if you have indeed had a work up of your heart it is likely you don't have one of those issues or they would have found it which puts your pvc situation in the benign category.

From what I have read, though I would clarify this with your cardiologist, is that the pvcs are dangerous if you get them while you are exercising.  They are common during the cool down process but it is only dangerous if you get them during the activity and even still I think in a healthy heart the threat is minimal.  But as others have said, if these are new symptoms that you didn't have before it is best just to go and get a check up to be sure everything is still looking good.  It likely is but the doctor really needs to be the one to sign off on that.

SVT stands for Supra-ventricular Tachycardia.  These are generally caused by an extra muscle fiber in the heart that can cause the heart to fall into a fast rhythm generally over 200bpm.  Though another conditions, afib and inappropriate sinus tachycardia and runs of pacs, are also considered svts but in general you are not likely to fall into one of these rhythms unless you were born with the issue.  If you haven't noticed that your heart speeds up for no reason or doesn't respond appropriately when you stop exerting yourself then you likely need not worry about triggering svt.  

In any event, I think odds are you are likely ok but if you are at all concerned then it best just to go and see your doctor for a check up.  Take care.

[JamesAA]

Tom, yes I am probably donig the Vaslva meaneuver during squats, but I also get these PVCs immediately after a finish a sprint...in other words when I ramp up to a high intensity exercise (squats, sprints, plyometrics, etc, for a 25 second duration (more or less), that's when they occur in clusters...and they occur immediately after I stop the exercise, and I mean immediately like within 1 second.  

Also Tom, I'm curious about this statement, " Just every once in a while, and they were often a precursor of an impending SVT event within the next following days or perhaps during the competition itself which forced an immediate withdrawal."

What's the significance of this?  Is this impending SVT event dangerous?  I don't know much about it.  

Thanks,
James

[JamesAA]

I had an echo & stress test done about 3 years ago and results were normal.  My cardiologist says, "not to worry," but I wonder.  I'd like more opinions.  I didn't know that their could be malignant PVCs in a normal heart per Mom2four85's post above.  That's news to me.  

[spade22]

Any palpitations that happen during exercise (including immediately afterwards when your HR is still elevated) should be mentioned to your doctor and evaluated.  No one here can tell you whether these are normal or not, only a doctor can do that.  As mentioned above, there are many benign reasons that this could be happening BUT it is impossible to determine whether your causes are benign without a workup.

[tom_h]

James, I also wanted to add that when you're doing squats or inclined leg presses you're most likely and unknowingly doing Vasalva maneuvers.  This maneuver where you're all crunched up and forcefully compressing your diaphram, suddenly and drastically alters internal pressure, and can cause a cardiac response like PVC's or PAC's.  I used it all my life to convert SVT.

[tom_h]

I know what you're experiencing all too well, as I formerly experienced this and occasionally after extreme physical output.  In my competitive skating and sprint cycling days, I often experienced clusters of PVC's as I cooled down and my heart rate slowed.  At the time, I could get my max heart rate to a little over 200 bpm in extreme circustances, approaching my SVT levels.  Cool down would often be accompanied by PVC's which gradually subsided as my pulse return to a resting rate.  My physician said these were benign, and attributed them to my accessory pathway issues.  Oddly, these didn't happen all the time.  Just every once in a while, and they were often a precursor of an impending SVT event within the next following days or perhaps during the competition itself which forced an immediate withdrawal.

[Mom2four85]

this is probably one of the most debated questions I've seen here in my time and really a cause of concern for many people; exercise and transitional pvc's...

the best person to answer if yours are dangerous would be a cardiologist just to make sure there's nothing underlying causing the arrhythmia's with a full cardiac workup

About 95% of all arrhythmia's are benign;  the other 5% are Malignant...Dr Peter Borek, MD says:
"In the settting of a normal heart; the malignant arrhythmias are usually caused by various channel abnormalities or congenital heart disorders such as Hypertrophic cardiomyopathy, ARVD.  the common channelopathies include long QT syndrome and Brugada's syndrome."

[JamesAA]

I think I should emphasize that these PVCs are happening IMMEDIATELY after I stop my sprint or stop the squats, when my HR is high.  They almost never happen during the exercise itself but in the seconds following stopping the intense 20-30 second exercise.  Then they are gone after a few more seconds.  Could this be a "transitional" PVC and if so are those dangerous or normal?

[spade22]

If you are having any type of arrhythmia palpitation when exercising, then you need to be checked out to make sure nothing serious is going on.