More PVC questions

[scarypvc]

Dr. McWilliams,

I have posted a question to you before, thanks for your help.

I am a 31 y.o. male, normal height (6 ft) and weight (190)with history of pac's and pvc's and mild white coat hypertension
I take Toprol 75mg qam and 160mg of diovan
About 5 years ago I started feeling "skips" and have had 2-3 episodes of what I call runs or multiple skips that have lasted 5-20 seconds.  I have had 2 stress echos, both of which are normal except for some ST segment changes in recovery.  Also have had 3 30 day monitors and 1 holter.  Normal blood workups in the past.  

My questions for you are:
1) sometimes while checking my pulse I seem to be able to induce a pac/pvc.  Have you ever heard of this?

2) I have never caught the runs of skips on a monitor and I am worried about VT.  If it is NSVT, what are the chance of VT developing?  

3) What more can I do/should I do....if this were yourself would you think an EP study appropriate or an implantable monitor that can be worn for a year?

4) How often should I have a stress echo?  I would feel comfortable with a yearly echo, is this too much testing?  

5) are there any ways for a patient to somehow buy a monitor that can be worn in times of "worry" that it seem the PVC crowd goes through.  I know this would help me because when I feel they are increasing I could put it on and make sure there are no dangerous rhythms.

I guess bottom line is, I worry about missing something and I don't want to be someone that has a problem and could have done more.  What would you tell your patient in this situation.

[Uboat]

I don't know if this has happened to others, but there have been a few times where it will be well into the day and it occurs to me that I haven't had a PVC all day! Guess what happens a second or two later? Yup, a little thump-thump-thump to keep me humble.

[Michael J. McWilliams, M.D.]

1. People can cause heart rates to slow or speed up by taking a deep breath and exhaling.  This is normal.  I haven't heard of being able to will yourself into pvc or pacs.

2. Very low.  As a rule people with structurally normal hearts and pvcs don't go on to develop sustained VT.  If it does happen (and again this is very), the probably of dying from it are exceedingly small.  Trust me, if it were dangerous, we would tell you.  Not only is it the right thing to do but we would get sued for withholding information.

3. Implantable loop recorders are ONLY indicated for unexplained syncope, never palpitations alone.  I would not due an EP study on myself or anyone else with a structurally normal heart, normal EKG, normal stress test for symptomatic pvc's unless I was intending to try and ablate the pvc's.  PVCs should be treated conservatively whenever possible.

4. That is too much testing.  If it was normal several years in a row, I would wait several years between stress tests or echo's.  The only reason I would do it is if I thought your anxiety from not knowing was going to affect your quality of life.

5. I do not know of any such monitor.  I also wouldn't recommend it.  I would be afraid it would feed into your fears and make you worry more.

I would tell them that their risk of sudden death is probably the same as mine.  No one has no risk of sudden death, but normal heart pvc and VT have a near normal prognosis.

I hope this helps.

[Barbmag]

I am the very same..I can just think to myself that I am having a pretty good day and wham...PVC's!! The other thing that I can relate to as well is that often when I take my pulse, I will experience a PVC or two or three!!!!! Just like that, out of the blue for no reason at all....they are so annoying.

[tsco]

Yes that's the crappy part.  Seems my programming (mental) skews toward the negative. I have actually been in ER two times (honest truth), where my SVT stopped within a millisecond of them administering adenisine.  Happened twice that way. But you are right I haven't quite figured it out either.

[kat4]

I think sometimes okay if I can cause them, I should be able to stop them.  I haven't figured out how to do that yet :-)

[tsco]

I had to smile with your comment on the peaceful day until you thought about it.  I do that same thing all the time.  I'll think man I'm having a good day and within a few minutes I'll get a hit.  Recently traveled to Japan, gone a week, only a few mild incidences, pretty good week, fly home, drive home from airport, walk in the house sit down and SVT hits. The mental part is too weird.  I'll bet the Doc I can will a PVC or PAC!

[Uboat]

When I was in the ER a month ago for an Afib episode I was able to see the EKG machine I was hooked up to for the several hours I was there. When it was under control (I self converted) I was in normal rhythm and when I had PVCs I could see them as extra little blips that felt worse than they looked on screen. I could then realize that they are benign.

[scarypvc]

Absoloutely, I have had that happen many times.  I like how you put it....to keep me humble.  I really start thinking my heart is doing well, and then, it acts up again.  What I can't believe is that there is not more studies being done on PVC's.  For me, I would be much better off if I had one of those event monitors that I could put on when I felt like the PVC's were really bugging me...because I think it would help me to know that is what they are.  I would be willing to pay for a yearly subscription for a monitor that can be worn as needed to reassure.  

[kat4]

Hi, scarypvc,

Welcome to the world of people who can induce ectopics.  I get so nervous about taking my pulse that I will often have an ectopic because of it, even though I can tell I have been in perfect sinus rhythm for several minutes before that.

I am not alone in this, as several people in the yahoo afib support group I am in have mentioned the same phenomenon.  I have mentioned it to my doctor once or twice and he was not concerned.

I think it is part of anxiety increasing the heart rate and incidence of ectopics.