Thank you for this opportunity. I am 42 years, in very good physical condition, and have a history (4 years ago) of A. Fib. I have had not reoccurance of it. About 6 weeks ago on a run I noticed a skipped beat. I have since went thru all of the tests at the ER and with my cardiologist. It was diagnosed as PACs, PVCs, and SVES. I wore a holter moniter for 24 hours. They have all said the same thing and agree with most of what is posted here - dont worry about it. I am a competitive runner and I have the Ok to continue running.
The problem is that the PACs really get active when I run and usually remain that way for about 24 hours (occuring every 5 seconds or so). Other triggers are eating (everytime), upon waking, any physical activity, and stress. Mostly typical except for the eating. I have also had a tremendous amount of gas (belching) for a while that started prior to the PACs. My questions are: 1. Could the PACs/PVCs be caused by a gastrointestinal problem? 2. Is it really safe to continue to run when it increases dramatically when I do? 3. Why does it happen when I eat? 4. Is there a procedure such as ablation that may work? 5. Is this a trigger for A. Fib.?
I have stopped all caffiene and alcohol intake. I have increased my dosage of Toprol (to 50 mg). I have decreased my stress level as much as possible. I have stopped running. None of these things seem to be helping. To say this has negatively affected my life would be an understatement. The anxiety that accompanies this condition is tremendous at times. One more thing, I have a follow up visit with my cardiologist soon. I like the guy but his response to relax and learn to live with it seems almost obtuse. It may be the least dangerous thing he sees in a patient but it is huge to me. It seems from my research that a cure for this appears to be ambigous. Is that the case? Thanks, Tim
1. Could the PACs/PVCs be caused by a gastrointestinal problem?
I am intrigued that both posts today mention belching and gas, but am still at a loss for the cause. Atrial fibrillation during eating and while falling asleep is usually attibuted to vagus nerve or the parasympathetic nervous system. The vagus nerve is active during digestion.
2. Is it really safe to continue to run when it increases dramatically when I do?
3. Why does it happen when I eat?
It could be increased activity of the vagus nerve.
4. Is there a procedure such as ablation that may work?
With the atrial fibrillation as infrequent as you describe, I don't think an ablation is the right option yet. If it becomes more frequent, you are a very good candidate for an atrial fib ablation. Pac ablations are difficult unless there is a single morphology (location) PAC that is easy to map.
5. Is this a trigger for A. Fib.?
It may be, but you will have to wait and see if it comes back.
It seems from my research that a cure for this appears to be ambigous. Is that the case?
The personalities that are drawn in to cardiology is one that likes to fix problems. There is no easy fix to pac/pvc's and think that frustrutes you and us alike.
There is some research into the origin of ectopic beats. Just last month in the heart rhythm society journal there is an article about neural crest cell migration and the origin of pvc/pac's. I do not think we are very close to a 'cure' yet. Ablations can help, but people have multiple morphologies and are difficult to treat with ablation.
Your symptoms are similar to mine, although I am now 59 and they started when I was about 53. I've been running and playing soccer all my life. It's my understanding that many athletes who train vigorously and routinely have a tendency to develop enlarged left ventricles (a good thing, as this is muscle and not edema). In doing so, other things get stretched as well. These things include the pulmonary vein entries (ostia) to the back of the heart at the atria. It has been found that foci (electrically active cardiac tissue located randomly in normal cardiac tissue) that are located in the PV ostia can and do leak their electrical signalling into the normal timing pathways of the heart. When this happens, you get the premature beat. Atrial origins result in PACs. Enough of them can result in PAF. The theory is that stretched tissue affords more opportunity for the ions pumped out by these foci to affect the heart's normal rhythm.
If they stay at the PAC level, they are absolutely harmless, but of course, may be difficult to ignore, especially when running. I have found that a focussed effort to ignore them, in particular, by avoiding pulse checking, carried out for several weeks (or months, patience!) will produce two beneficial effects: (1) anxiety will be reduced and (2) you will notice the 'skips' less. For me these two effects also resulted in less PACs. Easy to say, hard to do. In fact, it's extremely hard to do, but worth the effort. Remember, the reverse is true...that is, checking up on your pulse will train your nervous system to remain at high anxiety, which of course, will cause adrenaline levels to remain high, and result in more PACs.
