Hello, this is my first post and I was just looking for a 2nd opinion and reassurance. I have had 2 respected cardiologists tell me my heart is structurally fine and that I suffer from PVC's and PAC's with no identifyable cause. I am currently 47 y/o male and while I dont exercise much, I am fit at 5'11 and 162lbs with good blood pressure and a healthy diet. I have been on 50mg of Metoprolol Beta blocker since about age 40 and I feel great with a naturally low heart rate (48bpm on the blocker, 54bpm without it)

I did have open heart surgery in May 2008 to correct a leaky aortic valve at age 43 and while I have felt occasional PVC's since age 25 just like my mother, they seem to be a bit more frequent in the past 2 years, usually during stressful days which didn't used to affect me as much as they do now. I also never used to be concerned with them growing up as I thought everyone had them and I felt fine. But after my heart surgery I experienced post surgery Supra Ventricular Tachycardia on 2 occasions (150 bpm) a few weeks apart followed by hundreds of daily PVC's. Finally they subsided after 6 weeks and things returned somewhat to normal. I was a bit traumatized by the experience to say the least.

Unfortunately, I now appear to be more sensitive to developing PVC's especially when I'm anticipating them after a stressful day and while I can go several days without any palps, I can also have days where I get them throughout the day very frequently.

I have myself pretty well convinced via my cardiologist as well as info I have read, that they are harmless and just electrical disturbances I will have to live with from time to time.

What causes me anxiety, is wondering if they will get more frequent as I get older or at some point surprise me by turning into A-fib or some other more concerning arrythmia. I tend to now live my life in fear of traveling anywhere that isnt near a hospital. My PVC's and PAC's usually happen infrequently (5-6 per day maximum), so when the pattern changes to something more frequent, I panic thinking my repaired aortic valve is going bad etc. and the anxiety really takes over.

The sensations of the PVC's seem to vary for me and they can include any of the following:

1. When taking a deep breath I can often feel a single harder or extra beat

2. Sometimes I can feel a painless tightening sensation in the upper center of my chest and if I feel my pulse when it is happening, I appear to be in sinus rhythm but with a slightly elevated pulse. Suddenly the pulse corrects to normal and the sensation dissipates but never the feeling of a skipped or extra beat.

3. An extra beat followed by normal rhythm for a while then a minute or two later, another skipped beat.

4. multiple skipped or extra beats in rapid succession that feel like 3-7 arrythmias in a row and if I cough they quit. This happens rarely maybe once every two to three months, usually while sitting.

All of these usually occur while at rest with a normal resting heart rate at 54bpm. They rarely occur during exercise like bike riding or walking.

Any inputs that might reassure me once again that I should be fine would be great as I have a business trip to Germany scheduled soon and I always worry about what would happen if I developed a longer lasting sequence of arrythmia's on a 12 hour flight !

Thanks

Brian

Thanks for taking the time to add your advice. For what's it's worth, I was advised to take a Magnesium supplement. I started 500Mg 2 days ago and so far I think I have felt maybe 2 minor hickups which is a dramatic improvement !

From what I have ready it's an often overlooked treatment for arrythmia so i'm going to keep taking it and see how things improve longer term.

Brian

As one who has aortic valve work recently I thought I might weigh in here. I had my aortic valve actually replaced with a mechanical St. Judes 27 mm valve. I had SVT episodes (some of which were caught on either monitors or EKG's) starting several weeks after surgery. I was eventually re-hospitalized and placed on a drug called amiodarone first through IV and then oral tablets which eventually corrected the problem. I'm no longer on that drug and the only drug I take now specifically for heart rhythm control is diltiazem 180mg ER. It is a weak anti arrhythmic.

 My heartbeat at the time was very erratic and unsteady. Sometimes it seemed rate dependent and other times it seemed positional (ie standing vs sitting). Sometimes it converted to sinus at an elevated rate and others it went into sinus at a slower rate. Sometimes it was normal standing and others it was normal sitting. All very confusing really but the upshot was that I was in atrial flutter (like a-fib but more regular). My cardio said it was due to inflammation after surgery and I think he was right. The flutter waves were clearly present on both the regular hospital monitor and on the EKG. It felt like my heart was skipping on every other beat, and it actually was. This was not a "perceived" flip-flpping of the heart. How do I know?? Because with a mechanical valve, you can freaking hear it!! My Daughter can hear it from 8 feet away in a guiet room.  Every single beat of my heart can be heard by me as a click..click..click. When in flutter it would go click, thump, clickclick thump, click, clickclick, thump. It did this for hours on end. As I'm sitting here and for the last hour or so, it hasn't skipped once. But I still have bad days and good days in regards to palps and my heart rhythm.  

