Big increase in skips

[dbranden]

I have had palpitations for years--PVC's in the form of couplets, bigeminy, etc and PAC's. On every Holter I've had done in the past, I usually get about 150-200 PVC's or PACs during the 24 hours. Recently, I've felt like my palpitations have dramatically increased. I'm starting to get them more at night, which I never did previously. I am also feeling a sensation frequently that I'm not even sure is a skip, but my pulse feels uneven, like beatbeat pause beatbeat pause. But is isn't like the pause is a skip, it is more like the too beats are just coming too close together and not evenly spaced. I feel this especially in the morning and evening, but it also can happen throughout the day sporadically. I walk a mile or two daily and usually feel very few skips while I walk. I had a baby 9 months ago and the skips really started to act up when I began to have a menstrual cycle again. I have had problems with anxiety, and the more palps I get the more my anxiety grows. I am taking Buspar for anxiety, but haven't seen much improvement. Can anyone else relate to any of this? I feel very alone and hopeless, and I worry that the palpitations will just get worse and worse. I have seen my EP twice since having the baby, and he only did EKG's and told me to ignore my symptoms, but as the skipped beats get worse and worse that is very hard to do. Any advice? How have some of you weathered bad flare ups?

[yarrow]

Strictly speaking, palpitations are a particular awareness of your heartbeat, be it regular or irregular, regardless of the anatomical origin of the beat.  It's interesting that everyone has irregular beats--but most people simply don't feel them.  We sensitive types do.

You mention an uneven pulse.  The very nature of PVCs is unevenness:  The letters stand for 'premature ventricular contraction.' Here is what is going on:

The 'Pacemaker' in the upper right atrium normally sets the heart rate, but it's important to note that every cardiac cell in the heart is intrinsicially rhythmic and contractile.  They all sort of agree to abide by the timing of the pacemaker, but every now and then, there's a rebel or a cluster of rebels somewhere.  If you have been diagnosed with PVCs, your rebels are in one of your ventricles.

When you have a PVC, the rebels cause the ventricle to contract earlier than usual.  Because of the way the heart fills, this means the ventricle has not had the opportunity to get as full as usual, and as a result, this particular contraction is tiny.  People don't usually feel it at all.

However, the normal timing rules apply for the next scheduled beat in a normal heart:  It cannot contract until certain electrical things happen (called repolarization), so there's a delay.  That's the pause you feel.  Since the chambers of the heart are elastic, this delay gives the ventricle a chance to fill a bit fuller than normal.  Now, the 'Law of the heart' is that it is obliged to try to pump out all the blood that enters it with each cycle, and to do that, the slightly fuller ventricle has to give a big push on this contraction. THAT is the big thump you (we) feel.

When you are at rest, the Pacemaker slows down the heartbeat, and if you have what I've been calling 'rebel' cells somewhere, that's the perfect opportunity for them to do a little firing on their own, which is why you get more PVCs at rest.  When you're active, the Pacemaker speeds things up, giving the rebels less opportunity to act up.

For some reason, PVC sufferers have a particularly irritable bunch of little cells in the ventricle.  No one really knows why this happens, although there are bunches of theories, and some people are more prone to it than others.  From my own experience, I'd say that the demands of pregnancy and then the stress and exhaustion of raising children enhances the tendency towards PVCs in those who are likely to get them anyhow.

If your heart has been checked out thoroughly, and if you can perform all your normal activities, then the biggest problem is dealing with the emotions associated with awareness of your erratic heartbeats.  Again, in my experience, a good way to go at this is with the anti-anxiety medication that is right for YOU.  It is not a one-size-fits-all situation.  My shrink had to try me on four SSRIs (as I recall) to find the right one, which turned out to be Zoloft.  As my panic diminished, so did my awareness of the beats--and mirabile dictu--so did the actual frequency of the PVCs also diminish!  Once the drug is effective, I stay on it for a period of months, to let "the alarm system cool down," as my shrink puts it.  For some people, it might be necessary to keep taking the drug for a very long time. Whatever works.

If you are not getting relief on Buspar, you should talk to your doc about changing.  Just as a note, I have found that psychiatrists are ever so much more conversant with the biochemistry of drugs of this type than are GPs.

[Mom2four85]

I know it's not easy ignoring these dreaded things thats for sure, but if they've cleared you and done complete workups and blood work etc and say it's all ok, then you have to find a way to cope with them.

I don't have anxiety often and never over pvc's its usually silly stuff like kids or my main thing is stress and lack of sleep; just bad sleep in general and it makes me feel worse. Is your anxiety over them harming you or just a general anxious feeling about having them?

You may want to have your hormones checked, I know they play a big role in females with pvc's and symptoms.

There are alot of us out here who deal with tens of thousands pvc's daily and get by ok.  There's a great possibility they won't harm you and they're benign, but it doesn't make it any easier when you get them.

I can so relate; I've gotten 50,000+ pvc's daily for months on end; and I'm very symptomatic but I have ANS issues on top of electrical problems.

Maybe ask for a switch in your meds for anxiety? I tried lexapro for a month and many others have also and done well, I think the other is Xanax, but I've never tried it.