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Symptomatic Bigeminy PVCs
I'm a 38 year old male. For the past 3 months, I have been diagnosed with symptomatic bigeminy PVCs which the doctors say are benign. I have worn a holter monitor, echo, stress test, chest xray, and blood work came back all normal. I have been to the ER twice for shortness of breath and my O2sat is normal 95-98.
My holter picked up 600 pvcs but I think they are much more now. I am thinking of asking them for another. My GP and Cardiologist both think it's anxiety. I have gone through a lot since late February: Divorce, different health scare, Diet and excersise change (I lost 40 lbs in 4 months) my daughter was amitted to the hospital for 3 weeks for a medical condition, new long distance relationship, job change, hair loss worry... needless to say there are many reasons why they would think that it's due to stress and anxiety.
I admit I do have anxiety now due to this PVC issue. I get shortness of breath, dizziness/lightheadedness, nausea, and insomnia. I am currently taking tons of supplements in the hope that it will relieve the symptoms. The actual Rx meds that I currently take are lexapro and clonazepam as needed. I used to take atenelol but it made my blood pressure and heart rate too low and made me feel overall worse.
I know anxiety can make it worse but I don't think it is the actual root cause of my issue. I've searched all over the internet and it's hard to find any information regarding people who were able to overcome this fear, anxiety, and quality of life issues. Is there anyone out there with symtomatic PVCs? How do you deal with it? I need some help and possibly some encouragement to keep my hopes up that someday I can be normal.
aandcmom, November 18, 2017 8:21am ESTI know exactly how you feel. I am 39, and just had an somewhat successful ablation for symptomatic RVOT PVCs. They came out of the blue 3 months ago. My cardiologist did a 14 day Zio patch which showed a steady increase in the PVCs. Metoprolol did not stop them at all. I also take anti-anxiety meds. Anyway, two weeks after the ablation, I am still having PVCs, but they are much less symptomatic and much less often. The EP thinks he got a glancing blow on them, since they disappeared just after beginning the procedure! Of course! I am also struggling with the anxiety of my heart not working properly. I know these are "benign", but it is difficult for people to understand the fear that comes with a malfunctioning heart. When the PVCs started to get bad, I started yoga and meditation. That actually did help a bit. Also, I recommend talking to your doctor about adjusting the anxiety meds. That is helping me handle this a bit better. Best wishes.
Lovestohike1, December 31, 2017 7:09pm EST
Hi. I am 48 years old and have been dealing with benign PVCs for the last 12 years (about 15,000 in 24hr per holter). I also have atypical AVNRT (AV node re-entry tachycardia) and had a cardiac ablation for the AVNRT 8years ago but my cardiologist was unable to ablate the PVC's. So, I continue to have PVC"S which seem to be cyclic as well as PAC's and aflutter. When the PVC's are bad I also have significant sob. I am healthy otherwise and live and spend most of my time in the mountains hiking and skiing. I noticed a few years ago that when I would start having arrhythmias while on a hike it would be accompanied by anxiety- the anxiety would then make the arrhythmia worse- vicious circle. I have worked very hard these years to fight down the anxiety when it hits me. My anxiety is always triggered by my heart- either I am having arrhythmias or I am on a 20-mile hike and I become anxious because I am worried I will have an arrhythmia. Sometimes I get so tired of thinking about my heart and want to be like most people who don't feel their heartbeat. My Cardiologist (after my work up) has assured me that none of these arrhythmias are life-threatening but believing in that is difficult because of how horrible it makes me feel as well as the fact that I have had two uncles on my dad side and two on my mother's side who have died from sudden death. I would say to you that I have had these for over 12 years and I understand how you feel. I continue to do long hikes and ski but I can't say that I don't have anxiety at times. I have decided that I will not let it control me! I know that I have seen my Dr and I have done all that I can. I have learned my triggers (caffeine, chocolate, wine :(, lack of sleep) and I try to avoid them. When it is really bad, I tell myself that after having this for over 12 years I think it would have already killed me if it was going to. I cannot say that when I am traveling I don't always wonder where the closest hospital is.. but my goal is to overcome the fear and live my life the best I can.
