they are back again

[pvctom]

more of an update,

the annoying ectopic beats are back, went a very grateful 4 days without nary a one. now they started to come back slowly at first earlier this evening, and as i write this, they are very plentiful. damn, these things are awful, they ruin a nice day or evening. also, belching, got to be a connection. got an appointment with GI on the 6 June. just took a .5 Klonopin.

[Artaud]

Another trip to the E.R. yesterday. I'm driving my wife and dog nuts. This is the second trip to the E.R. this outbreak. Benign PVCs I was told by the woman doctor, the same I saw last visit. They did all the tests, bloodwork, chest X-Ray, continuous monitoring. What was plaguing me yesterday was non-stop PVCs, can't say I went 5 minutes without an awareness of them, and back-to-back PVCs, which occurred on my Holter and at the E.R. as well. I talked to her about the back-to-back-back PVCs, never seen it described before in medical literature, these are not "runs", and as she pondered, she understood what I meant, non-tachycardic series of PVCs. The back-to-back term I borrowed from a PVC sufferer like us, he had an EP and had an ablation, apparently not successful, but had access to a hotline for concerns through the medical group that did the ablation. He said he was told by the hotline that back-to-back PVCs are not runs, and if you go to the E.R. they won't do anything about them. That was my experience too.

Not all PVCs have a Compensatory Pause after them. But mine currently do. So back-to-back leaves you with, for the duration of the series, an extremely slow pulse, and I feel odd, eventually, when I get too many. That is the other reason a went to the E.R., I didn't know if my slow rate was caused by the pause after each of the back-to-back PVCs or if I was Bradycardic from the Vagal System withholding the discharge of the SA Node. We had an interesting conversation, she treated me with understanding, and she understood my concern that the Vagal (parasympathetic) system was incorrectly holding my heart rate two slow. She said she saw no evidence of escape beats, that's when the AV junction will discharge on it's own even in the absence of the SA Node discharge.

I even provided her with my phone to briefly read parts of the following:

"Cardiac manifestations and sequelae of gastrointestinal disorders".

http://bjcardio.co.uk/2009/07/cardiac-manifestations-and-sequelae-of-gastrointestinal-disorders/  

Yesterday, I had burning in my esophagus down rather deeply, I also was extremely symptomatic. Today, no burning, many less symptoms. The E.R. Doctor prescribed Protonix since the Prilosec I was taking twice a day wasn't ultimately effective. I'm convinced I have a Hiatal Hernia. For three days I could eat normally again, no junk, but I could swallow without PVCs, yesterday, the burning, difficulty swallowing, and crazy PVCs, yesterday and today, swallowing drives my heart wild. My Cardiologist wanted me to start taking 100 mg Atenolol once a day, currently I'm taking 25 mg twice a day. The E.R. Doctor said NOT to take the 100 mg, she said my heart rate was already bordering on being too slow.

I was glad they saw the back-to-back PVCs without reacting in terror, and that she saw no evidence of escape beats. I think people like me should routinely be given an event monitor to flag some of the things that concern us, thereby avoiding needless trips to the E.R.

Last thing for those new to these problems, if you start getting an irregular heartbeat for the first time, or for those of us that usually get them at a certain rate but the rates and/symptoms worsen, see your doctor for testing and diagnosis before you rely on comments from any forum.

[pvctom]

thank you for an informative reply, i will look into the vagus link you provided. and i sincerely relate to your troubling arrthymias. i have not eaten a whole lot of the things that I used to eat. taking aciphex 20 mg twice a day for gerd, hiatus hernia. Again, thanks for replying and a great deal of comfort is taken reading it. hope these thongs get better.

[Artaud]

There is a connection to digestion in the Vagus nerve. I've been plagued with ectopics since the Monday after Easter. They are especially bad as I swallow food and for a period of time while the food is in my stomach. I've noticed just chewing, before I swallow food for the first time, causes them as well, and even yawning, all of these items involve the Vagus nerve, in the pharynx at the back of the mouth, involved in yawning and early stages of digestion (ever see a dog salivate when you just show him food?), swallowing (the Vagus nerve courses along the esophagus) and digestion (it's on the stomach and regulates digestion) these all have tie-ins to the Vagus nerve and Vagal influence on heart rate.

My Holter shows the madness of what happens after I eat. Since it's so frightening, I don't eat much anymore, and when I do eat, I eat small portions of bland food. Pizzas seem like distant memories. My cardiologist has the Holter results, which include prime examples of the rhythm disturbance during eating, my GP as well, and a very good Cardiologist that interpreted the Holter results. In addition, an EP that I have yet to see said he would review my records for anything of concern and to determine if I need additional testing or intervention before our initial visit.

Regardless of how much these things cause me trepidation, the doctors seem to remain unconcerned. When I discussed the idea of a change to my prescription medications  with my GP, he had a hard time getting through to the cardiologist to confer about possible changes, but they concluded that either higher doses of a Beta Blocker is used, or a very low dose of a Beta Blocker and the addition of a Calcium Channel Blocker would be the way to go. Right now I'm trying the increased Beta Blocker dose.

The discussion at the following link is thorough on Vagus Nerve involvement in some arrhythmias, it's an interesting read.

http://*****.*****************.***/post-neurology-questions-f6/arrhythmia-caused-vagus-nerve-t396-45.html

One point that is made concerns Beta Blockers not being the appropriate medication for Vagally induced arrhythmias since the Vagal system represents the parasympathetic influence on the heart and Beta Blockers diminish the sympathetic influence on the heart, allowing the Vagus nerve free rein. Calcium Channel Blockers, on the other hand, do not block sympathetic influence and indeed is one reason I'm reluctant to switch since most of my adult life I've been on a Beta Blocker and am concerned that the sudden return of the helm of my heart to the sympathetic system may actually be overwhelming.

I'm sure some/much of this is rehash, but I just wanted you to know I fully understand the frustration. Trying to get doctors to look at the overall picture can be frustrating.