PVC Question

I have  a Medtronic Claria MRI Quad CRTD (9/7/23) and AV Node ablation.  Like so many others here, I am having PVC issues.  Had them right after device implant and ablation.  Calmed down, had rate reset from 80 to 70 about a month ago.  Had 2 weeks of really annoying PVCs and brief NSVTs.  On advice from knowledgable people here I spoke with my cardio and raising the base back to 80 for now seemed like a good move.  First week or so of that was good.  PVCs decreased quite a bit.  Now they seem to be rearing their ugly little heads again.  After reading much here, my tale of woe is not unusual.  My question is: Why might it mean that I get them the most during times when I'm sitting around or resting and don't experience them nearly as much when up and active (house work, taking care of 3 yo grandson etc).  From what I've read here, there are folks who get them at just the opposite times.  I'm just lately getting back into intentional exercise.  Might this help decrease PVCs?

Eating always seems to play a part, or an empty stomach as well.  Trying to figure out what I can eat without getting the stomach irritating the nerve.

 

Thank you!


6 Comments

Gastric-Cardiac connection is worth looking into

by Gemita - 2023-11-19 02:50:48

Karlynn, firstly welcome back.  I know you have a lot going on after having had an AV Node ablation and a CRT-D device implant just over 2 months ago.  You also have a number of arrhythmias to cope with (NSVT and PVCs).  Who wouldn’t be symptomatic?   Your symptoms should hopefully improve as your medication and CRT slowly help with your heart function and bring your ejection fraction back up.  But this process cannot be rushed and will take time.

You wanted to know why you get PVCs when you are at rest, rather than when you are active?  This is a good question. Some of us are clearly more prone to getting PVCs during rest (vagally mediated) while others notice more PVCs during exercise or other activities (adrenergically mediated).  Some of us may have both triggers at times. 

Our doctors will probably tell us that when our minds are occupied during the day and we are doing other activities and not focussed on our heart beat, we won't notice our PVCs so much, whereas when we are at rest we are more aware of rhythm disturbances and symptoms.  This can be true but I have found that when my heart rate naturally falls at night or during relaxing periods, it can trigger worsening rhythm disturbances like PVCs and other arrhythmias, but we cannot keep our heart rate continually higher in an attempt to stop PVCs, can we. It would wear us and our hearts out.  So what can be done when they occur?

I find lying down at night may trigger gastric symptoms and any reflux from diet or medication can be a significant trigger for any arrhythmia.  (You should also get checked for Sleep Apnea too if you haven't already - another important arrhythmia trigger).  It is well known that there is a strong gastric-cardiac connection because of the proximity of the oesophagus to the heart and the involvement of the vagus nerve.  

Sometimes taking gastric meds can help prevent ectopic beats.  I am taking Lansoprazole, a proton pump inhibitor which helps with reflux symptoms from my oesophageal motility disorder which can trigger arrhythmias.  I sometimes find positional changes when lying down can help stop ectopic beats (turning from one side to another), for example. Also taking sips of tepid water throughout the day and when I wake with arrhythmias at night.  Diet is important but another vast subject that we can discuss in another post if you wish.

From your description "Eating always seems to play a part, or an empty stomach as well.  Trying to figure out what I can eat without getting the stomach irritating the nerve", it would seem to me that you might benefit from speaking to your doctor to see whether stomach irritation perhaps because of meds like anticoagulation, Jardiance might be causing some problems for you?  And while you are seeing your general doctor, you could perhaps take the opportunity of asking whether you might need anything else checked, like electrolytes as a cause for your ongoing PVCs?

Exercise will help to keep you healthy and to improve your symptoms overall, so you may well find you will notice a PVC decrease as well, but only exercise gently and "pace" yourself.  Don't push through difficult symptoms like chest pain, breathlessness, worsening palpitations, dizziness.  Perhaps you could work with a cardiac exercise therapist who can teach you how to "safely" exercise.

Try to stay positive.  I can see you are asking all the right questions and I am confident that you will get to the bottom of your problems

PVCs

by piglet22 - 2023-11-20 06:16:16

I would certainly echo the view (Gemita) that PVCs are going to be more noticeable when you are resting or relaxed.

It's common sense that your awareness changes according to what you are doing and if you have heart problems of any description, you will be even more aware of pulse and heart rate.

I get a significant number of PVCs and they were causing real changes through pacemaker sensing leading to a low perceived heart rate. Symptoms included short duration blackouts or falls..

I also take a proton pump inhibitor (Omeprazole) but can't say that I found any correlation between dosage and PVCs.

My simplistic view is that resting allows PVCs to dominate whereas during exercise, the raised heart rate allows the PM to do it's job. When I say exercise, I really mean activity, like normal moving around rather than organised exercise like a brisk walk.

I suspect that the PVCs are there all the time and aren't triggered, or at least I haven't found a trigger like caffeine. The pattern was definitely activity related.

For what it's worth, the worst effects of PVCs are being kept at bay at the moment by a high dose (10-mg Bisoprolol, 5-mg twice daily) of beta blocker.

What happens if that solution fails is anyone's guess. I'm pinning my hopes on a PM that can distinguish between ectopics and "natural" rhythm.

Thank you and sorry for the late reply.

by Gramzo - 2023-11-24 14:32:43

I appreciate what you both had to say.  It makes a lot of sense.  I'm still on the upward slope of this learning curve and appreciate the knowledge of those who are way ahead of me in experience.  Up until the beginning of this year (prior to the ICE and ablation) I noticed that no longer would laying on my left side quell arrhythmia.  I'm still experiencing that after 37 years of doing that for my heart to behave more normally while at rest.  This year I had to switch to my right side in order to not get vegas nerve related arrhythmia.  I need to mention that to my IV cardiologist in January.  I do feel my sitiuation becoming better.  Not sure if it's because it is getting better or I'm just adjusting.  Probably some from column A and column B.

Thank you against for taking the time to answer.

Happy Holidays!

LBBB

by beardman48 - 2023-12-31 22:06:04

Have had LBBB for twenty years started with just a Defib last two are ICD EF at one time was 12% now at 57% never shocked battery last right at seven years + feel great you always wonder if and when a shock you never know go about normal life stay away from high electric motors etc scanners etc your good to go.

beardman48

by Gramzo - 2024-01-01 20:08:12

It's very heartening to read about your EF of 12% now at 57%.  I go at the end of this month for an echo and cardiology appointment.  It will be 4 month post procedure on ICD and AV Node ablation.  As Gemita commented on one of my posts, it has take 3 months for me to feel that my heart has adjusted to the AV Node ablation.  Then my 3 yo grandson gave me a rip roaring cold for Christmas and I've taken several steps back due to the cold.  So we'll see what the echo has to say about my EF at the end of the month.  It was 33-34% prior to procedures.

PVCs had finally calmed down until....

by Gramzo - 2024-01-01 20:14:34

...I started a bad cold virus last Wednesday.  No fever, It's not in the lungs, but lots of coughing from sinus drainage & irritation has destroyed sleep at night.  Hoping it's on it's way out, but I thought that yesterday - then last night was bad.  Had some NSVT periodically that is my heart telling me it's mad about this little setback.  

I've always been able to tell when I get a bug that is going to stick around several days.  My HR gets faster for a day or 2 then settles back down.  

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