Intermittent multiple PVCs

I had a PM implanted one year ago and was doing exceptionally well until about one month ago.

At this time I reported fatigue and shortness of breath to my EP/Cardiologist. After an EKG, Echo-Cardiogram and Nuclear Stress Test he diagnosed my problem as having multiple PVCs with associated cardiomyopathy.

He then scheduled me for an EP Study, during which he hoped to ablate the arrythmia.

Surprisingly, the EP Study revealed no multiple PVCs. As a result no treatment was administered.

My EP/Cardiologist is going to closely monitor me.

I am naturally concerned. Has anyone experienced this?
Your feedback would be appreciated.

5 Comments

Painful heart beats

by ElectricFrank - 2010-09-19 01:09:58

Keep after it Smitty.
A couple of thoughts about those heavy or painful heart beats:
1. Too high pacing voltage. The pacing pulse initiates a contraction of the heart muscle in the area of the electrode. The higher the voltage the larger the area stimulated and the faster the contraction will spread. It would seem that this would produce a more sudden overall contraction, which we certainly feel.

2. Atrial-ventricular timing. If the ventricle contraction starts while the atrium is in part of it's contraction the higher ventricular pressure would either slam the valve between chambers shut or regurgitate blood back into the atrium. Either would leave the atrium contracting with no outlet other than maybe back into the incoming vein. The timing problem could be from too short an AV interval, or fibs the atrial and ventricles contracting out of sync with each other.

Doesn't help much in knowing what to do, but gives some idea of what might cause the pain.

By the way these ideas don't come as much from my a great knowledge of the heart as it does from my engineering background working with 2 stage pumps.

best,

frank

PVC's

by ElectricFrank - 2010-09-19 02:09:02

PVC's seem to come and go with no identifiable cause. For the most part they are benign other than rattling us up. Most of the symptoms are the result of fear of feeling our heart thumping and bumping. I have averaged anywhere from 300 to 2500 PVC's per day for a number of years, and hardly notice them anymore.

You lucked out on the EP study. Rarely does ablation stop PVC's and has the potential to cause new more troubling symptoms. The same is true of many of the cardiac meds. Both of these have very useful purposes for patients with serious heart problems. They are also over used by cardiologists to satisfy a complaining patient, and it is easy to get started down the road of one treatment after another.

By the way the best treatment for shortness of breath is to relax and breath gently and deeply. (I call it Longness of Breath). You may find that breathing isn't as difficult as it might have seemed.

best,

frank

Irregular Heart Beat

by SMITTY - 2010-09-19 11:09:57

Hello PETEACHER,

You asked for feed back and while mine may not be what you hoped for, I'll tell you my experience with what, or something very similar, to what you are having. My problems have been ongoing for 3+ years. Started in Feb. '07. Not every day, thank God, but way too often to be comfortable. You name the test and I probably have had it. In fact a couple of years ago I had an echo and because of the "whatever" the results were useless, according to the Dr. He then ordered a MUGA.

If you are not familiar with the MUGA, this is similar to a chemical stress test where they inject a radioactive substance and take pictures of the blood as it flows through the heart. The big differences are different type of cameras are used and there is no exercise or blood vessel dilating medicines used in the MUGA. For the MUGA to be successful there has be a steady heart beat for 25 to 30 seconds. I failed this one too. By now about all my doctor was doing was offering sympathy and telling me to be sure and go to church regularly.

What I did then is a long story and I'll try to keep short here. The low setting on my PM was 70. When the extended runs of irregular beats started my heart rate would drop as low as 41 BPM. That was breathing taking and painful. Since my activity was now pretty much confined to sitting in a chair I started keeping notes and I discovered the pain didn't start until my heart rate dropped below 50 BPM. My logic told me that if I had the low setting on my PM increased to 80 and the rate response restarted, the increase in the low set point should keep my heart rate at least above 50 and it would no longer hurt. I got the changes made and the results were beyond my wildest dreams. I again felt like a human.

This was in July '09 and the good times continued until the battery on that 9 yr. old PM died in Oct. '09. I got a replacement and while things are still much better than before July '09, they are not as good as they were between July and Oct '09.

Now I'm back to having very painful heart beats, but they are very steady and are at an 80 BPM rate. So far I've had an ultrasound (I don't know what it was for) and 3 echoes. This week I go for more testing.

My opinion is my PM is a big contributor to my current problems. But there is no way I'll ever know if I'm right or wrong. But I will say to you and EVERYONE THAT HAS AN ON DEMAND PACEMAKER, don't just automatically accept your doctors word for everything they say about the pacemaker. Make them give you some details and long term effects from what they want to change. Also, don't hesitate to request a second opinion.

I don't dispute pacemakers are wonderful things. I know there are many people alive today that would not be here if it were not for a PM. But I also believe the jury is still out on the long term effects on our natural heart function by an on demand pacemaker.

Good luck,

Smitty

Good luck

by ElectricFrank - 2010-09-20 02:09:33

Good luck with the new EP. Maybe you will hit the jackpot.

My grandfather was a licensed steam engineer and I spent a good many hours reading his books as a kid. I remember the two stage piston pumps that returned water to a boiler. Funny how close the hearts two stages are to them.

frank

Something Out Of Sync

by SMITTY - 2010-09-20 12:09:59


Thanks Frank.

I've have had thoughts about it being ab out of sync problem as you describe in your number two.

Funny that you would mention your work with pumps as being the source for your reasoning for what may be going on. I too worked around many types of pumps in the water treating business and I guess it is my knowledge of them that gives me the idea I understand the mechanics of the heart pumping blood.

I have an appointment on Thursday with a new EP that is touted as being the "cats uncle" when it comes to fixing rhythm problems. I'll pass on the results of the visit.

Smitty

You know you're wired when...

Bad hair days can be blamed on your device shorting out.

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