MargieBrooks, February 15, 2018 11:42am EST
I know everyone keeps saying try meds but meds were not an option for me so I pushed ahead and found an electrophysiologist that would listen. Please, find someone to listen. They all thought that it was in my head with panic attacks and I found out that I had heart block and atrial tachycardia. I am not trying to upset you but be an advocate for yourself.
ReikiLady001, March 6, 2018 6:39pm EST
I've been dealing with PVCs for over two months, bigeminy/trigeminy/you name it. I came down with that awful flu at the end of Dec 2017, and ended up with this as a parting gift. I did the holter, echo, and nuclear perfusion test and everything came back normal, which is a good thing. But it doesn't help with dealing with the SOB, neck and jaw pain, sleeplessness, and frustration from no one having any real advice. I feel your pain and can only offer a little bit of advice: I purchased a portable ECG monitor and that has helped with the anxiety of not knowing what's actually wrong with me. I get symptoms, do a scan to verify and reassure myself, and try to relax and get on with my day. I found my monitor (Emay personal monitor) on Amazon for $80, and it was well worth the investment. I compared my readings with the 12-lead monitors in the hospital and the heart rate measured the same. The trace is a little different, but just having the ability to download and send my cardiologist my scans helps give me some peace of mind. She also appreciates that I can provide scans at moments when I'm getting bad episodes to help make more appropriate determinations. I still feel like garbage during my episodes, and taking Bisopropol 20mg QD makes me feel worse, but at least I can "see" what my heart is doing. Take care.
Allume, July 14, 2019 8:41pm EST
I also have symptomatic PACs/PVCs and SVT, they are so bad I've come very close to fainting when they occur. Also have nausea, chest pain, SOB and lightheadedness. I've done two 30-day event monitor tests (in addition to the other routine cardiac workup battery of tests which all were negative of course), the event monitors showed occasional bigeminy, but not severe enough for concern. I'm on a CCB and take about 360mg of magnesium daily but if anything they seem to be getting worse. My Dr won't even consider an ablation at this point as I don't have enough of them. I use a Kardia 6L monitor which gives me peace of mind I'm not going into aFib every time I'm getting a bad run, but that's about the best relief I've acheved. It really sucks because every trip away from home makes me anxious I'llI get a terrible run and wont be able to stop it. I agree with you that although anxiety makes them worse, it's a symptom of having the bigeminy, not the cause in our cases. At this point all I can do is monitor and do all the routine management stuff - no caffeine, manage stress, keep a sensible diet and exercise (although I can't do much without setting my heart aflutter), and remind myself I'm not having a HA when they are bad. Hope you can get some relief ♥️
Mgonzaga, July 31, 2019 7:28pm EST
I'm so glad I'm not the only one!! Done the stress test' nuclear stress test, echo cardiograms, ekgs, etc...no structural issues. I get runs of PVCs but also Bradycardia! Is it caused by anxiety? My Primary doctor says yes, my cardiologist doesn't know but says I'm to young to worry based on the test results and no family history, but when I get PVC's and feel like crap getting bigeminy, sure as heck doesn't feel like nothing to worry about😔 EP was like here take some Flacanide and come see me in six months. Flecanide did squat fornmy last run which ended as abruptly as it started. The anxiety is hell of real especially when you hearts rhythm is all out of whack ! Wish doctors all had a patient centered approach. Trying to find triggers not enough sleep? Stress? Dehydrated ? Combinations of several ? Feeling so frustrated. Doctors basically say dont worth about it, your not going to die from it and then I start surfing the internet and you all probably know how that goes!!! Aaaahhhhhrrrrggggg!!!!!😔
NewPacer73, August 1, 2019 9:02am EST
@mgonzaga and other posters; The common thread here is cardiology is behind the eight ball in compassion and empathy approaches in patient care. Not all. Took me 15 years to find a cardiologist team with compassion. They listen and know the emotional toll cardiac issues can have on the patient. Under one umbrella practice, they work together WITH me to resolve issues. Patient portals have been a godsend for me because when I have a question or concern anytime 24 x 7, I write and within one day, I have an answer or options to implement. I spend less than a day now wondering if what I am experiencing is dangerous. Imagine that! And 99% of the time, I don't need to go to an appointment or the dreaded ER. smile
I think it doesn't really matter if anxiety caused these problems or these problems caused the anxiety. It's real to the patient, and one day, I hope this specialty field catches up to what I see happening (at least in advertisements) with cancer. It's urgently required that cardiology treat the patient wholistically as a team. Who isn't anxious these days? Pile on that we have cardiac issues that seem out of our control and, like cancer, we feel it can kill us. Why cardiology isn't catching up is a mystery to me.