After you have been checked out with a normal heart, get back to running and ignore the buggers!
I'm concerned about the responses. I have been assured and reassured (and then some!) that PAC's do NOT lead to A Fib UNLESS you have a structural abnormality that would lend itself to Atrial Fibrillation. Comments?
I just ran a search on how that question has been answered her by the Dr and here is what I found:
"No, not all PACs lead to afib. In some persons with atrial fibrillation the trigger is thought to be PACs but if everyone with PACs developed afib the whole planet would have afib. Only about 5% of the population develop afib in their lifetime."
The same thing happened to me when I was about 40. I also did a significant amount of running and XC skiing. The PAC's were incredibly nerve racking at the beginning. I'll have to admit that they took me about 6 months to a year to really adapt to. But I noticed that by getting anxious about them they occurred more often. So I soon learned to relax. I continued to run just because I wasn't going to let something that was benign control that area of my life.
I agree with previous post as to cause. The main thing that you will need to be concerned about is that they will develop into AFIB for Flutter. This is what happened to me. I woke up one morning with AFIB when I was 46. I then tried to treat it with meds for 3 years. It didn't work, so I got an ablation at Mayo 3 years ago. That did the trick. It not only stopped the AFIB but also the large amount of PAC's I would get during the day. Still get a few, but nothing like before. I continue to run at a modest rate. No more 8 to 10 milers, but 2 to 3 a day. Course I'm now 52.
The doctors stated at Mayo that runners are susceptible to this. Ironically my brother (a runner) just got Flutter and had it ablated successfully. Also a fellow track coach (former distance runner) just got diagnosed with AFIB after I hounded him to get his irregular heart beats diagnosed.
If they are PAC's/PVC'st I would do is simply try to relax about these things and not obsess about them. I know it is hard to do because you think something is dreadfully wrong. It isn't. They will ebb and flow.
But I would also monitor for AFIB; especially since you got this before. Also remember that if they do develop into AFIB for Flutter than an ablation is a cure (albeit expensive).
My heart feels like it's going to stop ALL OF THE TIME...CONSTANTLY... since 11/29/1993 @ 5:05 PM when my heart beat oddly and violently for about a second. Complete workup revealed occasional PVCs and nothing else. They come in spurts and I can have several in a few minutes and then just several in a day or sometimes none in a day. BUT... I still fell like I'm going to pass out constantly...like my heart is beating wrong...whether standing, sitting, driving, or laying down. I have found that Co-Q10 (120 mg) has significantly reduced the PVCs and I also take Omega 3-6-9 which also seems to help reduce the number of PVCs. I have also been on Xanax for 2.5 yrs due to the anxiety created by the way I feel. I have lost 30+ lbs in the past 3 months but still feel no better than before the weight loss. Just thought I'd suggest the Co-Q10 and Omega 3-6-9 oils.
Forgot to mention...I also have a lot of belching...specifically belching "fits" that can last 30 minutes or so...I do also swallow air and force belching since this seems to make me feel better...I also lay on the floor with my hand between my chest (where my heart is) and the floor and roll around. This seems to help also. Have seen 15+ medical professionals plus alternative medicine with no specific diagnosis or treatment that helps.
Can I ask what it is you all feel when you are running when you get PAC's? I can understand you would be aware of PVC's due to compensatory pause, but was curious as to what made you aware with the PAC's since they often reset the sinus node (no compensatory pause).
Thank you very much for your responses. It all helps tremenously and I have gained some comfort from them. Its good to know that I am not alone with these systoms but disconcerting that so many people suffer with PAC/PVC and just have to learn to live with them.
Excellent advice Arthur about breaking the habit of checking your pulse. As if there was anything I could do about it if I did feel it happen! I am a little concerned about this being a trigger for A fib but I will chew that food when I have to.
As far as running goes, I am concerned that it increases the frequency and my heart rate tends to stay up longer post-run than it used to. I can still hit the gym without too much trouble but long sustained runs of 8 miles or more are out of the question for now. Writing this seems a little silly compared to some of the problems posted here. I wish I could help you all.
Again, thanks to all for your posts here. I will pray for each one of you for Gods blessing in your lives.
