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Avatar universal

Ongoing Palpitations

I have a few questions about ongoing palpitations and trying to understand the etiology of them. In particular, PAC's. I delevoped these PAC's this past fall. They come and go and can get quite frequent at times. I have seen a cardiologist (an EP doc) and had an event monitor, bloodwork, and an echo stress test. The PAC's were determined basically benign. But I feel anything but "benign" when they pop up. I'll admit that there is  some anxiety involved when they do occur but otherwise I do not have any issues with anxiety.
Could the palpitations be at all related to Epstein Barr virus?
I tested positive with "recent primary infection" after looking into a possible case of Mono and ongoing fatigue last May.
How and why are PAC's hormonally related to women? The EP doc indicated that he sees a lot of menopausal women with PAC's. I am not menopausal but I am 34 and just recently completely stopped breastfeeding. The PAC's seem to be related to my monthly cycle. But I have never experienced anything like this in the 20 years of having menstrual cycles so why now?
Also, I am told over and over that people have these all the time and I probably have too and I am just more aware of them now. There is NO WAY that I just "became aware" of these PAC's. I am not doubting that I ever have had them but I guarentee that I have never had them like now.
When I get the flare ups of PAC's, it is not just the "skipped beat" feeling that concerns me. I also feel very fatigued, dizzy, and discomfort in my chest area. I get sort of an "aura" and can tell they're coming. What is this?
39 Responses
239757 tn?1213813182
MEDICAL PROFESSIONAL
dracee,

the answers to pretty much all of your questions are: i dont know. i dont know and i dont know!


Some people are predisposed to atrial, ventricular or a combination of both types of arrythmias. In the setting of a normal heart, these arrythmias are rather benign. Thats not to minimize the overall suffering you experience from them in any way.

Most likely its not realted to EBV infection.  Many women clearly tie their symptoms to hormonal changes.

Look back to see how others have dealt with some of thier symptoms.
Avatar universal
As a fellow sufferer of PAC's for almost 9 years, I understand how you feel.  They can be extremely annoying.  It's hard for people who don't feel them to understand those of us who do.

I can also tell you that PAC's won't kill you.  They haven't after 9 years with me.  Thankfully I recently had an ablation done for AFIB and the EP doctor took care of the areas that were also causing the PAC's.  I can actually sleep at night now.

Here is how I coped with them.
1.  A doctor gave me a beta-blocker to help minimize them.  Beta-blockers don't eliminate them.
2.  I also asked the doctor to give something to reduce the anxiety if I had a severe attack of them.  Anxiety causes them to increase and it starts a vicious circle.  You need to stop the cycle.  
3.  I decided I would not let them beat me after awhile, so I continued to run even if I had them.  Mind over matter.  This actually helped reduce them, and I felt as though they weren't controlling my life.
4.  I took some bio-feedback courses that taught me how to relax more.  Stress, lack of sleep, etc.  causes them to increase.
5.  ELIMINATE ALL STIMULANTS. Eliminate caffiene, chocolates, and DO NOT take decongestants.  These irritate the foci causing the PACs.

Hope this may help.
Avatar universal
I am so happy to see your comments.  I have had similar experiences as all of you.  I have had PVC's for years before my monthly.  All of a sudden a month ago, they picked up horribly.  I have a stress echo tomorrow and if it is normal then I guess mine are benign as well.  I was experiencing 15-20 a minute and the ER also kept me over night.  I am on a low dose beta blocker which has not eliminated them, but has put me back into a more normal rhythm.  And the aura that is described by several of you  I completely agree with.  I know, I just know when it is going to happen.  I swear I sense or feel it.  Once again, I also feel, there is some reason this is happening.  

Best Wishes to all
Avatar universal


Dracee at least the doctor gave you an honest answer. The vast majority of healthy persons have atrial and ventricular arrhythmias(some complex and of no clinical significance) to which they are unaware, that is not to say that they are not down right alarming and life altering to those that feel everyone of them. I think dquenzer (Doug) gave you some good tips. By the way Doug I know this one is going to shock you a bit , but hold on. Did you ever get around to shelving the medicines and waxing the skis for winter? That was many many years ago and you are still around , so you can definitely tell people about PACs. I'm glad the ablation seems to be having a positive effect on you now!!


flip(Lyn)
Avatar universal
It was nice to read about your positive outcome from the catheterization. Did it eliminate the arrhythmias completely, so that you don't need to take meds anymore?

