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Forum Name: Arrhythmias
Question: Sound like PVCs?
|cavis - Mon May 07, 2007 11:08 am|
36 YOM, hypertension (treated with fluid pill at this point, put I don't remember the name), generally healthy as a horse, and very active (regular gym activity, coaching 2 baseball teams, Firefighter/EMT). 6'5", 275 lbs. Non-smoker, but use smokeless tobocco. Very little sleep on a regular basis, and I deal quite well with the stress of daily life. Family history of hypertension (mother's side only). No surgeries, other than a knee surgery back in High School.
However, a couple times a year a get a little heart irregularity. I'll be doing normal stuff, and my pulse will diminish for a beat, then a little more for another, then WHOOSH!!! one big pulse beat. It will occur ocasionally for an hour or so, then not again for months.
Does this sound like PVCs? Medics that I've worked with seem concerned when PVCs come up on the 12-lead, but I also know that emergency medicine and clinical medicine are worlds apart.
Should I be concerned? If treatment isn't necessary (other than to remove the annoyance), then I probably won't seek treatment. Two reasons: I'm stubborn, and I have a HMO. :-) But, if it can wait until my next doctor's appointment, I'll probably just wait.
|cavis - Mon May 07, 2007 1:23 pm|
More info - pulse at rest is typically in the mid 50s to 60, and pulse during exercise approaches 180. Didn't know if that would help at all or not.
|John Kenyon, CNA - Tue May 08, 2007 10:33 pm|
Hello cavis - Yes, what you describe certainly does sound like PVCs. Of course absent an EKG or Holter monitor it's difficult to say if all (or any) of them are PVCs (could also be PACs or PJCs) but your graphic description sounds like classic PVCs, and the occurence also is classic, in that it is rather random-appearing. Of course if you wanted you could quite possibly connect their occurence to a any of a number of innocent things like lost sleep, digestion, dozing off, adrenaline, etc. PVCs are actually fairly normal for most of us, as are PACs. They tend to appear randomly and can show up in little episodes such as you describe, or can be fairly frequent, occurring in some subjects at the same time every day or even all day and into the night. Others have them when getting ready to go to sleep.
As I'm sure you know, the only true cause for concern over PVCs comes with a low LVEF in someone with a damaged or diseased heart. You appear to be remarkably healthy, with the exception of hypertension, which is one more good argument (along with the potential for oral cancer) to break the smokeless tobacco habit. It is working against whatever medication you're taking to reduce the elevated BP which, as you know can, over time, damage the heart and even cause CHF. That clearly hasn't happened yet, but many people rationalize this away with the "Lots of time to quit" self-delusion. The problem with that one is that the injury to the heart (and other parts of the body) can be cumulative.
OK, enough of the lecture. As far as the technical question, I am sure you've described PVCs. I don't feel there's any reason for conern about them, but I do know how bothersome they can be. I'm more concerned about the smokeless tobacco, but you're in the business and I won't beat you over the head about that one.
In the absence of a severely comromised lef ventrical there is almost never a reason to treat PVCs unless they are simply driving the subject crazy (and if they are frequent enough they can). Since yours appear to be fairly infrequent the treatment (a beta blocker) wouldn't make much sense. No need for concern here, at least not about the PVCs. Hope this helps ease your mind. Treat yourself right! You'll be glad you did later on.
|cavis - Wed May 09, 2007 2:02 pm|
Thanks, John. After milling it over for a while (and urged by others), I went to the doctor. They took bloodwork to check electrolytes, and ran an EKG, and that came back clean. After the longest discussion I've ever had with a doctor, he decided to set me up with a stress test, my first. I'll be interested to see how that goes. I went out on a fire last night, and after a brief yet very physical burst, the PVCs were very prevelant, so I'm sure that they will show during the stress test.
And as for the smokeless tobacco, I hear about that quite a bit, especially from my Dental Hygienist wife. Not in denial or anything, it's just a bad habit.
Once again, I appreciate the help and this site. Keep up the good work!
|John Kenyon, CNA - Wed May 09, 2007 2:22 pm|
Hello again - I'm kind of glad you wound up bringing this to a doctor's attention, not so much because of the PVCs per se, but because people of your size and build are more prone to have hypertrophic cardiomyopathy, and that's something that can be ruled out while you at the same time get a good estimate of your overall cardiac health. For a firefighter/EMT it's something that should be required (in my humble opinion).
You mention that after a short burst of physical exertion the PVCs showed up. They often will do that after exertion, and it's normal - but it also got me to thinking about your build and the slightly greater risk of a thickened left ventricle. In people with that problem, post exercise is the most vulnerable period. The presence of PVCs alone doesn't suggest anything, but it is like a little tap on the shoulder. I'm glad you're having this done. Chances are you'll walk away with an extremely clean bill of health and yet another browbeating about weight, tobacco use and stress, but those are all controllable risk factors.
All the best to you. Please stay in touch.
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