Different Heart Beat Irregularities

[Rush20]

Even 3 years post-op, I occassionaly feel some heart beat irregularities. I was wondering if there is a difference and/or cause between a missed beat (example - regular beats followed by a pause) and subsequent beats (back-to-back quick beats).

This only happens when I drink too much caffeine or under stress. My cardio told me that many valve patients experience this and if it only occurs occassionaly, it's not something to be concerned about. However I'm curious between the two types of irregularities.

 

[ALCapshaw2]

YEP, all the vices in life (alcohol, caffeine, nicotine, stress) can cause arrhythmias that present as irregular heart beats (Premature Atrial Contractions aka PAC's or Premature Ventricular Contractions aka PVC's) or rapid heart beats (Atrial Fibrilation).

I believe Tobagotwo (aka BobH) wrote a tutorial on PAC's/PVC's. Hopefully you can find it through a SEARCH of the archives.

I suspect that arrhythmias are the "Common Colds of Cardiology" judging by the yawn seen on most Cardiologist's faces after they hear that you tell them you have an irregular heartbeat. Fortunately, PAC's and PVC's are (usually) considered to be benign. Not pleasant to live with, but typically not dangerous. Beta Blockers can often (usually?) control them.

Atrial Fibrilation that does not resolve soon (hours or maybe a few days) is of concern since A-Fib often results in clot formation. A-Fib can often be controlled by Beta Blockers or more targeted medications such as BetaPace (generic form is Sotalol), or the Sledge Hammer of Antiarrhythmics, Amiodarone (which can have SERIOUS side effects if taken for too long in higher doses).

For more stubborn cases of A-Fib, ablation (RF or Cryogenic) sometimes works. Finally, a MAZE procedure
is a 'last resort' invasive procedure that requires a full Open Heart Surgery to perform.

Hopefully, a sin-free lifestyle will keep your heart happy and you can avoid the more drastic measures.

'AL Capshaw'

 

[aussigal]

I have come to the conclusion that us valvers take more notice of our heart and its funny beats than regular folk because we know more about our hearts than those regular folk too. Al is correct , those are the same things my Cardio tells me when I whinge about weird beats. A Beta-blocker seems to keep mine under control unless I overindulge in caffeine or stress.

 

[hensylee]

Rush, I didn't have valve replacement - I had quad bypass. I have the same thing - pause, then catch up beats. I had a chemical stress test this month plus an EKG. The stress test was good, however the EKG showed a problem at the ST that was showing the bump in my regular heart beat. The cardio didn't seem too concerned but said he'd watch it. The irregular heartbeat had also shown up about 2 months ago at the office of my local physician and he, too, did an EKG and was not concerned. But we are keeping an eye out. I can feel mine when I lie on my side at night and things are quiet, also feel it in my wrist pulse.

 

[bvdr]

Even 3 years post-op, I occassionaly feel some heart beat irregularities. I was wondering if there is a difference and/or cause between a missed beat (example - regular beats followed by a pause) and subsequent beats (back-to-back quick beats).

This only happens when I drink too much caffeine or under stress. My cardio told me that many valve patients experience this and if it only occurs occassionaly, it's not something to be concerned about. However I'm curious between the two types of irregularities.

Just a little tidbit regarding the "pause". The pause is often referred to as a compensatory or non-compensatory pause. Cardiac cells have this wonderful property of each having the potential to fire off an impulse that puts a whole heartbeat into production. The area that is the most adept at doing this is an area referred to as the natural pacemaker and is located in the upper part of the heart. When another area in the upper part of the heart generates an extra beat (PAC) it is generally sandwiched inbetween the predominate sequence and is just that....an extra beat and throws off the rhythm a little. When the beat is generated by an area in a ventricle (PVC) then there is generally a premature beat and it replaces the next beat in the predominate pattern and thereby creates a pause before the next beat in the pattern appears. So the PAC is interspersed in the prevailing rhythm while the PVC replaces a beat in the prevailing rhythm. This is a bit simplified but is why the pauses are different. In atrial fib the rhythm has no regularity. Oftentimes there is a mix of PACs and PVCs and that is a little trickier too. Does that help at all?