If I were anyone on this thread, I would find the right cardiology team that works together and WITH you, the patient. They are out there. The search can be difficult, but once you do find the team, a huge weight lifted for the patient. The conveyor belt treatment model doesn't work for cardiac patients and I think it endangers the patient's survival. It certainly impacts on quality of life. Cardiac symptoms are most likely chronic medical issues. If not curable, they need a plan for management. Our confidence in cardiologists being on our team, looking out for our welfare, is crucial in giving us the best qualtity of life with the time we have left, whether old or young. We in the USA have the most expensive medical system among all industrialized countries in the world, yet the US ranks 18th in successful outcomes medically. We have the knowledge and research capabilties. The missing link for me is compassion and empathy blocking the required doctor patient communicaton.
How did I add to what I needed for support? I joined Mended Hearts in my area (nationwide group) and then formed my own cardiac patient support group in my town via www.meetup.com. I'd like to see if I can maximize my available resources, along with my great medical team. I want to see how that may impact my quality of life. Look on www.meetup.com and Mended Hearts and see if there is a group near your zip code. Cancer, pain management and many medical areas have support groups. I have not been able to easily find those groups in the cardiac field in my area or frankly nationwide.
I totally get the frustrations expressed in these posts personally. We need to turn this around to be a patient focused treatment model. Wishing you all the best. I will keep watching our progress in getting what we need. Keep posting so we can all share our experiences and gain some ideas on addressing obvious frustrations on not being heard.
MMalcolm, August 5, 2019 7:00pm EST
I realize that this is a rather dated post, but thought I'd respond regardless. It would presumably be appropriate at this point in time almost 2 years later to inquire how you're doing and whether the PVCs discussed in your post have abated or remain. By now, I'm sure that you realize that PVCs and PACs are both a very natural phenomenon and in almost all cases are benign in origin. Additionally, there are perfectly healthy people who live with conditions associated with PVCs such as bigeminy all their lives without deleterious effects that would in any way shorten their life span. In fact, many of these people never realized that their heart rate pattern was even present and typically found by the practitioner as incidental when performing routine health examination. All of these facts, however, sometimes do little to ease the worry for some patients who experience PVCs.
It's important to note that since the presence of PVCs and PACs are entirely normal variants, they are not technically classified as any type of true and clinically significant heart arrythmia, despite the fact the events do create a departure from what is recognized as steady sinus rhythm. The problem for most sufferers is that the health anxiety produced by the events typically has no regulation and thus regularly exceeds the bounds of probable and even possible outcomes. By the common sense rule, any disruption to one's heart rhythm is a potential antecedent to a much greater consequence. You might well guess by now that in most all cases of health anxiety that the only way to truly quell the ever-increasing rumination and fear of a problem being overlooked or somehow missed during evaluation is to undergo repeated tests to make absolutely certain that everything is normal or that if they had only discovered some underlying cause sooner that you might not now be faced with an even greater and imminent risk. It's how anxiety affects the mind and establishes a very frustrating series of moving targets. If one test comes back normal, then a different, more sensitive test is what is required to detect what the patient feels in their gut is a looming problem.
