Ectopic Snowball Effect

[SouthernChelle]

Hi, I've been reading here for a couple of years but this is my first post. I found the forum when, almost 2 years ago, I suddenly had a lot of ectopic heartbeats. I was in the shower and stressed out and they just suddenly started. I was having stomach pain at the time (stress) and after a couple of weeks went to the Dr. who diagnosed me with probable ulcer/gastritis. Was on Nexium for 3 months and the PVC's went away pretty much completely. (Had an EKG of course, and it was fine, just showing PVC's.)

They came back about 6 weeks ago, again, out of the blue (again with the life stress). This time I decided to go to the ER to get them checked out. Blood, chest x-ray, ekg all normal except for frequent PVCS. Blood pressure was very high but I have white coat hypertension and it goes down when I get home. A 24 hour holter monitor showed 11% pvcs. Cardiologist ordered echo and treadmill stress test. I think as much for the high blood pressure as for the PVCs. He didn't seem to have any faith in the fact that my blood pressure was purely White Coat.

But I am an RN, and check it regularly, and I know that my BP is normal. Echo was normal. Positive stress test, potentially false positive according to the cardiologist, due to elevated blood pressure(white coat) during the test (they gave me cardizem before the test. They wouldn't go through with it until my BP was down.)

The PVC's are much, much less than the 11% now. I will be having a 2 week holter monitor when I get back home (out of town for 2 weeks). The cardiologist doesn't trust that they are actually slowing down, but I feel every single one and know that they are definitely (at worst) less than half of what they were on the first 24 hour holter monitor. I have trouble taking any BP meds (though they practically insist) because my BP drops so low when I'm away from medical situations. Also, my resting pulse is usually 56-60 and when it goes lower due to meds I feel garbagy.

Now I have a cardiac PET stress test ordered for this upcoming week and I wonder if my white coat hypertension can give me another potential false positive test. I have an anaphylactic allergy to contrast dye and this cardiologist thinks this is the best test for me. I would much prefer something less invasive such as an advanced XRAY, a CT without contrast, or a calcium scan.

I'm 55 and have no family history of heart disease. Does it seem like they are being aggressive or just taking prudent steps? Thanks for any insight.

[jwsonoma]

I think it's great they are being aggressive. Better to find out now if there is a treatable problem before it progresses and gets hard to treat. Or get the all clear and no more worries. This cardiac electrical problem is sort of self fulfilling. Unusual stuff starts going on with your heart and the resulting stress just exacerbtes it.

[SouthernChelle in reply to jwsonoma]

That is a great way to look at it jwsonoma. I'm such a "touch me not" that I really balk at unnecessary tests, but I don't think I'll be able to really relax until I know for sure. And you're right, I can literally make PVCs come on by worrying too much about them.

[Jonp]

I can't comment on much of what you say but you might like to consider Roemheld Syndrome which docs may not pick up. Swallowing air (stress, fizzy drinks, hot drinks, talking a lot, gulping food) = stomach pain and pressure = pressure on vagus nerve and heart = PVCs. Sanjay Gupta on YouTube explains it. Hope this helps.

[SouthernChelle in reply to Jonp]

Interesting Jonp! I actually brought this up to the cardiologist and he'd never heard of it! He said to me that if I'm getting more PVCs with/after eating that it's purely coincidental. I absolutely know better! I'm in the states and it seems to be hard to find a Dr. (at least locally) that is up on the gastric/cardiac connection. I love Sanjay Gupta and have watched many of his YouTubes. Thank you for recommending him though. He's the best!

[Jonp in reply to SouthernChelle]

Of course you know better, you can feel them! I frequently have pvcs followed within seconds by a gurgle in my bowels or a sudden burp. Many others on this and other forums say the same yet their cardios deny it. Sounds like you or your insurers are paying for a lot of investigations. Here in UK, it is free but so difficult to get treatment, particularly atm. Hope you get some answers but many of us just have to live with pvcs.

