PVCs, PACs, etc

Triathlon Forum
1

These have been discussed multiple times here. I have 3-4 atrial fibrillations in the past. Vagally mediated, HR stays low (35-60) and thankfully, I easily identified the trigger (getting a cold drink, too fast, while mildly dehydrated…bam!) I can actually revert it by jumping on a treadmill and hitting LT for a couple of minutes (no…IRB wouldn’t approve). All the tests were done (3D echo, holter, etc) and no underlying pathology
Since April, I’ve been having frequent bouts of PVCs (EKG). No underlying pathology either. Blood tests normal (thyroid function, mg, k…) EKG shows changes consistent with athlete’s heart, elevated ST segment, inverted T wave, the usual 'stuff athletes have that MI people have too).

It seems that triggers are: anxiety (lots of that here), dehydration (hypovolemia), and it seems that it’s worse after eating, and also seems to be postural to some extent.

Has anyone seen other triggers since some here mentioned having PVCs, and have you been able to control them? Beta blockers are not really an option as my RHR is ~32-34.
And they affect training a lot.

2

I am not 100% sure what a PVC is/feels like and I have SVT not a-fib, but my skipped/extra hard follow up beats and svt have been greatly reduced since I stopped drinking caffeine. I tried modifying thyroid meds first, to no avail, but the easy quit using caffeine seems to be helping.

not sure if this applies to you or not or how far off I am from what you are looking for…

ps, tried a 200mcg caffeine pill 1.5 hrs before a TT last week(3 weeks post caffeine use) and well, that was just messed up. I will remain caffeine free, aside from some chocolate

3

No lavender room antics here.

Great to hear the echo was normal-in the presence of “abnormal” EKG. We’ve talked about medical experience in the past and it’s scary but some Dr’s would stop you at the EKG.

How do you know its a-fib… Holter? Some say the feeling of a-fib is similar to PVC’s, SVT.
(Love the IRB comment)

As for other triggers: I’ll throw out there-caffeine of course, supplements, and not warming up before exercise (ie speedwork…go!).
Tx options: PVC arrhythmias can be ablated. Friend of mine also wears a “life vest” think AED crossed with a gun holster.(http://lifevest.zoll.com/patients/patient-faqs.asp) Not a great option, just throwing it out there.

BEST of luck

4

These have been discussed multiple times here. I have 3-4 atrial fibrillations in the past. Vagally mediated, HR stays low (35-60) and thankfully, I easily identified the trigger (getting a cold drink, too fast, while mildly dehydrated…bam!) I can actually revert it by jumping on a treadmill and hitting LT for a couple of minutes (no…IRB wouldn’t approve). All the tests were done (3D echo, holter, etc) and no underlying pathology
Since April, I’ve been having frequent bouts of PVCs (EKG). No underlying pathology either. Blood tests normal (thyroid function, mg, k…) EKG shows changes consistent with athlete’s heart, elevated ST segment, inverted T wave, the usual 'stuff athletes have that MI people have too).

It seems that triggers are: anxiety (lots of that here), dehydration (hypovolemia), and it seems that it’s worse after eating, and also seems to be postural to some extent.

Has anyone seen other triggers since some here mentioned having PVCs, and have you been able to control them? Beta blockers are not really an option as my RHR is ~32-34.
And they affect training a lot.

I have been having bouts of PVCs for years. They started in my early 20s well before I started triathlon. I never paid much attention to them, they were just annoying.

For the past few years, they have been annoying enough that will lose sleep. I have never had any other issues with my heart. Never had an EKG. Was diagnosed by a doctor listening to my heart and describing symptoms.

By far the biggest trigger is alcohol. At 75% of the time I will get these a few hours after drinking. I have cut my alcohol consumption way back. I never drink late at night for fear of getting them when I’m trying to sleep. Sometimes it doesn’t matter when I drink though. I could have a couple drinks at noon and still get them for the next 36 hours. Heavy drinking makes them REALLY bad.

Other triggers in order of frequency are: heavy meals with foods high in sugar, lack of sleep, anxiety, after a hard workout where I’m dehydrated and tired, excessive amounts of caffeine. Note that these are minimal in comparison to alcohol. I drink a lot of coffee so a few cups is not a problem.

EDIT: I will also note that I rarely notice these while training…although I’m sure they happen.

Hope that helps

5

I have had 3-4 afibs. The first one I had no idea what it was. Back in mid 2002. Was done training, drank a cold coke and it kicked in. Two hours later it was still going on. Headed to the ER and was diagnosed there. It reverted into sinus rhythm on its own after about 5h.

The next time I was at cmu for work. Same thing. Cold drink after training. ER again. The resident in charge gave me beta blockers which (duh) made things worse as my AFib was vagally in nature. Cardioverted after. 24hr holter, 3d echo, stress test, and visit with an EP who happens to be one of the top guys working on separating athletic adaptation with pathological conditions in Pittsburgh at UPMC.
That’s for the the afibs. Nothing pathological was found.

Still have the same base EKG I had then with elevated ST segment and inverted T wave. I don’t get a feeling that caffeine triggers PVCs in my case though. Maybe because they are vagal in nature.

(And I sit on our IRB committee :wink: )

6

Same here. Alcohol will trigger them and when I exercise they’re gone. Just like I can revert an AFib with a high enough intensity.