There is also the common worry that a disruption to the heart's normal sinus rhythm could suddenly become a runaway train, with the patient unable to exert any influence or control over the circumstances. This, too, is an element of signficant anxiety disorder, the feeling of loss of control or no ability to easily intervene. With only specific layperson knowledge to guide your interpretation of the events, they can only represent an abnormality which interupts what you have always deemed to be the normal and safe function of your body, most particularly your heart, for it is the very muscle and organ which provides life to the body by its function. Any problem in that area is going to very naturally bring a person who has developed health anxiety regarding their heart to the very brink of imminent risk with every instance of a PVC. There is concern that these events can somehow over time injure or weaken the heart's structure, also a pereption that is clincially incorrect. The heart is an incredibly resilient muscle and organ and performs its function daily for every second, minute, hour, day, week, month and year of an entire lifetime. Now that's something to consider; An element of the human body capable of such resilience and endurance. On that scale, a PVC is the equivalent to the presence of a hangnail in the midst of normal nail structure and growth. Even patients with thousands of PVCs within a 24 hour period have suffered no repercussions and it should interest you to know if you haven't already searched it out on the internet that there has never been even a single death attributed to the presence of PVCs or PACs. Not one. So we can at least by virtue of that clinically historical fact relieve you of any worry regarding mortality being even remotely part of the equation associated with your anxiety in that regard. PVCs are clinically incapable of stopping the heart altogether, or even interrupting it to the extent that it cannot perform its function to the fullest extent. While mild symptoms do sometimes appear in patients such as the feeling of shortness of breath, your PCO2 is qualificable proof that your blood oxygen is well within normal limits. True dyspnia, or shortness of breath, is always accompanied by associated clinical signs that would explain actual air starvation to any degree. Most patients who suffer the sensation of shortness of breath with PVCs or PACs is actually more rooted in the associated anxiety by way of tachypnea, or short rapid breathing that slightly alters blood levels of CO2, or carbon dioxide, which results in lightheadedness and the persistent feeling that the patient is unable to obtain an inspirational breath, or full tidal volume breath response that itself produces relaxation. So in the absence of exposure to clincial training, the anxiety-afflicted patient links together a series of somatic experiences and assesses them as something in the furthest spectrum of a cardiovascular problem rather than anything benign. It is easy to understand how a patient using common logic can form the question "Well if there's absolutely nothing wrong and what I'm undergoing is normal, then why on earth am I experiencing all these symptoms, which by the way are very real!"
With all certainty the somatic features of health anxiety, or anxiety otherwise, are very real. Your body only has one nervous system central highway. Abberhent sensations resulting from anxiety feel precisely like those from a true underying problem because they both have only one option to express their sensation or detection by the patient. The critical point to remember is that true disease or illness never acts alone. By that, I mean that true disease and illness is always accompanied by a full host of variable symptoms and clinical signs which ultimately lead the health professional to a dianosis. So in the instance of somatic anxiety, a symptom or two comes along but is absent the company it must invariablty keep in order for it to be established as a true concern. Thus, when we see this absence of the proper constellation of signs and symptoms that absolutely must be there for true disease to be present, we call somatic anxiety a diagnosis of exlcusion. In other words, once the true clincial manifestations for disease are tested and ruled out, the only possible conclusion and diagnosis possible is an exclusionary cause, in your case anxiety disorder. It's symptoms are very real and so is the disorder, but it does not rise to the level of clinical disease.
So it's been nearly two years and as a retired healthcare professional, I'm betting largely that your still around and as full of life as ever and without any repercussions resulting from the presence of the PVCs. Generalized Anxiety Disorder and Panic Disorder if also being experienced, are somewhat problematic for persons specifically experiencing irrational health concerns because unless the symptoms abate, the anxiety remains almost as a protective mechanism to keep one constantly on guard for any sign of progression or change in symptoms associated with the focus of concern. Too, as the proximity to life's stressors become resolved or at least distant from their primary point of origin, so too does the intensity of anxiety connected with them and a sense of normality begins to resume its course.
