First Epdisode Continued PVC's - Worried

[soliloquy67]

Hi,

I am new here and hoping to find others that may help talk me through this, and give any sounds advice.

A little background: 43,male,  slightly overweight, borderline hypertensive, no drinking/drugs/caffeine but I do smoke almost a pack a day. 3 years ago had rapid heart rate episodes. Family history, nuclear stress test and the palps led to having a heart-cath. Heart-cath came back normal with only 9% arterial plaque. Echocardiogram showed mild Mitral Valve Regurgitation. 48 hr holter monitor showed sinus rythym, several pvc's and a couple pac's of non-signifigance.

I have had random pvc's at times (1 or 2 here and there) and often when lying down or bending over. Recent viral illness that has been ongoing for 6+ weeks without fever/congestion but lots of gastrointestinal and chest discomfort. Slight increase of the pvc's when lying down.

This morning I wake up at 6am and ten minutes later I have this odd sensation in the center of my chest up to my throat that keeps repeasting every couple seconds. Like heart flip-flopping or something. Sit down and check pulse and it feels like I am missing every 3rd - 4tbeat and the sensation happens with the missed beat.

Anxiety kicks in and my heart rate shoots up which makes the sensation and missed beats happen quicker. Drive to ER ( I know, dumb of me) and get hooked up to monitor, get ekg, get blood test to check for heart attack, and an aspirin. Oh, and a bag of fluids through an iv along with a .05mg xanax to settle me down.

While lying there watching the monitor (thinking I am about to die) I notice the inverted line when the odd sensation hits my chest. If I lay on my left side they happen every other beat and the chest sensation becomes severe and forces me to move t my right side or back.

Almost abruptly as they began, they stop and my heart goes into a normal no pvc's type beat. Hospital says blood tests look good and send me out to follow up with my primary. I have an appt. with him tomorrow, which is ironic because iwas seeing him next week for the results of my more recent echocardiogram (which the tech said looked fine).

So here I am. Scared witless, worried about what to do if this flares up again any minute because it was terrifying, and wondering if anyone else ever had something like this start out of the blue almost and run on for hours. Since then I have had several individual ones, mostly with movement, but not a repeat of the earlier episode.


Any feedback greatly appreciated!

[soliloquy67]

Ok, got my report after my meeting with my GP today.

48hr's 248145 beats
min hr was 47
max hr was 150
avg hr was 86

no st episodes
no af episodes
total ve (ventricular ectopy) beats was 4364
1 couplet
single/interp pvc 4083/0
single/late ve's 279/0

total sve beats 22
drop/late 0/12
longest n-n 1.5 seconds
single pacs 10
no bi or trigeminy beats

Interpretation:
Sinus tachycardia. No significant pauses.

Ventricular events 4363 nearly all isolated pvc's except for one couplet.

Supraventricular event were 22 atrial beats. these were all isolated pac's. there was no atrial fibrillation, flutter or svt noted.

Overall impression: Benign holter monitor with no significant dysrythmias. Occasional pvc's.


My Doctor felt the report was fine. And I have not had an episode of them like I did since. Matter of fact they stopped about halfway through wearing the 48hr monitor. So, all looks good so far as I can guess/been told.

I did also get my report from my echo and it actually had a couple abnormalities on it.

Grade 1 diastolic dysfunction
And an abnormal FS Chordal of 28% (norm being >29%, but I don't know what that means.
Something called LAD A-P es was 41mm versus the normal range of 23-38mm

Maybe I should see a cardiologist to go over these instead of my GP eh? I know my blood pressure has been kinda high the last few years (135/85 avg), but my doctor doesnt see a need for bp meds yet.

[itdood]

I had mild mitral regurge on my Echo as-well.  Also given the label as structurally normal.  The regurge was normal for my age.  I haven't givven it another thought.  I haven't died from it yet :)

[soliloquy67]

Reading around and finding multiple references to a "structurally normal" heart I have to ask if anyone can tell me-

Does my mild mitral valve regurgitation with no confirmation of any mvp make me structurally normal because of it's low regard, or am I one of the "abnormally structured" and can now be justified with any panic?

Ok, not panic. Those of you that know what I mean, know what I mean.

[soliloquy67]

Thanks for the advice, Lisa. I do not have the echo or ER report in front of me, and the holtor report won't be available until I see my GP on Nov. 15th. But getting copies of those is a good idea.

So far today after being up for 4 hr's there hasn't been a single "noticed" irregular heartbeat. Some light-headedness at times and a strange tingling in my back that has been off and on for several weeks, but no noticeable heart oddities.

I do need to ask for a cardiologist referral if my primary doesn't do so after meeting with him on the 15th. I guess his actions will probably be dictated by the report on my 48hr monitor.

[Mom2four85]

Have you gotten all of your test results? Look over the results take notes and ask questions.  I'm not saying they've kept anything from you but that's just something everyone should do - especially with symptoms that come and go or worsen.  

It may be 100% fine and you've worried for naught, but in my experience going to the ER really doesn't do anything :(  they tell all of us the same thing -  you're find see your dr in the next few days; then charge you and arm & leg for it.

Unfortunately, I'm one of the ones they missed the boat on and saw I was had things going on and let me go home.  That's the one and only time I've gone to the ER  and only because a dr prescribed Toprol and dropped my bp/hr to dangerous levels.

I've had pvc's and other arrhythmia's since age 9 as well as fainting episodes and progressively over the years, until age 42 when a doctor said hey these aren't "ok".  I went from occassional episodes to over 50,000+ pvc's daily and vt's that lasted for hours on end.