 

[Lynlw]

Thanks betty

Thanks betty

For the explanation, it gets confusing, Justin has weird beats, because of the way his heart was rebuilt for the rastelli surgery, I'll tell you something you never want to see after a cath, is a bunch of docts and nurses at a leading CHD center getting a book to try and figure out, the ekgs because they never saw it before. He ended up being in complete heart block and got a pacer the next day. luckily he kicked himself out of it after a few months, but usually goes into it after caths.
can you explain wenkebauer (sp) he tends to have that show up alot, right now he is without a pacer, (it broke) but we are pretty sure he will need one again in the future, Lyn

 

[bvdr]

For the explanation, it gets confusing, Justin has weird beats, because of the way his heart was rebuilt for the rastelli surgery, I'll tell you something you never want to see after a cath, is a bunch of docts and nurses at a leading CHD center getting a book to try and figure out, the ekgs because they never saw it before. He ended up being in complete heart block and got a pacer the next day. luckily he kicked himself out of it after a few months, but usually goes into it after caths.
can you explain wenkebauer (sp) he tends to have that show up alot, right now he is without a pacer, (it broke) but we are pretty sure he will need one again in the future, Lyn

You mean wenchebach (sp? ). It is also referred to as Mobitz I or Mobitz II depending on some factors. Well, the most common type of wenchebach is characterized by the time from the time and place the beat is generated from and how long it takes for the ventricles to respond with a contraction and it changes from beat to beat but follows a specific pattern. If you think of a person sitting on a chair blowing up balloons and is handed a balloon and can only blow with one breath and then is handed another and again can only blow with one breath and then another and another. The size of the balloons will progressively become smaller. On the EKG, a wenchebach rhythm shows the pattern of the ventricles responding to an impulse being: The first beat beat usually normal, the second beat the response time is lengthened, the third beat the response time is lengthened further and usually by the fourth beat or so the ventricles do not respond at all. The key factor is that there is a normal type impulse that is like a fired blank. (In the less common type of Wenkebach is that there are still some "blanks" fired but the predictable pattern is not there). It is a conduction type of abnormality called a 2nd degree heart block. The predictable pattern is usually considered less likely to progress to greater heart block than one without a set pattern. Sometimes there are so many PACs and PVCs and little runs of atrial fib that an underlying Mobitz is missed. I remember after OHS at Duke a couple of the cardiologists were outside my door discussing my rhythm and being perplexed. This is just from memory but I think it is correct. It has been several years since I had to deal with this stuff except as a patient.

 

[bvdr]

You mean wenchebach (sp? ). It is also referred to as Mobitz I or Mobitz II depending on some factors. Well, the most common type of wenchebach is characterized by the time from the time and place the beat is generated from and how long it takes for the ventricles to respond with a contraction and it changes from beat to beat but follows a specific pattern. If you think of a person sitting on a chair blowing up balloons and is handed a balloon and can only blow with one breath and then is handed another and again can only blow with one breath and then another and another. The size of the balloons will progressively become smaller. On the EKG, a wenchebach rhythm shows the pattern of the ventricles responding to an impulse being: The first beat beat usually normal, the second beat the response time is lengthened, the third beat the response time is lengthened further and usually by the fourth beat or so the ventricles do not respond at all. The key factor is that there is a normal type impulse that is like a fired blank. (In the less common type of Wenkebach is that there are still some "blanks" fired but the predictable pattern is not there). It is a conduction type of abnormality called a 2nd degree heart block. The predictable pattern is usually considered less likely to progress to greater heart block than one without a set pattern. Sometimes there are so many PACs and PVCs and little runs of atrial fib that an underlying Mobitz is missed. I remember after OHS at Duke a couple of the cardiologists were outside my door discussing my rhythm and being perplexed. This is just from memory but I think it is correct. It has been several years since I had to deal with this stuff except as a patient.[/QUOT


Clarification: When a Wenchebach rhythm (Mobitz I) looses it's predictability and it's "blanks" are fired at random then it is called a Mobitz II and is no longer referred to as a wenchebach. So, Lyn, the rhythm that keeps coming up with Justin is the lesser of the two Mobitz rhythms.

 

[Lynlw]

Thank you, the balloon thing really helped understand it. IF i am thinking right that would probably have to do w/ his delayed "P" wave EKGs are one of the hardest things for me to understand it's amazing what all those peaks and valleys mean, thanks

 

[Rush20]

Thanks for all the feedback. Very interesting reading. My cardio told me that after OHS and valve replacement, the heart's electical impulses can change and often takes years to eventually get back to normal.

However I think the earlier post that most us are now more heart aware has a lot to do with it. Stress is the real culprit IMO.

 

[bvdr]

Thank you, the balloon thing really helped understand it. IF i am thinking right that would probably have to do w/ his delayed "P" wave EKGs are one of the hardest things for me to understand it's amazing what all those peaks and valleys mean, thanks

Yes, the "p" waves indicate an electrical impulse from the atrium and the "r" wave the ventricles' response to it, and the P-R interval is the amount of time between between "p" and "r". In a wenchebach there are more p's than r's.