Ongoing PVC Bigeminy - heart block?

[Benno2k24]

I do apologise in advance for long post, but I know there are many people who have experience of this and I need advice.

I’ve been struggling for the last week with a big increase in VENTRICULAR ECTOPICS (diagnosed) to the point that I am pretty much constantly (day and night) having to cope with Bigeminy. It’s almost as if my system has flipped where the Bigeminy is the dominant feature and my normal heart rate is what happens every now and then. My heart rate now regularly drops to 38-40 bpm when the Bigeminy is running - and it does so for lengthy periods. I would say (underestimating) three quarters of my day is dealing with this. My BP is stable (a bit lower than normal) but still in a good ‘healthy’ range. My chest does feel tighter, but not to the point it’s painful, and when I do try to move about I notice I’m a bit more breathless but not to the point where I’m unable to do anything.

I’m on 3.75mg of Bisoprolol and 2.5mg Ramapril

I have no underlying heart disease and have previously had an angiogram and Echocardiogram which have all come back ok. The only thing that was highlighted back in September last year from a 24 hour Holter, was possible borderline heart block. This was done through the NHS and I’m yet to get clarification from them as to why they believe it to be the case (I think they’ve lost the detailed readings 🤦‍♂️) as all I got was a covering, 2-line letter.

Anyway, I have booked a revisit to my cardiologist for next Thursday BUT I’m now at the point where I’m wondering whether I might need to ‘bite the bullet’ and head to A&E - I so don’t want to as it will be ‘hell on earth’ for sure.

Has anyone out there had to deal with a similar situation and, if so, what did you do? Was there anything that helped with symptoms.

As I said, sorry for long post (again) but this site is really the only source of good advice I can trust.

[John3333333]

I experience lots of bigeminy episodes. I take flecainide to stop the episodes. It works every time. Before I was prescribed flecainide, I used to try everything to stop bigeminy. Ice cold drinks, lying down with no pillows, brisk walks, stretching, and deep, nasal breathing have all worked for me in the past.

[ForensicFairy]

I wouldn’t think it is urgent and requiring A&E. In having said that, if you’re feeling breathless and unwell, you’re better to get be looked at sooner rather than later.

I also have a normal heart structurally, but I have a defective conduction system which will in time cause structural issues. If you’re experiencing bigeminy constantly, you are at risk of developing issues of the left ventricle, and potentially other things.

It sounds like you need your meds upped or possibly changed. I was once on bisoprolol and was on 5mg a day. I’m now on Carvedilol and take 12.5mg twice a day. I was switched from ramipril to candesartan. I can’t take anti arrhythmias such as flecainide (the drug John333333 is on) as it will make my arrhythmias worse.

I hope you’re ok. Do update and let us know what you decide.

[MummyLuv]

I’m not in your position but when I do get bigeminy it makes me feel faint due to the long gaps my blood isn’t pumping properly. I got it more frequently after my mini maze but only occasionally now. You are doing the right thing and getting a cardiologist review given you are now in a position where they are very frequent.

If I was dealing with it almost constantly I personally would be seeking a catheter ablation

If you are symptomatic then you should go to A& E but I suspect they will prob only monitor, perhaps cardiovert then refer to a cardiologist. .

Good luck with the doc

[Ilovedogs12]

Hello,

You sound very similar to myself, I had constant bigeminy/trigeminy for a year. Your beats per minute, chest pain and breathlessness are exactly as mine were, and all scans etc show a healthy heart.

I was prescribed varapamil to begin with, then Bisoprolol which made me extremely fatigued and ill, and it is only since I changed to Diltiazem in September that I have noticed an improvement.

I now have days where I'm completely free of it, and some days when I might have a couple of episodes where I feel no symptoms other than the palpitations.

My cardiologist said it's not life threatening or anything to worry about, but it could eventually damage my heart if not brought under control.

I have the Diltiazem, I eat a healthy diet and walk a couple of miles pretty much every day. My cardiologist said to give up caffeine including chocolate which I have done. And I try to avoid stressful situations as much as I am able, but of course some things are out of my control.

I am on the right track, my cardiologist is pleased with my progress.

Personally I wouldn't want an ablation, there are many people in this forum who have had multiple ablations without success, others who have had successful ablations but still need medication, and I think anything along those lines shouldn't be rushed into. But that's only my personal opinion.

I would like to come off the medication eventually, I don't know if that will become possible.

I suggest that you ask your GP or cardiologist if it's possible to come off the Bisoprolol and try something else as it doesn't seem to be working for you. It seems to suit some people but there are many in this forum who it hasn't helped and some who have had side effects, including myself.

All the best.

[Buffafly]

I have had bigeminy a couple of times and found it stopped when I did something to raise my heart rate. A slow heart rate allows arrhythmias to take over control. But you don’t say what your HR was when not in bigeminy?

[ForensicFairy in reply to Buffafly]

I hope not as my cardiologist is striving to keep my heart rate as slow as possible!! My condition is nothing but arrhythmias. I think the slow theory may be applied in limited diagnoses, not all.

[Buffafly in reply to ForensicFairy]

That’s interesting, why does he want to do that?

[ForensicFairy in reply to Buffafly]

Because I’m at risk of all of the fast rate arrhythmias too. The heart, as I understand it, is less likely to go into an arrhythmia if its slow and controlled. Also, the faster the beat and harder the beat, the more damage to valves and the heart’s walls. That’s why so many of us are on beta blockers - to slow the heart rate and reduce its force.

[Ilovedogs12 in reply to Buffafly]

When mine is particularly bad and making me feel ill I find going for a brisk short walk helps, but I don't know why.

[Doggiemomma]

When I have bigeminy (too frequently to my way of thinking!!!!) it colors my world & not in a good way. I try to think of other things that are pleasant, and do controlled breathing, but I can still feel it in my chest!