PACs are a trigger for AFIB only when the "substrate" is amenable. As I understand it, paroxysmal AFIB occurs if the tissue making up the atria has just the right interwoven lines of electrically active cells, then a "spark" from the foci (which normally triggers PACs), can induce a 'circular' flow of polarizations/depolarizations (basically ions flying back and forth across the atria) which is self-sustaining or nearly so, as the pulsations from the foci may be needed to keep the circular flow going (kind of like the kid with the stick hitting a hula hoop to make it wheel along the ground). This circular flow of ions is fast (something like 200-300 bpm), but the SA node is geared to repolarize at a slower rate, so the result is an irregular sinus rhythm that usually runs a little high. This of course is all speculation based on a wealth of scientific information. Take it with a grain of salt (or MSG).
As I understand it, and forgive me if I show my ignorance here, what I actually feel are the compensatory pauses from the PVCs. In all actuallity, I rarely feel anything while I am running. I occurs after the run when my heart rate is decreasing to a normal level and then continues for some time (up to 24 hours) afterward. After I wore a holter moniter for 24 hours, they diagnosed me with both PVCs and PACs with the PVCs being the most prevalent by far.
All my runs since my diagnosis have been "test" runs of various lengths and speeds. Short runs of moderate paces have had little effect afterward. But the runs of 6 miles or more or shorter runs at a quicker pace (6-7 minute miles) have caused me the most problems. Another curious note may be that my heart rate takes much longer to normalize than it used to before this started.
I hope this helps. Like I said before, I have put my running on hold for the most part until I can get some more answers. I am still having to tweek my medicine and have a few more test the cardiologists want to run. Best of luck with yours.
PAC's and AFIB basically can come from the same source. They don't have to, but the fact that after I was ablated for AFIB my PAC's diminished is evidence of that. My PAC's were a sign that there were extra foci in my pulmonary veins. When too many of those foci were there later in my life it became AFIB.
PAC's are benign and I still get them from time to time. However my EP says they come from another foci in my atrium but not in my pulmonary veins. He didn't ablate that area because it was too close to my AV node.
As to "structural abnormality" is the reason for AFIB; that is only half the truth. I have found that many GP's don't have a clue about these things. In fact my doctor (GP) had no idea about the different types of ablations. I was the first patient he ever had that received one. I went through nearly 3 days of tests at Mayo before my ablation, and my heart was structurally normal yet I developed AFIB.
But not everyone who gets PAC's gets AFIB. Everyone has PAC's/PVC's. But only 5 per cent develop AFIB. So basically the likelihood of you getting AFIB is 5 percent.
Got it! So, is there a test to determine if you have that vein pronlem that can cause A Fib. Seeming a little paranoid, I know, but I have such a huge fear of these things. Its stopping me from enjoying life. I am supposed to leave for Florida in a few weeks for a wonderful beach vacation and I a worried sick that I am going to have a bout of skips and drop dead!
And the bad part is a therapist for anxiety cant really help because I actually have these things. Its not like its in my head.
I've been reading many of your posts regarding PVC's, and like many of you, I have had them for years. My PVC's had all but gone away, until I caught a cold in February...since then, especially when I run, they have returned in a big way. I am intrigued by the "belching" comments...in fact, I have noticed that when I run, and they start up, if I belch a few times it generally helps a bit.
I am concerned about my PVC's as they seem to be getting worse during exercise, something that I had always heard would be of concern. So far, an echo and stress test indicate all is fine...tomorrow I get a holter.
Your situation sounds EXACTLY like mine. My husband has been hounding me for a beach vacation...I'm terrified to get out of my "safe zone" for fear that I will have an episode and be too far away from a hospital to get help. I'm most terrified about the 6 hour drive that consists of long stretches where you are in the middle of nowhere!
I have been dealing with this since I was about 18, with my worst episode happening last year after I gave birth. I have been to 3-4 cardiologists and they all have the same concensus...it's just one of those things. I understand it may be a small thing to some people, but it's extremely hard to deal with when you are constantly afraid you are going to drop dead.
For everyone out there, the only relief that I have gotten from this is by taking an anti-depressant/anti-anxiety. I HATE taking pills, but this has improved my life dramatically. They make me extremely sleepy ( I almost feel sedated a lot of the time) which may be why they help. I have already tried the beta-blockers with no success...some of them even felt as if they made it worse.
