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Avatar universal

Too many PVCs?

Hello- I have been reading the forum and have also reviewed some archive topics, so I want to be sure I am understanding what is being said regarding PVCs correctly. From what I read if your heart is structually normal and have no previous heart history e.g. heart attacks than the number or kind of PVCs are basically of no concern. Is this correct? I will give you some of my test results. By 24hr holter I had 7,487 isolated PVCs. 1,176 couplets, and 174 bigeminal episodes.According to my echo report I had 60% EF, trivial if any MVP, mild mitral insufficiency,mild tricuspid insufficiency and trace pulmonic insuffficiency, aortic valve was OK. The Drs didn't seem concerned about any of these findings. I had a normal routine treadmill. So here are my questions. 1.According to what I have been reading, even though I have that many PVCs I still shouldn't worry? 2.Over a period of a few months it seems I have started having more couplets, triplets, and even a couple 6-9 beat runs, How can I be sure the PVCs I have will not deteriorate into something more ominious? 3.My EF was 60%. Is that OK? and does it fluctuate or stay about the same?  it seems I had an Echo one other time and my EF was higher than that. 4. How often should I repeat these tests in followup?  PS. I am a 37yo female.
44 Responses
Avatar universal
Pat65,

Thanks for the questions.

(1) I calculate that you had approximately 6-7 PVC/min on your holter.  This is a pretty high number, but there is no evidence that this will impact your long-term mortality given the other information you have provided.  It may impact your quality-of-life, however, if you feel them and are concerned about them.

(2) You cannot be sure.  Life is dangerous and we all accept some risks with everything we do, and every decsion we make.  Even if you developed VT, you would likely tolerate it just fine given your age, normal EF, and lack of other medical problems.  Some medicines can suppress the PVCs, but these carry risks as well.  Choosing the right medical therapy for you depends on a host of issues, and does not lend itself easily to the internet medium.  I will refer you to our discussion on 1/1/03 for further treatment options.

(3) The EF is an "eye-ball" number, and so will fluctuate considerably from reviewer to reviewer.

(4) The repetition of follow-up would depend on any new or worsening symptoms.

Hope that helps.
21064 tn?1309312333
Hi Pat,
I have been dealing with PVCs for 20+ years.  Holter monitor said 22,000 PVCs with couplets, triplets (only a handful), frequent bigeminy. I do have MVP with moderate regurgitation, but it is not a problem according to recent tests. During a follow up echo last month, my ejection fraction appeared to have dropped.  The doctor said that it is RARE but it has been reported that VERY FREQUENT PVCs can negatively impact the EF.  I am in the process of trying a new medicine to control them.  Then I'll go for another echo to see if the medicine allowed the rhythm to straighten out and correct the EF.  Have you heard that VERY FREQUENT PVCs can cause this type of change.  It is my understanding that it is rare, but it seems worth looking into.  
Good Luck to you : )
Avatar universal
I too have had pvc's for many, many, years.  The last two years have been a nightmare.  When I read how many you both have, I cannot believe it.  While going to Florida last week, I was listening to a doctor on the radio.  He said you should never feel your heart beat, and if you do there is something wrong.  I feel my heart every time it skips.  Enough to pick me right up off my seat and push the panic button.  I've had every test, including uper GI series which showed gastrointestional reflux.  I still say they come from the stomach.  No doctor agrees with me.  Take care.
Avatar universal
Hi ladies,  let me chime in here as a VERY frequent pvc-er.  I  also have 8,000+ pvcs in a 24 hour period on bad days, with plenty of couplets, triplets, and (at least) one 6 beat VT run.  My EP says "you are at no more risk of a cardiac event than anyone else your age (37, female)"  Isn't that a stunner?!  I want that carved in stone and hung over my front door!!!  In any case, they are miserable to live with and I am seriously considering an ablation (maybe for my 40th birthday?  a special treat just for me, ha ha).  These are not well controlled by atenolol, that is for sure.  Any suggestions from those of you with THIS many?  What medication if any seems to work?  Any other ideas about how we can cope?  I will be very interested in the Dr.'s response.  For the record, the last echo indicated an EF of 70 -75 so that is not (yet?) a problem for me.   My bad days are more frequent and for the past few months I have only had 5 or 6 days "off" between weeks of days with noticable, frequent and insanely annoying pvcs...  Definite triggers for me personally:  stress and hormones.  I will be reading reply posts with great interest.
Avatar universal
I have pvc's and pac's also.  They have gotten more frequent here lately.  When I have mine sometimes I'll have pain with it or tightening feelings in my chest area.  I also have periods where my heart races.  My doctor doesn't seem concerned about these.  I made a trip back to the cardiologist and he didn't seem concerned.  I mentioned the pain with them, but didn't get a chance to mention the tightening before he got paged and left.  He upped my dose of atenolol.  If that doesn't work for these I'm curious to know what else may be suggested.  Atenolol works for slowing your heart down when its racing.  God Bless!
Avatar universal
Thank you for all your responses. Its great to know there are others who are dealing with the same PVC problem as I am. Did any of your problems just increase over the years or come on suddenly? Mine just started suddenly one day and I have dealt with them ever since. I would be curious to know what meds you are taking that might help the PVCs. I have tried atenolol and toprol XL without a lot of success. I have thought about ablation but the Drs. here on this forum as well as my own cardiologist seem a little hesitant. They said I should try many drug trials first and then only procede after careful evaluation. I guess my biggest concern is that I will have a big run of VT resulting from frequent PVCs someday.
Avatar universal
Hi Risen,

