What could it be.

[Artaud]

I've had PVCs on and off for 40 years, since the day after Easter year this in far greater numbers than historically. The first visit to the E.R. showed frequent PVCs accompanied by PACs occurring once for every three PVCs. In the blood tests, electrolytes were normal with no marker for MI, and a chest X-Ray was normal. These PVCs get really bad after eating, and such episodes were captured on the Holter, but no concern mentioned to me. I'd also go into a geminy (every 4 or 5 beats) when a laid down to sleep, and have slept propped up since then. Yet I eventually slip into a laying position during the night and I've woken during the night and am quite clear of geminy patterns and clear of PVCs. But PVCs start up again early in the morning while waking for work.

I had a recent 24 hr Holter monitor,  it showed 6000 PVCs and no runs. I've seen two cardiologists (one wanted to redo my stress-echo test from mid December 2013 with a nuclear stress possibly followed by a cath procedure, all based on an inverted T-Wave I've had all of my life), the cardiologist that did the Stress Echo (my primary cardiologist) in December insists everything is OK when viewing the E.R. reports (I've been there twice) and the Holter monitor results. I've seen one E.P. who instantly offered to ablate it, saying the problem is "probably" in the RVOT, then saw an older E.P. that is well respected in my city that emphatically said the problem is not in the RVOT, but the Purkinje fibers, saying it is still able to be ablated.

The older E.P. wants to use anti-arrhythmic drugs to control or reduce the PVCs, but I'm circumspect about that avenue. Someone suggested to me to ask for Acebutolol, the E.P. readily agreed, and I've had some success with it (I had been on Atenolol 25 mg bid but am now on Acebutolol 200 mg tid) I'm able to eat much more normally, though my heart bangs around to a degree, and was able to lay down normally, but that has back tracked a little.

Friday, after walking steep stairs to enter work, I was fine, but shortly after that while walking on the level, my heart picked-up a persistent dysrhythmia, feeling like a normal rate uniformly and frequently visited by uncompensated PVCs (i.e. no compensatory pause was apparent). This went on for a good 5 minutes, even climbing the stairs to the shop, no other symptoms, no pain, no shortness of breath, no dizziness, just an annoying thump interspersed like clockwork with my regular rate. When I sat down, it persisted, then resolved into frequent compensated PVCs that I'm familiar with. This is the second time this has occurred, the first being in May also while walking.

I phoned the E.P., he said I passed my December Stress Echo, and said not to worry unless I get dizzy or pass out. I was a little non-plussed, since not seeing the rhythm on the Holter or on a Dr. Office EKG how he could be so cavalier about it? What might I be experiencing? Could it be bigeminy or trigeminy at a higher heart rate since I was walking and therefore not feel familiar. Could they have been compensated PVCs but since the Heart Rate was higher, the delay seemed far less. Can you switch between interpolated PVCs and compensated PVCs?

[Artaud]

Thank you and PVCTom for the replies.

When I had my 24 hour Holter on, I had more PVCs then I could psychologically bear and called the plant ambulance (we are not allowed to self transport even for a booboo on the finger) and went to the plant hospital. The Dr. had an attitude, and when she saw the Holter, after doing an EKG at the plant and assuring me all was well, banished me from the plant, not to return until cleared by my doctor and stipulated that no one is allowed to wear a Holter at work. 30 days would be too long, but I was wondering if the medical field uses an Event Monitor that couples to the fingers or that's held on the chest, to show basic rhythm activity, these I could stealth into work.

The razor thing, my my, how that brought back memories. In the hospital for arthroscopy of the knee, the day was too weird, I almost bolted. I'm in the prep room, and the Pillsbury Dougboy's fatter brother is walking down the hallway and I'm thinking, please don't let him have anything to do with my surgery. Well, it was my anesthesiologist. He sat on 2 chairs in the Operating Room. As I'm waiting for prep, the fire alarm goes off, with verbal instructions to evacuate the building, but no one's taking any notice of it. I can hear the Fire Trucks showing up outside, and a nurse comes in, she's there to shave my knee. I asked her about the fire alarm, she says it goes off all the time (this is in a well respected city hospital). As I'm watching, she's shaving away at my knee. I told her "if you take the cover off the blade, it would probably work better." She replies that it is off, but looks and realizes it wasn't. I wanted to go home. The surgery went well, thank goodness, but what a day.

Thanks again.

[Bromley]

hello artaud. I can definitely relate the frustration. I've had very similar issues.

An ecg or holter trace can say a lot. You haven't said so, but it sounds like you haven't captured your abnormal rhythm on a 12 lead. However, even a two lead holter can give you ideas to get you in the ball park. Can you get a 30 day event recorder?

Some of the comments here sound familiar.  Your descriptions remind me of some of the proposed explainations for my holter results. Terminology like "it could be in the RVOT", or in the Purkinje fibers associated with the left fascisular system, or afib with direct conduction into the ventricles. How the ecg or holter should look similar in all of these cases is not clear to me. But my understanding is that there are some significant differences in the way this complex of conditions responds, say in comparison to LVOT.

If you are shy about supposedly minimally invasive procedures, you could also consider looking for scar tissue through the use of MRI. The only thing I can suggest there is that if you do an MRI,  dont do it just before a stress test, and shave yourself using a razor you trust. I went to a very famous place for mine, but after two months still have a really nasty razor burn...  Also, after the contrast, I didn't feel that great, which made my stress test a bit of a challenge. So much for famous places.

Was your echo normal, or do you have MVP? I've heard that MVP is associated with palpitations as well.