PVCs with Dizzy Spells and a few "Gray-Outs"

[nativenolagal]

Hello all, I'm 51 years old and generally healthy if a little overweight.  One weekend in late March I started experiencing almost non-stop PVC's.  I had also been having more dizzy spells and actually several gray-outs, which I had attributed to likely low thyroid.  When the PVC's started I decided to get them checked and finally get the thyroid bloodwork done.  The PCP ordered a 24 hr holter and echo.

My mother has afib so I went to her cardiologist to have those done.  During the 24 hr holter I had roughly 3500 PVCs.  The echo was normal.  He didn't seem too worried until I described the gray-out episodes.  At that point I could see his expression change and I think he may have said, almost to himself, something to the effect of making sure it's not episodes of vfib.

I have been wearing an event monitor and will go back to see him on the 7th.  My thyroid results came back normal and wearing this monitor is making me realize how frequently (almost daily) I have the minor light-headded spells.  I haven't had any gray-outs on the monitor yet.

The other thing is I've had sleep apnea for years and use cpap religiously.  Even so I've always dealt with a lot of fatigue that seems to have gotten worse over the last couple of years.

I guess I'm wondering what I might be looking at dealing with here.  I do like my doctor and he has a very good reputation.  I know he doesn't want to speculate at this point, but I'm one of those people who likes to understand what's going on if only so I can ask the right questions.  Any thoughts?

[nativenolagal]

Update...I saw the EP yesterday.  Seems I was having runs of NSVT during my dizzy spells.  I think he'd like to ablate it but the 2 lead event monitor I was wearing didn't give him the info he needs to have an idea of where they are originating.  I go back in three weeks for another holter monitor.  

He gave me verapamil for now.  I had an echo which was normal a few weeks ago.  I'm 51, blood lipids are usually in the high normal range and I've never had anything I would call chest pain.  I've read that in the absence of structural issues or ischemia, NSVT is generally benign.  

I'm relieved he found what was going on and has a plan and while the pvcs haven't stopped in one day on the meds, I do sense it is settling down.

Any thoughts or suggestions?  Thanks :)

[Artaud]

Please pardon my sudden brusqueness.

I was terrified I had back-to-back PVCs, but the E.P. correctly said they were bigeminy. I argued the point, but he said we don't actually feel the PVC. Instantly I saw the truth in it, and it was a relief. For years I thougt one normal beat felt at the wrist, and 1 paused beat, was bigeminy, apparently that's trigeminy. The unfelt PVC, the paused beat, and a normal beat.

I can feel most of my irregular beats, and have had PSVT, couplets, PACs, and PVCs, and one extraordinary event where I apparently had a PVC and my breathing suddenly went very fast, and while I was pondering it, I had another PVC and the breathing went back to normal. My Cardiologist figured it was a Mitral Valve issue, I guess not sealing correctly.

But the most symptomatic of things to date is long runs of bigeminy, the heart rate is reduced nearly in half, and I start to feel the effects of diminished circulation. Fortunately if I stand and walk around, it holds them at bay, but sitting, especially after eating, and I'm plagued with them.

Thanks again for being civil about my uncivil brusqueness.    

[nativenolagal]

Hi Artaud,
I didn't mean to short change your response.  I think my initial post wasn't clear and you both suggested an event monitor which I already had.  My second post was intended to clarify my situation for both of you.  I'm accustomed to responding to threads as opposed to specific people in the thread.
Please accept my apology and I do thank you for your response.
NNG

[Artaud]

Well, I guess this puts me into the chopped liver category. It'd be different if we were paid to spend time writing response to people, then, just like unpleasant assignments at work, you could still argue that it "pays the same".

One of the other posts that I responded to today was one from 2008. Of the posts that occurred since then, I summarized the triggers that people have for their rhythm disturbances, so that the members could more easily see what most afflicts people. In it, I was surprised by a response from a member that said one of the causes of her (I believe it was a her) rhythm disturbances was reading this forum. I could associate with that, as I have experienced the same while reading but especially while responding. For some reason certain member's responses seem to have more allure for the readers than others. This is one reason I think it's ludicrous to have "Top Responders" for the various topics.

I write elsewhere too, but that site is not nearly as busy as this one. But one thing I do appreciate is the Moderator on the other forum doesn't speculate, she apparently has worked in critical care, and though she offers comfort, there is no doubt that she defaults to the medical professionals for something as important as the heart (rather than, say, an arthritic pain in the knee). I have yet to see that on this site, the moderators are interested in purging political content, swear words, and links, as I would suppose is often the case for moderators. The other site may not typically have such moderators for every topic, I suspect they don't, but fortunately they have one for the Heart Issue forum.

