Exercise-induced premature ventricular contractions

[Alejandrito]

Hi, I'm 17 years old, man, 1'82 cm, 60 kg. Since I was 14 or 15 I started having PVCs at home after I exercised in the afternoon. I was detected in a holter monitor 39 monomorfic premature ventricular contractions.

Some weeks ago I started to have them when exercising as well. I'm a bit worried about this because the number of extrasystoles is now higher than it was years ago and also because, as far as I know, extrasystoles are considered benign when they answer to stress and disappear with the exercise.

My cardiologist is in holiday and he will come back in October. Because that's a lot of time, I would like to know the opinions of other people informed about this topic and/or that suffers the same problem, because I'm worried about sudden death and diseases as arrhythmogenic right ventricular displasia.

Thanks in advance.

[Cleveland Clinic]

Most PVC's are benign, however, if there are too many of them they can cause a heart problem where the heart muscle weakens leading to a condition called cardiomyopathy.  Of course anyone with a structurally abnormal heart should have further workup.  I am assuming that you heart is normal.  Certain types of PVC can be suggestive of ARVD, especially if they are coming from the right ventricle.  Cardiac MRI with contrast is typically performed to evaluate for presence of this condition.  The fact that your PVC are becoming more frequent and that you are very symptomatic with them warrants further work up in my opinion.  You may also consider going on a medication called a beta blocker to try to suppress these.  I severe cases where pts are very symptomatic or there is cardiomyopathy thought to be due to this we perform an ablation procedure to try to burn the focus that causes the PVC's.  The risk of SCD with PVC is low enough where it is probably safe for you to be seen by your cardiologist in a month or so.  I am assuming that you have never passed out before.    If this is really bothering you emotionally, consider getting a second opinion.

[Alejandrito]

Thanks a lot for your answer.

When I started having PVCs I played soccer and, as I said, they came when I arrived home and I was sitting down watching TV.

A year later I stopped playing soccer and I started with tennis, having the same problem: PVCs came at home, after the tennis lessons.

Because I was concerned about them, I stopped playing tennis and since that moment I've never made any other sport. It was difficult to examine the situation at that time, but now I look back and and I think that the PVCs started being more frecuent when I stopped exercising. I've been one year and a half without doing anything more than walk to the school and come back home. At the end of June and all July I've not moved, I've been at home all day, not because of the PVCs nor mental problem, but I had a time where I hated society. Maybe it's the adolescence. Anyway, after that month at home, now I notice the PVCs more frecuent than in any other time in my life. In the morning and afternoon I can have one or two, but at night they are much more frecuent, and sometimes I wake up at night with some. In July I had an episode of v-tach while reading, I had a lot of skipped beats in a row, and that definitely scared me a lot. The past week I played tennis with some friends and I noticed some PVCs (like 4 or 5) in the 30 minutes we played.

I don't want to do exercise again because I'm not sure if the exercise truly helped me some years ago, so maybe I'm putting myself in risk and the PVCs don't stop. One thing I hate about the PVCs is the difficulty to differenciate their causes: sometimes I think is stress (when I'm in nervous I think that they are more frecuent) but I'm never 100% sure about it. The same happens with the exercise, I don't remember very well if I had more or less PVCs when I played soccer and tennis, I guess so but I'm not really sure about it. If it's true that I had more PVCs when I stopped exercising, they came like a 6 months or a year after stopping the tennis lessons. Maybe now I'm not in a good form and a bit of exercise make the extrasystoles come, I don't know.

By the time I visited the first cardiologist, I had PVCs while exercising and also resting, but not when I exercised. He made me a holter test and I didn't see him again. I only received a letter from him saying I had monomorfic PVCs, bigeminy, trigeminiy and sometimes two PVCs in a row. He recommended me exercising (??? the exercise caused me more PVCs) but he didn't explain me why he thought that I was fine. This cardiologist I'm gonna visit in October is a different one, the second opinion, but I supose he will say me the same as the other one. It's very difficult to be made a MRI with all this information that I've written. He will think that the exercise help me and will send me home with the same questions I had before the visit.