The MI is that an infarct?
And the SDS 'Sudden-Death-Syndrome' arrythmia, how does that feel?
Sounds horrible!
-
Bey - Ianna*
Avatar universal
MI is an infarct. AWAFUL !!  But the SDS was horrible, a total loss of the heart as an effective pump. I was very blessed because the ER doc was able to convert it back to normal. I would like to chat with you through email if it would be ok with you. Let me know either way, ok?   Gary M
Avatar universal
Hello Pat, Momto3 and Chris;
You all write about "Couplets." I had a Treadmill Stress Test not too long ago and on the report it says "2 couplets were seen."  What are couplets?  Can anyone tell me?

I do get "Skips" daily but I did not feel any during the test!
Ever since I found this board I do not get so scared anymore when I get these skips or my heart races up to 140 bpm for about 5 - 10 minutes.  I can see lots of you folks have a lot more problems than I and you still around and kicking!
Laura
Avatar universal
Hi all..... I too am experiancing arrhythmias of several different kinds. Until I found this site I really had believed I must be the only on who had these nasty scary irregular beats of different kinds and intensities. Makes no difference what I am doing, standing, sitting, sleeping and other postural positions. They hit with a vengence, some hard and painful and others not painful. I was on many meds over the past many years and some seem to help to some degree but eventually quit working. The latest one was rythmol (propofonol) and when I had an acute MI the rythmol through my heart into the dreaded "SDS" (sudden death syndrome) arrhythmia that was the scariest I have ever experianced. It didnt stop for about an hour untill the ER doc injected lydocane in my IV. I plead for you all in support and contact to help me realize I am NOT alone. I am in contact with 3 new friends from this site and I would like to hear from more. Thank you all so much! GaryM    ***@****       gman@(LNI).net
I am 54, dont smoke or drink since at least 25 years ago......
                                                         ^
21064 tn?1309312333
Hello again!!
I'm the one with 20,000+ in a 24-hour period.  Fortunately, I do not feel all of them!! The ones that get my attention are the ones that come in patterns (bigeminy, trigeminy, couplets, runs, etc).  THOSE I NOTICE.  Funny, the PVCs first showed up on a routine exam when I first became pregnant (over 20 years ago).  I spent about 10-12 years on Inderal to keep them "quiet."  Over that period of time, sometimes I was on it every day, other times I took it as needed.  The docs all felt that it was a good drug to keep me comfortable.  Anyway, about 4 1/2 years ago, I went to the doctor because the PVCs seemed to be increasing.  My regular doctor sent me to an EP specialist.  I have been seeing her ever since.  She spent an hour with me on my first visit and went over everything I wanted to know about PVCs.  I decided to go off the medicine and go it alone....Well, that worked for quite awhile, and I could take a 20mg Inderal as needed (rare).  I learned to live with the extra beats and recognized that they were not indicative of a pending problem.  Long story short....they peaked again this past fall and when I went for my annual follow-up echo, the EF was at 40%.  Doctor ruled out my MVP as the instigator because the EF improved when I did the stress test. She said that was a good sign it was not the MVP causing EF drop.  When I had the test, it was next to impossible to get good images because of bigeminy.  I was admitted to the hospital to try Flecaide.  It was the doctor's hope that the medicine would tame down the beats and we could get more accurate pictures.  Beats calmed down, but EF is still 45%.  Next step is to redo the echo in a couple of months to see if the arrythmia was the cause of the EF problem.  I guess that it is rare, but it DOES occur.  Anyone else hear of this?
Avatar universal
Ok, I am trying to gather as much data as I can from folks suffering from these dreaded things. I have talked to many people who suffer from these and have come up with some conclusions but I'd like to ask those here for their experiences also.

