Arrythmia

[Applehorse]

42, male, 170/5

[footballmum]

I've been having PVCs for 2 months now & I just felt I needed to tell you all that you're fantastic!  Tickertock, mumto3 - all you wonderful people who have made my life so much more bearable.  My PVCs came from nowhere - no stress, no illness, nothing.  I get no other symptoms (although I did at 1st - because I was so anxious, this made me feel symptoms that in retrospect were not really there!)  I've had a great 2 days - no PVCs at all but, I know they'll be back.  Think mine's hormonal as they're really bad (1000s) before my period.  I've had bloods/echo/ECG/Holter - all fine mild regurgitation on one valve but thats not related to PVCs.  I've tried BB - made my BP drop too low & increased PVCs as I have them more when my heart rates low.  It's a mystery & if my cardio doesnt know them i'm damned if I do!  I'm waiting for a 5 day event monitor - perhaps that'll give answers - but I won't hold my breath!  Thank you so much again - you're great!

[mom3kids98]

. Does anyone feel like your chest is sort of vibrating or something? I feel like my heart vibrates when I have pacs,also, does anyone know if they can do an ablation for pacs? My ep dr. says they can't hardly catch them to ablate them during procedure. Any thoughts? Thanks, Joy

[Momto3]

So happy to read that your hubby is done with his treatments.  Hopefully, you will both be able to enjoy the holidays more now that that is behind you.

On a side note, my mom had arm pain earlier this year...tingling in her fingers and sharp pains down her arm.  It was from the nerves!!  She had a titanium plate (little) put in her neck to fuse the disc or something like that (don't know too much detail about neurology stuff). She is doing great - pain is all but gone!  Just thought I'd pass that along.  Prior to that she tried some PT, and it did help some.  Maybe that would help you too.

I'm so glad to hear the new medicine combo is working for ya!!  Maybe a "warm" holiday drink will help with those MP3 directions....I just can't keep up with all the technololgy anymore...I keeping hearing "ipod."  Huh?  Back to Best Buy again...

As to your comment about why docs do not understand how people with pvcs feel.  I think it's like anything - some get it; some don't; some are more empathetic than others.  Medically, we know that they are insignificant, but physically they are debilitating.  I always think of people who suffer with migraines and how it must FEEL like something very serious, but medically, it is not.  Doesn't seem possible.  We'll just keep on keeping on.  

A retired nurse!!!  AWESOME!!!  What type of nursing?  I have been very fortunate to have had great nurses.  Kudos to you : )

connie

[tickertock]

in lead V1 on the ECg the PVC will usually have LBBB appearance, if coming from the right ventricle. see http://medstat.med.utah.edu/kw/ecg/mml/ecg_conduct.html

[dafan]

are the rvot pvc's shaped like a bizarre normal beat on an ekg? or do they appear as the inverted beat?

[madgeOwens]

I finally figured the bugger out well enough to get some songs on it for him haha......can't frink with my meds anyway haha...thanks for all the great posts, you have helped me alot.
I used to be a medic in the army during vietnam time, and I was a med/surg nurse about thirty years ago. Thanks again and have a great holiday and a Merry Christmas!!!!!:)
ps
yeah I think the disc in my neck is the culprit for arm numbing, but it can just stay that way, I have enoough to deal with now.

[Applehorse]

Thanks to all for your interesting comments - esp. to Momto3 and upbeat63 with whom I seem to have v. high frequency in common (so far).  Upbeat - yes I have had echo and stress.  Echo was okay as far as I know and stress showed frequent PVCs from resting up to my max heart rate of 180 bpm.  They want me to repeat both tests q 6 months "to keep an eye on me".  Thanks for your description of symptoms.  Momto3 - thank you.  Yes I understand from posts that your development of cardiomyopathy was a rare case - I wish I knew how rare.  How long did you have v. frequent PVCs before your heart started showing signs of CM?  also I'd be interested in knowing what the docs said regarding rarity - did they tell you that you were the 1 in 10, in a 100, in a 1000 in 10,000, in a million etc. with beats as frequent as yours (and mine) that go on to develop CM in the structurally normal heart.  I've seen no studies or stats.
Thanks in advance and thanks for your description of symptoms.
Hanging in there....