Maybe one day there will be a magical cure, until then.........
Good luck Carey, and I hope you make it to the beach and have a wonderful time!
It's a shame that it takes a lot of digging and study to understand the hows and whys of PACs, and how and why they lcould lead to AF. The shame is that once you've gotten that far, you realize how difficult it is to explain to anyone...a conundrum, since I do recall being clueless and now, not exactly as clueless, I am cursed with jargonitis.
I think you've got the idea. PACs are one thing, and PAF another, and it's generally difficult to generate a PAF. For many, they do start with bunches of PACs, but the wiring in your heart has to be amenable to keeping the abberant signals going for PAF/AF, and that seems to happen to very few folks (5%).
PACs, PAF and AF will not kill you, EVER. Aside from the nuisance, you WILL NOT DIE from these critters. So, I am not sure where the fear comes from. Having said that, because AF causes some of the blood to gurgle around in your atria for a while before being sent out, there's an increased chance of blood clot formation which is not good. But again, that's only if you're in AF. So stop worrying and enjoy life. "Dealing with it" is not to keep worrying, it's to ignore it!
Two days ago I went to emergency room because I have been experiencing irregular heart beat for most of the day. Doctor told me that I have PACs and that they are nothing to worry about. I did some research and found out that lot of people have them and many don't even feel them. I feel every one of mine and they are continuous as they were in emergency room. They showed as three consecutive beats and a gap and so on. I've had them all day today. almost without break.
I hear people have them here and there (isolated). I have them continuously for hours (three faster beats, gap, three faster beats, gap....)
Do others have them continuously as well?
It really drives me crazy (scares me really bad)
Hi! I am 54 yrs old and since my very first attack of Irregular heart rate approx. 3 yrs ago, I have been checking into this forum and finding solace from reading all of your comments. I am frequently plagued by the occasional pvc/pac/atrial tach (brief runs), I have learned to pretty much ignore these on a day to day basis, but its when I have days like today that I find myself running to the ER (3 trips in 3 years) Today the skipping and accompanying shortness of breath was just too much. Dx? PAC's and low potassium. In fact, each time I have been to the ER with this I have had a low potassium which is why they must be soooo persistent and scary. The reason for potassium loss is probably, without getting too graphic, IBS. Also, I was diagnosed in the past with IST by EP study, placed on Tenormin 50 mg daily and thankfully this has helped tremendously but as you can see I still have some "breakthru attacks". I am always intrigued by the GI component to this as I too notice that when I feel that annoying gas distention, I seem to be more prone to arrythmias. Burping ALWAYS seems to improve the condition...Although the doctors I have seen prefer to look at me like I'm pretty crazy to even think there could be such a correlation. Anyway I just wanted to say I certainly understand how these sensations can rule ones life and rob one of pleasure. I have been there and still go back from time to time, like today. Thanks to all who post, your comments and similar experiences have gotten me thru the tuff days, we're all in this together, I hope this lengthy post helps someone else in need of a little reasssurance.....because as bad as I felt earlier today.....I am still here!
So I have now been through an echo, nuclear stress test, and 24 hour holter monitor...they tell me I am having late stage PVC's (less to worry about than early stage they say) and PAC's (even less to worry about)
The EP doc recommends magnesium if my stomach can take it. One interesting observation though...I enjoy wine (good for the heart, right?) Well, I haven't had a glass of wine for a couple of days and the PVC's have decreased....hmmm, this is gonna make me mad. :)
Anyway, I am still convinced that much of the PVC/PAC thing has to do with digestive stuff, but thought I would share my observations.
I am 59yr and have had these same problems mentioned since my 30's. I too am at a loss for the reason behind the pvc's and flutters. I have been to the ER about 4 times and have had the monitor etc. All the Dr. say is not to worry and to try and ignore it. Easy to say but I try. I am overweight and want to exercise to lose but every time I try to the pvc's start in so I would rather not push my luck. I too have noticed when I have a lot of gas the pvc's crop up. There are so many of us with this problem that you would think the medical profession would take more interest and study this more. The single skipped or extra beat is easier to deal with than the irratic flutter that sometimes occurs and with that comes some pain and extreme rush. I think what really bothers me most is that because the Dr. has said not to worry, people around me think it is all in my head and I should just forget about it. They should all go through this as well as the Dr. and maybe they would be a little more sympathetic.
