Runs of ectopics...could I get your thoughts?

[Rosemary349]

Hi everyone

I've had many ectopics in the past and I've had normal holter tests, event tests (although I never really captured those on the monitor), normal BP, low cholesterol, normal stress test, etc.

However in the last two months I was getting ectpics that were lasting neearly all day....and particularly runs of them....here's a typical episode:

I'd be at work, getting tired (i work on my feet all day), would go to break, have a sandwich, would want to eat more but there wouldn't be anything really suitable, would think that will be ok til I get home.  Would go home, get dinner ready......then as soon as I sit down to eat, major ectopics going on.  I remember getting these as a young person but back then I used to think my heart was just dancing with delight at the food!  After eating and resting, they would still be going on but would gradually calm down.  I've always put it down to tiredness....

I mentioned it again to my doctor though because I've had numerous heart anxieties since I saw my father die in front of me from a heart attack.  The doctor has always tried to reassure me but this time he listened to my chest, felt my pulse and then said 'I think you are describing something different and I think we need to have another 24 hour monitor.'

I got upset at which point he said 'I didn't hear anything untoward then, I just think you are describing something different, you've never mentioned runs of them before.' and 'Considering that you've had lots of tests before I expect these will just turn out to be ectopics, but I'd like to be sure we are not dealing with some other kind of arrythmia.'

So I'm worried.  I've made sure I've eaten well since that appointment and it seems to result in a somewhat camer heart....

I'm wondering if I overdo things physically then i mess up my electrolytes or something?  and if so how can I prevent this?  I don't seem to have any warning apart from feeling a bit tired but everyone at work is tired, it's ot until i sit down and rest and replenish with food, etc, that they start up usually.

Has anyone got any opinions on what this sounds like?  The ectopics feel like a jumpy heart, not fast or anything, just jumpy.  Usually they are spaced apart.....every 4 beats or so, and as they calm down it goes to every 7 beats then 10, then seems to disappear but can take up to an hour.  On one occasion i was so aware of them whilst watching tv that i felt my pulse and it all felt a bit random.....but it still felt like ectopics, it felt like the ectopics were making the heart rhythm seems random because there was a lot of them....I did think maybe it was atrial fibrillation, but I think it was just a lot of ectopics still.

Anyone any thoughts?  I'm so scared about having another monitor.  I'm scared of everything at the moment.  It's ruling my life because I don't want to do anything that wil trigger them.

I may also be peri menopausal.  I will go and get a blood test for that....if so is it possible that this is causing them?

thanks for listening

[oldtrout466]

Hi I think all the above are very sensible comments. My ectopics increase when I stop after being busy all day, when I'm hungry, tired, stressed, concentration. And like you, I'm perimenopausal -by the way -one off blood tests won't pick that up - you need a series to see what is happening over time/cycle.

I also had a massive increase and change in pattern after a severe virus and take medication now but as I slowly recovered from the virus my hesrt rhythm has returned to just single ectopics. It was just a thought -are you run down? or had other illness?

[gothic_beauty]

I agree with the others that your arrhythmia is likely not dangerous. However, if you want to reduce the frequency of these episodes, I would suggest that you alter your diet, because it seems that they are related to what you eat. This was the case for me, and it is the case for many people.

For one thing, it sounds to me like you wait a long time between meals, which means that when you do sit down to eat, you are already very hungry. This means that your blood sugar is probably really low, which can trigger irregular heartbeats. I personally have had some of the worst ectopic beats of my life when I let my blood sugar take a dive by going for a long time without food. Now, I make sure to keep my meals closer together, and to eat a snack in between meals if too much time goes by. If my blood sugar stays stable, my heart rhythm usually does too: it's a rule of thumb for me, and it may be for you too.

Secondly, you may not be eating enough. I'm not sure if you're at a healthy weight or not, but I know that my PACs first started when I lost a lot of weight awhile ago. Now that I have gained most of it back, they don't happen nearly as often. They still happen, but not as often as they did. If you maintain a healthy weight for your body, your heart is happy, and when it's happy, it's less inclined to scare you!

Ectopic beats are triggered by different things for different people. For some people, their ectopic beats have nothing to do with what they eat. From what you have described, however, it sounds as if yours are influenced by your diet. This is good, because it is something that you can control, which will allow you to feel more in control of your heart rhythm overall. Don't despair: I'm sure that you'll feel better soon. Hope this helps!

[Dave2923]

    The thing about ectopic beats is that people who experience them have little microscopic electrical defects that cause a spot of your atriums or ventricles to be irritated and send out a premature beat due to over-excitability. That is something you can't change without an ablation. But what you can change is all the triggers that cause this naturally irritable spot or spots to fire off. Two of the more common triggers are GERD (as you said food seems to have a correlation with these) and hormones (you said you might be going into menopause). Furthermore, as you get older you may experience more ectopic beats than when you were younger.
     So long as your heart is structurally normal you are not in danger of cardiac arrest. The most common spot for ventricular ectopics is the RVOT, and the there are three substrates of RVOT arrhythmias (all of which are well tolerated, with no hedodynamic compromise forthcoming so long as the heart is structurally normal): 1.) PVC's, 2.) Sustained monomorphic VT or NSVT, 3.) Paroxysmal catecholamein induced RVOT VT. All three of these substrates have shared initiation mechanisms, which means that if you have had benign idiopathic PVC's your heart is fully capable and in fact likely to at some point in your otherwise healthy life experience the other two arrhythmias which are both more sustained (#2 at rest, #3 with exercise and stress).  
      PVC's and VT are feared in people with heart disease because they can lead to bursts of polymorphic VT where an electrical storm of sorts causes the heart to quiver instead of beat (V-fib) and you die. You have a good, normal, strong heart so experiencing PVC's and even NSVT or sustained monomorphic VT or exercised induced VT is not going to compromise your heart's ability to function. This is why you aren't passing out when you feel palpitations. This is why you are not having cardiac arrest with your palpitations, and this is why you will not pass out or have cardiac arrest with your palpitations. This is why your doctors are not worried.
     If you research long and hard enough you can find some freak cases where in a normal heart a case of idiopathic ventricular arrhythmias went bad and caused sudden cardiac arrest, but this is the vast exception to the rule 99.999% of the time. Otherwise, there wouldn't be all these people on these forums who have had ectopic beats and runs of SVT and VT and such their whole lives and are still doing great decades and decades later.

[MichelleP_3811]

Based on what you have described here I would say you likely do not have anything to worry about.  It sounds like you are having run of the mill ectopics.  You may be experiencing more of them then you use to but you do not have any troubling symptoms with your irregular beats like difficulty breathing or passing out.  In the absence of those symptoms you likely have nothing to worry about.  It is possible stress or simply your stomach revving up in anticipation of food and after food is stimulating the vagus nerve which sends signals to the heart causing it to act up.  The doctor likely ordered the monitor just to be safe but I would suspect it will come back with isolated ectopics with maybe a few patterns of them thrown in.  I also will say that I have feelings of my heart jumping around a bit from time to time that feels different then my ectopics and it really is just a bit of sinus tachycardia and nothing more serious.  So I would say once you have gotten the results of your monitor back and everything appears to be as normal as a person with ectopics can be then do your best to try and work through your anxiety about your heart.  The stress and worry will take its toll on you more than your ectopics ever will. Also, if you need to talk to someone about your father's death please do so.  It was a very traumatic thing you experienced so there is no shame in getting help to work through those emotions you are carrying over the experience.  So hang in there and please do get back to us with your holter results.  Take Care.