PVC's and Fainting

[nativenolagal]

I had posted a while ago about having dizzy spells and recent onset of lots of PVC's.  I've had a 24hr holter, a 30 day event monitor and am on my second 48hr monitor now. The cardiologist had told me that I had a lot of PVCs going on when I had the dizzy spells.  I falsely assumed he meant NSVT.  He put me on verapamil and scheduled a follow-up.

I feel better on the verapamil and have even found that I wake up in the morning much more easily which is a huge plus for me.  (I have sleep apnea and have had neighbors bang on walls because my alarm was going off but I wasn't waking up...)

I still have some dizzy spells but wasn't too worried until I actually fainted last week (first time in 30 years).   I go back to see him next week and hopefully this 48hrs will show something.

I got the reports from earlier tests and don't see anything that would really explain how bad I feel much less the fainting.  The highlights...was having avg 162 PVCs an hr down to 113 per hour after verapamil started.  the PVC's are monomorphic and appear to suggest RVOT focus.  Both ecgs indicate "possible left atrial enlargement" because of notched p wave, (though my echo shows normal size), incomplete RBBB.  the first ecg showed aberrant conduction but that was gone on the next one.  Both ecgs were "borderline abnormal".  QTc was 446ms on first, 442ms on second.  the event monitor showed sinus rhythm with very frequent pvc's during dizzy spells but there is no mention of any patterns, couplets or nsvt.

I hardly notice the PCVs now with the meds though I'm sure they are still there.  My biggest concern is the dizziness and fainting and incredible fatigue.  The fatigue has gotten worse over the years but my sleep apnea is managed well with CPAP and nothing else ever seemed wrong physically so I have just dealt with it by making sure I get plenty of rest and strictly pacing my activity level.  

My sense is something is not right but none of the tests seem all that unusual.  I'm wondering if anyone has any idea what might be up with this?  Thanks

[tucsonrunner]

I used to have many PVCs - every 2 or 3 beats, sometimes every 4  - 6 beats.  I often got very dizzy.  Often I got on the floor so I wouldn't hit the floor if I passed out.  Sometimes when driving I'd have to pull over very quickly and put my head on the passenger seat until the dizziness passed away.  My EP thought I should have an ablation.  This procedure eliminated most of the PVCs.  Now 10% of beats are PVCs (as per holter).  I am still often dizzy, but that may be due to low blood pressure.  I did an event monitor and the EP said that most of the time I had an event it was due to PVCs.  

[georginaissick]

Fainting + ,arrhytmia is not a good think. I would suggest you  to así for further and more specialized test. A stress test, an echo and an mri. Its important to rule out any SADS conditions

[nativenolagal]

Thanks.  The dizziness and fatigue go way back.  I've always had low normal blood pressure (say 90/60).  Over the years I had gotten used to being careful when I would stand up, making sure I didn't get dehydrated, liberal with the salt etc.  It had all been getting worse over the last couple of years but I had assumed I needed to get my thyroid checked and wasn't too worried, that is until the pvcs came on so strong over a weekend when I felt like I couldn't even get out of bed.  That's when I finally made the appointment to get it all checked.  Thyroid is fine.

Also, I don't know if it means anything, but "very frequent PVC's" was the wording they used in the report.  Maybe they were more concentrated during certain time periods?  I do like my cardiologist.  My mom has seen him for years for afib and has always loved him.  Hopefully he'll figure this one out.

[is_something_wrong]

Fainting during arrhythmias/palpitations is always a serious symptom.

That being said, you have documented very frequent PVCs during dizzy spells but everything else was normal. PVCs (unlike PACs) tend to lower blood pressure (during the event) because cardiac output with a PVC is lowered compared to a normal heart beat, which the next hard heart beat is unable to fully compensate for.

As far as I know, there are two possibilities:

1. You did have extremely frequent PVCs, which (along with Verapamil) reduced your blood pressure to a level where you fainted.

2. You had another arrhythmia (like NSVT) during the fainting spell.

113 PVCs/hour should not cause symptoms. It's only two a minute, which isn't even frequent (I guess it's "occational"). I hope you will get an event recorded during the time you're wearing the Holter/event monitor. If it happens again, I would recommend seeing a doctor without any delay.

[achillea]

Side effects for Verapamil include dizziness, fainting, and fatigue.  I'd suggest checking back with your doctor for a discussion of this medication.