PVC’s (ectopics) or AF?

[Samazeuilh2]

I’m now home following a bypass about three weeks ago. Whilst I feel fatigued, I’m managing to walk 500m or so daily. My resting heart rate has come down to about 58-68 bpm. The medication which I am taking daily to control arrhythmias is Bisoprolol 10mg which replaces my former Sotalol.

There is one particularly concerning fly in the ointment however: I have noticed over the last five days or so that when I lie on my back (or sometimes on my side) that the heart frequently becomes irregular after a while. It continues to beat slowly, but seems to “skip beats” frequently-perhaps every five or so beats. I’m not sure what this is- slow AF or premature ventricular contractions (PVCs aka ectopics). If I sit up then the arrhythmia generally goes very quickly. Usually, when I sit up I bring up some wind in the form of a belch or belches. I had this sequence about 20 minutes ago after waking up from about 2.5 hours of sleep. On turning onto my right side, I noticed the heart was beating slowly but very irregularly. On sitting up to take a Kardia reading the irregularity went almost immediately and I got a normal Kardia reading of 56bpm showing I was in sinus rhythm. I belched up a small amount of wind. Has anyone experienced this sort of “positional” arrhythmia before, or know what it is? Is it AF or just ectopics?

[meadfoot]

Any gastric symptom whatsoever cause me to have heart pauses and ectopics so I identify with your description. I dont know the mechanics of it but I clearly recognise th3 outcome. I wish you well. See what your medics say. Mine seem unconcerned but I find it unnerving.

[Samazeuilh2 in reply to meadfoot]

I’ve always had vagal AF which happens at night, but usually any irregularity quickly flips into AF. This doesn’t seem to- it corrects when I sit up and belch moderately (although it may recur later). And it’s very slow with the pulse barely detectable. I’m hoping it’s just temporary.

[CDreamer]

Yes it’s quite common and triggered by the vagal nerve. Without an ECG it will be impossible to say if the irregularity is ectopics or AF but considering your recent bypass your whole system will be upset so these may well settle, hopefully sooner rather than later.

You might try raising the head of the bed about 5 degrees (pillows don’t tend to wok) - it can sometimes help.

Wishing you a speedy recovery.

[Samazeuilh2 in reply to CDreamer]

I’ll give the head of bed idea a try -there is nothing to lose. I have always had vagal AF at night, but with this the pulse doesn’t seem to be raised at all and the arrhythmia goes on sitting up. I’m hoping, as you say, that it will settle down.

[BobD Volunteer]

The problem is that when you lay down, pressure builds on your internal organs which is different from when standing or sitting. This often means that you feel things differently and become more aware of them. Try to ignore as it is far too soon to worry . You will still be recovering and improving. in some months time.

[Samazeuilh2 in reply to BobD]

Hopefully. I’ve been told that I am doing fairly well at the three week stage, but these arrhythmias are always a worry. It’s also difficult to get advice from the hospital. When I was in the local hospital a couple of weeks ago there was an excellent cardiologist who said that I could ring her directly on the ward if I needed advice. However, she has now left. When I rang a couple of days ago nurses said “she was only a locum” and “she probably should not have said you could ring the ward.”

[RobertTonkiss]

I think irregularities in the heart rate post operatively are possibly common, I suffered from a permanent mild tachycardia following an aortic valve replacement a few years ago and was informed by my cardiologist that it wasn’t uncommon and was probably due to scar tissue from the operation. I ended up having an ablation about 4 months following my op which seems to have settled the tachycardia. I also found it felt more pronounced at night at the time though that may have just been my awareness as during the daytime I was more distracted by the daily activities.

[Samazeuilh2 in reply to RobertTonkiss]

Yes, it could be the product of the bypass-the difficulty is knowing whether it’s short or long term. Then problem is that there was almost no information from Basildon Cardiothoracic Centre on what to expect post-procedure. It’s almost impossible to get any advice or information from anyone who is familiar with my case.

[Ppiman]

I gather that the heart can, in some of us, be sensitive to being pulled and pushed about, all through natural processes but leading to ectopic beats forming as well as various levels of chest discomfort. I had this first in my twenties and the cardiologist back then showed me an X-ray and explained it was trapped wind in the stomach and intestines pushing the stomach against the diaphragm, and that against the heart. I hadn't realised just how close the organs were together.

