Skipped beats, SA-block/AV-block or cardiac neurosis?

[is_something_wrong]

My first post here, I have some questions about my heart symptoms, that are really scary.

I first noticed some skipped beats (premature contractions) some months ago, got scared, and requested some tests (Holter, echocardiography, stress ECG test), and of course some ECGs at rest. Results as follows:

Resting ECGs: All normal
Holter: My cardiologist said "everything normal, some PAC's, low number.
Echo: All normal.
Stress test: All normal, one PAC at rest a couple of minutes after max load.

For some reason I was not completely relaxed (still feeling some dizziness, premature beats, tachy), but I believed this was caused by my anxiety, and went to see a doctor for hypocondriac therapy.

She went through the Holter data results with me, and the results was as follows:

15 PACs
50 PVCs (according to her and cardiologist analysis errors and artifacts, there were no PVCs)
Max HR 184 (due to some sprinting under test, just to check for symptoms)
Min HR 38 (a couple of times during sleep).
Avg HR 76.

I got a panic attack (at MDs office) due to the severe brady at night. I have read too much medicine (cardiology articles) and did NOT want to know the Holter details. When I now know them, I can't stop thinking about them.

From this, I have obtained a bad habit, checking my pulse all the time, especially before sleep. It's often irregular, but rarely with PACs (I know how those feel now). My HR seems to vary at least 30% with breathing (I know this is normal), but also some times without breathing. I'm really afraid this is caused by a blocking somewhere in my heart.

I can also feel my pulse "shivering" (hard to describe, but sometimes at night, I feel like the pulse beat is a little "long" and actually 2-3 small beats within a quarter of a second, not like a PAC). This is probably impossible and just my imagination, or is it?

Questions:
- If my Holter contained heart blockings, would that be visible, and told me by cardiologist / reported to my GP?
- My Holter is 3 months old. Is it possible that I have obtained heart blockings now, that was not registrated on Holter?
- Is my bradycardia at night severe? (I'm 28 y/o, normal shape, some exercise)
- I have a resting HR (in the morning) about 60 BPM. I sometimes feel slightly light headed 30 minutes after exercise, when my HR tends to drop to 55 BPM. Can this be caused by bradycardia, or simply anxiety?
- What can those funny heartbeats described above be? Just my imagination?

Other info: Male, some CAD at high age in family, normal cholesterol, BP varies from 110/65 to 130/85.

[ireneo]

No one likes to think their heart is less than perfect. The fact is we all have little burps and giggles going on in our body. If we're lucky, we don't notice it much. And the older we get (not sure of your age but I'm 57), the more our body parts act up.

I'm not sure why the difference between US and Norwegian doctors' opinions. If data confirms that a few hundred ectopics a day are not dangerous, then there's no reason to vary so much according to region.

I do hope you can find some solid answers to give you peace of mind. I pretty much trust my cardiologists' opinions. On top of that, I've had a life time of arrhythmias and can say from my own experience, I know my funny rhythms aren't doing me much harm.

[is_something_wrong]

Thanks a lot for answering :)

I tried some therapy but it was then I got confronted with the data material from Holter. For someone with cardiac neurosis like myself, this was hard to handle.

It's strange really, how US cardilogists are more "liberal" considering PVCs than Norwegian MD's. The first response from my MD why I didn't have PVCs was: PVCs in this number (50) may be dangerous, thus it's wrong. Really helpful.. :(

[ireneo]

First off, yes, an ecg tracing would show any type of heart block. A Holter report done just 3 months ago is fine unless you've had some heart event since then (like a heart attack or had been sick and the virus affected your heart in which case you'd have other symptoms as well). Your brady is low but most everyone has low heart rate while asleep. I get light-headed during and after exercise but I think it's the increased oxygen that does it for awhile. I have no idea about the "funny heartbeats" you described.

You've been checked 3 different ways by the doctor and all the tests are clearly in the normal range. For example: I have 1-5 PVC's/PAC's a minute every day plus I have short bouts of atrial tachy a few times a week - rate runs 150-198 bpm. And I'm considered pretty normal. Unless you were having tens of thousands of PVC's or PAC's a day, your heart is in good shape.

The next step is finding a way to convince your emotions that the facts are accurate and you're in good health. You may want to ask your doctor about that.