Since these are benign, it is unlikely we are going to see a drug company fund research. Even if they did, it wouldn't get rid of them but rather mask the symptoms and cause more side effects than the PVC's themselves.

We know this much. PVC's can be caused by:

1. Caffeine
2. Stress
3. Alcohol
4. MSG (and foods that comtain MSG)
5. GERD
6. Esophagus problems.

Some people also claim that by moving their bodies in certain positions can change the severity of these. Many docs believe that far more people have these but just aren't lucky enough to be in tuned to their bodies like you and me. From the research I've done, I'm leaning more to GERD, acid reflux and esophogus issues as a cause. Some I've talked to (myself included), have noticed incredible periods of stress where we didn't notice these. Others have told me they consume caffeine and did't notice them. Many have stated that eating certain foods causes them to flare up worse. Ok, if all of this is true, then the esophagus route may hold some validity. I have talked to a few docs that say there cannot be any relationbship but I think you can never say never (especially when they really don't know the cause)

Does anyone here that suffers with these either have acid reflux or esophagus issues? I think that caffeine, alcohol, stress CAN be causes BUT not all on their own. I think many stress out and get anxious when these occur which just feeds into them more and makes the situation even worse. Logically, we know they are benign and just a nuisance but when you are experiencing them, logic sometimes flies out the window.

by the way, here is the definition of esophagus:

"a muscular tube that in humans is about nine inches (23 centimeters) long and passes from the pharynx down the neck between the trachea and the spinal column and behind the left bronchus where it pierces the diaphragm slightly to the left of the middle line and joins the cardiac end of the stomach"

Notice the word "cardiac"?

All responses will be welcome!

Rick
21064 tn?1309312333
Hi Laura!!
Couplets are two PVCs in a row.  Triplets are three in a row.  On the other hand, bigeminy is when every 2nd beat is a PVC. Trigeminy/Quadrigeminy is when every 3rd/4th beat is a PVC. Hope that helps : )
Avatar universal
Hi. As you have probably read I have plenty of couplets, triplets, etc. Couplets are 2 PVCs together without a normal beat in between, and of course triplets would be three beats together. By the way, has antbody out there experienced PVCs for years and been treated for them only to have them seemingly dissapear one day? That happened to my mother who was treated for PVCs with Quinidine but now she seems to be free of them. Thats what I am hoping for!
Avatar universal
Your comment about frequent PVC's lowering EF is very interesting... For several years I suffered from frequent PAC's to the point where I was constantly experiencing palpitations.  I went in for an ECHO which showed an EF of only 30.  I am currently on 150 my/day Toprol-XL and 10 mg Lisinopril.  I know experience very few PAC's.  My ECHO 3 weeks ago showed an EF of 54.  The doctors are confused and not sure what to think.  Do you know of any literature/other info supporting severe palpitations as a factor that decreases EF?
21064 tn?1309312333
Disappeared?  How wonderful for your mother!  What's the secret?  Like you, I have my share of these "events."  I'm taking Flecainide and they are quieted down, but still lurking. For really annoying breakthroughs, I still take 20mg Inderal.   I have tried Tenormin in the past...did not agree with me.  Mine seem to quiet down for periods of time, and then reappear. How long has your mom been "free" of them?
Avatar universal
Hi,

I've never posted here before, but I read the forum often.  I can't get on to ask the doctor.  I have many PVC,s and I have many questions.  Is there a support forum for people who suffer with PVC's?  They are really hard to live with sometimes, and I'd love to talk to other people who have them.

I was also just wondering if any of you have other symptoms, like sweating all the time, or heat intolerance?  I allready had my thyroid checked and it's not that.  I had a 24hr monitor and it did show a lot of PVC's.  Also, when I do over-heat, my PVC's are much worse.

No matter how many times my doctor says they are benign, they still scare me.

Thanks for listening!