Dr's do miss or overlook things as someone else said; not only did the ER miss something important with me; my PCP I went to for a few years signed off on ekg's that my cardiologists & ep's say he never should have.  Had he sent me for treatment back then in April 2007, I may not be where I am today and not gone through a life changing ordeal.   I can't change it, but I can be a more informed patient and learn from what's happened.

Look for your triggers as you've been doing; google pvc causes or check the post http://www.medhelp.org/posts/Heart-Rhythm/Benign-or-Malignant/show/1386752 that has quite a few causes.  

Also, you may want to keep a book/journal or notes of episodes with dates/times/symptoms; that's one thing that seems to be very helpful to doctors with treatment.

[itdood]

Glad to hear you had a better day!   You might have some ups or downs, it's expected, but things will keep heading in the right direction.

[aylish28]

always best to see a cardiologist to go over all test results they are the absoulute specialists in the heart field docs are good but they can miss stuff -best to get a referalll and just check it all out with specialist chances are your fine and pvc s benign but best to be safe

[soliloquy67]

Hi itdood,

I am actually having a good day today! Finally!

Yesterday I met with the doc and he told me the scho I had last week was fine. Some mild mitral valve regurg but everything else looked good. He thinks with my having had a good cardiac-cath 3 years ago, and the recent good echo  that these are likely benign. Matter of fact he said strenusou activity was ok to do.

He did put me on a 48hr holtor monitor I am wearing right now.

So I picked up 200mg of magnesium and a bottle of 50mg of the coq10. I already have fish oil caplets here at home. For breakfast I ate two bananas, a glass of OJ, 200mg magnesium and a fish oil caplet.

The PVC's didn't start upon waking this morning (yay) like the last two mornings, but the did come and go in a lessening fashion. Just random ones here and there.

I threw myself into some active housework and stayed mobile for about 3 hr's and that seemed to help them greatly. I did get one or two after sitting down, but for the most part I have gone as long as 30 mins. without noticing any physically.

I did have the beginnings of a repeating episode, popped a xanax and relaxed for about 30mins and they subsided.

So far I am calling this a good day. Tomorrow the monitor comes off at about 2pm and I find out my results from my doctor on the 15th of the month.

Whew. It is hard to describe how relieving it feels to have them back of from their multiples a minute for hours I tell ya. I can deal with random ones throughout the day, 10-15 a minute is too unnerving.

I will keep you updated!

Hope you're all doing w

[itdood]

Are you OK now?  Did you try any of the suggestions I had to make them stop?

[soliloquy67]

Thanks ocdish,

I don't have a cardiologist. I have a primary doc who I see today at 1 o'clock, so maybe he will refer me to one.

What I also don't have is insurance (until Jan. 1st), so I am not sure I can afford a cardiologist or much testing before then. I am thinking I will try some of the home treatments I read about here (increased mag. potassium, fish oil and COQ10.

I find with sitting they help lessen the time between them (from 3-7 beats apart to as many as 12-23) but activity increases them and the light-headedness.

I guess what has me most concerned is the fact in the past I had the random one or two, and now all of sudden I have 2 days in a row with hours long events of them.

Thanks for the reply! They seem to reassure and are helpful getting them!

[ocdish]

It can never hurt to call your cardiologist. If nothing else, it might ease your mind. when I get the strong urge to go to the er during an episode, sometimes calling my doc really helps. And of course, some people have 20,000 - or 30,000 PVC's a day and are ticking along just fine. thinking about that really reassures me.

I hope you feel better.

[soliloquy67]

Well, looks like this morning I am having another long episode. Every 4th - 7th or so beat is one.

Taking all my willpower to not panic and head for the ER again. Did your episodes that lasted for hours have the pvc's hitting at least once every 7-8th beat?

[soliloquy67]

Thanks Itdood, I really appreciate you taking the time to write that thorough response.

Funny you should mention gastro issues. For the last weekor so I have some really odd ones with excessive bloating in the upper abdomen, trapped gas pressure, some lower bowel issues, stomach nausea...etc.

Tonight I am only having random pvc's and they see to be happening when I get up to move around a little. Bending over seems to provoke them too.

Thanks much!

[itdood]

These are called PVC swarms.

I went through something very similar.  I'm the same age, male.  This happened to me back in Jan-2009.  

It started out with a lot of GI issues.  Then I started to get the swarms.  I would get 3 episodes a day lasting about 2-3 hours each.  They were sensitive to position.  

I had every test imaginable.   I had a cardiac MRI.  Nuke stress, echos.  I went as far as to get an endoscopy and colonoscopy.  Everything was clean.  No evidence of CAD at all.  

The swarms were really bad from Jan to about May.  They slowly started to settle down.  By Aug things were much better.

I tried every med and supplement you could imagine.   Beta Blockers and Calcium Channel Blockers made things much worse so I avoided those.  Don't let that discourage you from trying though because everyone is different.

Believe it or not, Maalox extra strenght helped me a lot.  

I started to get OK at stopping the swarms either with the Maalox or I would take a hot bath with Epsom salts.  

I supplement magnesium with calcium.

Things were excellent from Aug '09 to about 3 weeks ago for me, I started to see an uptick in PVCs recently.  These things come and go.

Today I was in a meeting with some folks and I had bunch of them.  I just kept talking and carrying on with my life.  Forgot about it in 30 seconds.  

I haven't died from them yet.  My ejection fraction is excellent still, measurements are good, arteries are clear.  I'm grateful for what I have.  It could be much worse.

Keep the communication high with your doctors.

I always advise people to use a cardiologist your primary doctor works with on a regular basis.  This is because they will communicate.  A study was just published confirming that outcomes are better when the PCP and Cardiologist communicate well. Good luck, and chill out :)  

[soliloquy67]

Anyone?

I am kinda worried about having them for that 3 hours straight every 3-7 beats. Anyone else ever gone though that?

Thanks.