[SouthernChelle in reply to Jonp]

That is one of the biggest frustrations to me. I'm not good with not being listened to or believed when I'm talking about my personal medical experience! The cardiologist actually said to me, "frankly I don't think you have whitecoat hypertension, I think you have uncontrolled high blood pressure". I had brought pictures of my blood pressure taken at home for the two weeks prior to my appointment. I don't know what else I could have done. Yes, the tests are expensive. I have health insurance but a huge deductible that I have to pay first before anything is covered. The PVCs make me super anxious, but I can live with them as long as I know everything is ok.

[Hidden]

Hi SouthernChelle, I guess the most relevant thing to all of this is, are your medical professionals being thorough? In your shoes I think I'd feel that they are. Aggressive is maybe not the most helpful way in which to think of their interaction with your symptoms. What's important is that you are satisfied with outcomes, so that ultimately you aren't worried about the symptoms you've been experiencing, or that there is a cause for worry and that worry is being addressed. Sometimes I think it's best not to overthink things.

[SouthernChelle in reply to Hidden]

Being thorough! That's a much nicer way to look at it for sure! Thank you for that perspective Callendersgal! I am a worrywart and do tend to overthink things. Now if I could just get this whitecoat hypertension under control! It's exhausting!

[Jgirl333]

I also have white coat syndrome and my blood pressure goes up in any medical facility. This week I have also had more frequent ectopics which always concerns me but I try to remind myself that it is just anxiety in my subconscious causing it. All tests have been normal. I will say that I have ST depressions on EKG tests which I wonder if this is a result of hyperventilation due to anxiety and white coat syndrome. Whenever I go to a general practitioner and they do an EKG they refer me to the cardiologist. However, he is not concerned and says it’s my “normal”. I definitely think anxiety and stress can effect medical tests as well as cause PAC’s and PVC’s. I had plenty recorded on my event recorder, even a run of 3-4 at a time. Good luck with your testing and try not to worry. 🙂

[SouthernChelle in reply to Jgirl333]

That's what I had on the treadmill stress test! ST depression! But I was super stressed and my BP was very high. I feel like I just white knuckle my way through these tests! How did they determine that the ST depression was your norm? It's incredibly frustrating because everything else was totally normal with me (except for the PVCs of course). My BP really does skyrocket in any medical situation. I can see why it's startling to the medical professionals but I've followed their advice and taken a single BP pill only to have my BP bottom out later at home. Also, my heart rate gets way too slow. I completely agree with you on stress and anxiety can effect these tests. Thank you for your kind words and your reassuring reply!

[Jgirl333]

Were your depressions 1 mm or less? I have asked my cardiologist several times why I have the depressions and he simply said, that’s just your norm. I’m assuming if they don’t see other issues and they are under 1 mm upsloping then they consider it to be normal. It can also be a response to tachycardia which makes since since white coat syndrome usually raises your heart rate significantly. Have you asked your cardiologist is he is concerned about your ST depressions? GP see this and automatically associate it with myocardial infarction I think. I monitor my bp at home as well and it’s usually quite normal. You are quite welcome. It’s always reassuring to hear from others experiencing the same thing and sharing information.

[SouthernChelle in reply to Jgirl333]

I actually don't know the depression. It was only during the treadmill stress test. I told the nurse that I didn't see much of a dip (admittedly my eyesight isn't the best and I was several feet away) and she said, "a little dip is normal sometime". So I was a little surprised when I got a call just a couple hours later saying the cardiologist wanted another test (the cardiac PET stress test) to check for coronary artery disease. He said that it could be that the positive test came from my high blood pressure, but he wanted to be sure. I was going out of town the very next morning so it's scheduled for this upcoming Thursday. I've tried to look it up on my medical chart, but they don't have the results listed. Thankfully, I had a normal echo just minutes before I had the treadmill test. I got winded, but didn't have any pain and got my heart rate up to about 190 over several minutes. I'm not in the best of shape, but I hope to remedy that when, God willing, this next test comes back good! (How's that for positive thinking?)