Mikki
Avatar universal
Hi, I'm 23 years old and like many of you suffer from nasty PVC's. My question is what is "EF"? I go for a stress test on Tuesday, will they be able to tell me what my EF is? When it is low is it bad? If PVC's cause this to be low, how can PVC's be benign? I'm soooooo confused about all of this and want answers. Also can anyone tell me about the stress test, how long does it take, do I have to run to the point where I'm out of breath etc.... I'm very nervous and scared about it. I tell people I'm stressed out about my stress test and they just laugh!

Thanks in advance,
Michelle
Avatar universal
Hi Mikki, I've been trying to find a support group on the net but haven't had much luck. I would feel much better if I could talk to people that are experiencing the same thing as I am, especially when I'm having a bad PVC day. Up until now I've basically kept this constant fear to myself. I didn't want people to worry about me or treat me differently. It scares the hell out of me when my heart starts to act up. You were talking about other symptoms..... well the only other symptom I have is dizziness. I've felt "off balance" for the last 2 weeks. Also sometimes my stomach feels bubbly when my heart starts to skip.
If you happen to find a support forum let me know.

Michelle
21064 tn?1309312333
WOW!!  That is exactly what I am talking about!  My EF dropped form 55 to 40-45 and the doctor is trying to determine whether or not the PVCs are the culprit.  She found one study which poses the question.  My PVCs have been crazy for the last several months...Now, with the new RX they are manageable.  But, as with any medicine there are side effects and risks....When I go back in a couple of months, we are going to redo the echo and if the EF is back up I can opt to stay on the medicine or consider an ablation, though that does not appear to be her first choice.  If the EF is still compromised, then I go on an Ace Inhibitor, like lisinopril. Sound familiar?  WOWWOWWW...I'm still amazed that you have had this happen.  What does your doc think?  What area of the country are you in?  I am in Cleveland and am fortunate enough to have a fabulous EP.  She is with a major medical center here...and the Cleveland Clinic is within easy reach.  The only literature I have come across is a study form Japan (http://circj.jstage.jst.go.jp/cgi-bin/rs.cgi?SID=141149936f2e4bb8171c0c44a27303e3).  I don't know if you will be able to access that site, but the article is titled "A Case of Cardiomyopathy Induced by Premature Ventricular Complexes" by Hirokazu Shiraishi (Circulation Journal Vol. 66 (2002), No. 11 1065-1067.  I'm still looking around for any other feedback or studies....Thanks for sharing your story!
21064 tn?1309312333
EF is short for ejection fraction.  It refers to the amount of blood contracted from the ventricle.  Normal is said to be 55-65.  I do not know if the stress test will measure EF, but if they do an echo also, you will be able to find out.  The stress test is not bad.  You will be asked to walk quickly (I have never had to run) and try to achieve your target heart rate.  I am generally only on there for about 10 minutes.  Of course, I'm twice your age : )  Good luck.....It is not bad....Not painful or invasive, just a little tiring.
Avatar universal
Hi everyone...i've been reading the posts on here since around October and they've been a great help at times and at other times have led me to unnecessary worry.  i also have been struggling with these strawberries as i like to call them since august.  i've actually had them since i was a teen, and now i'm 23...but only in the past six months have i really began to perseverate on them.  anyhow, i read that many of you guys had been inquiring about a support group and i found one through yahoo which i believe is the only one on the net.  here is the link...it helps to read others posts, etc.....http://groups.yahoo.com/group/PeoplewithPVCs/
hope everyone gets some relief....and try to take solace in the fact that the doctors consider these benign, no matter how distressing they may be.
Avatar universal
I agree with your idea of other connections with these pvc's.
Read on mvp, its seems as though everyone with pvc's has a mvp problelm also. Now to the esophagus issue i have esophagal spams and My cardi said certian foods really could effect the heart due the fact the esophagus lies right next to heart. I quit caffaine, chocolate and smoking all at once because of pvc's.
My cardi said caffaine and chocolate dont bother most people and that it would be okay have them but i said no way. I find one of the BIGGEST things is lack of sleep, if i dont get enough rest i get alot of them the next day. Im a night owl so that has now changed.I dont want to go on meds. masking the symptoms and getting ten other problems not worth it to me! Good luck
Avatar universal
Ditto your post on potential causes.  I don't have mvp, but I have had both easy and "nasty" pvcs, over 16 years, sometimes for weeks on end.  I wonder what age has to do with them, too.  The only reassuring thing, is that so many of us are in the "family" together.  God Bless.  Obi.
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