I find myself also failing to at least offer thanks for the people that responded to my post, something I am reevaluating, as truly, nothing is to be gained by taking of one's time to try to comfort other people, it is a kind gesture of considerate people.

Anyway, this chopped liver is signing off for the night. I hope your issues resolve.

[nativenolagal]

Thank you!  That helps a lot.

[Bromley]

OK, well the nurse might see something on the strip but not know the significance of it. Not all runs, nor all dizzy spells, are indicative a major problems.

For myself, I have short runs of benign VT, which in some cases has caused doctors to become prematurely concerned. However after every checkout, we get back to the same benign working diagnosis. In fact, it doesn't make me super, falling down dizzy, on the rare occasion that I get it, but I am affected by it slightly and have no restrictions. A light dose of beta blocker, and some care on my part not to drink too much caffeine, and to consistently do some exercise works wonders to control it.

Moreover, just having a run doesn't mean that you have VT or VF. You may have some type of SVT (often times permanently curable), or a string of PVC's. At this point it could be anything. In fact, the short runs could be symptomatic of some other problem such as hormone imbalance or some other systems issue, not even cardiac related. I wouldn't get too excited about this just yet, just hang in there and give the cardiologist a chance to work their magic...

[nativenolagal]

Thanks for responding.  I think I I wasn't clear the first time.  I saw the cardiologist the first time after having the echo and the 24hr holter monitor.  I had a lot of PVC the day of the holter but I didn't have any of the more severe lightheaded spells that day.  When I described those to him, that is when he got worried, said something about vfib (I think) and said we were going to do a 30 day event monitor (which I'm wearing now).

I'm a little less than halfway through the 30 day monitor trial and have sent in probably a dozen milder dizzy spells.  I'm assuming it's standard procedure, but the folks who receive the recordings aren't allowed to say much about what they see.  After one recording, the nurse said I had 'had a pretty good run' (of what I'm not sure).  She asked me to just sit and relax for a few minutes then call back with a follow-up recording.  I guess the second one looked better.  I did manage to ask if they could tell me if they had seen more than just a bunch of PVC and if it might help explain my problem with fatigue.  That might have been pushing the limits but I did get a "yes ma'am" to that.

I'm assuming that if anything notes was imminently dangerous I would have been told to call 911 or go to a hospital.  I'm not driving myself crazy with worry but now that I'm realizing how often I get 'little dizzy spells' I am finding it disconcerting.

Thanks  

[Bromley]

I dont see how it could be vfib if you experienced your symptoms while you were wearing the monitor. Surely the vfib would have shown up and they would have put you in the hospital.

Otherwise, if you did not experience your grey out symptoms while you were wearing the holter, then yes it could be caused by several different heart rhythm disorders.  Just keep in mind at this point that "could be" does not translate to "probably is", or anything remotely like it. They just give you the monitor to get some clue as to what might be going on, and most of the time the result shows nothing more than PVC's. The idea is to capture recordings during all important symptoms, like "greying out", so that they can definitively rule some things out before any wild imaginations can get carried away!!

It sounds like communication between you and your doctor was not optimum, and you just need get a recorder or event monitor for a longer period of time...

[Artaud]

My most recent Holter showed 6000 PVCs and the doctors are unconcerned. If you had the Grey-out episodes while wearing the Holter, they should be able to correlate your symptoms with your rhythm from the Holter. If the rhythm was not recorded, i.e. you didn't have the Grey-out episode while wearing the Holter, ask for an Event Monitor. These you can wear for 2 weeks or more if needed, some phone the results in automatically, others have to be phoned in. You essentially get instant answers, rather than turning in the Holter and waiting until it is read.

And they can be removed for showering.

I get what I started to call back-to-back PVCs, felt like no normal beats in between, just slow thud, thud, thud, up to 12 of them, or more in a row. My E.P. said it is Bigeminy. He said we don't feel the premature beat, just the pause they often cause, then the normal beat, which thuds due to the extra blood (due to the pause), don't feel the next premature beat, then the pause, thud, etc. My point is I feel odd when this goes on for more than a few beats, especially when they're in a row, since the heart rate is only about half of what it should be due to the pauses.

If you have a lot of PVCs, you may be experiencing something similar. But it is important to have the rhythm recorded, so ask for the event monitor or redo the Holter.