I experience quite a variety of irregularities in my heartbeat; sometimes I will feel a single extra beat, as if my heart got excited and didn't want to wait enough time between beats, while on other instances I have the impression that my heart stops for a moment before grudgingly deciding to resume its function. Other times (and these are the occasions that really make me scared) I will feel a sort of extended skipped beat. Today it was as if my heart seized up, rose into my throat, gave a few hard fast thumps, and then, just when I was certain it was going to stop for good, sank gracefully back down into its natural position and started back in on its usual rhythm as if it hadn't just misbehaved so inconsiderately! I have heard so many times that skipped beats are not dangerous, and I believe it, but I think am never certain if my type of irregularities are the same as other people's. I bet you all have heard such statements uttered before too; I think a lot of people on here are convinced that they are the exception to the rule. It just seems like my heart irregularities, while perhaps not always as frequent, are much more pronounced than those of other people, and thus much more life-threatening. Am I right?
While PVCs usually just feels like a completely skipped beat and a hard beat, PACs are more likely to present in various ways, with two rapid beats, pause and hard beat, three beats in a row with no pause after, the "flip-flop" sensation; one beat in the throat and one in the chest, skipped beat (just like a PVC) and finally, PACs can occur in brief runs.
If you are really bothered by this (which it seems like you are) it can be a good idea to get your premature beats monitored (if you haven't already, I don't remember). A holter monitoring, a stress test and an echo should be enough to rule out any scary condition :)
what mine feel like is a difficult question for me because I have so much going on inside sometimes it's hard for me to know what is going on when
pac's & psvt/svt I feel more in my throat area; like a fish flip flopping around inside and like I'm trying to breathe through a small straw while my heart thumps wildly and the blood is pumped up through the straw
pvc's & vt I feel more on the bottom part of my heart underside and behind my chest if that makes sense...sometimes when my HR is really high and I can feel my heart hitting something if it's a really bad episode; maybe from being enlarged or pounding so hard? still not sure
sometimes the episodes leave me dizzy, nauseous, I get cold/hot at the same time, shaky and sweat then I feel faint which may last for 3-5 days non stop and then vertigo sets in on top of it...my HR is like a roller coaster and I can tell it's pvc's/vt runs...
other times there's no warning and my heart goes wild; feels like it's stopping but not like pvc's and I faint - I can't really explain those episodes because it's really weird when it does it.
I wish I knew if the more pronounced ones meant life threatening because then I may have an answer for me also; not all my symptoms are pronounced or prolonged. I just wish I didn't have the problems I do; my life would be alot less complicated.
that's the million dollar question - what makes arrhythmia's life threatening...I'm still searching for the answer
The earlier the PVC (or PAC regarding atrial tachyarrhythmias) fires, the more risk connected to it. But the problem is, we are all different regarding how good we are able to handle early beats. A healthy heart with homogenous de/repolarization can handle early beats. A non-healthy heart where some parts depolarize (can be seen on SAEKG) or repolarize (long QT dispersion) much later than others, can't handle this very well.
In an EP study they provoke arrhythmias by pacing say 10 beats at 600 msec interval (heart rate 100) and one beat with interval 400 msec, next test 300 msec, etc.. until they close in on the previous T wave. If they trigger arrhythmias, the test is positive.
Now, if you would be so kind and transfer the 1 million dollars, I'd be happy :)
Just kidding. Your question was a bit wrong formulated, so I had to have a little fun with it. The real pickle is to know what's causing the heterogenicity in de/repolarization.
Wow, I didn't know there was such a difference between PACs and PVCs! Obviously, I knew that they originate in different parts of the heart, but I didn't know that they cause such different sensations. Thank you for explaining, is_something_wrong ... what I experience definitely sounds like PACs. When I had my last holter monitor, it recorded my irregular beats as PACs, so it makes sense that this is the type of irregularity most common in my heart. Unfortunately, my holter monitor never caught any of the extended skipped beats that I described above, where my heart feels like it pauses, slips up in my throat, then does two or three rapid beats before going back to normal, or similar. It only recorded what felt like a single extra beat at a couple of instances. That's why I thought this longer, more intense instances of arrhythmia could be different, but maybe not, after all. I may mention it to my doctor when I go next week and see what he says.
