PVCs, anxiety or more?

[FC in Texas]

I am today 6 weeks out from my AVR. So far, I have had a pretty smooth recovery and am feeling better than I did before the surgery and dare I say approaching normal. I had follow ups with my cardiologist and surgeon about 2 weeks ago and everything looked good. My EKG showed a couple of PVCs and I could feel them on occasion, but the doctors seemed generally unconcerned. And just said keep on walking, etc. I have been on 50mg of Metoprolol since the surgery. I am doing pretty good on exercise and am now walking about 50 minutes/3miles every morning with no problems or complaints. The last couple of days, however, I have had this spell of PVCs that seem to come on around lunch, maybe when I eat or drink. Either the irregular heart beats or anxiety induced by the PVCs really gets my attention. Next thing I know I am checking pulse and it's high (around 95), getting an increase in PVCs and some anxious/lightheadness feelings. I can't tell if the PVCs are causing anxiety or if there is really something going on with my heart. This also seems to happen if I am at work and engaged in a conversation about something important. I am thinking they are normal and part of the recovery/remodeling process but am obviously not sure about that. I would appreciate any thoughts, common experiences or input before I start calling the cardiologist. Otherwise, it seems like I should walk more and quit work.

 

[Eva]

You had the right answer...this is normal! Your doctor is not concerned as he can tell they are *benign* PVCs. Keep your good attitude and do not worry as long as the HR does not go above 100 nor stay over 100 continously for over ten mins and repeatedly.

Caffeine, medication, inadequate sleep, etc. may trigger them. I get more pvcs after i drink caffeine-free coke or chocolates!

Also, anxiety and stress which are normal to experience during recuperation are triggering factors!

You are fine and continue to walk

 

[Greg a]

You had the right answer...this is normal! Your doctor is not concerned as he can tell they are *benign* PVCs. Keep your good attitude and do not worry as long as the HR does not go above 100 nor stay over 100 continously for over ten mins and repeatedly.

Caffeine, medication, inadequate sleep, etc. may trigger them. I get more pvcs after i drink caffeine-free coke or chocolates!

Also, anxiety and stress which are normal to experience during recuperation are triggering factors!

You are fine and continue to walk

Can't put it any better, so everything Eva said times two................

 

[Julian]

Beta blockers like metoprolol can cause PVC's lol! Im 8 months post and still get these off and on. May go away may be a new normal for you only time will tell. I will say one thing they suck.

 

[FC in Texas]

Thanks. They are probably normal and hopefully they will subside over time. But they do seem to be triggered by something, which leads to anxiety (for me), which leads to more PVCs, and repeat. Julian's description is particularly accurate.

 

[Dgreenbee]

Sorry to sound ignorant; what are PVCs?

 

[FC in Texas]

Sorry to sound ignorant; what are PVCs?

bee-

PVCs are premature ventricular contractions. As I understand it the ventricle initiates a heart beat instead of the normal way through the atrium (sinoatrial node). It feels like a skipped heart beat, even when you are just feeling your pulse, or a flip-flop feeling in your chest/upper abdomen area. I think they are generally not a concern, but they feel really weird and make me nervous.

I am finding that a beer helps. So, I suppose my new life is walk, have a beer and quit work. . problem solved. I knew this AVR thing would turn out good.

 

[Ovie]

I'm at least 2 weeks ahead of the last 2 people to start threads and they are walking 2-3 miles a day! Good lord..I'm at like 15 mins twice a day on a treadmill going 2.2mph.

I didn't mean to sidetrack, but either I'm not pushing myself as hard as I should or you are just godly. I always thought I wasn't suppose to over do it for the first 3 months..I was misinformed apparently.

Great job!!!

 

[FC in Texas]

I'm at least 2 weeks ahead of the last 2 people to start threads and they are walking 2-3 miles a day! Good lord..I'm at like 15 mins twice a day on a treadmill going 2.2mph.

I didn't mean to sidetrack, but either I'm not pushing myself as hard as I should or you are just godly. I always thought I wasn't suppose to over do it for the first 3 months..I was misinformed apparently.

Great job!!!

Thanks Ovie. I have been fortunate to have a smooth recovery. Also, I think I am pushing it pretty hard. In the years before becoming symptomatic, I raced bicycles and trained like a nut. In the weeks before I could not have walked 15 minutes at 2 mph and a flight of stairs was a challenge. I find myself walking harder and farther just because I am so happy that I can actually do it again. Thinking back to my OP, I am wondering if I might be doing a little too much and that is contributing to the PVC/elevated HR thing.

Anyway, it's not a race brother. Just keep doing what you are doing. You will be back to stronger soon enough.

 

[Cooker]

I’m over six years post-op and I still have PVC’s now and then (not often). The triggers mention above are correct, IMHO. Also, I seem to notice them when I am very fatigued.

Sounds to me like you are right on track! Keep up the great recovery!!!:thumbup:

 

[TheGymGuy]

Hey FC, great job on getting out there and walking. I asked my surgeon about walking lots and he said it can only help.

If you are leisurely walking, there is not really much work output that your body has to provide. Thus, leisurely walking could probably be whatever the weather permits and as much as possible. Ok, so average pedestrian walking speed is 3.1mph (http://en.wikipedia.org/wiki/Walking) and if you push yourself to 3.5-4mph I can see doing it for several minutes and then backing off into leisurely walk. My heart-rate starting stabilizing and lowering (it is already at 68-72 average) after I started doing a bit of interval walks daily. That and lots of moving around.