NHS
Avatar universal
I too am a 34 year old female and started having PVC's about 7 months ago.  They definitely increase during my cycle.  Stress also seems to have an effect on them.  Did I mention that I have six kids ages 5 to 13 and my husband is away on military duty.  Just a little stress... Anyway I too experience the auora you mentioned.  I also have begun to experience some other symptoms that I wonder if any of you share. From time to time I also experience shortness of breath and my chest is sometimes sore.  The one that bothers me the most is this.  I can't lay on my left side because of the discomfort it causes.  It is not painful but I can't quite describe it.  I can just tell it is affecting my heart in some way.  I had a complete work-up during a hospital stay in November (echo, treadmill stress test, etc) and their exact words were "It would take the hand of God to stop your heart."  I just feel like I have gotten worse since then.  I wish now that the only thing I was dealing with was the PVC's.  I actually was able to come to terms with that but these new symptoms really seem to be getting to me.
Avatar universal
The "aura" sounds intriguing...it sounds like you are feeling the weak beat (the "skip") before the strong beat (the make up beat).  I feel this too, but never referred to it as an "aura".

The "skip" is simply the premature atrial beat, which most of us can't feel very well, since it occurs early and therefore is rather weak and unproductive (since the ventricles did not fire).  This is followed by a normal atrial beat, which now triggers the ventricle into action, and is felt a bit more strongly since now the atria were more full than normal.  Contrary to popular opinion, there is no extra beat.

-Arthur
Avatar universal
"How and why are PAC's hormonally related to women? The EP doc indicated that he sees a lot of menopausal women with PAC's. I am not menopausal but I am 34 and just recently completely stopped breastfeeding."

I also started having palps after ceasing nursing with my third child.  I had basically been pregnant or nursing for over 4 years.  I think the sudden change in hormones were definitely the cause of my PACs and PVCs.  I also had them just before my period would come.

Thankfully, I think my hormones have really evened out.  I am off a beta blocker and have had not noticeable palps for almost two months.  *knocks wood*

I am off caffeine, though I do indulge in chocolate sometimes.  I don't drink or smoke.  I started a regluar exercise program, which I think has also made a difference.

Good luck.
Avatar universal
It is difficult to know if it eliminated the AFIB completely.  It has greatly reduced the number of PAC's I used to have.  I used to get about 2 or 3 a minute, and at night when I woke up my heart would be very erratic from PAC's.  It made it very hard to sleep.  Now I don't have really any at night, and I have them from time to time during the day (2 or 3 an hour). I could have them more but really don't notice them much.

Since the ablation the first week I had 3 episodes of AFIB which were in short duration (1 a few seconds to 2 a few hours), the second week I had 2 episodes ( 1 seconds and 1 a few hours), and then a few episodes of seconds since then.  Compared this to half a day to day and half every 2 to 3 weeks that's definitely an improvement.  These episodes could be from a foci not ablated or from the irritation caused by the ablation.  If it's the latter then eventually it will dissipate.

I'm on 50mg of atenolol to basically keep the irritation of the heart down.  I use to be on an tikosyn and 25 mg of atenolol. I'm also on coumadin and small amount of klonopin (atenolol gives me insomnia and the klonopin helps with that).  They did want me to stay in the hospital a few more days to go on flecanide (sp?), but I needed to get back to work so they just increased the atenolol.  Besides if I was on an antiarrythmic I wouldn't know exactly if the procedure worked or the antiarrythmic was working.

But the jury is still out.  The real test is at about 8 to 12 weeks.  By then the nerves are healed.  If I am still having episodes of AFIB then I may need a 2nd ablation.

The wierd thing right now is that my normal heart rate has been elevated by about 15 beats per minute since the ablation.  Normally if I was on 50 mg of atenolol my resting rate would be in the low 50's.  Not it is about the mid 60's.  The lit. states that this may occur for several weeks after the ablation.  Not sure what "several" means.  I'm hoping this will end, because I am hoping to get off the atenolol as well.  My goal is to be med free in 3 to 6 months.

