different types of pvcs

[kbear89]

Hello -
I am new to the forum and have a question.  I have had pvs, pacs and psvt for years.  I have also had all the tests required to determine that I have a healthy structurally sound heart.  (Stress/Echo test, Stress test, Echo, 24 hour holter).  Maximum amount of pvcs and pacs on my holter was around 300 in 24 hours.  Recently I decided to change cardiologists and she agreed with all the findings however wanted me to wear a 30 day cardionet mcot holter for additional peace of mind.  I just heard back from her and this was her response.


"I looked at all of your strips, and they are all just isolated PVC's, single, sometimes with a pause afterwards, sometimes not. Which doesn't really make much difference as far as concern about them, however the two types may feel a little different from each other. The bottom line is that since they are isolated single extra beats they are nothing to worry about."

Now I worry because I didn't know pvcs could be different.  Has anyone been told they have pvcs, some with pauses and some not?  What exactly does that mean?  I can definitely feel the difference.  Sometimes I feel the early beat after a normal beat then the pause.  Sometimes I feel just a normal beat then two quick beats then a normal beat again.  I always thought that was some type of couplet because of the double beat feeling.

Now I am more confused than ever.  :(

[itdood]

It's good to check into PVCs.  Once the cardiac muscle checks out OK it's time to stop worrying.  I know how hard that is because I've been there.

[kbear89]

I meant heart that is not healthy.  I wish there was a way to edit.   So she said that they don't even worry about them in a heart that is not healthy.

[kbear89]

I am sure she was referring to the pause after the pvc.  She said in another email that I was in normal sinus rythym except for occasional pvcs.  She also send me another email last night confirming that I did have a few interpolated pvcs but they were of no concern.  She said they don't worry about any pvc interpolated or not in a healthy heart and she also went further to say that they don't even worry too much about them in a heart that is healthy.  
I just have never been told that I had interpolated pvcs before.  Most likely I have but my old doctor just didn't feel the need to explain that and this new one did.  

[itdood]

When speaking of heart rhythm and I hear the word "pause" I step back.  There are two types of "pauses".  A true "pause" is the complete (temporary) absence of a sinus beat.  

Then there's the "pause" people talk about when they hyper monitor their PVCs.  They observe a pause in systoles (pulse) but it's not a true pause that a doctor would define on an EKG.   When a PVC occurs, the normal sinus rhythm is still going along like a clock.  However when that sinus rhythm heads into the ventricles it doesn't do anything because either the ventricles are in the middle of their own premature beat (which the ventricles triggered on their own) or are in recovery from the PVC.  The Ventricles then have to wait around for the next sinus beat (which is still on time), but you'll feel a longer time between the systoles (pulse).  hopefully that makes sense.

I'll try to illustrate.  The top line is the Atrium.  The bottom line represent the ventricles

B----------B---------B----------B----------B
-B----------B---P-----------------B----------B

The heart works by initiating the beat pulse in the sinoatrial node (atrium) top line.  This propagates through the atrium down into the ventricles for a well coordinated cycle.  The ventricles should contract moments after the atria for peak efficiency.  On the bottom line, see that P?  that's a PVC.  You can see why it feels like a pause.  


Below is a true Pause

B----------B---------------------B----------B
-B----------B--------------E-----------------B

That E is something called "escape rhythm".  

So which type of pause was the doc referring to?  A true pause or the lag one experienced after a PVC?

Either way, like the others have said, if the doc saw something of concern you would know.  Bad news travels fast in the medical world.

[MichelleP_3811]

Yes, the ones without the pause could very well be interpolated pvcs as well they could be pacs that look like pvcs.  There is no clinical difference between interpolated and noninterpolated pvcs.  Isolated has nothing to do with interpolation  Isolated means they are happening in ones as opposed to happening as a bunch in a row or in a pattern.  Even some in a row or in patterns aren't dangerous unless you have an unhealthy heart.  I believe the ones that may pose a threat are the ones that come R on T in a person who also has long QT.  But again, if your heart is healthy even R on T doesn't mean you will fall into a dangerous rhythm.  I had an R on T recorded and my heart kept beating fine so try not to worry too much.  You have run of the mill pvcs that are just annoying more than anything else.  You are not alone.  Take care.

[kbear89]

Okay thanks to both of you.  I just thoght it meant one type might be that interpolated pvc and aren't those dangerous?  They also don't  have the pause.  Does isolated mean they aren't interpolated?
Thanks again for helping me wrap my mind around this and move on.

[MichelleP_3811]

As DeltaDawn said, there isn't anything to worry about.  The key word is isolated.  Even couplets are not dangerous.  I believe that sometimes pacs can look like pvcs and they do not have as long a pause.  Or it could be the timing of the extra beat did not create a pause.  But ultimately they are no different in their threat meaning neither are a threat so just try and put them out of your mind as best you can.  Easier said than done sometimes but the more you can ignore them the less they will bother you.  Take care.

[DeltaDawn23]

The take home message here is  2 doctors have told you "you have nothing to worry about.  I don't think you have to know whether they're pvcs or pacs, because you have a healthy heart and they are not dangerous.  It has been my experience that sometimes we can dwell too much on these small details and not see the big picture -- that we are basically okay.  Hope this helps -- good luck to you.