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Forum Name: Arrhythmias

Question: PVC intermittently


 Nadia1 - Fri Oct 23, 2009 11:52 pm

I am a 33 year old female. Started smoking when I was 21 and drank quite a bit of alcohol during my 20's. First time quit smoking when I was 30 but then started again and have intermittently quite since but have not smoked at all for the last 2 months. I excercise regularly and have weeks when I don't drink any alcohol and then occasions when I drink every weekend for a few weeks. HAve had quit a bit of stress in my life as have immigrated to another country and all sorts of other stressors.
About a year ago I first started feeling my heart 'skip' a beat or give an extra beat but from what I have read from others it sounds like PVC's. They happened especially just after having a cigarrette. Also since then have been almost constantly been aware of my heart beating especially when lying down. I was also drinking quite a bit at that stage. Was still trying to excercise by going running. In January I then finally managed to quit smoking cold turkey. I went running everyday and my heart seemed fine. Was not aware of it and did not feel any extra beats. In March I went travelling for a few weeks and unfortunately started smoking again. I started being really aware of my heart beat again . Was also drinking quite a bit of alcohol during this time. In May I then managed to quit again cold turkey and excercised regularly. I then started feeling these extra beats again . Most noticably in the evening when lying down. Also intermittently more aware of my heart beating. Between May and august had the occasional social cigarrette with friends but have not smoked at all for the last 2 months.
Have just recently moved to a new country and last week I felt really relaxed and happy and started excercising everyday and toward end of week did not feel any extra beats or my heart beating out of chest and felt really good. Then just suddenly 2 dys ago started feeling a bit tight chested with extra beats again. Have not drunk any alcohol in past week . Have had an ECG done at rest but that was normal . Have been declard fit to scuba dive. Am really worried about these heart beats. Could I have damaged my heart with all my smoking and drinking? Why have the extra beats returned even though I am at my most relaxed I have been in a long time and have not had any alcohol or cigarettes?
 John Kenyon, CNA - Sun Oct 25, 2009 9:15 pm

User avatar Hi there -- There are several different issues which need to be addressed here, but first of all come the PVCs (which is very likely what you are feeling, but could be mixed with premature atrial beats -- PACs -- as is so very common). The fact is most of us have some premature beats -- PVCs and PACs -- off and on anyway. It is normal, common, and not diagnostic, in itself, of anything, although certain situations, drugs, substances, etc., can increase the frequency compared with the baseline number, which varies with most everyone. Also, smoking will make them more frequent (nicotine irritates the heart muscle and also constricts the blood vessels); alcohol makes them more freqeuent because of the opposite effect, since it causes the blood vessels to dilate somewhat. Both, by altering the state of the vessels, can make one more aware of one's heartbeat even when it is quite regular. Still, they are, of themselves, inconsequential, even though they may also appear more frequently in a diseased or injured heart. Since they occur normally (randomly) anyway, they don't give much of a clue to what may be going on under the surface

That being said, you do have a very significant family history for heart disease, and so need to take this into consideration for the future. While as a young female you currenly enjoy some protection from naturally produced estrogen, you would likely be at some greater risk anyway, and once past menopause would be at significantly higher risk just based on the family history (although this may have been due almost entire to smoking). You also have been a smoker, which until you are no longer smoking, remains a risk factor (one that goes begins to diminish once you stop and within a year of no smoking, at your age, is no longer a risk factor). Another risk factor you carry is having used cocaine. Why this is so is not entirely clear, but we do know cocaine, while actively being used, can cause some pretty dangerous arrhythmias and, for some reason, does cause narrowing of the arteries in some people. Given all these factors, even though you are young and female, I would suggest a one-time cardiac workup to establish a baseline for your heart health, so it can be used for comparison purposes in the future. You are likely to come up totally clean with this, but even if you didn't it would be better to know what's going on in there now in order to get the jump on it. It is extremely likely nothing will show up at this point, and that should be good motivation to keep it that way.

All this is in spite of the premature beats which, as I've already pointed out, are not, of themselves, dangerous nor predictive of anything. It got your attention, and this caused you to bring your history to our attention, which is all to the good. Having a bad family history plus a history of smoking does increase your ultimate risk for heart disease, but the good news is it is early enough to prevent or at least manage any future problem and reduce the risk tremendously. I hope you'll consider doing this, and also seriously consider the huge risks posed by both tobacco and cocaine use. You have a rare oppotunity to avoid big trouble. I'd take advantage of that if it were me.

Good luck to you and please follow up with us here as needed.

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