I hate to keep asking questions...I am sorry but I have a new thing that is happening for the last week or so. If anyone has read my older posts they know that I have been having rate issues. Well now I have this crazy thing kind of like a pvc except that I will have three or four fast beats then a pause then a hard beat(not two in a row like a pvc) then three or four slow beats. This goes on for hours at a time. Does anyone have a clue what this is and why my pacemaker wouldn't step in during the pause?? I am beyond frustrated at this point and don't go back to the doctor for three more weeks!

 

 

I don't know but if you find out let me know! I have the same thing and no one seems to tell me what it is!

Good luck-
W

 

Mine beats normally, then pauses and then a hard beat, then repeats after a few more beats, then sometimes continues on for awhile and the does it again.
I am taking extra magnesium in the form of magnesium citrate (because it dissolves with higher % of Mg) along with some (it varies) added potassium.
This, I believe, helps reduce these "episodes" but I cannot swear to it. Reason to do this? Both elements (I'm a retired chemistry teacher) help the electrical system of the heart by improving conduction, or at least this is what I read in the literature I've read.
This is only my opinion and you will have to evaluate whether this is an option for you or not. I am only offering my own ideas based on what I have done to "fix" this problem. It is annoying to say the least.
Your doctor can make adjustments. Mine will be doing the same the next time I see him (March)
Hope this helps....and get some exercise. While exercising there are no "pre-beats" thankfully.

 

I get the same pattern as FirstDuely (sorry, don't know your actual name!) with the pause then hard beat every 4-5 beats, but it appears to happen only when the PM is working (based on my heartrate always being exactly 80 when I experience this.) The device rep explained to me that it is due to some irritability of the heart during pacing, and is harmless, but I'll be asking my EP more about it at the next visit, also. It is pretty uncomfortable at times.

 

This is some information I pulled off the web some time ago when I was exploring these questions for my own issues. The last paragraph is a good explanation