 

[FC in Texas]

Just a quick update. No issues this morning. . walked, etc. All good. Then just after eating lunch, I got a bunch of these things. Seemed like one almost every third heart beat. They subsided after about an hour. Mostly gone after that but some anxiety and an occasional PVC remaining. I called my cardiologist's office and they said that there were probably normal and in the absence of other symptoms like chest pain, or shortness of breath, did not seem too concerned. They did offer to run an EKG on Monday to take a quick look.

So my question to others with these things, are the "normal" episodes you had/are having just one or two a minute or like a whole bunch that really get your attention?

 

[neil]

hiya ,yea there do suck,ive had them on and off for months now, ive had the echo done and ekg done and they where normal, gonna get a monitor fitted in 2 weeks to see whats going on, but my cardio doesnt seem worried,sometimes i get them for 3 or 4 hrs and its not a nice feeling,but he said it may be something i will have to live with, anxiety cert makes them worse,

 

[FC in Texas]

Well, I am now wearing a Holter monitor. I had a bunch of palpitations over the weekend and they caused me a lot of anxiety. Frustrating because I have always felt pretty mentally tough. Anyway, I went in to get an EKG just to check. Fortunately (I suppose), I had a few palpitations during the EKG. The physician's assistant came in after and said it looks normal, see you later. For whatever reason, I didn't just walk out and continued asking questions and wondered out loud if it wasn't something more. She said I was having sinus tachycardia and it was totally normal 6 weeks post-op as I did more exercise, return to work, etc. I guess I kept on too long. . . so they gave me a Holter. I doubt they would have let me walk out if they were concerned but at least this will be more definitive than the 30 sec EKG.

 

[jordan]

First, glad to hear recovery, for the most part, is going well for you! I was taking 75mg of Metoprolol twice daily after surgery. It wasn't until 2 months post-surgery when my cardio cut me to once daily. I was able to finally convince him to transition me down to 25mg daily after my resting heart rate was around 45 bpm. Those transitions in Metoprolol dosing is where I saw small peaks in PVC occurrence that then tapered off to very rare occurrences.

Yesterday was my first day in about a month with noticeable PVCs. However, yesterday was the first day in about a month that I drank a Monster. I know that much caffeine triggers PVCs for me, but I had a craving for a strong dose of caffeine. I drink coffee on a regular basis, so a "normal" amount of caffeine is fine, but the double dose in an energy drink is too much. Especially sitting at my desk at work where my heart rate will be around 50 bpm. For me, <=50 bpm is where I have an increased likelihood of PVCs.

Again, I know this, so I wasn't worried about PVCs yesterday because I knew they would happen. Knowing your triggers is important for know what is normal when it comes to your heart.

 

[neil]

fc let us know how the monitor goes

 

[FC in Texas]

Well I turned it in yesterday and haven't heard any news (which i figure is probably good as they said they would look at and call if something was up) and have a follow up appointment on Monday. I think my own diagnosis and the initial comments I got here are probably right - irregular heart beats that are normal after AVR surgery as magnified by my own anxiety. Since the surgery I have been pretty aggressive about walking and exercise and started working from home after a couple of weeks and in the office after my post op follow ups. It's my speculation, but I think all that triggered some irregularities that sent me down the worry path leading to more symptoms like higher HR, higher BP, more PVCs, etc. It's kind of funny because i worried a lot that last month before surgery (because I was very symptomatic) that something might happen before ever getting to the OR. Then post-op that cloud started to really go away - exercise with no SOB, smooth recovery, etc. Then the irregular heart beats threw me right back to worry. I have only had a few minor palpitations after getting the monitor and almost none today. My morning 3 mile walk today was uneventful. Hopefully, I will get a clean bill on Monday and be less sensitive to any future hiccups.

 

[FC in Texas]

OK, had a follow up visit with the cardiologist yesterday to discuss the Holter. Turns out that while I did have a number of PVCs, the palpitations that were bothering me were actually brief episodes of A-Fib. During the 24 hour recording, I had 5 A-Fib episodes with the longest lasting about 45 seconds. They all occurred in a two hour period late afternoon. In general, he was not concerned about them and said pretty normal. Also, they have mostly subsided since the monitor (stress as a factor?). We did decide to up my Metoprolol from 50mg once a day to twice a day. He suggested trying this for a while to reduce the likelihood of palpitations/A-Fib and lower my HR, as it is averaging mid 80s. I really didn't want to up the dose, but will be happier if it helps. I still have the occasional episode where my HR just hangs in the mid 90s. Doesn't seem to be tied to exercise, eating, etc. I assume it is likely par for the course until everything gets more settled.

 

[sarahsunshine]

Glad you got it checked out, and that it's not too serious. I hope the metoprolol helps short term so you can wean yourself off it later.

 

[pem]

bee-

PVCs are premature ventricular contractions. As I understand it the ventricle initiates a heart beat instead of the normal way through the atrium (sinoatrial node). It feels like a skipped heart beat, even when you are just feeling your pulse, or a flip-flop feeling in your chest/upper abdomen area. I think they are generally not a concern, but they feel really weird and make me nervous.

I am finding that a beer helps. So, I suppose my new life is walk, have a beer and quit work. . problem solved. I knew this AVR thing would turn out good.

As far as I know, PVCs tend to occur when your heart rate is slower. So if you are having more PVCs than usual, you could do something to elevate your heart rate, like going for a brisk walk, and I wonder if that would make them go away.

Best,
pem