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PVC´s in trained athletes

I´m a 32 year old male, physically fit and with a competitive swimming background since my childhood. About a year ago I transitioned from sprint swimming events to endurance triathlons, gradually increasing training hours during the week. In the peak of my preparation, after 9 months of training, I started experiencing severe episodes of PVC’s, together with anxiety, muscle twitching, shortness of breath, and chest discomfort.  Palpitations would show up during rest and rather in the evening, staying active for at least 2 or 3 hours with a 3 or 4 beats/min frequency, although anxiety and the other symptoms could come and go at any moment during the day.  Sometimes, when going to bed I would also feel a very weak heartbeat and a steadily growing fear of a sudden cardiac arrest. Quitting my training would help only partially, as the PVCs still showed up, although with less frequency. As soon as I retook exercise the symptoms got worse. Cardiologists undertook all the possible tests, including, EKG,  holter, echocardiography… you name it, but did not find any evidence of serious problems. They claimed that my episodes were benign (apart from PVC they found some isolated PAC’s as well) and prescribed a light dose of beta-blockers , which turned out to be ineffective. I also consulted with a naturopathic doctor who suggested a full clean up of the system in order to rule out an electrolyte imbalance or any other chemical disorder. After a strict diet of vegetables, vitamins and minerals (magnesium, calcium and zinc), symptoms improved notably and almost vanished (except the muscle twitching) after a few days.  As I convinced myself that I was cured I went back to training only to find out that PVCs were still there after a week of moderate aerobic work.
After three months ruling out possible causes and extensively researching the net I came across an interesting article about the role of the Vagus Nerve on this type of disorders.  Apparently , when irritated, this nerve can cause all of the symptoms above , although the exact cause of the irritation usually remains a mystery for most patients. This irritation kind of suits very well with my inner perception of the symptoms, since the only way I can describe it (apart from the extra beat of the PVCs) is as a sort of nervousness around my chest. Besides, the vagal hypothesis is also consistent with the fact that beta-blockers did not work (as the vagus nerve belongs to the parasympathetic system, whereas those drugs work on the sympathetic system), and with the fact that symptoms were worse during the evening (parasympathetic predominates over sympathetic in the vening).  Stress is pointed out as the best candidate for most patients, but I don’t think that applies in my case since I quitted my job just to join a full time training program and I have had a rather stable emotional life during this period. No alcohol, no drugs and no caffeine.  Now I’m handling other hypothesis such as the athlete heart syndrome, which I don’t see as a plausible cause given the short time of endurance training , or maybe other type of physical vagal stimulation stemming from a bad posture or a hiatal hernia. I’m really desperate cause my competitive season is almost wasted by now. Doctors say that symptoms are benign but I feel terribly sick when they show up and it feels like my heart is going to stop suddenly.
Are there other possible explanations for my problem? Although doctors say that there’s no reason to worry, is it safe to train having this terrible symptoms?
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Avatar universal
No there is no possible reason. I played competitive soccer in Europe for many years, and it's a known fact that athletes often experience palpitations. The muscle twitching is a given for any sport that involves endurance. I used to wake up in the middle of the night with muscle cramps after games. It's normal and fine. Just keep up with the electrolytes. Potassium and calcium most importantly. Yogurt is great after hard training sessions.
DON'T worry about your palpitations. Everyone gets them. They are not dangerous. In fact I'm no doctor, but if your heart shape is normal which it is, and you have normal stress tests, then beta blockers will do you more harm than good when competing at high performance sports.
You say you're not stressed yet you're clearly looking deeply into the matter even after you've been cleared by a cardiologist. Take my word they are normal, and not dangerous, and most people do get them at night time especially when laying on their side.
Even after reading this I sense you will still be worried. So, you could try supplementing magnesium 200-250mg works great along with fish oil. Many people see results from that combination, and also making sure you're getting enough vitamin C. It's also been shown to help lower the amount of palpitations one gets.
You're fine. I worried for too long when I first started becoming aware of my palpitations. I say aware because I've only become aware of them in the last 5 years, but thinking back I've had them since I was 17 just never paid them any attention at that point.  The more you look into them the more you'll be fixated on them.
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1124887 tn?1313754891
No need to fear ending up like Alexander Dale Oen. That was truly tragic.

That said, why PVCs and PACs suddenly start to happen is a mystery quite a few people have tried to understand throughout the years. The important thing to find out, is IF the cause can be malignant (heart muscle inflammation, narrow coronary arteries, inappropriate restructuring of the heart, high blood pressure, heart failure, etc). Most of them are definitely ruled out in your case and the rest do not apply to you.

Why your doctor started treating this with beta blockers is unclear (I'm not a doctor) but usually, if your resting heart rate is low, beta blockers may actually worsen the problem. The longer your diastolic phase is, the more likely are premature beats to occur. If your PVCs and PACs did happen during exercise, beta blockers would be much more likely to occur. As you are an aerobic athlete, I assume your resting heart rate is fairly slow.

You may have had a tiny irritation somewhere in your heart after a cold, etc. You may just be stressed at the moment (and premature beats don't always happen during stress, mostly after stress), It may just be a coincidence. Who knows. Your Holter results may reveal if your PVCs origin from one or more locations and if their coupling interval is the same all the time. If they origin from one location and the coupling interval is constant, they are always benign.

Further testing may be a cardiac MRI but if you only have a few PVCs during rest, I wouldn't go that far. Your heart sounds healthy. I assume your physical condition isn't significantly reduced after you developed those PVCs.

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Avatar universal
Thanks, so much for response. Funny that you mentioned the Norwegian swimmer case, cause it has been in the back of my mind, even after convincing myself that I was fine. I guess I was needing some comforting words apart from my doctors´ views, and that really helped. Thanks
Helpful - 0
Avatar universal
Thank you very much. Hearing testimonies like yours helps a lot. For some reason, no matter how much faith or understanding we have on health science, knowing that some people went thru the same can make a difference. Cheers

btw I went back to training and things are good, although some isolated PVCs show up here and there
Helpful - 0
995271 tn?1463924259
We sound very similar though I'm 13 years older.  My anxiety disorder started around 31-32.  It was a process for me to get control.

I too was a hyper trained athlete at one time.  I was starting to give up on the training right around when the anxiety kicked in.  I don't think the two were tied together.  For me the anxiety was bad, heart palps weren't too much of a issue though I did get occasional PVCs.  My worst PVC flare up was in 2009 with about 6k per day.

My PVCs come and go.  I get flare ups, episodes, the flares will occur like clock work during a time of day.  I also noticed once or twice that during major flares, if I caught a cold, the PVCs would disappear while I was sick.  As I would start to feel better from the cold the PVCs would start back up again and I thought damn, I would much rather have the cold.

Beta blockers and calcium channel blockers didn't do a dang thing.  In fact I think they made it worse.

I honestly thought my anxious days were over, no real symptoms for the past 5 or 6 years.

I'm battling the flu or some other virus right now that kicked my butt.  During my fevers I had the worst anxiety I have felt in many years.  As the fevers have gone away so has my anxiety.

I continue to ponder whether this disease has some sort of viral or autoimmune etiology.    For instance, Chicken pox hides in nerves for out entire life if you've had it, you may some day end up with Shingles as you get older...  Perhaps we've gotten some sort of virus that is messing with the CNS.

We will never know.  This issue is not studied at all.  The suffering is immense.  If either my anxiety or PVCs flare like that again it will be rough.
Helpful - 0
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