There is growing evidence that clinical help with anxiety disorder, particularly Cognitive Behavioral Therapy, has shown positive results in some patients but more research is needed and some people simply don't benefit from this type of approach. The best course to proceed in the absence of such treatment is learning to recognize the antecedents to anxiety disorder, health disorder in this case, and not only come to place trust in your physician and the test results as far more reliable than the gut sensations and ruminations associated with anxiety that can make a patient certain that their own impressions are more valid than the literal thousands of test results which help physicians every day around the world make accurate assessments and the ability to distinguish true disease from that which merely mimics it. So anxiety then, is about learning to trust and the ability to restore the eroded self-confidence that likely took its toll so often while the presence of the PVCs appeared so relentless in their presentation. Lastly, the ability to recognize, acknowledge and live accordingly by the undeniable fact that as human beings, we sometimes lack the ability to control everything in our lives, that in some instances we must be able to accept and overcome that frailty in the absence of allowing it to forestall the remainder of our lives with our loved ones and be able to move forward. This is indeed necessary for there is no other option capable of offering a full life, the alternative of which is to spend one's remaining days searching ever deeper for a cause that in reality, does not exist and is only maintained by the mind. It's critical for you to understand that the brain is a very ingenious organ and ruler over the body because there are several regions in the brain which store all salient information relative to what is perceived to be a threat to our safety and survival, whether real or imagined. Once those features are stored, any subsequent recurrence that closely enough resembles the initial cause for concern immediately reproduces the perception of threat. It is in place by virtue of evolution and it is how humans survive in the face of danger. It could almost be cast as premonistic in that it provides forewarning that has in some manner been experienced before and sets into motion what has come to be termed "fight or flight." In response to any perceived threat of significance, the brain engages the body to either stand and fight off the threat or alternative escape from it.
This mechanism was used quite redundantly in primative man, for danger in that era was steeped in a predator-prey environment. But in this contemprary age where complexity has driven much of our senses, the ability to detect real threat from an imagined one is far less accurate. This is where anxiety gains its greatest advantage over human beings in this age because the inability to successfully process the immense complexity and full knowledgehouse of information has resulted in the perceptions of a threat to more often be inaccurate than real, in other words very often a misperception based upon the variable knowledge and experience we all use to navigate our world safely. Thus, many people at some point in their lives expeirence anxiety disorder of one type or another because we have limited insight into the complexity of modern circumstanes in order to distinguish what may or may not pose a threat to our safety and survival. This is particularly true if misperception constitutes the origin of the threat, if you see the relevance here. If our understanding of a physiological manifestation is misinterpreted as a threat, then any subsequent event resembling the original is engaged even before the event may undertake its full course. Thus we develop an inappropriate anticipation of the next event and the next such that it produces a status of fear that the patient can't seem to abate and with good reason for it is the brain itself stimulating the effect in an almost autonomous fashion. So in learning to overcome anxiety we must also come to understand how the brain itself establishes intervention as an influence to the external cues provoking the anxiety status and in doing so, we come to the realization that much of what drives anxiety is misperception and a response set by the patient based upon limited information.
I do hope that the passage of time alone has put distance between you and your anxiety, moreover the PVCs which held you prisoner to efforts to relentlessly discover their cause or other method to avoid or extinguish their presence.
A retired old practitioner with either a mispent word or alternatively food for thought and hopeful relief that has already been pressed into the pages of history.
NewPacer73, August 5, 2019 8:41pm EST
@MMalcolm. What an interesting post relating to the effects anxiety has in some patients with some cardiac symptoms. I could never figure out if the anxiety caused the symptoms or the symptoms caused the anxiety and I'm not sure it matters. Both for really threatening cardiac conditions and some minor ones, anxiety plays a huge role in subsequent quality of life. As a former practitioner, looking back, do you wish more emphasis or compassion was placed on anxiety in the mix of services provided to treat the cardiac patient more wholelistically? Quality of life is the goal. I had symptoms over the years where some test results were missed and I got seriously ill that resulted in a myectomy at Mayo (out of state for me). I also had a bradycardia incident (slow heart rate) that resulted in a cardiac arrest in route by ambulance to the hospital. I now have a pacemaker. This back up generator in my chest and I are getting to trust each other now and I have more confidence that it will do the trick. Two things happened: 1. Time has passed now since June 1, 2019 and I noticed I have had no more serious events and 2. The second pacemaker clinic (I moved it from the hospital where it was installed and put it in my cardiologist's practice so all will have the same data) was amazing in that they totally answered my questions and let me participate in the settings. Maybe a third thing is the second clinic really explained what a pacemaker does. The first post hospital pacemaker clinic was a conveyor belt visit with the nurse collecting data, saying nothing until pressed about whether or not I was seriously pacing, etc. I now know I am experiencing arrythmias that are minor and not dangerous. Also, if I write a question or express a cardiac concern on the patient portal tonight, I guarantee you I will have a response tomorrow by noon giving me some data to keep me in the land of reality. Probably sent three messages in a year. What a great feeling to know somebody is there to help me understand what is going on and helping me determine what's serious and what is not. This extra compassion has defineitly impacted my confidence in my care. I would like for you to see what you can do wherever you are now to convince the very talented cardiologists who are loaded with amazing medical tools these days, to do a tiny bit of compassion and discuss anxiety with empathy. My wish is every cardiac patient has a patient portal with responsive cardiac specialists, so worry is limited. I know there are support groups for cancer but could not find a support group for cardiac patients near me. So I created one on www.meetup.com. I have five members signed up in the first two weeks of posting. I'm hoping that it's an outlet for those who worry a lot about surviving cardiac minor or major incidents. Thanks for posting. And thanks for the food for thought you did share. I did hear you loud and clear. Take care. Thanks for supporting us. The more I learn about what is going on, the better for a person like me.
