question about r on t pvc

[Navywife1022]

Hello I am a 24 yr old girl, slightly overweight for my height.  Lately I have been feeling weirdness in my chest like skips or flutters.  

I went to my cardiologist who gave me every test imaginable to put my mind at ease.

I had 3 normal ekgs, normal echo and normal stress test. Also normal bloodwork. I also wore a loop monitor for 2 weeks which only showed sinus tach.  I also wore a 24 hour holter, which came back normal, not even one pvc or pac.

I went to the ER a couple weeks ago for chest discomfort which they diagnosed me with esophgeal spasms.
However because I was there for chest discomfort they had me hooked up to a heart monitor for about an hour and a half.  At one point the monitor beeped and it said "r on t pvc".

I asked the doctor waht this meant, and he said it was benign and that it wont kill me.

I have since gone online and read up on it(probably the worst thing a person can do),...and have read it isnt as benign as i thought.

Am i at increased risk of sudden death cause of this PVC?  Is it benign in a healthy heart?

Is it possible that it was an artifact, because i was moving around when the monitor beeped.

Please any info would be appreciated.  I am going crazy

Nina

[csfarhan]

" R on T" is a phenomenon which has been studied in the critical care setting of various Acute MI patients and those with Ischemic heart disease. In the context of such patients and people with a genetic disorder known as 'Brugada syndrome', R-on-T phenemenon becomes significant.In case of MI patients, a study has shown that out of 44 patients with R-onT PVCs, only 6  (14%) developed fatal arrhythmias like V-Tach and V-Fib. Many other studies have also revealed similar results.14% is very significant in Medical science and cannot be ignored, so it has become customary to take the R-on-T phenomenon into consideration. I don't know of any studies being done on the significance of this phenomenon in persons with normal hearts. 10 % of V-Tachs are suffered by people with normal hearts.These are known as "Idiopathic VTs". They rarely cause a sudden death and the prognosis is excellent.Normal hearts can tolerate VTs for many hours before they transform into V-fib or a Cardiac Arrest. Timely medical help and drugs like "Veramapil"  can easily control VTs.Sometimes Vagal maneoures also help. Often the VTs in normal people are Non-Sustained, which means they subside on their own within 30 seconds. Some may take longer.And emergency medical care can take care of them.
In a nutshell, benign PVCs rarely lead to R-on-T phenomenon. Even if they lead, there are 14% chances (That too in diseased hearts) of initiating a V-Tach.Even if it does, it may be a non-sustained VT.Even if it is 'Sustained' , deaths are rare and you can seek Medical help or it may subside on its own even before that. Risks are there in almost every activity that we indulge in e.g. driving a car has its own risks,Travelling by air has its own risks, so on and so forth. Put your trust in God and go on cheerfully.....hope it helps.

[Bromley]

Hi PVC's in a normal healthy heart are nothing to worry about.

I did glance at some information on the internet about the r on t type, and it says that this type of PVC is more of a concern because if the heart is in an ischemic situation, it will be more likely to have difficulty dealing with the extra heart beat(s) if the rogue R wave is on the T wave.

Now I am not a doctor, but this makes sense to me intuitively.  The T wave represents the portion of the heart beat where the ventricle (the hearts main pumping aparatus) recovers in preparation for the next beat. If it is forced to beat again while it is in the process of recovering, I think there are some questions as to when the ventricle has an opportunity to recover, or how well it can recover.

Your question is very good one.  As a scientist, and PVC sufferer, I would want to know more about the statistics behind a statement like "PVC's are benign in a normal heart".  In this context, does the model account for a tendency for PVC's to be located late in the cycle? How does one determine whether one PVC seen on a single standard EKG, even one that lasts for an hour and a half, represents a "tendency" for a PVC to occur late?

If you haven't done so, it might be worth seeing an electrophysiologist to help you dig into some of the answers.  There guys are able to do some signal processing that might be helpful. But I would not worry.  I would not worry.