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Date of last update: 10/20/2017.

Forum Name: Arrhythmias

Question: PVCs during physical exertion

 paravantis - Tue Jan 13, 2009 1:40 am

Male, 49 yo, mild MVP (no regurgitation). 10 years ago, after stressful period (marriage, 1st child), began suffering from PVC's, mostly resting, worse when heart rate went up. My exercise tolerance has always been very low. ECGs, Holter (256 PVC's per 24 hours), echos & treadmill (few PAC's), all normal. Quit caffeine, Colas, tea etc & had been almost totally PVC free since!

Over the last 3 months (another stressful situation at home), I noticed that when I walked vigorously I got few extra beats (felt like PVC's). Slowing my pace and heart rate down, made extra beats disappear. Following a week of Clarithromycin a month & a half ago, I got significantly more PAC's that lasted a couple of weeks after the antibiotic was stopped. Some of my PVC's came back, but mostly it was PAC's (no Holter, just my feeling). 10 days ago, I started exercising on recumbent bike for 45 minutes daily. When I get my heart rate in aerobic zone (120-137), I get a few extra beats (that feel like PVC's). When I walk vigorously, even downhill, only a couple of mins into the walk, I get quite a few PVC's that scare me and I reduce tempo to get heart rate down. These forceful PVCs that occur with physical exertion are definitely a NEW SYMPTOM for me.

Cardiologist performed ECG & Doppler heart echo (w/ sounding of carotid & stomach arteries) that were normal. Heart dimensions were exactly same to those of echo 10 years ago (performed by same physician), of importance because I am mildly hypertensive (145/95 morning, 135/85 afternoon, 125/80 when relaxed). Cardio doc did NOT suggest that I do treadmill test due to relatively low cholesterol (189) and absence of heart disease in paternal & maternal parents and said that a hypertensive patient is more likely to receive a false positive result & "unnecessary extra testing".

Does it sound like the ectopic beats I get when my heart rate goes up may be attributed to CAD? May they be caused by mild MVP? In light of testing carried out, might a more serious condition such as ARVD may be in the making? Is anxiety causing them ("Oh my God, I am going to get them again") when I start walking vigorously? Should I have a treadmill test?

Thank you very kindly for this forum and your time.
 John Kenyon, CNA - Thu Jan 15, 2009 11:08 pm

User avatar Hello -

Here's the deal with ectopic heartbeats (and especially in the setting of MVP): while the conventional wisdom (and most common scenario) is that PVCs occur at rest and disappear with exercise, there is no hard and fast rule about that. With MVP there are more PVCs and PACs than there would likely be otherwise in many patients. It is extremely difficult to tell, subjectively, when we are feeling PVCs, PACs or a combo. Sometimes, if one is way too somatically oriented, it can be done, but even then half the time one would be wrong.

Further: those 256 PVCs on your Holter monitor recording are really unremarkable. Truly.

PVCs, in the absence of structural or organic heart disease (with marked left ventricular dysfunction) are of no significance whatsoever. Neither are PACs unless you start getting runs of them lasting for minutes to hours, in which case you have a whole different (and still not terrible, but much more disturbing) problem. That doesn't appear to be the case.

Many people, especially when stressed, will develop premature beats (PVCs and/or PACs) or even accellerated idioventricular rhythm (which tends to be regular but feels like something's not right) during exercise, which seems wrong and can quite often interrupt exercise due to the unpleasantness of the sensation. It still doesn't mean anything, however.

So far, so good. It seems unlikely your PVCs and PACs are due to CAD, since they will occur in the average subject whether or not there is any CAD present, and even if there is, again, they are of no prognostic significance. So you can't really use those as any kind of indicator of anything except, perhaps, the level of stress in your life at any given moment.

The only thing I would fault is the choice of your doctor to not perform a stress test (and, in fact, a nuclear scan with stress test would be the ideal). You're at the right age to warrant this, and with the nuclear scan any elevated BP artifact would be irrelevant. The test would ease your mind considerably, most likely, even if it did uncover some unlikely CAD (which would be what we call "occult", since it is quite hidden, having no symptoms -- the ectopic beats do not count as a possible symptom). I personally feel you -- and your cardiologist -- would benefit from a nuclear scan/stress test, because it would ease the pressure on both of you. If your cardiologist refuses to yield on this one you might want to consider a second opinion or change of specialist, as there are many out there who would be more than happy to spend the time to lay this to rest once and for all.

All that said, the ectopy, when it is perceptible, can be pretty disturbing, but it is harmless -- and meaningless. I hope this is helpful to you and please do follow up with us as needed, especially if you have any further questions or would like to add any information. Good luck to you.
 paravantis - Fri Jan 16, 2009 5:05 am

Dr Kenyon,

Thank you very much for an outstandingly helpful reply.

Since I posted my original message, I have had a 24 hour Holter. The test found around 120 PACs, 4 of them in bigeminy, and 14 isolated polymorphic PVCs. My heart rate ranged from 48 to 151. No ischemic changes were observed. The doctor considered the results to be very good.

I am a bit less concerned in light of these results BUT I am seeing another cardiologist next week and I will request that he consider sending me for a nuclear stress test.

Again, I am much obliged to you for your extensive response.
 John Kenyon, CNA - Fri Jan 16, 2009 11:46 pm

User avatar Hi John (excellent name, that):

This is excellent news. Everything sounds perfectly normal, but the additonal consult certainly won't hurt anything, and may well help clear all the air for you. Please let us know how that goes. Otherwise, carry on!
 monster1987 - Fri Apr 17, 2009 1:23 pm

im very sorry to jump in like this, i got a bit confused as to how i can start my own post, i noticed that the topic of conversation was regarding heart beat irregularities during exertion. i actually have heriditary polycistic kidney disease, i have a nephrologist who has been monitoring me, i don't take any medication and the usual check ups and echos of the kidneys are fine, as in under control. the thing is when i excercise at times i can feel my heart beat skip, i don't really notice the shortness of breath either, but it worries me at times, should i reduce the excercise i do, i just to light weights 2.5 kg for each arm and a use the same weights for some chest excercises as well, i have been doing exams though and during the past three weeks i seemed to have gotten alot of acne as well, a friend of mine whos studying medicine said it could be due to stress? so if this is true could this stress also show itself during my work outs ?? i finished my exams today after a few sleepless nights more or less, is it advisable for me to stop excercising for a couple of days try again and see what happens or?? im a bit lost on this issue and frankly its quite worrying?

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