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Forum Name: Arrhythmias

Question: single PVC during exercise


 soletterre - Wed Feb 13, 2008 4:32 am

Hello,

I am a healthy 25 year old female, no medications, no family history of heart disease, and I have been having PVCs for the past 4-7 years. Sometimes I go weeks without having them, and I find right before my period I get more, like one or two a day. I had an episode 14 months ago where I was getting them every 15 minutes, went to the ER, they recorded PVCs, and this lasted for about 2 days, after which they subsided. At that point I cut out all caffeine (I think the big cup of coffee I had that time brought them on), and I think that has been helpful in reducing my PVCs to almost none, except if I am upset, or PMSing. There is one other exception: I often get a single PVC during cardio exercise. This has been going on for the 4-7 years, perhaps every time or every other time I do any type of strenuous activity (cardio machines, hiking uphill, running outside).

After the ER visit I had an echo done (where they record the sounds of the heart and take the video-like image similar to how you view babies in the womb, sorry if I am using the wrong term). Everything came back normal, so I am assuming my heart is structurally sound. I had a fever when they took the exam, I think my pulse might have been around 100 (maybe less), so I don't know if that would have impacted the results in any negative way.

Ever since then I have had no problems, other than an occasional single PVC during the day, and a single PVC when I exercise, perhaps every other time I exercise (I try to exercise about 5 days a week, 45 minutes a day). I find that the exercise PVCs happen when I am hiking and going uphill, and tired, or I am running and tired - basically at times when I might have been going "too hard", even though I try not to let my heart rate go above 165 when I am at a gym machine and can record it. Perhaps 165 is too high for a 45 minute workout? Sometimes they happen when I don't feel tired, but maybe I don't realize how much I am working out. When I get them an I'm outside hiking or running I'm sure my heart is going over 175 because those hills are tough!

Anyway, I am wondering if I should bother to go back and get a stress test done. I have read that exercise-induced arrythmias are a cause for concern, but I am not sure if that is only true because they are a marker for underlying heart disease. I don't think I am going to drop dead, because this has been going on for so long, but I don't want to do any damage. I love working out, and I enjoy the tough workouts, but maybe they are bad for my heart? Perhaps a heart rate of 165 is just too high for a 45 minute workout? My resting pulse is between 45 and 55.

I have terrible anxiety, but since I cut out caffeine my panic attacks are very infrequent (ironically, going through caffeine withdrawl for a week increased the panic attacks during that time!). I feel like every time my heart gets "excited", like when I am upset, I get a PVC. My theory on the exercise-induced single PVC is that something changes in the blood composition during exercise, perhaps a release of adrenaline or a temporary reduction in oxygenation, resulting in a single PVC until the body adjusts. But I am not a doctor :-)

Is there a difference between exercise-induced PVCs and normal PVCs, and are they a cause for concern, if they are so infrequent? And my echo a year ago came back normal? Am I exercising too hard? What could be causing them during exercise? Should someone who gets PVCs keep their heart rate below a certain number during exercise because of their 'defective heart'?

Sorry for the incredibly long post! Thank you in advance!
 Dr. A. Madia - Sun Mar 16, 2008 1:57 am

User avatar Hi,

At 25, your target heart rate on exercise would come to 220-25=195. Which means you are not exerising beyound the limit.

PVCs are premature ventricular contarctions. Most often they are physiological. There would hardly be an individual on this globe who have never had a PVC. Adrenalin is the hormone which is responsible for the trigger. Adrenalin increases force of contractions and reduces the refractory period of the heart mucsle, at the same time stimulates the surrogate pace makers of the conducting system like AV node, His Bundle, Bundle branches and cardiac myosite itself. Stress also increases chances of PVC through adrenalin.

There are formulated criteria to define which PVCs are 'physiological' and which are abnormal, or dangerous. PVCs less than 6 a minute are considered benign and not requiring treatment. PVCs occuring single as against in pairs of twos or threes [salvos] are benign. Salvos are always dangerous and to be treated immediately. PVCs occurring very close to the preceding T wave of the cardiac cycle are dangerous. PVCs, though single but of different morphology, [multifocal] are not benign. PVCs in the setting of a 'Heart Attack' or a Cogestive Cardiac failure are NEVER benign.

Your exercise is well within acceptable range, occasional PVC occuring during exercise in never a concern. You are not wirking out excessively. The only thing you are doing in excess is being Anxious! Anxiety will invite adrenalin remember. So do not pay any attention to the PVCs, concentrate on exercise and your other daily activity.

Take care,


Apurva
 soletterre - Mon Apr 21, 2008 8:31 am

Hi again,

Thank you for the response. I keep getting fewer and fewer PVCs as I learn to be less anxious. I've also found, that the LESS exercise I do, the fewer I get, which is odd but not a very good excuse to quit the gym ;-)

I actually have another question which is not directly related to the PVCs, but since I have my history here, it would be better I just ask with that data available. My dad has high blood pressure and recently bought a BP+HR monitor. We were trying it out at home yesterday night, and it said my BP was 90/50 with a pulse of 40! I have had my pulse in the 50s for a couple of years, but this surprised me. It seems too low to be justified by the exercise I do weekly (cardio 4-5 times a week for 50 minutes). I don't really have any symptoms of dizziness or fainting, only when I stand up suddenly, but that has been going on all my life. My only symptom seems to be anxiety ;-) Just curious if you had any comments about such a slow pulse. When I exercise it routinely gets up to 165. I was planning to take some sleeping medication for an overseas flight in 2 weeks (OTC Unisom), but with a pulse so low, is that a good idea?

Thanks again!
 Dr. A. Madia - Fri Apr 25, 2008 12:56 am

User avatar Hi,

A pulse of 40 is definitely not okay. Try to cross check by physically checking the pulse and compare it to the machine reading. Get in touch with your internist.

Taking sleeping pill is okay.

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