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PVCs (or PACs), POTS, wierd feelings in chest, low pulse before sleep

Hello to all!

First of all let me say Thanks to all of you. Reading this site really helped me a lot in coping with my condition. Thank you.

About my problems.
Last year in July i noticed some weird behavior in my heart. When i was sitting or lying in bed, everything was fine, however, just standing was unbearable, my pulse went up to 110-130 in mere seconds. Sitting will drop it to 65-75 under a minute.
I was scared with this, so, being hospitalized with my gastric problems (what a coincidence), i underwent ECG, Echo and Holter testing. Everything was fine, no problems were found. The doctors said that it was just an anxiety. I was prescribed with antidepressants and was left to myself.
The problem however still remained. I was convinced that my pulse problems were affected with my mind, so for some time it was actually fine, for other it was worse. I finished my antidepressant course, to no result.
During those times i started to feel PVCs (or PACs, can't really tell the difference by myself), and was quickly reassured that they are mostly harmless (as my heart was fine in Echo).

The real problem in my situation is a complete lack of knowledge of anything related to my problem in my country. I was lucky enough to hear from one doctor on a medical forum that my condition looks like POTS. I researched into it, tried drinking a lot of water, and i could say that for some time i was quite relaxed.

In November i tried a new cardiologist. He put me on Holter, and right after that i went to do blood check, were, in the first time in my life, i passed. On Holter there was a pause, 5sec, then another 5sec, then 3 sec. The doctors said that due to a provocative situation (lost consciousness when my blood was taken), those pauses are justified and can be considered harmless.

4 days ago my PVCs have returned. I get them all the day long, the most comes when i'm sitting. They can be just random, sometimes they form in "beat-beat-PVC-beat-beat-PVC" pattern (trigeminy?). One time, when i was lying on my right side, i felt an unusual fast heartbeat, for a few seconds, then it stopped, and after a few minutes again, fast heartbeat for a few seconds. Having read aboun Vtach and other dangerous forms of tachycardia, i'm now scared. Called emergency, they performed ECG, it was fine (to no surprise). In a 3 days i will do Echo again, and will insist on putting me on Holter again. Is it something that i should be worried about?

Another big concern for me is my low resting pulse. When i'm lying in bed, especially before going to sleep, my pulse drops to 45-50 bpm. I feel nothing that would worry me, found it by accident. (feeling tired is all i'm feeling during this). Should i be concerned about it?

Regarding my POTS, i have noticed that i get worst episodes during first half of the day, especially in the mornings. In evenings i could say that my heart is beating as it should have (80-90 when standing). The main problem is that here in Russia no one could diagnose me with this condition, everything i get is anxiety, nerves dysfunction etc.
3 Responses
Avatar universal
I nearly forgot, today i checked my Thyroid, T3 T4 and THS is fine. The Thyroid itself is normal size, with echotexture mildly heterogeneous (hope i translated it right)
26 year old, male, 2m height, 94kg weight (was 124 in July, when it all happened, lost weight due to diet and poor appetite)

Done blood check, everything is fine except for bilirubin (got Gilbert)
20748650 tn?1521032211
Well; 99% of what you said sounds normal.

POTS is defined as a rise in heart rate over 30, without a loss of blood pressure consistently over 6 months.

The appropriate test for POTS is a "Tilt-Table Test" not a Holter.

A Holter however is used to detect PVC's. Trigeminy does put you at a higher risk for VT as opposed to a normal PVC.

Fortunately that risk isn't necessarily TREMENDOUSLY higher. We're talking maybe like a 3%- 5% increase in VT risk as opposed to an individual with no PVC at all.

The best approach to suspected trigeminy in my opinion is 24 hour Holter, Exercise Stress Testing, standard labs for BNP and electrolytes, Echo and low dose (12.5- 25 mg) Metoprolol.

I would then reassess on a second 24 hour holter 2 weeks later to see what sorts of changes are apparent when comparing the 2. With a negative stress test the risk of VT development in trigeminy is next to nill.

Depending on the results of the stress, I would be looking for different things. For a negative stress I'd be more interested in the overall ectopic burden, if the stress looked concerning I'd be more focused on specifically comparing the quantity and duration of Trigeminal "episodes".

If negative stress Beta blocker therapy should reduce the ecoptics that start episodes of Bigeminy, and hence symptoms. If positive stress beta blockers will attack the pathway itsself, so it's a win win regardless.
Thank you for your reply!
I'm definitely going to do another Holter and Echo.
I can't say it is unfortunate, but today, after about a week of constant PVCs assault, they are almost gone. Right before i was gonna perform Holter monitoring. Like they new about my plans and are hiding now and waiting for another opportunity to ruin my life again.

Regarding Beta blockers, i'm not sure if it's safe to take them with my low resting pulse. I heard that they can lower you pulse, so i'm a little bit concerned about them.

Anyway i'm gonna talk with my cardiologist on Friday, will see what she will tell me about all of it.

But until then thank you again for giving me some relief!
20748650 tn?1521032211
Whether they are safe will be the determination of rhe cardiologist and tailored to your individual needs.

Generally speaking the resting pulse and BP isn't as big of a consideration for beta blocker therapy as some might think.

As long as you're not in shock or like.. Having issues with hemodynamically compromising Sick Sinus, 1st degree avb or Wenkebach block you should respond well.

We put my spouse; an otherwise healthy young person, on beta blockers with:

Resting pulse 40 - 45
Resting BP- S: 85-95 / D: 40-70

With the therapy her lowest HR on Holter is 31, but her MAP is solid (at least 60) and she retains good control with Healthy Escape mechanisms in tact while sleeping. That's an acceptable endpoint.

If she was older or her circumstances were different it may be a bit different.. Just depends.
Thank you again for your reply, your feedback is really helping me!

Today i haven't got much sleep, when i was lying on my right side or on my back, i felt a very fast heartbeat. It lasted for 3-4sec, after which heartbeat slowed down. It happened again after some time, and again, and again. With that i also had a hard time breathing, it was as if i couldn't get enough air in my lungs, very small breathes. I get that this could be related to panic and anxiety, but it's not what caused that in the first place, panic came after those "NSVT" (if i may call those symptoms that).

Yesterday i did echo, everything is normal except mild MVP. Today i went to see my cardiologist, who said that it's probably nothing to worry about, but still redirected me to see arrhythmologist to rule out possible Sick Sinus Sindrome. I hope that he will put me on Holter and we will see what is going on here.

But until that time, is it really something i shouldn't be so panicked about? How dangerous it is to get those tachycardia episodes when i'm ready to sleep or even during sleep?

Thank you so much for your support!
I've managed to approx. calculate the amount of beats per minute, it was about 83 bpm. So, considering it lasts for about 3-4 beats, which lasted for about 1-2 seconds, or 3 sec at worst, is it safe to assume that this was not NSVT, but rather benign AIVR?
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