Mom2Four, I am sorry about your symptoms ... they sound quite unpredictable and scary. I'll bet they are not as dangerous as you think, though, and I sincerely hope that you are able to keep them under control and prevent them from taking over your life. It is so difficult not to let these problems monopolise our minds, but it is possible, as I am learning. Take care: I'll be thinking of you!
And I too would appreciate a translation of your last comment, is_something_wrong!
I wish mine weren't dangerous - I just happen to be one of the ones who really didn't believe I could ever have anything wrong because I didn't feel bad even when I fainted, had 50,000+ pvc's or felt my heart stopping.
I have a malignant form of PVC's they found during my ablation called Polymorphic Ventricular Tachycardia found in 3 separate places in my heart which causes VTach episodes and makes my heart stop.
I had to have an ICD implanted and been shocked many times as recently as June 2011 my heart went whacko and stopped 3 different times.
They think this is due to a genetic condition and at first thought it was ARVD but then diagnosed me with HOCM (Hypertrophic Obstructive Cardiomyopathy) it's a toss up what's really wrong - dr's disagree with each other which is the correct dx.
I don't know all the answers for me because I seem to be a medical mystery to dr's - even ones who teach other world class EP's at the largest university here....he threw his hands up and said what else do you want me to do for you? nothing else can be done medically and told me to go back to my original EP because my case was too complex for him :(
Wow. I'm sorry. Your condition sounds extremely scary. I guess that modern medicine can help with a lot of problems, but not always as much as we would like. I am just glad that you have received some help, and as I say, I will be thinking of you. Take care :)
thank you =) I was like everyone else before; had palpitations and thumps and pains and really nothing wrong (or so I thought) my ekg and even an echo came out "normal"
then I had a holter monitor and stress test done where they found some inconsistencies and problems...I still have a ton of questions because pvc's/pac;s just don't morph into something dangerous....not that I have found so far.
I've learned a lot from is_something_wrong but it is very technical. I'm just not quite as smart about the heart. I found a website that helped me understand it a little more. http://www.mauvila.com/ECG/ecg_premature.htm
The area between Q and T on EKG is known as the systolic phase, where the heart contracts. The other part, (the "flatline") is known as diastolic phase, where the heart fills. Some people think that the heart only contracts during the QRS complex (the spike) which is wrong. So when measuring the QT time, you are really measuring the time the heart needs to contract.
During the diastolic phase, premature beats may occur. How benign the premature beats are, depends to a certain degree on when in the diastolic phase the premature beat fires. With PVCs, you have two opposites:
A) A fusion beat, where the PVC is so late that it merges with the NEXT normal sinus beat.
B) An R/T PVC, where the PVC is so early that it merges with the PREVIOUS normal sinus beat. In other words, the heart isn't fully electrical "recharged" when the PVC fires because the T wave represents heart "recharging".
In a healthy heart, the "fire" (depolarization, QRS complex) and "recharge" (repolarization, T wave) happens more or less similar through the heart. In other words, it's unlikely that a PVC will fall on the previous T wave because if one part is repolarized (and able to fire off a PVC), the other parts will be repolarized as well, so the T wave is finished.
In addition, in healthy hearts, early PVCs are often benign even if they occur (due to a phenomenon known as EAD, early afterdepolarization) because the heart cells are stable and not suffering from ischemia.
In people with non-healthy hearts, a variety of things can happen if you get early PVCs, because the repolarization often takes longer time, because the heart now has different types of tissue with different electrical abilities. In HCM, the septum can have other qualities than the rest of the heart, for example. After a heart attack, scar tissue leads electricity poorly. In long QT syndrome, some parts repolarize later than others or the repolarization itself takes too long.
That's the reason why people with old heart attacks can have ventricular tachycardia triggered by an early PVC. The heart muscle, except the area around the heart attack is repolarized and may fire PVCs, but the area around the heart attack is not. When the PVC is conducted there, however, this area has repolarized, so the impulse is moving around the heart attack, and by the time the impulse has passed, the rest of the heart can receive impulses and you get kind of a "ping-pong" effect, where the impulse is travelling back and forth. This is known as "reentry ventricular tachycardia" or "sustained ventricular tachycardia".
The same goes for other "structural heart diseases". Different repolarization and depolarization time is the key. How early the PVC fires, is differing "benign" PVCs from "PVCs that may cause an arrhythmia". If the PVC is late, chance that the entire heart is "recharged" is higher.
