What kind of arrhythmia is this?

[trus75]

I'm not looking for a medical diagnosis with this question, but I know there's a lot of people with a long experience in this forum, so can you tell me what are possibilities for this rhythm?

- When My HR is fast because of anxiety / panic, I feel frequent PVCs / PACs (I'm not sure which one) and sometimes short runs of super fast beats... If I could define them, it would be something like:  

There's no way I can measure those very fast beats (4-5), but I'm sure they're 200bpm+

the rhythm would be something like:

x-x-x-x-X---x-x-x-X---x-x-x-x-x-x-x-x-X---x-x-x-x-XXXXXX---x-x-x-x-X---x-x-x-X---x-x-x-x-x-x-x-x-x     and so on...  

(x - normal beat  |   X - ectopic  |  - normal pause  |  --- larger pause  |  XXXXX - short run of very fast beats

Questions:

1) The XXXXX beats are NSVT for sure? Can it be SVT? I can feel them very well in my neck, don't have any weird sensation, no fluttering, it feels like the heart just decided to beat twice faster for 1 second.

2) The X beats are PVCs for sure? Can it be PACs?  My Holter caught both PVCs and PACs, but never an episode like this...

Thanks
P.S. In theory, after lots of EKGs, Echo, stress test and Holter, I don't have any heart issue

[trus75]

thanks michelle. The trigger for these frequent PVC/PACs + bigeminty + these short runs of "something" is 99% of the time panic attacks in my case.  At first I thought it happened when my HR goes high (150+) but then I had some situations when it went fast without panic, and felt nothing. For some reason, these PVC runs only occur when I have very fast HR caused by panic (I'm not really sure what is the physical explanation for this, but probably way too much adrenaline in a situation when my heart was supposed to beat at 80bpm but it's actually beating at 160?)...

[MichelleP_3811]

It definitely is more likely a run of pacs as opposed to pvc but even if it is on the off chance a run of pvcs in a healthy heart that short duration is not a threat.  Your heart is healthy so work on the anxiety and you will likely lessen the amount of ectopic activity you are having.  I get little runs of pacs from time to time but very seldom.  I don't worry about it but if you are super concerned and they happen often enough that you think you can catch them within a months time you can ask for a 30 day monitor to catch it and see what it is but honestly there is likely nothing they would do for them except tell you to try and be mindful of the things that trigger ectopic activity like caffeine, sugary foods, carbohydrates, acid reflux and stress.  Try to work on those things and focus less on your heart.  Take care.

[trus75]

Hello, thanks a lot for your answer. Yes, I can feel them very well, it's just like normal beats but twice as fast or so. (I once felt 5 of them in a little more than one second, which would give me a HR of 250+ for that specific short run). It's good to know that they are probably supraventricular.  Thank you  

[is_something_wrong]

No they are NOT for sure NSVT. I would say that NSVT is the least likely explaination.

If you can feel the ectopics/tachycardia in your throat/neck, they are very likely to be supraventricular, because the ectopic beat is activating the atria against closed AV valves. So in other words atrial or junctional origin.

A few ectopics in a row are statistically also far more likely to be supraventricular than ventricular. True NSVT is rare. Often, even wide complex runs are supraventricular but is the rate is so fast, it's often conducted with functional bundle branch block. The same goes for PACs on Holter tests. A PAC is often conducted with BBB, making it wide complexed and mistaken for a PVC. A PAC can also be completely blocked. The pause will still be there because the sinus node resets.