Thanks for asking.  
Avatar universal
Wow! A lot of awesome advice/comments as usual. Is it not funny how sometimes you can feel almost "silly" because of the symptoms you experience? But to hear others have the same exact thing is refreshing. I thought I must really be reaching if I am experiencing an "aura" before the PAC's start. Also to hear other women having the same problem with hormones/breastfeeding is comforting. I cannot imagine the complete train wreck I will be during menopause if I am having the problems I do now!!! You think they could figure out how to help women balance their hormones better. and to USAR....as I described I also get a chest discomfort and sometimes pain as well as a feeling of shortness of breath, very fatigued, and a sort of lump in my throat during flare ups. I also get tachycardic or my heart will "pound" and I can even feel it in my hands at times as well. So, like you, it is not just the PAC's. It is the entire group of symptoms that occur that is frightening and frustrating. The nurse practitioner that I saw at the cardiology office recommended a calcium channel blocker (30 mg) for flare ups. I have not yet tried it and am just hoping this craziness goes away on its own. Fortunately, it seems to have slowed down(knock on wood). I know that all of these heart meds come with side-effects and it is basically the lesser of two evils so I am hoping and praying that my body balances itself back out! I too try to get regular aerobic excercise but I always have. Even right before this all started I walked several miles per day and work with weights. And I don't do caffiene nor do I smoke. I do suffer a type of insomnia (frequent waking, sometimes trouble falling asleep)so that could be a part of it. Thanks to all for the great input!
Avatar universal
The "aura" I am referring to is not actually the "skipped or premature beat". I am actually referring to a real aura. Like hours before they start happening. I start feeling all of the previous listed symptoms. I can tell when they're coming. That is what I mean about the weird "aura". I think it is all the symptoms together
Avatar universal
Hi,

This is the first time I've ever seen the "aura" discussed, I get it too.  It is very hard to define, but definately there.  It's like I know when they are coming, but it's not just a physical awareness or a mental one, a bit of both.  


I also cannot lie on my left side.  It isn't a pain thing with me either, but very uncomfortable, unsettling?  A lot of these things are hard to define arn't they?

Anyway, always good to know one isn't alone in all of this.  I am a 36 year old female, and my PVC's where diagnosed 2 years ago after the birth of my third child.  I'm convinced my pregnancy had something to do with it.


Take care
Lianne
Avatar universal
Thanks for the information about your condition and your meds. It's provided some helpful, additional insight. Hope you'll have a complete recovery. Please keep the "message board" posted on your progress.

NHS
Avatar universal
Hi my name is Pat and I am a 23 year old male, after reading your comments made me feel a little bit better. With me Like 7 years ago i had mono and thats when i started to smoke as well..But thats when I started to get the palpitations but after a month they pretty much went away besides when i did some activity then my heart would pace hard and fast for about 30 seconds then go back to normal..But now I feel my heart beat pretty much most of the time which is very very annoying on the verge of driving me crazy..Went to the Doctor few days ago and checked me out and said i was fine but still got the echocardiogram and the holter monitor and the tests results were normal..But in my head its not okay yet until i stop feeling my heart beat..My doc says it deals with my stress, anxiety and little bit of depression but can;t understand how that can affect me feeling my heart beat..I get a little bit of loss of breath but its no big deal..I am chlostaphobic and sometimes when i am in a normal place it feels like i need to go outside and catch my breath..Also i quit smoking like a week ago and going through that and all the anxiety i guess its too much for me right now...Just want all this to stop because i am getting really scared, i'm too young for this stuff to happen..Anyone out there have any pointers, should i go to a heart specialist??...thanks..Pat!!
Avatar universal


I definitely can relate to the "aura" it is like you wake up one morning and just know that this feeling you have over you is a feeling associated with PVC/PAC activity to come on soon. It is a feeling of foreboding that you will have some that day say, even for quite a awhile before they actually occur. other times it can occur within minutes or seconds of actually feeling the PVC or PAC.

There is no extra beats. They are premature atrial or ventricular contractions. they are no extra or skipped beats, that is just general term that is used, only premature beats results in a small amount of filling and thus the following beat is much harder because of the extra volume of blood pumped out, surprisingly the beat that you feel is actually the normal beat , just with more force and blood volume.

I can aslo relate to this" buzzing " feeling chest your chest, that has no relation to the pulse or is not shown on ECG . I agree with Arthur that is probably electrical impulses firing  that never reaches the cardiac tissue to actually effect the heartbeat and I guess it is a good thing it doesn't, because it is so rapid it feels like a buzzing or humming, more than a fluttering.

I suspect persons that have this is probably more susceptible to A-fib, PVCs, PACs and other irregularities of the heartbeat.