I too, have had PVC's for years just shortly after the birth of my first child. I find that I can go long periods without any, then, out of the blue they kick in non-stop for days and weeks at a time. I have took many foods out of my diet, including MSG and Aspartame. I also notice a huge increase around hormonal times. My biggest triggers seem to be eating these days. Sometimes if I am too hungry or have heart burn, i dont have them,but the minute I eat, they start up. Some days I want to run away from my own body, but who can do that? i am glad to be able to look on here and see others who have the same problem.
My doc suggested taking 250mg of Magnesium two times a day. I have been for about one week, and my PVC's do seem to be less...have no idea if it's the magnesium or something else. Just thought I would share the information
I am a 35 y/o male. About 9 years ago I had two years of what seemed to be SVT episodes resulting in multiple ER trips and subsequent anxiety counselling. They subsided by themselves over time and I have been symptom free for the past 9 years. 4 days ago I had sudden onset of PVCs and am getting about 3 or for every minute.
It has taken me back to the level of anxiety I had all those years ago but at least the DR (I went yesterday) could see these things on the EKG! (they never managed to catch my earlier SVTs). He ordered a Holter which i wore today for 24 hrs.
So - here I am - constant PVC beats and feeling totally down about it.
Interestingly I too belch a lot recently. I also have GERD. I wonder if they are related. Breathing and Belching does seem to influence my PVCs and I concur - checking your pulse often makes them worse.
I have a consultation with a Cardiologist to discuss my Holter results next Wednesday.
Like many of you I have had PVCs. I have had them since childhood, now 48. I get episodes lasting several days and then free for up to weeks at a time.Yes, they do scare the hell out of you and I have been to the emergency room many times thinking this was it. I have seen many doctors and had many tests, they all say my heart is fine. One doctor descibed PVCs as the heart just re-adjusting itself. Some PVCs are small and some are big. The big ones make you stop and I always think I'm going to die right then. Reading the comments here have put me a little at ease, even though when I still get them I still think this is the big one that will do me in.
Hello there from (at the moment) sunny England! I stumbled accross this site by accident whilst trying to research my problems with palpitations/irregular heartbeat. I am amazed and incredibly reassured by the amount of people communicating here and the help/support you are giving each other. I cannot find a similar site in the UK. If anyone out there could just answer a couple of questions please as I find all the jargon a bit confusing. I am 46 yr old female in excellent general health and I was dignosed 2 years ago with what my cardiologist tells me is 'pa;pitations' or 'slight arrythmia' whatever the heck that means! I had been through a year of extreme stress and anxiety but was more or less over it when all this began.I was told this was probably the trigger for my condition. I have been hospitalised once and have ongoing tests which all say that my heart is 'normal' and that I am healthy - just try to ignore it.
I take a beta blocker, (bisoprolol fumarate) plus low dose diazepam, (2.5 mg) for the anxiety this is causing me. I have been told to 'just take another b/blocker or more diazepam if it gets bad'!!
I am constantly tired - I think from the beta blocker - and am probably pretty well addicted to the diazepam now. I am so unhappy and confused because I have a wonderful family who are supportive but just cannot begin to comprehend how frightening this is for me. I don't like to travel as I get panicky when I am away from home - this from a woman who used to fly as an International Air stewardess!!!
Please can someone tell me what AFs PACs and PAFs are? Also AFIB? We are not really encouraged here in England to ask too many questions of our Consultants/Specialists and also I find when I am with them I am quite intimidated and feel like a fraud! (They can be quite patronising - ther there dear try not to worry' etc!! I have just had another overnight attack with my heart 'bumping about' and missing/putting in extra beats all the time. I get chest pains sometimes too and I am so so scared i am going to die. Sorry this is so long a post - but I am at the end of my tether and need to take this into my own hands now to try to come to terms and cope with this problem. I am not a wimp but feel like I have lost myself and my confidence over these years. Thank you so much if you have had patience to read this - I hope maybe someone could give me some suggestions/support/explanations/ANYTHING!!!!
much love to you all over the pond xx
You are certainly not alone in your fear/anxiety re. palpitations. Having said that, the feeling of dread you are having is completely unnecessary. It is however very hard to avoid.
