How Do You Know .... ????

[CrohnieToo]

How do you know that you are having a PVC vs a PAC vs ..... whatever??

I know my heart beat becomes strong, erratic, thumping. If I am near my oximeter I can see the HR jump around all over the place. I don't always have my oximeter w/me so can't always see what my HR is but I can sure FEEL what is going on.

While the episodes are still short, maybe 10-15 minutes or even less, maybe 5 minutes sometimes, they are increasing in frequency - and in discomfort. I really dislike the constricted throat and throat/neck discomfort, the chest pain/discomfort I can understand, the throat I don't understand.

It seems whilst on the 30 day event monitor that I ran the gamut of "events": Sinus tachycardia > Atrial Fibrillation > Rapid ventricular response > Premature Ventricular Contractions > Premature Atrial Contractions > Paroxysmal supraventricular tachycardias > PAC triplets

[CrohnieToo]

Whoooo Hoooo! Talk about falling into a pile of poop and coming up smelling like a rose!!! This cardiologist is a KEEPER! He was the cardiologist on call when I had the last (second) event on the event monitor. I didn't even know he was a local cardiologist I thought he was a TX cardiologist w/eCardio when he called me on the phone. The first time I saw him he was pleasant, etc., his office staff have been GREAT! But today, our second visit I KNEW. He listens to his patients, he respects their decisions and thoughts on a matter ... he explains things and why, he seems to have the patience of Job. He doesn't rush his patients thru ...

Dr Firas Alani w/Covenant Heart Specialists in Saginaw, Michigan. He also sees patients in Caro and Shepherd, Michigan.

And he sure has my number and I suspect has already figured out how best to work w/me. *wicked grin*

I pretty much had myself talking into starting the Rythmol. He has suggested giving the Diltiazem 24 Hr another 6 weeks at a higher dosage since I'm on the very low dosage. I was "almost" disappointed he wasn't going to start me on the Rythmol since I had myself almost talked into it. And I suspect he is very much aware of that and is taking advantage so that "I" will suggest, want and ask to go on the Rythmol if this increased dosage of Diltiazem 24 Hr doesn't do the trick.

[CrohnieToo]

Thanks for that "description" of what is probably the A Fib, itdood. That helps me "accept" that I'm most likely going to have to go the Rythmol route and pray that it works w/o causing more problems.

I ran the Nonin Onyx oximter for a few minutes this afternoon when I had an episode. 132 > 94 > 71 > 79 > 145 > 129 > 103 > 82 > 75 > 98 > 103 > 109 > 100 > 96 > 80 > 102 > 111 > 115 > 95 > 88 then it stabilzed in the 80s & 90s for a few minutes and then another "run" for a few minutes, then stabilized for a bit, on and off for about 2 hours.

[CrohnieToo]

Thank you for the replies, itdood and is_something_wrong. I've finished w/the Event Monitor - unless I start the Rythmol, which it is looking like I am going to have to do - if we do the Rythmol then I'll go back on another 30 day Event Monitor to monitor my response to the Rythmol. The cardizem (Diltiazem 24 Hr) I opted to try instead of the Rythmol isn't cutting the mustard. My events that I am aware of are becoming more frequent w/more discomfort.

I see the cardiologist tomorrow. Because of a couple of meds I take and the dosing regimen for them we are having some difficulty stabilizing my INR and coumadin dosage. I'll let you know what we decide to try tomorrow afternoon or evening.

[is_something_wrong]

Sorry, misunderstood the question :(

[itdood]

p.s., your heart rate jumping around on the pulse-ox is probably from a-fib.  When you're in a-fib it makes the ventricles beat erratically due to the chaotic pulses coming from the atria.

[itdood]

Your main concern, I would think, is the a-fib, not the PVCs/PACs.  I'm assuming that's your question, how to tell those apart....   I would think your docs would be squarely focused on the a-fib.  That's what the rhytmol would be for.  The coumadin is for afib too.  Coumadin thins your blood so that during a-fob you don't throw a clot and have a stroke.

If you have an event monitor you can take notes.  Some events will let you press a button when something happens.  Write down what you felt at that time and review this with your doctor during the follow up.  But yea, get that a-fib taken care of.

[CrohnieToo]

Thank you. I'm just still confused. My family doctor ordered the 30 day event monitor but the cardiologist who handled the affair and I've only seen once started me on coumadin and suggested Rhythmol which so far I have declined. An ER doctor suggested cardizem instead of the Rhythmol and I opted to take that instead of the Rhythmol but after a week or so of no symptoms the arrhythmias have become more frequent and stronger. I see the cardiologist this Thursday.

[is_something_wrong]

Hello.

No way to tell for sure.

Both PACs, junctional premature beats and PVCs can cause this throat discomfort. The mechanism is slightly different, though.

PACs cause this when they fire early, so the PAC atrial contraction occur while main chambers still are pumping blood. PVCs can cause this if it's close to simultanous with the next normal sinus beat. PJCs can cause this if atrias are activated after main chambers.

If you get the sensation of a complete skipped beat, like the heart rate is 1--2--3--none--4--5 it's more likely to be a PVC. A PAC would feel like 1--2--3-none-4--5, but it is hard to tell by just measuring the pulse, as the difference can be really small.

Anyway, it doesn't really matter, premature beats are almost always benign, regardless of where they origin.