Of course this is just my personal opinion and should not be taken as facts, at the end of the day who really knows??


flip(Lyn)
Avatar universal
Hello, I am a 33 year old woman.  I developed pac's and pvc's 7 years ago after having my son.  It actually came about one year after having him.  They are just about the most horrible feelings I can think of, and there are different "types" of the skipped beats with me.  I really hate the hard thumps that take your breath away, and the ones that do 3 or 4 in a row.  Sometimes while they are doing it, it feels as if my heart actually rolls around in there. Strange feeling.
Mine always are worse 3 to 7 days before my period begins. I too can "sense" when they are about to happen, even up to hours beforehand.  Sometimes I sit and cry when I have them, you would think that after 7 years I would realize that it isn't going to kill me, but in the back of my mine is that "what if...".
I did some research and was told by a few Dr.'s that these indeed can be hormonal, and sometimes get corrected when we correct our hormones.  This certainly isn't true for everyone, because as the Dr.'s say, many humans have this benign condition and neither realize it nor is there anything wrong with their heart. I however believe it is hormonal in my case.  I developed many symptoms after having my son; asthma, sinusitis, bronchitis, acne, pms, mood swings, low resistence to infections, weight loss, headaches, low sex drive, etc. which can all be contributed to my hormones being off.  I am going in next week to get tested on them and see if I can't get mine figured out.  Worth a shot anyways, huh?
Magnesium has really helped the number of my pvc/pacs, except during my periods.  Nothing takes them away than. But it's worth trying that too.  Stress is a major factor.  Lack of sleep also.  It even seems that if you dwell on the pacs, you even give yourself one.  I am glad that we have a place like this that we can come to and share our experiences and hear others, doesn't make me feel quite so "alone".
Thanks for letting me ramble on my problems, I hope that someday we can all find a cure for this horrible nuisance.  Michelle
Avatar universal
Although I feel like my PAC's are hormonally related or even initiated by hormones, they have come for no rhyme or reason and follow the same pattern that you have described. since I have only had them since about OCT/NOV I am still trying to associate them with something as well. But I have had the same exact pattern that you describe. Maybe they should put us all in a big room and do a study!
Avatar universal