MMalcolm, August 6, 2019 2:06pm EST
Well, what you seek is certainly laudible and very frankly, to be expected as a patient. What you ask, however, is quite distant from the former. It must be remembered that physicians are medical scientists and people that are drawn to the sciences, regarding humans or otherwise, very naturally and to the greatest extent unavoidably have their interests focused on the "science" itself. I've been around a good long time and within the profession of medicine I will share an observation that hopefully will not come to represent a disappointment. If I myself needed a physician in a time of need I'd unswervingly choose the professional who appears rather blunt in his bedside manner but rapier sharp in his medical diagnostic skills. Physicians who have an overwhelmingly attractive bedside manner tend to be less savvy in their medical skills. Proficient, to be sure, but simply less savvy and intuitive by comparison.
Never let the reason for your visit to your physician slip too far from sight in exchange for something else you might be seeking, very naturally the quality and effect of reassurance. A pat on the back and some words of confidence do make many patients feel relieved. If those chracteristics, however, are voiced from a source more average than exceptional then it really tends to lend a half-baked pie, if you share my thought here. The mindset of needing or expecting reassurance as a quality and characteristic of sound medical standards of practice is always available but sometimes not through the same source. While holisitic medicine combines the approach from a variety of resources, it can still leave one with a nagging speculation about their outlook and comfort unless the component exists within that combined realm.
Anytime a patient experiences a medical event, whether accute or chronic, emergent or non-emergent, it can produce a sense of doubt and question regarding longevity and quality of life. One's self-confidence is also rattled to variable extents and perspective plays a very large role in how much a patient needs or seeks reassurance and a sense of closeness to their healthcare professionals. Fortunuately, there are vast recouces of physcians in every speciality and much like water seeking its own level, so too do patients often find the healthcare team that is considered a comparable match to their specific needs and expectations. It sounds as though you, yourself, found such a combination in the healthcare group mentioned.
My point is merely that I've spent the better part of my life among physicians and the medical community and it is very fortunately composed of a great variety of professionals within a spectrum of performance and attention to the framework of medical practice. Don't harbor disappointment that a good number of these scientists lack a winsome bedside manner, for it is a fact of life that can seldom be challenged or overcome. Scientists have a love for science, with a portion of these professionals finding humans within the medical sciences to be more incidental to their goals of discovering and resolving an equation that piques their interests and passion, while others lean a bit further in the desire to be in touch with the human elements in a more compassionate and social manner as a means thought to better address the entire circumstances involving medical care. Whether one style or the other is wrong, however, merely depends upon your own perspectives regarding what human medical sciences should represent to you as a patient. Some patients do in fact prefer the rather straightforward and limited contact with their healthcare provider, with the simple goal in mind of being treated or cured in order to move on to their primary objectives.
When at war seek the company of warriors and in times of peace, the council of peacemakers. One must choose for themselves the resources best suited to prevail. Both are formidable and qualifiable and both have their respective place at the right moment and place in time.