I had PACs/PAF erupt about seven years ago (I am now 59). At that time, not knowing a thing about these critters, I was in fear for my life. I had checked into a hospital emergency room, and had the misfortune of having a cardiologist eager to plant pacemakers diagnose me. The experience started an anxiety binge which lasted roughly a year...I was even fearful of getting out of bed!
About 6 doctors later, which eventually brought me in contact with an experienced EP (electrophysiologist), I was diagnosed accurately with a PAF whose origins were clearly understood. An RF ablation procedure took care of the problem.
I still get PACs once in a while, and even an occassional PAF...but now I understand their origins and their prognosis. There's simply nothing to fear.
A premature atrial contraction (PAC) is an early beat of the heart which comes from a prematurely triggered signal from the atria (upper chambers of the heart). A PAC is often felt as a skipped beat, since the premature beat is hard to notice and the ensuing normal beat is extra heavy as it carries with it some extra blood volume. It is thought these are caused by isolated "islands" of hyper-active cardiac tissue...we all have these, it's just that some of us have these located near areas within the heart that can ellicit the premature beat. Then there is PAF...paroxysmal atrial fibrillation...which can be triggered by PACs. Atrial fibrillation is a condition wherein the atria continuously fire at a rapid pace, with only some of the firing being picked up by the lower chamber of the heart (ventricle) completing the beat..ergo, an irregular heart beat. This condition persists for as long as the atria keep firing ... for a paroxysmal case, they'll stop doing that on their own after a while. PACs and PAFs are of themselves not life-threatening. Fibrillation, if continued for too long, can result in blood clotting in the atria (since it pools there for a bit)...so, care should be taken during such an episode to take blood thinners, where even aspirin can help (here you need the advice of a cardiologist).
If all you have is basically PACs, then my advice is to get over the anxiety, as anxiety itself will precipitate further PACs by stimulating your nervous system. The single best trick I found to cure myself of this type of anxiety was to avoid measuring my pulse. The action of checking your pulse has a subtle but strong feedback effect on you nervous system, training it to worry about skipped beats. If you've got the courage to avoid checking, you'll see a remarkable change in just a few weeks (yes, weeks, as you have already trained yourself to remain in high anxiety, it will take time to break the habit).
I am a 54 year old female. I have had PVC's/PAC's since I was about 21 years old. After many visits to cardiologists and hospitals, I went on a beta blocker, Inderol for about 8 years. In 1984 I went off of that drug. I have continued to have skipping during certain times i.e. full moon, tiredness, anxiety, etc. I take plenty of calcium and that has helped me over the years. For several years I took Cal-ma Plus by Standard Process and then took Eniva Minerals that really helped to sustain a regular heart beat. About four weeks ago I developed a sinus/allergy problem that caused light headedness and ringing in my ears. About 4 days ago, I developed PAC's that were pretty consistent through the day and night. I don't know if there is a connection to the allergy problem, but having PAC's all day and all night are new to me. I went to the hospital early this morning, they hooked me up and told me they were PAC's and not dangerous. I have started taking Standard Process Cal-ma Plus again, and thinking about taking Co Q10. I will be following up with my Cardiologist today. Hope this helps some of you out there. I know what it's like to go through this type of thing. I've lived with it nearly all my life. May God grant you peace and healing.
I have suffered PVC's and PACs for almost 8 months - holter monitored at 1 per minute - but I know there were 2 - 3 per minute a lot of the time.
One week ago I went to see a naturopath who prescribed COQ10 plus other natural products to reduce toxins in the blood - the toxins cause the PVCs and PACs as they irritate the heart. Makes sense to me.
Within 6 days of taking what the Dr prescribed - all of the PVCs and PACs are totally gone and this is the first time they've let up since they started.
I was fed up enough to try anything and everything so that I could feel "normal" again. If you've been to your medical doctor to rule out heart disease, then try seeing a good doctor of naturopathic medicine. Mine spent 1 1/2 hrs testing me on my initial visit and I've never had a medical doctor give me more than 5 minutes!
Just thought I'd share this in case it helps another sufferer.
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