[madgeOwens]

I get occasional pain in my left arm as well. They chalk that up to nerves.or the disc in my neck.  I get such shortness of breath and chest pain still.thats why Im suppose to take the anti anxiety pill when the inderol isnt enough.......but the klonpkin makes me about crocked.so I hesitate to take it.........I don't understand why they do not take us more serious.  Just because they do not understand it doesnt mean we are all nuts........up until a few years ago they didnt understand allergies either. So Ha....Im a retired nurse so I can say HA! hahahaha

[tickertock]

Hi Jeff,

I am thankful and doing fine. How are you these days? To be honest about the holter channel 1, 2, and 3, I really don't know, I wish i could help, but my medical knowledge is very limited and i'm not qualified to answer  what i really dont understand.My speculation would be and its my speculation only is that the channel 3 holter is equivalent to a 12 lead ECG thus enabling it to be interpreted more accurately and identify the true origin and type of arrhythmias, ie. SVT or PACs with abberancy Vs. PVCs & VT.. Please beware that this my speculation only, ask your cardiologist or EP for a more definitive answers. Happy Holidays & take care.

[jeff 67]

Tickertock,

It has been a while ... how are you?

Hey ... do you know with Holter's when they say channel 1,2 and 3, which of the standard I, II, III and V1 to 6 are these?

Jeff

[Momto3]

You said that perfectly (about why you come to the Forum).  Me too : )

After thinking about a bit more, I do remember having shortness of breath and some dizziness, but I'm still not sure it could be directly correlated....

Ah, that dang anxiety....sigh.  That's a biggie for me too....getting better though : )

[upbeat63]

Yes I get some symptoms. Mostly *mild* sense of lightheadedness, not really dizziness or maybe dizzy for a split second. I have experienced a sense of not being able to get enough breath, feeling like my chest is shallow and sometimes a fluttery feeling in my chest, but the greater possibility is that I might be hyperventilating (?). And I have left shoulder/arm pain/pressure occassionally, but I believe that to be muscular.

While I believe some symptoms, sometimes, might be attributable to the PVCs, the doctors seem to think not. I was on a 48hr holter and wrote my symptoms/times throughout the day. The cardio report came back with an unsatisfactory "patient records symptoms while experiencing frequent unifocal PVCs, but records no symptoms at same level of unifocal PVCs, suggest no correlation". Gee, must have been my other nemesis anxiety!

It was after finding this forum and reading momto3's posts that I thought I was looking at myself in a mirror. I've never heard of anyone else having 24,000pvc/day like me. By this time I've had the PVCs for 22 years so I requested an echocardiogram and stress test to rule out cardiomyopathy--no matter how remote that chance--it happened to momto3. My tests turned out ok. Maybe an echo and stress test are in order for you, if nothing else than for peace of mind and a baseline.

I have researched medline extensively and anything else I can on these nasty things. Most studies are on small populations, or in people with structural heart problems or effects of arrythmia following heart attack. I have previous doctors and current who say PVCs=benign, and all the other people on this forum whose doctors--some top docs at major centers, say benign. I return here to provide encouragement and to receive it when I'm having a particularily bad day. And to make sure there's not some new news about PVCs that I've haven't heard yet :-))))Hang in there.

[Momto3]

Like Upbeat, I used to get over 20,000 pvc`s/day (24%) and even with those numbers they were considered "benign."  Rest assured, we're both still ticking.  My case is different from Upbeat's in that I had pvc ablations because I was one of those who developed cardiomyopathy from very frequent pvcs. Other than that, we are both here to tell ya, these dreaded things are generally benign.  As long as you are getting checkups, don't worry about complications; they are indeed rare.  Even when I had tons of pvcs/day, they were not considered medically significant.  I had pvcs for nearly 25 years (I wish I could say I was 26, but NOT...lol) and never really felt symptoms other than the jumpy, anxious feelings.

Have you ever had an event monitor?  They are different than holter monitors in that they record your heart's rhythm at the time you feel any odd symptoms.  When you are symptomatic (short of breat, pain, etc), you push the record button and can send the "rhythm" over the phone line.  They are really nice for pinpointing what's going on when you are feeling symptoms.  Have you even had an echocardiogram?  I don't remember seeing those tests in your posts and just wondered if they might be helpful.

I do know that flu (dehydration) can bring on the palps...