Causes of Heart Arrythmias
Your heart is divided into four hollow chambers. Divided top to bottom, the chambers on either half of your heart form two adjoining pumps with an upper chamber (atrium) and a lower chamber (ventricle). During a single heartbeat, the pumps operate in a two-phase cycle. First, the smaller, less muscular atria contract and fill the relaxed ventricles with blood. A split second later, the powerful ventricles contract and discharge blood as the atria relax and fill. Efficient blood circulation requires rhythmic coordination of this priming and pumping system. In addition, it requires proper heart rate control, which, in a normal heart, is 60 to 100 beats a minute when the body is at rest. Orchestration of these two factors is performed by the heart's electrical system. Ideally, this system operates in the following three-step sequence:
• Initiation. Each heartbeat normally originates within a specialized group of cells called the sinus node. Located in the upper-right atrium, the sinus node is your heart's natural pacemaker. It has the ability to spontaneously produce the electrical impulses that initiate heartbeats. Other cells within the heart have a similar ability, but they're normally inactive when the sinus node is doing its job of setting your heart's pace. Doctors refer to normal heart rhythm as normal sinus rhythm.
• Propagation. From the sinus node, electrical impulses travel through the heart. As an impulse travels, the heart muscle contracts. In a normal heartbeat, the impulse first spreads across the right, then left atrium. After activating the atria from top to bottom, the impulse proceeds to the atrioventricular (AV) node, located at the center of the heart. The AV node normally is the only electrical path between the atria and ventricles. Within it, the impulse slows for a split second to allow the atria to fill the ventricles with blood. Exiting the AV node, the impulse is conducted along two electrical pathways (right and left bundles), which spread impulses throughout the right and left ventricles.
• Relaxation and recharging. Each cell in the heart that helps to conduct the heart's electrical impulses has two electrical states — a poised (polarized) state and a relaxed (refractory) state. In a polarized state, heart cells are ready and able to conduct the electrical impulse that will cause a heartbeat. After a heartbeat, the cells are momentarily in a refractory state before recharging to a polarized state for the next heartbeat. While it's in the refractory state, a heart cell is unable to conduct an impulse.
In a healthy person with a normal, healthy heart, it's unlikely for a sustained arrhythmia to develop without some outside trigger such as an electrical shock or the use of illicit drugs. That's primarily because his or her heart is free from any abnormal elements such as a spot of scarred tissue. Scarring can result from numerous forms of disease — most commonly, from a previous heart attack — and may disrupt the initiation or conduction of electrical impulses. In addition, the inability of heart cells to conduct electrical impulses during the refractory period acts as a buffer, preventing the occasional offbeat electrical impulse from developing into an arrhythmia.
However, in a heart with some form of disease or deformity, the initiation or conduction of the heart's electrical impulses may be destabilized, which makes arrhythmias more likely to develop.
Conditions that my lead to arrhythmias
Any pre-existing structural heart condition can lead to arrhythmia development due to:
• Inadequate blood supply. If blood supply to the heart is somehow reduced, it can alter the ability of heart tissue — including the cells that conduct electrical impulses — to function properly.
• Damage or death of heart tissue. When heart tissue becomes damaged or dies, it can affect the way electrical impulses spread in the heart.
These pre-existing heart conditions may include:
• Coronary artery disease. Although it has been linked to many arrhythmias, CAD is most closely associated with ventricular arrhythmias and sudden cardiac death. Narrowing of the arteries that occurs with CAD can progress until a portion of your heart dies from lack of blood flow (heart attack). An old heart attack leaves behind a scar. Electrical short circuits around the scar can prevent normal heart function by causing the heart to beat dangerously fast (ventricular tachycardia) or to quiver (ventricular fibrillation).
• Cardiomyopathy. This occurs primarily when your ventricle walls stretch and enlarge (dilated cardiomyopathy) or when your left ventricle wall thickens and constricts (hypertrophic cardiomyopathy). In either case, cardiomyopathy decreases your heart's blood-pumping efficiency and often leads to heart tissue damage.
• Valvular heart diseases. Leaking or narrowing of your heart valves can lead to stretching and thickening of your muscle (myocardium). When the chambers become enlarged or weakened due to the added stress caused by the tight or leaking valve, there's an increased risk of developing arrhythmia.
Types of arrhythmias
Heart arrhythmias may occur when any phase in the heart's electrical system malfunctions. Doctors classify arrhythmias by where they originate (atria or ventricles) and by the speed of heart rate they cause. Tachycardia (tak-ih-KAHR-de-uh) refers to a fast heartbeat — a heart rate greater than 100 beats a minute. Bradycardia (brad-e-KAHR-de-uh) refers to a slow heartbeat — a resting heart rate less than 60 beats a minute. Not all tachycardias or bradycardias indicate disease. For example, during exercise, it's normal to develop sinus tachycardia as the heart speeds up to provide your tissues with more oxygen-rich blood. Athletes at rest often have a heartbeat less than 60 beats a minute because their hearts are so efficient.
Tachycardias originating in the atria include:
• Atrial fibrillation. This fast and chaotic beating of the atrial chambers is the most common arrhythmia. It affects about 2 million, mainly older Americans. Your risk of developing atrial fibrillation increases past age 65 mainly due to the wear and tear that may affect your heart's function as you age. During atrial fibrillation, the electrical activity of the atria becomes uncoordinated. The atria beat so rapidly — as fast as 300 to 400 beats a minute — that they quiver (fibrillate). The electrical waves have the same chaotic activity that you would see if you threw a handful of pebbles into a quiet pond. Fortunately, not all of these atrial impulses reach the ventricles. The AV node between the atria and ventricles acts as a gatekeeper, usually letting only a portion of the impulses through. Still, extra impulses often get through the AV node. This may accelerate your pulse (ventricular contractions) during atrial fibrillation to 150 beats a minute or more. In addition, the atrial impulses that reach the ventricles often arrive at irregular intervals. This may cause an irregular heart rhythm. Atrial fibrillation can be intermittent (paroxysmal), lasting a few minutes to an hour or more before returning to a regular heart rhythm. It can also be chronic, causing an ongoing problem. Atrial fibrillation is seldom a life-threatening arrhythmia, but over time it can be the cause of more serious conditions such as stroke.
• Atrial flutter. Although atrial flutter is less common than atrial fibrillation, the arrhythmias are in some ways similar. In fact, both can coexist in your heart, coming and going in an alternating fashion. The key distinction is that more-organized and more-rhythmic electrical impulses cause atrial flutter. These occur because atrial flutter, unlike atrial fibrillation, arises from a short circuit. In typical atrial flutter, this short circuit exists in the right atrium. This is an important distinction because typical right atrial flutter is more amenable to some forms of treatment, such as catheter ablation.
• Supraventricular tachycardia (SVT). SVT is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular). SVTs usually cause a burst of rapid heartbeats that begin and end suddenly and can last from seconds to days. These often start when the electrical impulse from a premature heartbeat begins to circle repeatedly through an extra pathway. SVT may cause your heart to beat 140 to 200 times a minute. Although generally not life-threatening in an otherwise normal heart, symptoms from the racing heart may feel quite strong.
• Wolff-Parkinson-White syndrome (WPW). One type of SVT is known as Wolff-Parkinson-White syndrome (WPW). This arrhythmia may, rarely, run in families and is caused by an extra electrical pathway between the atria and the ventricles. This pathway may allow electrical current to pass between the atria and the ventricles without passing through the AV node, leading to short circuits and rapid heartbeats.
• Ventricular tachycardia (VT). This fast, regular beating of the heart is caused by abnormal electrical impulses originating in the ventricles. Most often, these are due to a short circuit around a scar from an old heart attack and can cause the ventricles to contract more than 200 beats a minute. Most VT occurs in people with some form of heart-related problem such as scars or damage within the ventricle muscle from coronary artery disease or a heart attack. Sometimes, VTs last for 30 seconds or less (unsustained) and are usually harmless, although they cause inefficient heartbeats. Still, an unsustained VT may be a predictor for more serious ventricular arrhythmias such as longer-lasting (sustained) VT. An episode of sustained VT is a medical emergency. It may be associated with palpitations, dizziness, fainting, or possibly death. Without prompt medical treatment, sustained VT often degenerates into ventricular fibrillation. Rarely, VT occurs in an otherwise normal heart. In this setting, it's far less dangerous but the condition still needs the attention of a doctor.
• Ventricular fibrillation. About 90 percent of sudden cardiac deaths, which claim the lives of about 300,000 Americans each year, are caused by this arrhythmia. With ventricular fibrillation, rapid, chaotic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, instantly cutting off blood supply to your vital organs — including your brain. Most people lose consciousness within seconds and require immediate medical assistance such as cardiopulmonary resuscitation (CPR). Your chances of survival may be prolonged if CPR is delivered until your heart can be shocked back into a normal rhythm with a device called a defibrillator. Without CPR or defibrillation, death results in minutes. As with VT, most cases of ventricular fibrillation are linked to some form of heart disease. Ventricular fibrillation is frequently triggered by a heart attack. However, ventricular fibrillation may also be your first indication of heart problems.
• Bradycardias.Although a heart rate below 60 beats a minute while at rest is considered a bradycardia, a low resting heart rate doesn't always signal a problem. If you're physically fit, you may have an efficient heart capable of pumping an adequate supply of blood with fewer than 60 beats a minute at rest. However, if you have a slow heartbeat that isn't pumping enough blood, you may have one of several bradycardias including:
o Sick sinus. If your pacemaking sinus node isn't sending impulses properly, your heart rate may be too slow, or it may speed up and slow down intermittently. If your sinus node is functioning properly, sick sinus can be caused by an impulse block near the sinus node that's slowing, disrupting or completely blocking conduction.
o Conduction block. A block of your heart's electrical pathways can occur in or near the AV node or along the bundle branches that conduct impulses to each ventricle. Depending on the location and type of block, the impulses between your atria and ventricles may be slowed or partially or completely blocked. If the signal is completely blocked, certain cells in the AV node or ventricles are capable of initiating a steady, although usually slower, heartbeat. Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia. Even without signs or symptoms, a conduction block is usually detectable on an electrocardiogram (ECG). Since some blocks are caused by heart disease, an ECG showing a block may be an early sign of heart problems.
Premature atrial contractions and premature ventricular contractions
Although it often feels like a skipped heartbeat, a premature heartbeat is actually an extra beat between two normal heartbeats. Premature heartbeats occurring in the ventricles come before the ventricles have had time to fill with blood following a regular heartbeat.
Thus, the beat feels weak if it's felt at all. This premature beat is usually followed by a pause, during which time the ventricles fill with more than the usual amount of blood. The ejection of more blood from the ventricle causes the next regular heartbeat to feel stronger than normal.
Although you may feel an occasional premature beat, they seldom indicate a more serious problem. Still, a premature beat can trigger a longer-lasting arrhythmia — especially in people with heart disease.

