PAC's / PVC's

[tim6003]

I'm not sure where to start, and at the same time I want to be as informative as I can, but not overload with info that is not  important.

I am having PAC's.

I am a 50 year old male.  225 pounds.  I am two years out from Stage III base of tongue throat cancer HPV+ (metz to one lymph node in my neck).  I have been NED (no evidence of disease) since my treatments ended January 2012 (now two years out).

I lost A LOT of weight in treatments-  I was 320 lbs and as I said, now I weigh 225 pounds.  My treatments were Erbitux and radiation only. I had a feeding tube for six months after my last treatment, which was January 2012.

I currently take 1 Ambien to help me sleep through the night 10mg.  It's more to help me sleep through a dry throat (I still have very little saliva) than anything else.  Sometimes I will take a Tylenol PM 500 mg on top of the Ambien, but not often.  I don't take any vitamins or supplements of any kind.  No other meds but an occasional motrin or bayer aspirin for a headache.

I do have a standing order of Tramadal for joint pain of my shoulders and elbows which they say could be related to the radiation / Erbitxu treatments I received.  Who knows, but I rarely take one as I don't feel I need it. I stopped taking my Tramadal just in the last month.  I was taking one Tramadal in the am and one in the pm before that, but again, no Tramadal for the last month.

Though I was a very large guy before throat cancer, I had only pre-hypertension and all my life I have had "skipped beats" or what have you.  I noticed them when I was about 11 years old and over the many years I have had pretty good and thorough work ups on my heart.  However, it's been at least 6 or 7 years since I have had a major work up.

So here's where I am at.  This past fall during hunting season I noticed more and more as I exerted myself that my skipped heartbeats (after wearing a halter monitor the doctors said they were PAC's) became more frequent and more pronounced.  Steadily it got to the point where it just seemed very pronounced.  Upon a routine visit to my GP  she discovered I had a ventral hernia.  One year earlier to this new ventral hernia I had surgery to repair an umbilical hernia, mesh installed and all was good.   In the office the GP felt pretty sure it was a ventral hernia, but because of my cancer history and a mass, she ordered a CT of the Chest, abdomen and pelvis.

I remember when I was out hunting  it seemed as thought this "mass" or lump in my stomach was growing worse, but I attributed that to the weight loss.  When I say I was active, I live at 5000 feet up in a remote area of Idaho.  I cut 7-8 cords a wood summer, fall and winter and I hunt at altitudes of 7000.  I climb very steep terrain.  I am out from sunup to sundown many days, days at a time.  I remember this particular day I got lost from my suburban, climbing high I could see it in the reflection of the sun, but every time I climbed down to get to it I would lose it again (I don't carry one of those satellite thingies).  So before the sun went down I climbed a very steep vertical rise for nearly 400 yards.  Took me over 2 hours and I was carrying my 25lb back, rifle and shotgun and of course I was dressed for cold weather (9 degrees that day). Surprisingly during the climb, no issues, but once on top and locating my vehicle (which was another 30 minute walk to) I started having REALLY bad PAC's.  My chest was hurting, I felt for sure I was going to die.  I even wrote a text to my wife on my cell with no intention of sending it, but if they found me it would be on the phone for her to see.  No reception anyway if I did want to send it...but I didn't it.  I actually had to sit down several times while walking, the PAC's (now remember that's what I'm saying they are based on the halter monitor results).  From there forward for over a month it went downhill.  I could not split wood (I use a maul) I could not bend over or exert myself hardly at all without a run of PAC's.  My PAC's were coming at 3+ in a row and very often 12+ in a 60 second span if I was not just resting.  Most annoying thing!!!

To back up a second, I was out splitting wood  shortly after having these real bad PAC's, this is also after I found out and had scheduled my ventral hernia repair, and boy did I have a VERY bad run of PAC's.  So bad an ambulance was called, ended up in the ER and there is where they decided to give me the 48 hour halter monitor which detected the PAC's.

Now, back to present, I moved up my hernia repair because being an armchair doctor I told my wife "I think maybe this hernia is pressing on my vagus nerve and causing this issue".  Now remember I did say I was armchair doctoring.  So we  moved the hernia surgery up.  Turns out the mesh from the previous hernia surgery not only failed (probably bc of all my weight loss and or my activity level)  but the mesh had become entangled in my bowels.  So a 2 hour surgery turned out to be 6.5 hours.