What a great story! That it is why is so important to have second or even third opinions and the correct testing to aid in a true diagnosis. You followed your heart and also your head, with that combination proven you right you have a right to be merry!!
Avatar universal
I wrote a message yesterday on here and if some people cal read it and tell me what they think it would help out alot..But see i have a regular heart beat like 80bpm but when its normal i can still feel my heart beat sometimes, depends on if i am worrying, anxiety or whatever..Then sometimes it will just pound fast then slow back down after a minute..had tests done and they came back fine, but it aint fine until this stuff stops happening..They say its all about anxiety for me, which i did start to take Paxil cr and its helping a bit..If i had one wish it would be to stop being able to feel my heart beat because its so annoying and drives me crazy...Pat!!
Avatar universal
Like you, I (and some health professionals I have met) also wonder about the relationship between my chronic infection of Epstein Barr and my arrhythmia.  I am currently using some antivirals (not pharmaceuticals).  Another possible root cause that some researchers and practitioners suspect is heavy metal toxicity.  To pursue this I have just undergone a (urine) test following IV DMPS (which, I am told, is an amino-acid-like substance that chelates especially mercury).
Avatar universal
Hi, I'm a 30 year-old male that started having PACs last May.  Just wanted to chime in on this "aura" business, because I feel it too.  It's indescribable, but definitely there.  I get them about 2-4 seconds before a PAC, and just know one is coming.  I start thinking "Oh no, oh no, oh no" and then 'zap' the PAC and then the dreaded pause before the normal beat.  I have also had something interesting happen since May and wonder if any of you have it (preferably males as there are no monthly hormonal changes).  Since these started, I have them for about 3 months, then they go away for 2-3 weeks and then start back.  This is my first time on this board since 3 weeks ago because they inexplicably stopped.  Then 3 days ago, they started back.  Gradually at first, like 2/hour on the first day, 2/minute the second, then 10/minute today.  They have followed this start/stop pattern 3 times since last May, and I can't for the life of me figure out what I'm doing different to make them stop, nor do I know what I'm doing to make them start back.  I'm not on any medication (took Beta-Blocker in May, but they didn't help) and don't have any kind of anxiety disorder.
Avatar universal
This all started with me after my third child as well. It has to be hormonally related or definitely some sort of chemical imbalance. It is amazing to me that they know so little about the "why" of these palpitations when they are legitimate and so many suffer. I recently had some hormone testing. Not just the female hormones but other such as cortisol, acth ect. Female hormones are definitely hard to track with one blood test as they fluctuate throughout the day everyday. A better test for these are a 28 day saliva test. Usually alternative MD's are more open to this type of thing. In fact, for things that traditional doctors just cannot find answers for and label as "stressed" or "anxious", Alternative doctors (MD or DO)have a different approach and help a lot of people. Especially with your group of symptoms Micheller. It sounds like you've been suffering for awhile. Has your doctor found anything or any explanation for all of that?  
Avatar universal
You are definitely not alone.  I am 37 years old and I, too, have suffered from these premature beats on and off for years now.  I think they started in my early 20's.  Initially, they were infrequent, I had normal tests, and I was reassured that they were benign.  Eventually, they became more frequent and I started taking a small dose of beta blocker (Inderal) as needed to control them.  I found that a small dose (just 10 mg) usually worked very well for me.  Then, the amount of stress in my life increased when I went to medical school.  I began taking a daily dose of Atenolol to control my palpitations and, generally, I would say that it worked very well.  I still had the occasional "skipping" feeling and the occasional episode of persistent premature beats, but they were pretty manageable.  Around the time I graduated, I had an increase in symptoms that responded to increasing my medication dose.  Recently, I have been going through a rough patch with them again.  I have had them every day for a couple of weeks and have had several days where they were so persistent that I could hardly force myself to function normally.  I had a Holter monitor last week (still waiting for the results to come back) and am having a repeat echo today.  Medications are not helping as much as they usually do.  I have been reading the comments here because I have always found it comforting to know that other people have these, too.  I finally decided to share my own experience to reinforce that all of you are not alone and you are not crazy for finding these sensations so disturbing.  I am a doctor (pediatrician).  I have had these for years now.  I have been told over and over that they are not dangerous.  Logically, I know that premature beats in a normal, healthy heart are actually quite common and generally do not cause problems.  In the hospital, we commonly see patients having occasional PAC's and PVC's on EKG's and monitors and we usually do not worry about them at all.  Most people don't even know they are there.  However, knowing all this doesn't make it any easier  to tolerate them when they are bad/frequent.  They feel so awful and make me anxious and completely exhausted.  I wish I had a magic cure for all of us.  Thank you all for sharing your stories.  Hang in there and work on doing your best to relax.
Avatar universal
I was having regular heartbeats also. Two years ago, I found myself in intensive care because of this. My heart was also racing at 170 beats per minute. I was sweating, had pain in my throat and not my chest. I remained calm, but had two heart catheters. One in my chest and leg. I had no blockages. I was finally "diagnosed" (notice the quotation marks)with right ventricular dysplasia and ventricular tachycardia. I was assigned a new Dr. in town and this eager beaver of a Dr. said you can drop dead because what you have is what an athlete has and he drops dead while exercising. This nice Dr. brought in his salesman to pressure me to have a device planted into my heart that woud start my heart again if it stopped. I was horrifed. I told him I did not want to live like a robot the rest of my life and sure didn't want to experience the horror of feeling as if I had been kicked in the chest by a mule(the dr.'s description of the device) when the device detected my heart had stopped. The Dr. was furious at me and sent me home. I changed to another Dr. shortly after and this Dr. felt that if I had been told that I needed the device, then just take it, but he humored me and I asked him what else could be done. He suggested the only other thing I could do was to get a heart MRI, which is the most effective thing for seeing if my heart had any damage. This town, Amarillo, Texas, did not have a Heart MRI and I was sent to Dallas. Baylor Medical center did the Heart MRI and, GUESS WHAT? I did not have what I was diagnosed with. I was very angry that I was about to have the rest of my life changed by a wrong diagnosis. I was told that an ablation(sp?)for the irregular beats or could take medication would fix the problem. I took the medication and after a time, the fast beats and irregular beats left and have not been back. All I am saying is, do not take what a Dr. says a face value. Get a second or even a 3rd opinion just as I did. I got a 3rd opinion even when the 2nd Dr. said, "I guess you can keep going until you find someone who will tell you what you want to hear. That Dr. had to eat his words when the heart MRI came back to him and he said, I have to say you made the right decision when you decided to not have that device. WE WERE WRONG!!!! Remember, Dr.s are human and do not have the answer. Sometimes we need to listen to our own common sense and not let fear drive us to go against what we feel deep down inside.
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