 

Hi,
My post is going to be very short. I get the exact same thing as you and my doctor has finally caught it on both the monitor and on an EKG. I have been told that it is bigeminy. Basically it means that your heart is throwing in an extra beat. I don't know why, but if it is going on for hours, you need to get this checked out sooner rather than later because the other thing it could be is a-fib and that can be dangerous. I have both bigeminy and what they call slow a-fib. I have just been diagnosed with the a-fib. I actually am on an event recorder now to try to figure out why and where this is coming from. You need to speak with your doctor ASAP and see if they can do a Holter or something to try to catch the rhythm so that they know what you are dealing with. If you get this again over the weekend, get into an ER and get an EKG ASAP. This could end up being harmless, but until you and they know for sure it's better to be safe than sorry. Read the last part of the comment from Cabg Patch. There is a lot of truth to what they say about a premature beat triggering a longer lasting arrhythmia. This is more common in people with pre existing heart conditions and it happened to me. I ignored the symptoms for a while until it got so bad that I started fainting. Get it checked OK?

 

This is a very common type of PVC. On the interrogation report from a pacer checkup they are in a section called PVC Runs. There are labels for the various types. I picked this up off Wikipedia:

"There are four different patterns of premature ventricular contractions. Bigeminy is where one PVC occurs after every normal beat, in an alternating pattern. Trigeminy is where one PVC occurs after every two normal beats. Quadrigeminy is where one PVC occurs after every 3 normal beats of the heart."

Of course there is the dreaded Deadgiminy LOL.