A few days after that surgery my PAC's seemed to get better and a full month after that surgery I had hardly any PAC's...then this past week I was rushing to and for, getting in and out of my Jeep, sitting, standing as I was rushing and WHAM...I start getting a run of PAC's.  I don't each much anymore, I live mostly on 2% milk and Whey Protein mix for nourishment simply because my throat is about half the size it should be from the cancer treatments and I don't have much taste...so I have just grown addicted to drinking a gallon of milk a day (seriously) and a couple of those have the whey protein in them.  If I do eat, it's mostly scrambled eggs (soft) or foods that are very soft in nature.  I have to drink water with every swallow, so then too I fill up on fluids more than actual food.  Thus the milk habit.

So today I decided to write this and see if anybody has some suggestions or ideas.  I do know the doctor kind of dismissed (nicely though) my thought that the hernia and the vagus nerve might be the issue, turns out after this past few days my armchair doctoring seems to be wrong.

When I get these PAC"s they run together quite a few and then I get a headache my chest feels a moderate pain (like a stabbing) on my upper right side and to me it seems I get a small bit lightheaded.  I'm not the anxious type and because I have had these all my life they don't scare me as much as they annoy me...but this just seems different mostly because they seem to come on with bending, going from sitting to standing or exertion.  I read somewhere that PAC's / PVC's are not as concerning UNLESS they seem to be brought on my exertion, then there is a more worrisome issue...what is that issue?  I'm plain vanilla and I am the type of person who believes "it is what it is" ...so anyone with some knowledge on this ....I'm open to hear.

I did call a cardiologist and I got an appt this Monday / Jan 20, but I know that first appt is just going to be an office visit, so I want to be armed with a humble request list.  Example, hello Doctor:  May I please have a stress test, full blood workup and an echocardiagraham? :)  Is there anything else I should have?  Suggestions?  I have sat around for six weeks after my hernia surgery being very good and resting, now that I want to get back to hunting and cutting wood this issues comes up again and I am truly discouraged and annoyed.

Thanks all...sorry for the book.  I am a type A person and I am a very "engaged" person...but I want to be sure and listen and do what the doctors say, but I just want to hurry up and do it :) LOL

Family History:  My mother has had Tachycardia all her life and just two years ago she had a heart ablation which seems to have done the job.  Mom's heart would "race" like crazy and beat very hard.  She is 73 and but for that she is in good health.

Tim6003

[Bromley]

Hey tim, I liked the book. I enjoy working out in the outdoors as well and can relate to the story of trying to get down. Had an experience similar to that several years ago in northern california.  What I remember most was the sun was going down, and I couldn't find my way down. Really nerve racking.

One thing here. Exertionally related doesn't necessarily mean more worisome. Exertionally related can mean its due to SVT rather than VT. This would be less worisome. On the other hand if VT is brought on by exertion, it can be a sign of ischemia, or blockage, which is a potential worry. If you have a cardiac workup to preclude blockage, however, that particular issue may become a non issue for you. Ask your doc.

PAC's and PVC's can be made worse by stress, such as the stress you feel when you become anxious, as well as by the stress you experience when you work hard (splitting wood or climbing mountains at high altitude).

Your mom might have had atrial tachycardia, atrial flutter, or afib.  They all come from the atria, but have a different sort of origin. A lot of people get afib as they age. You could be a candidate if you are getting a lot of PAC's and your mother had it, I would think.

Your approach sounds correct. Tell your doctor about these things. Since your symptoms seem relatively minor, it  may be something they can treat easily with drugs. You can of course suggest whatever testing you would like. No problem there, and it sounds to me like the testing you are suggesting is appropriate. (I am not an expert, just had a few of my own test and know what to expect at this point).

[MichelleP_3811]

It is not likely you have the same thing as your mother.  She likely had an extra muscle fiber in her heart that caused the electrical signal to get caught in a loop causing the heart to beat at least twice or more as fast as it should.  I had it all my life as well and finally got it ablated a couple years ago.  You are having extra beats in your heart that are mostly one offs and are actually caused by an irritated spot in your heart that is firing off an unnecessary beat as opposed to the signal going the wrong way.  This said, if you notice that they are starting to run together it is good you are being checked out.  It could be that you are falling into afib though they would need to capture one of these events to know for sure.  In general if it is just runs of simple pacs you are probably fine but afib does sometimes require one to be on blood thinners.  There is some test I believe that would determine if blood thinners are right for you.  But you first need to get diagnosed.  So go to your doctor and let them know what you are feeling and when you are feeling it and any other symptoms that occur with it.  I would think a blood workup and an echo would be good test as well to check on the health of the heart.  Best of luck monday and let us know how it goes.