NSVT??

[poohbear2026]

Hi,

I have suffered with pvc's and pac's for over 15 years. (I am now 33)  I have had alot of testing through the years including ekgs, 2 nuclear stress test, echos, holter monitors and event monitors.  They have all come back as being in normal range except for my last event monitor caught a 4 beat run of NSVT.  My cardiologist acted a little concerned with this and that is when he sent me for another echo and nuclear test.  He said these came back good and my EF was 68.  He said he will see me again in August for a holter test and then if everything is good he will clear me as a patient.  I had went to him because I have started having episodes about once a month where it feels like my heart stops for a few seconds (longer then the regular palps I get).  Of course this did not happen when I had the monitor.  He said it was probably nothing to worry about since my heart is structurally normal.  My question to you is should I be concerned with the NSVT? I have felt another episode of what I think was another run of pvcs.  Alot of what I read about NSVT is scary.  I am scared that I should have a EP study done or have a pacemaker put in.   He did offer to put me on a beta blocker but I am afraid of the side effects of those.  The long pauses also scare me.  I am currently taking Lexapro and Ativan for anxiety.  I have tried several therapist but nothing has really helped me that much. Do you think I am in any greater danger of sudden death then the general population?Would you recommend any further testing? and what do you think the long pauses could be?  Most but not all of the long pauses have happened the night before I get my period, could it possibly be hormonal?  I have an appt with a hormone doctor tomorrow.

Thank you so much,
Anita

[Michael J. McWilliams, M.D.]

Anita,
NSVT with a normal heart is not a big concern.  You are not at significant risk for SCD.  Structurally normal heart NSVT does not need an EP study or a pacemaker.  Beta blockers are sometimes used.  I think that people afraid to take medications to treat the problems that are meant to treat the problem that the are afraid of (that is a mouth full) tend to have more anxiety issues.  Anxiety, as you know, is very difficult to treat.

The long pauses were probably just PVC, it could also be NSVT.  It sounds to me like you have a lot of normal tests.  I am not sure what more tests will tell you.  It sounds to me like you worry a lot about things that your doctors have already told you that you don't need to worry about.

Extra beats can be more frequent depending on hormone levels, but there is no specific way to treat that unfortunately.

I hope this helps.

[LukeL]

I can agree with the  doc about the medication. I also suffer from anxiety and cardiac neurosis (fear of heart disease) and outside of my betablocker and paxil, hate taking medication for anything. I was given a script of xanax back in february and have  only take 2 pills since.

[upbeat633]

I think that, in some cases, the anxiety over these odd sensations in our hearts is exacerbated by the medical community itself.

I have read post after post after post, where a person goes to the E.R., or to their medical doctor, or as in poohbears case, a cardiologist, who orders more tests (following a finding of a single 4 beat run of nsvt). If, after ordering yet another echo and nuclear stress test everything was clear, why would he want to see the patient again for another holter eight months later?  I have read many posts where a person with high frequency pvc is treated much differently than another person with high frequency pvc. Why?

I have many runs of multiples and in my 27 yr history of pvcs have had two visits with a cardiologist, two stress tests, two holter monitors and one echocardiogram that I had to request myself because my frequency dramatically increased from about 20pvcs a minute to sometimes 35 per minute. I went to see an electrophysiologist this time. And he asked why was I having so many tests done!!

I think anxiety is an issue for every person walking around on the face of this earth, just like having the occassional pvc is. But without effective treatment for either, or both, then a person is left with more worry. I see nothing wrong with questioning the suggested treatment when it seems to range from nothing, to beta-blockers to antiarrythimic drugs to ablation. When the medical community's only approach is to try this, and if it doesn't work, try that, and if it doesn't work, then try this, it's easy for a person to feel frustrated, scared and/or angry.

[tickertock]

I had a documented run of NSVT(5 beat) on my one and only holter back in 1987, nearly 21 years ago, the EP at the time even discontinued my inderal 10mg twice daily after the workup. I saw the same EP purely by coincidence in 1993 , he then prescribed atenolol 25mg twice daily for me and told never to take anything stronger than a beta blocker for my pvcs. I now take atenolol 100mg daily in divided doses and rarely have pvcs anymore, I think most Eps have seen it all and by now they even have a better picture on the prognosis pvcs. I've learned it really isn't that much one can really do but to try and accept the fact that PVCs pose very little risk if any in the vast majority people. I know it is easier said than done.

[fwilson]

I think the reason for the much different treatment is that there is very little data as to what the PVCs mean prognostically.  Until more conclusive studies get run, docs are left with the current crop of conflicting information regarding PVCs.

[upbeat633]

I was told by the EP never to take anything more than beta-blockers too. And not to consider ablation unless my life were so drastically affected by the pvcs that I could accept the risk of the procedure (which isn't intended for pvcs afterall). So it was nothing, or a beta-blocker.

I'm glad you are having so much relief from the nasty things. I'm trying acebutolol right now and it seems to have stopped the long runs, of which I had many, many, so now trigeminy almost seems ok. lol

[poohbear2026]

Thank you Dr. that makes me feel alot better.  I really hate having these things just wish I wouldn't always think I am going to die when they happen.  

Thanks,
Anita

[poohbear2026]

Thanks for your comments. I also used to be on Paxil for about 10 years then changed to Lexapro when the Paxil started messing up my Liver count.  I now take Lexapro everyday(as long as I remember) and Ativan when needed.  I just went to a new dr today and she is testing me for all kinds of deficiencies (she took five blood samples) and I am also doing a month long test on hormone levels.  Hopefully she can find something to help me.

Anita

[poohbear2026]

Thanks so much for your comments, it makes it easier to know there are so many out there with the same problems and feelings as I have.  Thank you so much for the support.

Anita

[LukeL]

This is also another problem with medical tests, when a doctor orders blood tests which test for sometimes  over 100 things along with multiple imaging tests and exams, odds are something will show up (and may be very non specific or a false positive), which only leads to more tests and anxiety.

[poohbear2026]

My dr office called back today with the results and said my Vitamin D is low and my thyroid.  She wants me to start taking Armour Thyroid and vitamin D-3.  I have read that if you have an arrhythmia you should be careful in taking thyroid medicine.  Do you think there will be a problem with me taking this?

Thanks,