Actually, while they can be uncomfortable, PVC's aren't necessarily an indication of some deeper underlying condition. They are common even in young athletes.

My concern is that some are starting to recommend aggressive treatment of them with Beta Blockers or even worse, ablation. I'm trying to locate the recent study I ran across that found treatment to increase the risk of sudden cardiac arrest.

Emotional upset can cause an increase in their frequency so getting upset about them creates a self fulfilling diagnosis.

best,

frank

 

First of all I want to say how grateful that I am to have all of you!! It means so much to know that I have somewhere to go to get answers!! I don't know what I would do without the support.
I am so glad that I am not the only one feeling this!! At least that means I am not just imagining this and that I have not gone totally crazy yet! lol
This could be some form of a pvc like bigeminy or trigeminy however at one point I was having around 10,000 pvc's a day(before the ablation and pacemaker) and some of them in bigeminy and trigeminy pattern. This feels very different and unlike anything I have ever felt. That's why I am at such a loss and why it is so unsettling. You are right Frank that if I get upset I am sure it just makes it worse. I am trying to just relax when this starts but that is difficult. I have tried the magnesium but not with potassium so maybe that will help. I took three atenolol today which I know is more than I should be taking.
Again thank you all for the wonderful support and for making me feel not so alone in this!!

 

A heart beat of this type is called arrhythmia. An arrhythmia is a change in the rhythm of your heartbeat. When the heart beats too fast, it's called tachycardia. When it beats too slow, it's called bradycardia. An arrhythmia can also mean that your heart beats irregularly (skips a beat or has an extra beat). At some time or another, most people have felt their heart race or skip a beat. They usually are not a cause for alarm. Arrhythmias that occur more often or cause symptoms may be more serious and need to be discussed with your doctor.

 

Hey,
After all of that, I agree that you need to find a way to relax, but I do understand what you are feeling. I get the same and my doctor has said that sometimes it's bigeminy trigeminy and relaxing can help, but not always. a-fib can be another problem this is why I am now going to say to you that eventhough everyone's advise is great, seeing your own doctor is even better so that you know what is really going on and if it is a problem they can treat it.
I'm going to say again, as a nurse if this is something different and unlike anything else you have experienced, like you said, you need to see your M.D. Playing with your meds is not the best idea. It can in some cases make things worse. Atenolol is not a drug that you should be taking more than prescribed.
As a nurse and I have using this card, you need to see an M.D soon. Try relaxing if you can, but if this is different from your usual and unlike anything you have experienced you need to go to the ER especially if it is going on for hours. One question which is what helped me figure this out, does the rhythm change with movement, better or worse?

 

You asked if it gets better when I move around. The answer is that most of the time no it does not help. I usually notice it when I am doing something and start to feel funny, so I sit down for a minute. Then when that does not work I try getting up and walking around. Most of the time nothing stops it until it wants to stop. I have noticed that walking alot or any form of mild exercise seems to bring it on.
When I was not able to get in with my EP early I called and made an appt with my gp but it is not until next Friday. I may see if my regular cardio doc can see me sooner or may end up in the ER like you said. So far today I had not had it again. Thank you!

 

Your sense of something being different is very important especially after an ablation. The ablation destroys heart tissue with the idea of eliminating the offending area that is causing the problem. Even if done well by a skilled EP there is no way of being 100% sure that it won't alter the intricate conduction paths in a way that will cause a new problem.

I had an experience a couple of years ago where I was skipping beats, but it didn't feel the same as pvc's. I hooked my self up on my ECG and found that the pacer was losing capture for as many as 4 beats at a time. I could see the pacer sending ventricle spikes, but my heart wasn't responding. My sense of it was right..it was different and seriously so. I didn't even try to drive to ER and called 911 for a ride. Fortunately it only required turning up the pacing voltage a bit to correct the problem.

By the way I have experienced the 10,000/day routine and they sure keep your attention.

best of luck with it,

frank

 

OK, I know you just left a comment on my post and you are not going to like what I say, but if it gets worse with exercise or doesn't make it go away or resting doesn't either you need to have this looked at right away. It's good that you haven't had it today, but it does need to be checked out. Try keeping a diary for the next few days and write down time of when it starts and time of when it stops and what you feel. I know the ER is the "fastest" way to get this checked out, but if you can wait and call the doctor on Monday and see if they can see you sooner you should try that. Did you have an ablation recently?
Your doctor knows you best and if you do need to be in the hospital they will tell you. I'm trying to help you avoid the ER, but if it gets worse and typically I tell patients if it lasts more than and hour you need to go to the ER, but even I can't take my own advise so how can I expect someone else to. If you need to talk more send me a personal message and we can stay in touch.
Taryn

 

maybe that's a compensantory pause due to ventricular extrasystole. a type of arrythmia. why don't u ask ur doctor?