Exercise Induced NSVT, fitness, anxiety, catheter ablation and beta blockers...

Hi all,

I am so happy to have found this forum. I feel like I don't know what to do.

I am a super active 37 year old male. about a year and a half ago I started getting pvcs while exercising (running, rock climbing, surfing). They started to get increasingly worse. They seemed to come on while I began exercising and would fade away as my heart found its rhythm. I thought this might have had something to do with the fact that I had returned from Nepal where I trekked and climbing to 20,000 feet and spent months at a time at high elevation. Prior to this, I was rangering and living at high altitudes in the Sierras.

So when I came back down to sea level and started running a couple of times a week and hitting the rock climbing gym - the pvcs showed up. I could hike 20+ miles a day and climb El Capitan before this without one skip. Ugh.

So 8 months ago I went and saw a cardiologist. He did a stress echo and found that I did get a lot of pvcs and even runs of nsvt. He said that my plumbing was fantastic but my electrical could use some work. He said I could do an ablation, but the skips were just a nuisance and that I could try and ignore them.

So I tried. I now take magnesium, coq10 etc. But about a month ago they got worse. I had two episodes, one after running and one after surfing - a week later - where my heart couldn't find its rhythm for an hour or a little more. Both of these episodes induced a panic attack and sent me to the ER. So scary.

So today I visited another cardiologist (I moved to SoCal and found a new one locally). He looked at my old stress echo and listened to my stories and suggested a cath ablation. Just like that. Not once have I been given the option to take beta blockers. Why is this? Honestly, poking around in my heart doesn't sound great - but I would really like to fix this issue. At the moment, I am so scared to exercise that I have completely fallen out of shape. And I'm anxious to all hell - walking up a hill is giving me skipped beats.

So Anxiety plays a role for sure. I do get anxiety when I run, surf, climb etc. I can't help but wonder if adrenaline and anxiety is to blame and some anti anxiety meds might help? I actually asked my cardio this and he said no this isn't anxiety, you have an arrhythmia etc. But one month ago (when I ended up in the ER due to an hour of skips after running) I switched jobs and moved south. And I was anxious about it and I went for a run and had a panic attack. That made me even more anxious and it's been terrible ever since. I can't help but feel like there is a connection.

Also I believe that there is a connection in fitness level. I am way less fit then I was 6 months ago and even less so than I was 1.5 years ago. The more I fall out of shape - the more skips I get when I run or walk up steep stairs etc.

Couldn't I see a shrink, get anxiety meds and slowly get myself back into shape? Or is it all really just that the electrical system in my heart broke 1.5 years ago - out of the blue - and no one knows why?

It's just all so confusing.

It is impeding my happiness and my life so I need to do something. Any advice from anyone with exercise induced NSVT with a structurally sound heart? If so, do you think it could be caused from anxiety? Have you noticed less skips the fitter you get?

Thanks so much for any help.

Post Edited (AnxiousAboutAblating) : 4/10/2014 1:25:34 AM (GMT-6)

Thanks Screaming Eagle, for the response :)

Well, heck. At the risk of seeming crazy I'm just going to keep talking. Has anyone figured out the high blood pressure is the cause of their palpitations? I can't help but think that mine might stem from there... anxiety gives me high blood pressure - I can feel it when my BP goes up. Yesterday at the doc i was 140/100 which is crazy high for me.

My years of exercise is what kept my blood pressure and anxiety low but now that I am too scared of the palps to exercise - my BP and palps are up.

It's tough to know whether to treat the palps, the blood pressure or the anxiety.

That's why - with a little research - I have come to propranolol. Has anyone tried this? It seems to treat all three issues... I am returning my holter monitor to the doc (that wants to do an ablation) today and thinking of asking him if I can try this for a few weeks.

Any one else tried it?

Again, thanks so much.

AnxiousaboutAblating

PVCs are supposed to go away with exercise. PVCs during exercise is not necessarily dangerous but they more often indicate heart disease than PVCs during rest (which almost never indicate heart disease).

 
Two conditions are known to cause PVCs during exercise. One is coronary artery disease and the other is myocarditis. I assume you have ruled out CAD, but infections may at some point in your life (maybe after a common cold) affect a small part of your heart, which may fire lots of PVCs. If your echo is clean, your heart isn't damaged, but a clean echo can't rule out microscopic infections (and remember, just a few cardiac cells may cause lots of PVCs).

That said, it should be kept in mind that most PVCs/PACs during exercise are caused by excess adrenaline and poor exercise condition. Did your doctor tell you to keep exercising or stop?

I know how devastating premature beats during exercise can feel. I controlled mine with beta blockers, and when I got into better shape they went away. If you can't control yours even with antiarrhythmics, I guess last option is ablation (or living with them). Of course, if you are choosing the last alternative, you can't let them ruin your life quality and that's not easy.

As far as your fear of the procedure that would be normal for anyone.

What are you doing to manage you symptoms ? Also we have a great Anxiety forum if you would like to post there too.

Please remember, I am not a Dr. so make another appointment and advocate for yourself.  Get a list of all your options. Reference - MedHelp

Kindly,

Kitt

 

just came across this Post, I have the same problems. I'm a jogger too. I am 37 and just had an ablation back in July for atrial fibrillation. I have not had afib episodes any more after the ablation, but I have thousands of PVCs a day, sometimes they happen every 2-3 beats and can last for hours and hours, day after day. Sounds like you may have seen Dr. Natale in California, if you have ,he is one the best. I see him in Austin Texas and he has assured me to not worry about PVCs because they have done test after test and ruled out all the bad stuff. Just said to not let them bother me. I for one can tell you getting out of shape and ANXIETY, will make PVCs worse. I also have an enlarged ascending aorta with 2 bulges measuring 4.3, and a hole between the atrials, which is a right to left shunt. These aneurysms make jogging a bigger anxiety for me, and that has made the PVCs worse. Keep disccusing all this with your doctor and talk to him about all your concerns. Have you ever been in A-Fib, or just skipped beats? I have so many skipped beats happen it seems I'm out of rythym, but when you go into A-Fib, you know it.. A-fib is what can cause blood clots to form in your heart, so I had an ablation to stop the A-Fib...

You will definately know if you are in a-fib, just sitting down you can see my chest shaking from the erratic heart beat. When in a-fib my heart is beating at 180-over 200 beats per minute and completely erratic, blood pressure shoots up and down in extremes. Exercise has never started an a-fib episode, they just start out of the blue for no reason. But since the ablation I have not had any a-fib episodes, still have PVCs daily, but doc says not to worry about them, they are harmless for me. If I have PVCs every other beat, jogging sometimes makes them stop, but if I'm very anxious they get worse and alot more frequent... there are millions of anxious people that have PVCs and don't even know it, once they feel and are aware of them, they will notice them all, then they will get worse, because we are anxious and anticipating the next skip. 

by the way, doing extreme sports like you have... If you consume energy drinks, get a little dehydrated or both at the same time can cause erratic heart beats... If I drink a caffeinated drink and try running, my heart goes crazy.. absolutley no caffeine, no even decaf stuff for me... and no energy drinks when exercising, just good ol water..