Mine was a documented case of atrial flutter. For the most part, the flutter is gone but I still feel like it is just below the surface. I'm fairly certain that the sac around your heart was opened during surgery. For reasons relating to something I think is called cardiac temponade it is seldom closed. It could be the fact that the sac is no longer fluid filled and this allows it to rest on the outer cells of the atria and irritates them causing one of them to fire and the wave it initiates conducted into a full beat (although out of time with your normal rhythm). I think that is happening with me.

After the intense pain of having your chest cracked open subsided, did you notice that your heart felt more (for a lack of a better word) "raw" inside your chest? Like it was pounding against your ribs, or just in general "less cushioned" or just different in general? Mine does, although much less now than just after surgery or maybe I'm just used to it.  

Were you monitored at any time during the SVT or heavy palpitation incidents or immediately following them? If so, was anything other than benign palps present? Any sign of atrial involvement? Anyway, your case sounded similar so I thought I'd relate my experience as well. Since my valve is mechanical, I was on anti-coagulation meds immediately after surgery and there was little if any danger of tossing a clot during my atrial flutter episodes. That is the greatest danger of atrial fib or flutter is that the blood pools there because they never fully empty and clots can develop. If the bouts of SVT you had were short and you had an otherwise normal sinus rhythm, you most likely were not in any danger. Also, many people with biological valves or even valve repair are placed on warfarin for a couple of months after surgery. Was this true in your case?

Anyway, I hope you feel better soon. Nice to meet a fellow OHS valver on here.. BTW, I also take magnesium to help with my heart rhythm and I feel it does help. I take 750mg all at once every day at the same time I take my warfarin (7.5mg M,W,F and 10mg all the other days), just before bed. I will have to take the warfarin every day for the rest of my life and have my INR monitored to stay in the desired range for my type of valve which is 2-3. I haven't been outside that range for months and I eat just as many greens (vitamin K1) as before my surgery.  

Paul.

 

Hello Brian and welcome to the forum. I've read your posting and concerns.

You've been directly evaluated by two cardiologists who concur regarding your condition, so another opinion is not what you need but rather acknowledgement and acceptance of the facts rather than yielding the irrational premise of fear. In its most repugnant form, anxiety is the apprehension of great consequence for which no prediction can be defined. It is, in its most basic form, helplessness.

The problem in your instance is very much the same for many who are guests or members to the forum. You are seeking to locate and define an underlying physical cause for symptoms whose origin has no such basis. Vagus nerve-induced palpitation events originate from outside the heart and they are the consequence of a chronically stimulated central nervous system arising from constant apprehension and stress.

These events are more akin to a muscle twitch than any type of classified arrhythmia. Remember that the heart is as much a muscle as it is an organ and unlike any other in the body, the heart is extremely dynamic in function. When changes to the normal patterns demonstrated by the heart occur, worry is established that steps must be taken to locate and remedy the cause in order to prevent risk to life.

The problem in such scenarios is first establishing whether the premise of the outcome is accurate. Life is not at risk whatsoever from the presence of vagus nerve-induced palpitation events and just as the twitching of an eyelid cannot result in blindness, these palpitations are unable to invoke a deadly arrhythmia or actually result in asyncope.

It's important to realize that you are substantiating the outcome based upon your own perceptions rather than the actual facts as provided by the cardiologists. This is the boundary which many people cross and it's critical to recognize the implications of doing so.

There is nothing of your prior medical history to suggest that a problem is either developing or nearing any type of event stage whatsoever and the surgery you underwent is quite common with excellent prognosis. I would urge you to reflect upon your methodology for arriving at such conclusions as described in your posting and realize that when you perceive your life to be in potential danger, the brain very innately responds to such circumstances in a very predictable manner. It is the force which compels you to continually seek to identify and resolve the threat which is challenging your survival from a perceptual standpoint.

You are at no such risk and you should schedule your trip without such concern. The palpitations are arising from stress and can also arise if GI inflammation of any type is present, ie excessive gas, abdominal distention, constipation or other feature which can produce upward pressure against the diaphragm, resulting in the potential for vagus nerve-induced palpitation events to occur.

You're going to be just fine and you have a long life yet ahead.

Best regards,

Rutheford Rane, MD (ret.)