Oh, I also have a Kardia mobile 6 lead and I've not been able to replicate an ST depression greater that 1mm and to my untrained eye, and from what I've researched online...it's upsloping.

I'm sorry you're dealing with more frequent PVCs this week. They are certainly unsettling.

[Jgirl333]

Yeah, I have no idea how to read ekgs, no medical background at all but I’ve researched so much that sometimes I think I am a doctor in my own mind. Lol! I just read the reports from my tests to see the depressions and PVC’s on the event recorder. I also had PVC’s on cool down after the stress test. Are they wanting to do the PET as a result of the depressions or is it because of something else? When I was doing my stress echo a cardiologist came in and asked me if I ever feel any symptoms. When I told him that I do not, he commented that I must just have a quick heart rate then. Although I know it is mostly from the white coat syndrome. I also got my heart rate up there quite quickly, but again, my heart rate was already high to begin with because of anxiety. I’m 35 and about 115 lbs but do not exercise or anything so I am also not accustomed to jogging like that. Lol. I like your positive thinking! I actually got a squat machine and stepper afterwards to use. Now, how many times I have actually used it is another story. 🤪 From what I’ve read upsloping and under 1mm can be normal depending on the circumstances. I’m sure the cardiologist looks at other things on the test along with the depressions to determine if it is normal. Yours may be perfectly normal but your cardiologist may just be taking extra precautions just to be safe. Thank you, I hate when I suddenly start getting palpitations again and then I wonder why they seem to come out of nowhere.

[SouthernChelle in reply to Jgirl333]

We do become very "Dr. like" don't we? When I finally got a chance to talk to my cardiologists nurse, she was quite obviously surprised by some of my questions! I had PVCs on cool down too. But I also had them when I first started. They did go away when I was exercising at max capacity. Which I've read is a good thing? The Dr. didn't come in while I was having the test. And it actually took them a while to be able to even start the test because my BP was so high. They had to give me a BP pill and I had to sit and wait. Nothing like a little medical anxiety, huh? I'm not really sure specifically why they wanted to do the PET. When I talked to him very briefly after the test, he said that the EKG wasn't normal and showed possible ischemia. Since I had no symptoms during the test, I was surprised by this and didn't really know what to ask in the moment! And then later when I asked the nurse, she basically said the same thing, but didn't know what specifically he'd seen. She did tell me that he had said to them that it was likely due to my BP being so high. So I'm hopeful that he's just being safe by doing this other test, but also still worry. I completely understand how you feel about the PVCs coming out of nowhere and that causing anxiety about "why". It's very helpful to come on here and see so many shared experiences. So thank you again for sharing yours with me. 🙂

[CurlyPretzel]

Thanks for this post! I think you read mine the other day, and I agree it's really helpful to find out that people have also had a sudden onset of PVCs with no other symptoms. Feeling like you are not alone and that there are other people out there who know how horrible it feels is really helpful.

I am sure stress makes mine worse. I always feel better at the weekend. I am having a mammogram this afternoon just as a precaution but now my PVCs are rocketing. I wasn't worried about it until yesterday but now the health anxiety has kicked in 😩.

I am seeing a cardiologist next week so I need to write down the questions! I am sure I will go blank when I am in with him.

[SouthernChelle in reply to CurlyPretzel]

Oh my gosh! Yes! Mammograms set it off for me too! I just Saturday got back from a two week vacation with the family on the Atlantic coast. On the trip down (we drive, it's roughly an 8 hour trip) the PVCs got much better. But I still had them pretty consistently for the first 3-4 days. And then it was almost like they all but disappeared! And then...packing to come back home, they came back a little more. Then even more the first day back home, knowing I have this medical test coming up this week! And I also have to write down questions I want to ask. I draw a blank if I don't every time and then I'm super frustrated with myself for not remembering. Getting to speak to this cardiologist is extremely difficult!

And yes, thank you for sharing your story. It really does make all the difference.