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Significance of PVCs during and after exerxcise
Thanks for taking my questions as usual. There has been much debate on the forum lately about studies showing an increased risk of death with PVCs after exercise, I know the doctor was kind enough to give us some insight into understanding this study.
In simple terms, in your opinion does PVCs at rest , during or after exercise increase the risk of death in a structurally normal heart? I myself tend to get exercise induced PVcs, but they are less frequent after exercise so this subject interests me very much . I must say that I am taking atenolol 25mg of atenolol 4 times daily, prescribed 50mg twice daily, but I find that 25mg of atenolol 4 times daily appears to be more effective, I still get the 100mg daily, my internist agrees with this approach if I find it more effective that way. To add I rarely get PVCs now, so I assume the medicine is working, I also take Cozaar 50mg daily, this also sames to suppress the PVCs when combined with atenolol, Are you aware if Cozaar might actually have anti arrhythmic effects when combined with atenolol, could be coincidental , just wondering?
I also understand that some persons with a normal heart has exercised induced ventricular tachycardia, it is my understanding that this type of tachycardia is usually "benign" and the the risks of sudden death with this condition is very , very small, almost negligible(sp), even though I hate to use that word, could you confirm if my understanding of this is correct?
Is it true that atenolol is very effective in suppressing exercised induce VT in some studies.
i am 28 male and try to exersise also..i take 25mg atenolol for tachy and pvcs..i notive them also more when i exersise,i want to get in good shape again but affraid of exersiseing becasue of this..its also prob anxiety now.
tanks
tanks
Hank,
The docs here tend to be evasive if they are not 100% sure of the answer (& probably rightfully so). The way you worded the question may provide an out: "in your opinion does PVCs at rest , during or after exercise increase the risk of death in a structurally normal heart?" The key phrase is "structurally normal heart". That's a loaded question much like "Can I die if I'm healthy?. The answer is probably no if the heart is truly structurally normal. But the fact is that even if a heart appears (from echo tests, etc.) to be structurally normal, it does necessarily insure that it is so (there could be a hidden problem). Dr. Lauer's study on post exercise induced ectopies would suggest that if you have 7 PVCs or more a minute, ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, or ventricular fibrillation AFTER EXERCISE, your heart likely has a hidden problem. In effect, Lauer has invented a new test to determine whether a heart is "structurally normal" or not, involving a treadmill and the appearance of frequent ectopies post-exercise. Unfortunately, the published paper (which as I pointed out earlier can be obtained from the New England Jounal of Medicine webpage upon registration) does not break down the risk of the various ectopies - - in particular, the risk of dying from having 7 or more PVC's a minute after exercise. I would guess that since PVCs are a more common occurance than the other mentioned ectopies, that would suggest that frequent PVCs (7 or more a minute) contributed substantially to the "prediction" of an increased mortality risk.
Here's an abstract of Lauer's paper from http://ora.ra.cwru.edu/showcase/showcasedetail2004.asp?type=post&id=107 . I have issues with the article Connie suggested.
"Poster Abstract
Background: Exercise-induced ventricular ectopy predicts death in population-based cohorts. We sought to examine the prognostic importance of ventricular ectopy during exercise and during recovery, when reactivation of parasympathetic activity occurs, in a clinical cohort. We hypothesized that ventricular ectopy during recovery predicts death better than ventricular ectopy during exercise. Methods: We followed for 5.3 years 29,244 patients (age 56+11, 70 percent male) referred for symptom-limited exercise testing without heart failure, valve disease, or arrhythmia history. Frequent ventricular ectopy was defined as: > 7 ventricular premature beats per minute, ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, or ventricular fibrillation. Results: Frequent ventricular ectopy during exercise only occurred in 945 patients (3 percent), during recovery only in 589 (2 percent), and during both exercise and recovery in 491 (2 percent). There were 1862 deaths. Frequent ventricular ectopy during exercise predicted death (5-year death rates 9 percent vs. 5 percent, hazard ratio 1.8, 95 percent confidence interval 1.5 to 2.1, P<0.001), but frequent ventricular ectopy during recovery was a stronger predictor (11 percent vs. 5 percent, hazard ratio 2.4, 95 percent confidence interval 2.0 to 2.9, P<0.001). After propensity matching frequent ventricular ectopy during recovery predicted death (adjusted hazard ratio 1.5, 95 percent confidence interval 1.1 to 1.9, P=0.003), but frequent ventricular ectopy during exercise did not (adjusted hazard ratio 1.1, 95 percent confidence interval 0.9 to 1.3, P=0.53). Conclusion: Frequent ventricular ectopy during recovery after exercise predicts mortality better than ventricular ectopy only during exercise."
Fizzixgal,
BTW. I'm in physics too (Ph.D. Cornell, early 70's). Still work in a DoD/Navy lab (NRL in DC) performing R&D in the area of lasers and optics (with military applications).
