Weak beats in pulse and PAC's????

Hi everyone,

I posted a few weeks ago about PAC's and PVC's that I have been having since the end of April. I am 31 years old and I have had Lyme disease and the coinfection Babesia since April of 2008. I have never had any heart issues prior to this disease. My main symptom since the onset of my illness has been tachycardia and dysautonomia.

A few months ago I started to have PAC's, PVC's and sinus arrhythmia. The PAC's and PVC's have increased since then. I will have up to 4 or 5 PAC's a minute constantly. I saw my cardiologist in early May and wore a 24-hour monitor and also had an echo. Everything was normal and my echo was good. I saw my cardiologist 2 weeks ago to discuss the increase in PAC's and PVC's but he did not seem concerned at all and said it was harmless. I insisted on a 2 week monitor to see exactly how many of these beats I am really having.

A little over a week ago, my fiance started to feel what feels like shallow or weaker beats in my pulse. I was having around 4 or 5 a minute as well as PAC's. I went to the emergency room because I got very scared and had no idea what these weak beats were. They did not care and just sent me out the door to follow up with my cardiologist. I spoke to a nurse at my cardiologist's office and she said these weaker beats that happen are most likely PAC's and I do not agree. It is like a regular beat but at only 25% of the normal strength.

I spoke with a  good friend of mine who also has Lyme disease. Her fiance has it as well and he was having the same "weak beats" as me. A cardiologist told him they were caused by mitral regurgitation. He changed to a gluten-free diet and these strange beats got much better.

Lyme disease is known to cause many issues with the heart and my cardiologist does not seem concerned. It can cause Lyme carditis, pericarditis, and many forms of carditis in addition to heart block and heart attacks. I have had numerous EKG's at the ER in the past few months and weeks and nothing has been found. Also in May of this year my echo was normal.  All of my echo's in the past have shown trace regurgitation in 3 of my valves but I was told this is normal. Could I have developed a major issue with my heart since that time?? I am worried that I do have this mitral regurgitation and will need a valve replacement or die from this.

Does anyone know what weaker beats are in the pulse? They are about 20-40 beats apart and are sometimes followed a few beats later by a PAC. For the past few days I have been having 2-3 of these weak beats a minute and 1-2 PAC's with them. What are these shallow/weak beats and am I in danger?

Thank you

[Jerry_NJ]

Sorry you are having such an impact fro Lyme Disease...my wife had a bout of that last year.  Happily in her case she seems to have recovered.

The echocardiogram is the "gold standard" (I believe) for measuring heart valve operation and condition, and you seem to have normal echo results (if we are talking about the same test, I'm not sure).   The echocardiogram also measures the ejection efficiency, which would I think show if one had a weak beat that wasn't pumping a good volume of blood... do you have the weak pulse often enough for it to observed during an echo?  

I have had valve repair (the first choice, rather than replacement) for a leaky mitral valve.  I was fortunate to not have to address that problem until I was an old person, I tell you this to give you hope that some "minor" valve problems can be simply monitored to be sure they don't become threatening... I have an echo every three years or so because of my MV problem, in fact I had one yesterday, as a second year follow up on my heart surgery in 2007.  Again, I'm giving you my story in the hope that you will draw some comfort knowing even old people survive valve problems, and all my work has been done on a scheduled or non-emergency basis.  

Sorry I don't have any help on what's going on with the weak pulse, but I do suspect your measurement methods are not very accurate, so the results you get may not be strongly indicative of the true level/strength.

Do you have a stethoscope?  I have one purchased at Walmart for only a few $$ and I do listen to my heart beat some, it may be helpful in your self analysis of your heart... e.g., does what your perceive as a weak beat also sound weak?  Just some ideas.

Hope you get some more valuable inputs.

[Wisconsin2007]

I'm not sure if this will make you feel better, but the doctors are right, 4-5 PACs a minute isn't clinically significant.  PACs are the most benign type of arrhythmia you can have.  I've had as many as 30 PVCs in a minute and I'm told I'm just fine - and so far, they've been right.  

I'm wondering about the "weak beats" myself.  If someone is just putting their ear to your chest to listen, there are so many other bodily noises that can change that sound that I wouldn't consider that a reliable measure.  

If there's a nice thing about arrhythmia problems (and I'm not sure there is, but go with on this for a minute), it's that they very rarely go from nothing to life threatening in a short period of time.  Like the valve issue Jerry mentioned, most of these arrhythmia progress slowly, and even the really dangerous ones usually start with what might seem like a harmless loss of consciousness, and it can take year for them to start becoming serious.

It sounds like you've been tested pretty thoroughly - I wonder if, like I did, you might benefit from a prescription that can take some of the stress and worry away.  That can help your body to stop releasing all the stress hormones and adrenaline, and give your heart a chance to settle down a bit.  I know it's worked well for me.

[BlueCheetah55]

Thank you Jerry & Wisconsin2007. Your input is much appreciated.

These shallow beats can be felt in my wrist or in my carotid artery when taking my pulse. It is like a normal beat but at 25% strength of a normal beat. I have searched the internet high and low trying to find answers and I am getting no where. I have even asked several doctors who could not answers me.

Lyme disease and Babesia attacks the heart in some people so that is my main concern. The Lyme bacteria and the Babesia parasite can cause major havoc in the heart. An echo done on me in May of this year showed an ejection fraction of 60% and trace regurgitation in 3 valves but all was normal. Most Lyme patients with cardiac involvement are to have an echo done every 3 months because things can develop such as carditis, etc. That is my concern at the moment. I have no symptoms with it and cannot feel them at all.

I just wish I knew what these "weak beats" were. The PACS do not bother me at all. I am just alarmed by the weak beats that happen 2-5 times a minute. I am going to schedule with my cardiologist again and hopefully the event monitor I am wearing right now will show something.

Thank you both very much.

[Wisconsin2007]

I'm not a doctor, so take all of this with a grain or two of salt.  The thing I'm having trouble getting to fit in my head is how a weaker than normal beat could even occur.  If it was a valve issue, it wouldn't be a once-every-20-beats valve issue.  It would happen every time.

And as I understand the heart muscle, the electrical signal propagates through it like falling dominoes fanning outward.  If the electrical signal doesn't propagate properly, like with bundle branch block, there might be a conduction delay or no conduction at all - but that wouldn't happen for a single beat and then return to normal.

And a contraction is a contraction, the heart doesn't have the ability to modify how hard it squeezes from one moment to the next.  So if the electrical system is working properly, then your heart muscle is squeezing out 60% of the blood inside it on every beat.  If there were less than the normal amount of blood in the ventricles, it would be possible to have a feel a weaker pulse, but again, the systems at work don't function in a way that could allow a single contraction in normal sinus rhythm to simply be weaker.  

If it were a PAC, then sure - by definition it came early, so there's less than the usual amount of blood being pumped.  Same for a PVC.  But for NSR, to quote Bugs Bunny, it just don't add up.

So I guess I'm in the same boat as your doctors.  I can't think of what might be happening that you have that experience, and I'd suggest that it's not something with your heart, but in the person (even yourself, if you're taking your own pulse) checking your pulse.  

This might be before your time, but did you ever see the show That's Incredible?  There was a guy on there once who could make it appear as though he had a different heart rate in each wrist.  There was a nurse or doctor taking his pulse at each wrist, and just through tensing some arm muscles he could make his pulse in one arm disappear, make it slow down, whatever.  I would bet that it's something along those lines that you are sensing.