What does your doctor say at this point? Since the BB's are not working for you, has he/she offered an alternaitve for some symptomatic relief?

Hey Upbeat!!  Glad to hear you are doing well.  

Happy Holidays everyone!!!

[gdeniseg]

Hey Anacyde, I just read your comments and found them very interesting.  I was diagnosed with CMV in 1991 and my PAC's/PVC's have started since that time.  I can't remember ever having even one before that time.

Anyway, my doctors hardly told me a thing about CMV - and certainly not the long-term effects of it.  They just diagnosed me (with + lab results) and sent me on my merry way.    
What I am wondering is since you see a rheumatologist, has he/she made a connection from the CMV to the PVC's/PAC's?  Or have they told you of any other long term effects of CMV?

The only info I have ever gotten about it was research that I done on my own and even still there is not a lot of info out there on it.  

Thanks in advance for your reply.

[Applehorse]

Upbeat63 thanks for your comment - your frequency of PVCs seems similiar to mine but luckily I have had no nsvt/vt and of course I do not have your long history of PVCs.  Its a consolation to me to see that you are alive and well in spite of the villains.  Do you experience any discomfort or other symptoms with them and have you ever considered ablation?
Francie12 thanks also for your comment - yes I have been told to have a repeat halter, echo and stress test in 6 mths.
Woodruff - thanks for your read of that article. Your opinion and critical appraisal makes sense to me - it does seem a very rosy picture that makes ya wanna run out and get abalated but I think I should bear tickertock's comment in mind - dont want any EPs or Cardioloists going balistic on me :-) pity there are no better studies (at least I can't find any).
Anacyde - thank you - CMV is something I will look into.
tickertock - thank you - very interesting comment - lots of simmilarities with my current situation (i.e. unifocal RVOT PVCs in the 30% of beats range).  I guess I am just a bit freaked out by how sudden this has come over me and how constant it has been - I know I would be happy at a few hundred or a couple of thousand a day but this near constant bigem day and night has done a # on me.  I guess I will wait and see as it is early days in my case and maybe they will subside given some time.  As I asked upbeat; do you have symptoms of chest discomfort, pulsing pains, fatigue and mild dizziness? (as I do).  I take it from your comment youve never had RFA - are you satisfied with this because you are and episodic/recurrent sufferer and would you accept doctors smoothing it over if your PVCs were constant?

Thanks to all of you and best wishes for a PVC-free x-mass

[Momto3]

Ditto on Tickertock's comments.  Although I had successful RVOT and LVOT pvc ablations, it was not a first line (or second or third...lol...line of treatment).  I think keeping a healthy interest on your personal well-being coupled with periodic physical exams is the best way to handle benign pvcs.  That being said, if they become debilitating or physically troublesome whereby you would require further medical treatment, seek out a center that specializes in the particular type of procedure.

[tickertock]

I agree with woodruff, all of my PVCs are unifocal RVOT PVCs, though I rarely get them anymore, though whenever I had a bad attack of them lasting in the 1000s daily from days to months I would always have them rechecked, usually every 3-4 years I can look for a bad attack, the last bad one was 4 years ago.

Even though PVCs originating from the right ventricular outflow tract can be extremely symptomatic they are the ones most to ablatable as i understand it , it is important to get ARVD/ARVC ruled out, i mentioned ablation to 2 cardiologists and one electrophysiologist, all 3 went nearly ballistic on me. I even mentioned the possibility about PVC induced cardiomyopathy, they mentioned it as a very rare complication of frequent PVCs and that they almost had to occur daily in 15-20% range of your total heartbeat for years for this to occur, even then it was a very rare complication.

  I think anyone with recurring PVCs should get checked out every couple of years to make sure their heart function is fine, if symptoms are intolerable or very life altering then ablation would be reasonable to pursue( make sure it is done by a doctor who has performed many many of them), some are very successful , on the other hand sometimes the success is shortlived and another foci pops up, technology is improving all the time, maybe one day in the very near future this very distressing palpitation can be eliminated or greatly reduced, just my personal opinions only. Happy Holidays to everyone.