7

For me dehydration is the primary trigger for me (I tend to be prone to dehydration) since I started hydrating well during the day and the during my training they happen very infrequently…

Joel

8

I have a really bad habit of not paying attention to hydration, and live in a hot and dry place, and it seems that hypovolemia really affects PVCs quite
badly indeed.

9

I also have benign PVC’s. I think everyone can be different, but I tend to get them in the form of “storms” that can last anywhere from a day or two to up to 10 days or so. During those periods, I experience them for a few minutes every 5-15 minutes pretty much 24/7.

Increased alcohol consumption over a period of days (like on vacation or during the holidays) seems to be a trigger for me too. I’ve also noticed over the years that if I’m not getting enough sleep and/or not eating healthy a storm is more likely to occur.

Training consistently, eating healthy, maintaining good hydration, and getting enough sleep seems to be the best way for me to avoid them.

10

That’s how it’s been for me for the past few weeks. I know they are benign, but they’re just bloody annoying.

11

I have a really bad habit of not paying attention to hydration, and live in a hot and dry place, and it seems that hypovolemia really affects PVCs quite
badly indeed.

If I get dehydrated enough, I get occasional PVC’s, and I can hear a valve audibly click. (I think it’s mitral, but it only happens when really dehydrated).

John

12

Increased alcohol consumption over a period of days (like on vacation or during the holidays) seems to be a trigger for me too.

+1. I take a trip to an annual trip to a wine festival with my wife and 3 other couples–and the thunder rolls…once things get stirred up, it takes a few days or even a weeks to subside.

A big meal with a few glasses of wine followed by total inactivity will frequently get the vagal bouncies going for me also, even when I’m not in one of the stormy periods. A short walk helps avoid that.

I have had 2 ablations for atrial flutter. The 1st failed after about 5 months. It’s been nearly 20 months since the 2nd though and all quiet. I think I have a few seconds of a fib every now and then (though I am unsure of where to draw the line between those and PV/A/C’s.

here’s some input from Mandrola (a bicycle racer and electrophysiologist in Louisville) on the topic:
http://www.drjohnm.org/2013/06/benign-pvcs-a-heart-rhythm-doctors-approach/

13

Not sure if this will help at all, but here goes. I have PAC’s. Had a full full workup, stress echo, etc. I am on atenolol, small dose. Has not affected my training at all. My resting heart rate was about 58, down a bit on the meds.
For me, big meals later in the evening was a trigger. Caffeine is not my friend. I can do some ice tea, but stay away from coffee. My PAC’s were only annoying when lying down, getting ready for sleep.
Never get too dehydrated-so don’t know.
Good luck, I know they can become frustrating.

14

We are all different. RHR was also ~30bpm. Not sure, but I think that a yearly Holter would have shown my PVC count/24 hrs increasing above 1K. Also RBBB from birth. Everything else normal, including MRI (but RBBB invalidates interpretation of signal averaged EKG.) I you have not done so, SAEKG and Holter – ought to be smart phone Apps :wink:

Beta-Blocker do very little for my PVC’s, but lowering blood pressure helps.
$.01

15

Francois,

Here’s a link to a very rational approach to athletes with PVC’s. Written by John Mandrola and easy to read, even for non-medical folks:

http://www.drjohnm.org/2013/06/benign-pvcs-a-heart-rhythm-doctors-approach/

PAC’s and afib are obviously very different problems.

.

16

I just opted for the easy solution (to be on the safe side) and will go see Ben Levine at UTSW.
My PVCs are mostly at rest, and their frequency varies quite a bit depending on stress levels,
caffeine (been off it for a week now, and virtually zero pvcs) but since Trey knows Dr. Levine
might as well enjoy a trip to UTSW. Heck, that may get a case study paper out :wink:

17

Caffeine, particularly coffee is the biggest trigger for me as well. I can drink soda without issue, but after three or so days with a cup of coffee in the morning I start feeling PVCs without fail. Within a day or two of going off coffee they go away almost completely.

Anxiety, and alcohol don’t help much but they don’t seem to be a trigger on their own, and a cold drink usually doesn’t do much more than cause the odd flutter for a second or two immediately after taking a drink.

18

caffeine (been off it for a week now, and virtually zero pvcs)

Good news! Check caffeine on the trigger list. (Re: cold drinks and eating, you may have an enhanced vagus-mediated swallow/gag reflex). Have you questioned NSAIDs?

I used to get short runs of SVT. After a negative electrophysiological study of the right atrium, I quit all NSAIDs and that solved the issue

19

I don’t take any meds at all, NSAID included. My holter and ephys studies are a bit old, but I saw a top specialist at UPMC in Pittsburgh, and he wasn’t worried at all. Since the PVCs in April, May and June are somewhat new (but came at the same time as a lot of stress and probably an excessive consumption of strong coffee) I will still go see Dr. Levine to be on the
safe side. My colleagues (I do research while most of them are clinicians) keep telling me that my EKG scares family practitioners, but the sports meds guys aren’t worried.

And yes, definitely vagus-mediated…The couple of Afibs all were (slow HR), the PVCs occur mostly at rest, after eating. After normal size meals, no issues most of the time.