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Forum Name: Arrhythmias

Question: PVC's or PAC's while exercising


 panicleah - Mon Apr 27, 2009 7:17 pm

Hi I am 28 yrs old with a history of panic attacks and anxiety. (About 6 years of history). I havent had a panic attack in months and I have gotten a control on my anxiety which is why I refuse to say these PAC's or PVC's are anxiety/panic related.
I take Klonopin PRN and I am starting to convince myself that the occasional "skipped beat" I feel could be a Side effect of the med seeing as I take one pill daily.
I have had a few EKG's, a few holter/event monitors and just two weeks ago I had a stress/echo done. It did show "occasional PAC couplet" which I felt and saw one on the EKG as it happened, other than that the echo came back normal according to my doctor.
my EF was 55-60%
No ischemia
89% HR acheived
It says less than 1mm depression at 80 msec post J point
Comments: Rare fusion complex

I have no idea what those last two comments mean, and neither did my doctor.
It would help for me to know they are or aren't of potential concern.

I do not get palps with anxiety per se anymore, they just come one at a time and go, but what concerns me is having these couplets WHILE exercising. I started a brisk walking routine about 2 months ago and a few times I have felt a skipped
beat. I have not had my cholesterol level checked yet. I have heard that these events at rest are not of concern but while exercising it is serious. Thanks you in advance for your response.
Concerned,
panicleah
 John Kenyon, CNA - Tue May 12, 2009 11:18 pm

User avatar Hi there --

First, please understand that an acknowlegement of panic disorder/anxiety is a huge help, as these can often blur the clinical picture of many physiological problems. However, and this is a very common concern among laypeople, PACs and PVCs are extremely common in the healthy general population and almost everyone has them from time to time. Also, while PVCs (not PACs) used to be considered problematic when occurring during exercise (and they are more common at rest), they can occur during either state and mean nothing. PVCs are more likely during rest, sleep, and after meals. PACs, however, are common, when they do occur, regardless of activity. They are also more likely to occur during exercise randomly. PVCs have absolutely no diagnostic nor prognostic significance, even in the critical care setting. PACs rarely have any significance, although they can, in some people, be precursors of various atrial arrhythmias which are not life-threatening. You've not had that problem, so are just having PACs and occasional PVCs, which means you're in good company -- you're normal. And while both PACs and PVCs can be made more frequent due to anxiety, they also sometimes just happen for no specific reason. I assure you, though, the one thing that's not causing them is Klonopin. Also, that is a very excellent tool for getting a handle on anxiety and especially panic disorder. It will not provoke premature beats.

As for those last two notations on the stress-echo report, bear in mind everything that is under consideration is also commented upon, even if it's within normal limits. This is so you have an accurate set of baseline data for comparison with any future tests. So: "less than 1 mm depression at 80 msec post J point" means exactly that. Well, what it really means is the precise measurement of how there is no ischemia. In other words, a normal finding. It's an observation about your EKG tracing during the stress test, and it's what you want, nothing you don't want. The "rare fusion complex" means, again, exactly that, but of course doesn't explain.
One would expect a doctor to know this one, but I guess specialization takes a certain toll. A fusion beat is merely a meaningless event where a PVC happens to fall exactly on the regular sinus beat. It means nothing, but it is visible, so must be noted, since it is something other than a regular sinus beat. This is what happens routinely in most people but isn't noticed because we're not being monitored all the time.

I'll admit palpitations during exercise feel more funny than those at rest, because the heart's beating harder. Still, they have no meaning and it's best to try and learn to ignore them as best you can. I know that's not always easy, but it's a worthy goal anyway.

In short, you're in great shape, you're making excellent progress with the panic attacks and anxiety, and the future looks bright. Enjoy!

I hope this is helpful and if you have any further questions please don't hesitate to follow up with us here. Good luck to you!
 panicleah - Wed May 13, 2009 1:31 pm

Thank you so much for taking the time to respond John!
I really appreciate your feedback. Breaking those terms down for me and explaining how they report for baseline purposes makes sense.
Yes, the whole exercise palpitation thing had me confused, but you have helped clear that up. Why didn't my doctor take the time to explain this to me? She had to have known I was going to go home with my results and google everything I didn't recognize on it.:-)
Thanks again John,
Leah
 John Kenyon, CNA - Fri May 15, 2009 4:50 pm

User avatar Hi Leah, and you are very welcome. Unfortunately this happens extremely often, that a doctor will provide exam results but not take the time to explain what they mean. I wonder if sometimes they don't just forget these things are hardly self-evident to laypeople. At any rate, I'm very happy to know this was helpful to you. And you know, maybe you've made a very important observation here that needs to be shared and spread among the medical community: people will, if they are left holding some mysterious medical information, go home and google them! It's natural now, it's human nature to want to know, and they could really save the patients (and themselves) a lot of anxiety by taking an extra minute or two, even if its only to tell the patient how to effectively look up what they want to know. The internet is part of our lives now.

Again, you're very welcome.

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