I have over the years found quite a few references to this on the internet - but not as many as I would have thought, considering that the doctor was quite certain of his diagnosis back then. In some people, the heart distortion can set off ectopic beats, and these can, in prone individuals, set off AF. I have since been told that this isn't the vagus being irritated or anything like that and that that would be quite different causing sudden and severe bradycardia with swings of tachycardia, which I certainly never get.

Steve

[Samazeuilh2 in reply to Ppiman]

Did you ever manage to get this resolved? Sometimes I’m getting 3 or 4 PVCs in 30 seconds which seems a lot.

[Ppiman in reply to Samazeuilh2]

I didn't really. It did go away of its own, but over the years since then ectopic beats have been, on and off, a part of my life. Back then, a cardiologist told me that, if I was lucky, they would come to nothing and for decades that proved to be true. Then in 2019, I had atrial flutter, which an ablation stopped in its tracks, but since then I get a great many ectopics at times, accompanied by a mildly racing heart. This all comes and goes but at its worst can be hard going. I'm thinking of asking my GP about it once again even though he's told me in the past not to worry. That's easily said but harder to do.

Have you got an Apple Watch or Kardia to record yours on? In a thirty second strip, I find I can count 6-10 sometimes, a mix of PVCs and other ectopics.

Steve

[Samazeuilh2 in reply to Ppiman]

I’ve got and have used the Kardia. It shows from between 1 and 4 PVCs on the second strip (which follows the ECG). I wasn’t aware of a difference between PVCs and other ectopics- how can you tell the difference on the Kardia?

The same pattern repeated itself a few hours ago: I turned onto my left side and noticed the irregularity which Kardia confirmed was PACs not AF. When I turned onto my back the irregularity ceased quickly. The problem is it isn’t very consistent: sometimes I get the PACs on standing (or following standing). I anticipate getting this problem addressed won’t be easy. I didn’t have it immediately after the bypass; it’s arisen over the last four or five days.

[Ppiman in reply to Samazeuilh2]

I don't know whether a Kardia can always tell a PVC from another ectopic such as a PAC and I'm not sure myself what the difference looks like on the Kardia strip. These extra beats can occur from many places in the heart muscle, I gather - in the atria as well as the ventricles. If they occur in multiples, then there won't be a "compensatory pause" between the ectopic and the next beat (it's this that causes the "thump" feeling, I gather, as the valve closes more firmly). When they come in short runs, I have read that doctors count them as a form of tachycardia, but, again, from what I can gather, they are not considered of any consequence, assuming the heart itself is structurally sound.

If it weren't for the holiday and the pressure my GP will be under this week, I would try to get an appointment but when they re-open tomorrow, I think he will be too busy with all the covid and other viruses that are all around this neck of the woods at present.

Steve

[DIB69]

I frequently experience exactly the same and now after a few years of these I feel a little more reassured that it's the effect of the vagal nerve and its relationship/proximity to the heart. I guess our organs sort of rearrange themselves when lying down and any build up of wind/gas adds pressure to the vagal nerve.

[Samazeuilh2 in reply to DIB69]

Did the PVCs improve or go away? Do they ever trigger AF?

[Snowgirl65]

Glad to hear your health has improved after your recent fears. I find that laying on my side with knees drawn up seems to trigger an ectopic or two. Laying flat on back or midway between back and sideways seems to be the best for me, and puts me to sleep in an instant with no heart issues.

[Samazeuilh2 in reply to Snowgirl65]

I woke up about 40 mins ago with an irregular heartbeat. I took a Kardia reading and it showed sinus rhythm with PVCs. Took a second Kardia 10 minutes later and got a normal sinus rhythm. When I got up, walked about then returned to bed I got another reading showing PVCs, then later a normal one. Sometimes the PVCs are very frequent : say 1 every 10 seconds. No idea whether this is serious or not. It seems to me it’s related to position.

[Snowgirl65 in reply to Samazeuilh2]

I'm no expert, but it does sound like position-- especially after what your heart's been through recently. Would it help raising your torso up a bit with a wedge pillow when you sleep? I found that helped after my first ablation when I felt pressure in my chest when laying flat for the first week or two after the procedure. I would think some PVCs would be normal for a while since you're still recuperating.

[Samazeuilh2 in reply to Snowgirl65]

The pillow idea is worth a try. Sometimes, I get the PVCs on standing (or after standing) so I think this will be tricky to resolve. I’ll ring Basildon hospital to see if I can speak to the duty doctor, although they have not been helpful so far imo. I had a phone appointment with a GP booked last week but he didn’t ring whilst claiming he had!