Where from here

[Kubota]

History: Male 6' 1" 180 lbs. 55yoa  LDL130 HDL 45 TRI 85 I am 95% vegetarian BP 122/78 Resting HR 52.  Do not smoke or drink can not tolerate Caffeine.  Father had Heart attack at age 60 died at age 78.  I have been an athlete, weight lifter and distance jogger. Stopped because of Gerd.  Have had 4 stress tests(10 yr period)  one showed PAC and one showed several PVCs. One sonagram normal, one thallium stress test was normal.  Only exercise now is yoga, push ups and hiking on hills.

Problem: periodic episodes where there is a definite long pause between heart beats during exercise followed by faster than normal HR.  During these episodes it feels as if my breath is taken away and a spasmodic feeling in my R chest and /or stomach. When I stop the activity the heart rate returns to normal fairly quick. These have never been seen on Holter monitor or stress tests. One or two times I got this same feeling working bending over after a meal and would get even more skipped beats in a row.  I have to stop the activity or I feel they would continue or I might get dizzy. These come and go but seem to be more frequent. When they are active the same exercise that would get my HR to 90 BPM will often be 150 or higher with occasional skipped beats. These are changing my lifestyle and not for the better.  None of the cardiologists have any hope or offer or answers, but then these problems have never been witnessed by them and I think they may not even believe me.

Sorry this is long but I am hoping for some direction here.
Thank you,
KSH

[Michael J. McWilliams, M.D.]

Hi KSH,
The only way to answer the question is to capture one of your symptomatic events while you are wearing a monitor.  I would give you a 30 day event monitor to wear and encourage you to do all the activity that usually brings them.  The way the monitor works is that you have an activator button that you press when you have symptoms and it records the heart rhythm for a specified period before and after you press the button.  

I have seen patients with your symptoms that had premature ventricular contractions and also had patients with similar symptoms that have sustained tachycardias.  The only way to know is to capture it on a monitor.

Try talking to your doctors about wearing a 30 day event monitor and hopefully it will help answer the question.  If you go though 2 months worth of event monitors and don't have an event, I would consider an implantable Medtronic Reveal monitor.  You can wear that for over a year and it is similar to an event monitor.

This does not sounds like a hard question to answer with a little perseverance.

I hope this helps.  Thanks for posting.

[Kubota]

Thank you for taking the time to read and give some options.  Believe it or not today was the first day I felt good in about 2 wks. I was able to do my hike with no symptoms. Once this happens, it may be weeks or months before another episode.  I hope so anyway.  When they recur I will go straitway and try to get an event monitor.  Thanks again, KSH

[Michael J. McWilliams, M.D.]

the trouble is once they recur you may have missed your chance.  it might be worth trying 30 day event and repeating if the first is uneventful.