[woodruff]

The Japanese study cited was very small, only forty-five people (of whom five were lost to followup); overwhelmingly female (possibly significant, considering the evidence that women's heart symptoms are different from men's); and the followup period was quite short, 12 months at the max.  The authors mention that they were examining only pvcs generated from a right ventricular outflow tract, and also note that they did not control for all factors (for example, brain natriurietic hormone was evaluated in only five of the patients).  Their selection criteria and conclusions thus seem a tad self-serving to me.

If this study had been done on a large scale with rigorous standards, repeated several times independently, and published or referenced in worldwide publications, it would have more weight.

I do believe it is worthwhile to further study whether or not RFA  for pvcs might reduce risks for disability and death, though so far, I believe the larger body of evidence indicates that in those with structurally normal hearts, unifocal pvcs alone do not seem to be a significant risk factor for disability or death. For those with valve problems, coronary artery disease, and so on, it can be a different story.

[francie12]

I have daily PVC's that are not really a problem for me--2000+ a day recorded on the holter monitor.  Is there any kind of follow-up recommended to keep track of this?  Just wondering if any of you are on any kind of schedule for ECG's or any tests.  Every 5 yrs, 10 yrs...?  I know I'm one of the lucky ones who don't experience any kind of distress, but I do feel them off and on all day almost every day.  Good luck to everyone.

[Applehorse]

Thank you all for your detailed comments.  Thanks also to the Dr. for his/her answer however short.  He/she mentions complete my medical Hx - I said clear - that means no prior Med Hx.  He/she mentions how I feel now - see my closing commets the answer is there.  I think my question remains substantially unanswered. I hope that with your input and further med work up some answers may come.  Yes greater than 30% PVC came from 24 hr halter.

Anyway if you guys get the time I would like to hear your opinions on all this "benign stuff" and what this scientific and published article says:

http://arrhythmia.circulation.or.kr/webmagazine/webmagazine3/files/jacc2005_45_1259%20rvot%20pvc%20abl%20&%20lv%20fx.pdf

Also see this historical answer from another Dr of this forum (CCF-M.D.-KE on 09/30/2002):
http://www.medhelp.org/forums/cardio/messages/33648.html

Are we being given consistent answers?  Thanks once again to you all - glad to make your acquaintance - pity its as a fellow sufferer :-)

[upbeat63]

Sorry to hear about your situation. Regarding the risk of continuing with near constant bigeminy.....if you have a structurally normal heart then there is no greater risk for you than the rest of the population who do not experience PVCs.

For 22 years I've had PVCs at pretty high rate (averaged 450/hr per holter) but following 48hr holter this spring my heart beat is over 20% unifocal PVCs (average 1220/hr).

I have been in constant bigeminy for days upon days, and nsvt over the summer which a short course of toperol xl (12.5mg/day) stopped, but PVC frequency remains very high. Currently I'm almost in constant trigeminy. But the answers I get are the same as the one just given you, no greater risk.

I guess that should be great news, but I'm still visiting here  because people like momto3 (who has been in my exact position) is very helpful and supportive. My greatest fear was of developing something more sinister because of such a high frequency, but I've come to learn this is not common. And after 22 years of high frequency I haven't developed anything more than a very very strong dislike of the darn things, and now a stronger belief in own ability to withstand them (most times). I hope you find some comfort in reading the many posts of people in a similar situation and I hope the PVCs end as quickly as they started for you.

[dande4]

Did you have an ep study or was this diagnosed from the holter study?

Certainly any viral illness can cause some to experience tachycardia etc, especially since your body is trying to fight off the virus it works harder. I know when I have a cold, stomach virus etc, my resting rate becomes higher and just getting up increases it even higher. With a fever/sweats you lose water, minerals and it makes you even more susceptible to tachyardia etc.

Hope you get some answers.

[Momto3]

Not sure if you are a candidate, but I had successful ablation for multifocal RVOT.  I'm told that unifocal procedure is "easier" to correct.  Has your doctor ever mentioned the possibility of an ablation?  It is not considered a first line treatment, but in some cases, it can be quite effective.

[Cleveland Clinic]

Applehorse,

Sorry your havent been feeling well.  You fail to mention how you feel now.  Its hard to tell if the 2 episodes are rlated but probably not given they were separated so far in space and you felt well in between.

Overall there is no risk of problems from the PVCs if the rest of your cardiac evaluation is normal. If they dont cause you great symptoms, I would say no medication is fine. Without knowing your full history specific recommnedation of other drugs is difficult.

good luck