People with prolonged QT are vulnerable to early beats, but through another mechanism, and with another arrhythmia triggered.
During an EP study, the doctors are provoking earlier and earlier PVCs to see if something happens. If it does, the test is "positive". If not (no arrhythmia triggered) it's "negative".
I'll have to read this several times to understand it; but one question comes to mind - does the positive test always have adverse reactions like mine did with VF arrest and asystole as well as polymorphic VT ?
I know others (I think Cindy; but I'll have to look back) who during the EPS their hearts stop; they're shocked back and aren't dx with anything dangerous, so I'm trying to wrap my mind around this.
another thing is I don't understand how is it I had structurally "normal" heart and had VF arrest and asystole and dx with PVT? no dr can really explain that to me and my HOCM was only found days after my EPS and Cardiac MRI...I'm wondering what was missed?
My original ekg's and tests showed only unifocal pvc's; however tests I had done in the ER showed I had multifocal pvc's and suspicions of CHF like cardiomegaly and some vessels crossing or something like that I'll have to pull out the files and see exactly what it was called.
My stress test showed slow R wave progression in the precordial leads; the QRS segment of PVC's narrowed substantially with exercise, widening again in recovery; in the 4 minute test there was increasing Dyspnea was noted with exercise stress as well as increasing dizziness; frequent pvc's w/ 2 PVC couplets and 1 PVC triplet in recovery and I fainted.
Well, if an EP doc tries hard enough, he will always be able to produce a dangerous arrhythmia. That's the reason why people die from electrical shocks - if the shock is provided during the so-called vulnerable phase of the heart, which is (if I remember correctly) the first 2/3 of the T wave. Luckily, PVCs don't occur that early.
That's also why doctors use a so-called synced shock while converting A-fib and other atrial arrhythmias - to not mess this up and possibly causing a more dangerous arrhythmia.
I don't think any EP doc deliver an impulse that early - there are protocols regulating how early the impulses are delivered. We are all different regarding how early impulses we tolerate, and I'm not sure what's defined as a "positive" test or not. You'll have to ask your EP that question, though it's not really relevant or interesting.
People with serious ischemia can actually (though this is VERY rare) develop ventricular arrhythmias from PACs because some parts of the heart are extremely slow recharging, it reaches far outside the T wave.
Provoked arrhythmias indicating a "positive" test is monomorphic or polymorphic VT (there are several variants of the latter) and of course fibrillation.
not sure I trust any of my dr's much...cardiologist said my problems were from my long term HBP lol which I didn't have until 3/2011 and no way I can go back to the original EP and my current EP told me he didn't want to see me again my case was too complex for him [cries] so I'll have to get in to see Dr. Asher (HCM guy 5 hours away) and just wait to see what he says...
the original EP and his reports say I was "easily" inducible and given my history of arrhythmia's and syncope and the fact mine were polymorphic meant I probably had something they just didn't catch before; it bothers me I may never know what it is
I just need to quit asking questions and forget about it and stick my head back in the sand and act like I know nothing...I was alot happier then
Wow, You don't need another million I wouldn't imagine. Sounds as if you have a decent education. As well as I would hope, a properly paying job where you are able to help people, as apparently you enjoy doing.
Stumbled upon you because For the first time in my life my heart let me know it was there by hitting hard every eighth beat or so then went to every fifth or sixth now its only every once again, but quite bothersome I must say. Now its a double hard beat, then one normal, then one hard, then two normal, then two and a half hard. I am feeling it all in my chest cavity. mostly toward the bottom of my rib cage.
I am a 32 Yr. old Male that was born a month and a few days premature weighing 9.5 lbs. I was in an incubator because my lungs weren't fully developed. I smoke a pack plus a day and honestly probably average a six pack plus. As far as I know only my Grandfather had heart attacks. I was 295 lbs. a few months ago. As of this evening I am 241.8 lbs. It's all good weight loss as well except a little food poison maybe from some spinach at a Round Table buffet, (which ***** because I am a member of their frequent flyer club) a couple days ago.
Got anything for me?
I hope you are currently practicing, I don't know **** about **** when it comes to how hearts work, but based on what you've written that I have read it's a bit like a battery and an alternator in one. I appreciate the way you are able to explain. I am at least somewhat correct with my analogy yes?
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