Best regards to all,
va_tony
The docs here tend to be evasive if they are not 100% sure of the answer (& probably rightfully so). The way you worded the question may provide an out: "in your opinion does PVCs at rest , during or after exercise increase the risk of death in a structurally normal heart?" The key phrase is "structurally normal heart". That's a loaded question much like "Can I die if I'm healthy?. The answer is probably no if the heart is truly structurally normal. But the fact is that even if a heart appears (from echo tests, etc.) to be structurally normal, it does necessarily insure that it is so (there could be a hidden problem). Dr. Lauer's study on post exercise induced ectopies would suggest that if you have 7 PVCs or more a minute, ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, or ventricular fibrillation AFTER EXERCISE, your heart likely has a hidden problem. In effect, Lauer has invented a new test to determine whether a heart is "structurally normal" or not, involving a treadmill and the appearance of frequent ectopies post-exercise. Unfortunately, the published paper (which as I pointed out earlier can be obtained from the New England Jounal of Medicine webpage upon registration) does not break down the risk of the various ectopies - - in particular, the risk of dying from having 7 or more PVC's a minute after exercise. I would guess that since PVCs are a more common occurance than the other mentioned ectopies, that would suggest that frequent PVCs (7 or more a minute) contributed substantially to the "prediction" of an increased mortality risk.
Here's an abstract of Lauer's paper from http://ora.ra.cwru.edu/showcase/showcasedetail2004.asp?type=post&id=107 . I have issues with the article Connie suggested.
"Poster Abstract
Background: Exercise-induced ventricular ectopy predicts death in population-based cohorts. We sought to examine the prognostic importance of ventricular ectopy during exercise and during recovery, when reactivation of parasympathetic activity occurs, in a clinical cohort. We hypothesized that ventricular ectopy during recovery predicts death better than ventricular ectopy during exercise. Methods: We followed for 5.3 years 29,244 patients (age 56+11, 70 percent male) referred for symptom-limited exercise testing without heart failure, valve disease, or arrhythmia history. Frequent ventricular ectopy was defined as: > 7 ventricular premature beats per minute, ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, or ventricular fibrillation. Results: Frequent ventricular ectopy during exercise only occurred in 945 patients (3 percent), during recovery only in 589 (2 percent), and during both exercise and recovery in 491 (2 percent). There were 1862 deaths. Frequent ventricular ectopy during exercise predicted death (5-year death rates 9 percent vs. 5 percent, hazard ratio 1.8, 95 percent confidence interval 1.5 to 2.1, P<0.001), but frequent ventricular ectopy during recovery was a stronger predictor (11 percent vs. 5 percent, hazard ratio 2.4, 95 percent confidence interval 2.0 to 2.9, P<0.001). After propensity matching frequent ventricular ectopy during recovery predicted death (adjusted hazard ratio 1.5, 95 percent confidence interval 1.1 to 1.9, P=0.003), but frequent ventricular ectopy during exercise did not (adjusted hazard ratio 1.1, 95 percent confidence interval 0.9 to 1.3, P=0.53). Conclusion: Frequent ventricular ectopy during recovery after exercise predicts mortality better than ventricular ectopy only during exercise."
Fizzixgal,
BTW. I'm in physics too (Ph.D. Cornell, early 70's). Still work in a DoD/Navy lab (NRL in DC) performing R&D in the area of lasers and optics (with military applications).
Best regards to all,
va_tony
I`ve never learned what kind of treatment Stuart O'Grady had, but from what I`ve read I don't think it was ablation (and I agree it was pretty crazy to continue racing while experiencing VT), but he`s raced, successfully, for a few years since that episode.
Alec
Alec
I`ve never learned what kind of treatment Stuart O'Grady had, but from what I`ve read I don't think it was ablation (and I agree it was pretty crazy to continue racing while experiencing VT), but he`s raced, successfully, for a few years since that episode.
Alec
Alec
Thanks Connie, I only wish that degree was still worth something after 10+ years. Understand about recovering from grad school, wish I didn't have to go back into that grind! What you say about your bp makes sense, but I guess we're all different. I was getting borderline high readings (140/80) at the clinic on my worst days before the verapamil cut the ectopics way down.
Alec, I can't imagine anyone pushing through an hour of constant pvcs much less VT, that's just awesome... and pretty crazy. Conditioning makes a big difference in what someone can tolerate. Since O'Grady is still competing, what kind of treatment did he have? I don't have any news about Greg Welch's medical developments after his retirement from competition. If he's actually had surgery (as opposed to ablation) then I assume that something structural eventually turned up.
Alec, I can't imagine anyone pushing through an hour of constant pvcs much less VT, that's just awesome... and pretty crazy. Conditioning makes a big difference in what someone can tolerate. Since O'Grady is still competing, what kind of treatment did he have? I don't have any news about Greg Welch's medical developments after his retirement from competition. If he's actually had surgery (as opposed to ablation) then I assume that something structural eventually turned up.
It always helps to know we're not alone. Or crazy.
Thanks! ;-)
Thanks! ;-)
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