worrying about pvcs vs. nsvt – please help!

[thaft]

I'm a 23 year old healthy male, but I'm a smoker, I drink alcohol and I have a pretty serious anxiety disorder. 2 years ago I started having PVCs – some days I would feel like fifteen of them, others a lot less. One year later I had my heart checked up with the stress test, ECG and echocardiogram – everything was fine. Last month, I had a weird PVC run, like 5 or 6 in a row, it felt like this: beatbeatbeatbeatbeatbeat stop and it went back to normal. I was very afraid, searched it online and figure it could have been NSVT, which made me very worried. I went back to the doctor, had another stress test and he put me on a 24 hour holter monitor and it diagnosed about 14 PAC's and 3 PVC's.  The doctor said that I had absolutely nothing to worry about because last year me echocardiogram was fine and so was everything else. But I am extremely worried about that 5-6 PVCs in a row I had: is that really normal? am I really under no risk? was that NSVT? my doctor said that there is no reason my heart would have v-tach since it has no structural disease.

[Dolor_]

Well, my case is slightly different. I have got confirmed record of NSVT that lasted few seconds, an 11-beat run on a holter monitor. I think I have already few NSVTs more, but I hadn't had holter then.

I am trying to deal with it for 3 years. There are better times, and sadly there are worse ones. What happened last time (today) started to really worry me. For the last 2 months I am l going through the "better times" I have mentioned before, which means that I have almost no PVCs at all 1-2 a day is max, lots of days totally clear. And suddenly, without any warning, today I get NSVT. Again it lasted seconds, went away as quick as it came, but really scared me and I know it was NSVT, for someone who feel every single PVC, run of NSVT is trully nightmare, and there is no way that it could be mistaken with normal but much faster heart beating.

Now I am trying to calm myself down, but I cant help thinking, askig why this is happening... What worries me most is that when I am going through bad times (hundreds of PVCs a day with lots of bigeminys) I feel really bad, tired of this, unsure, feared BUT I have never had NSVT then, the "worse times" never ended up in driving to NSVT.
And now, when I feel perfect, heart works fine, BP and HR are totally normal, when I am starting to think, that everything ma be allright, that finally I am able to deal with my all heart condition (all tests results are always very good), health worries, all this heavy stuff... BOOM - there comes NSVT, in moment I haven't suffer a single PVC for 3 days. I can't find anything in web, medical articles, I mean anything about case like mine that is the ratio of PVC/NSVT, about someone who doesn't have much PVCs, his/her highest number is few hundreds a day (which I know is not considered as huge amount of PVCs), but still his/her heart is able to go into NSVT. I read about people having thousands PVCs a day, burdens of 30, 40, 50 percent - sill NSVT-free. And it all leads me to conclusion, that something is really wrong with my heart, and soon it is going to end really bad for me. This is really draining all my will to live, no matter how strong I can feel before it happens :-(

[thaft]

Thank you so much for your explanations! I feel much safer now.

I have been trying to quit smoking for a while, I'll try again as soon as I feel a little stronger.

[MichelleP_3811]

Is Something Wrong did a great job explaining that a healthy heart will handle the short runs well and pose no danger to you but the lack of sleep, caffeine and anxiety very likely played a huge role in whatever run you had and will have in the future if you find yourself in that position again.  Anxiety especially is a big trigger.  I am well aware quitting smoking is hard and when I had high anxiety it was the only thing that helped me keep my sanity but if you can get a handle on your anxiety you may find it easier to quit smoking which will take a toll on your heart in the long run more so than the pvcs ever will.  Best of luck getting control of these things.  If you ever need to talk about any of it stop by anytime. Take care.  

[is_something_wrong]

No, your heart can't stop from stress. Not if it has normal pumping function and your EKG is normal (which it is).

NSVT (I bet you didn't have it, but let's say you did) is not dangerous in the setting of a normal left ventricular function. The danger with VT is if you have a scarred heart from old heart attacks, heart failure, etc, which may make impulses go in circles around the scar within the heart (so-called re-entry phenomena). If so, the VT can go on for a long time, which in combination with poor circulation and poor coronary artery function can make the oxygen supply to the heart get too low and cardiac arrest may happen.

In healthy hearts, NSVT follows another mechanism (just a salvo of PVCs) - there are no re-entry circuits and the heart is able to maintain cardiac output even during VT. So it won't stop.

However, you should quit smoking. It's not good for you, or your heart.

[thaft]

Thank you all very much for your attention. My belief that it was a PVC run was because I did not have any symptoms while I had PAC's wearing the holter, while I did have symptoms with the PVC's. One of the PVC's was a couplet, altough it felt like a normal one to me. When I had that heartbeat run, I had only 5 hours of sleep in 2 days, some caffeine, a lot of cigarettes and a lot of reasons to feel anxious. That probably explain why I had it, altough I'm not sure what I had.

Since then, I've been feeling very afraid that when I'm too stressed out, drank coffee or had poor sleep my heart will go crazy and I'll die. Am I really being crazy?

[is_something_wrong]

It's weird that you mention it. I've experienced this so many times now, and it's really strange that the brain works that way.

Back in 2012, I developed a fear of mental illness instead of heart disease. Since I have a fear of death, the fear circled around going crazy or lose control and kill myself. Which meant I focused on (and avoided) so many "dangers" in daily life, like medications, knives, balconys, traffic, etc. And more weird, I felt "drawn" towards the dangers, because I focused so much on them.

It's exactly the same. And more weird, during the two years that I had this fear, I hardly ever felt an ectopic beat. I just wonder if I had them, just didn't notice them, or they actually stayed away.

[itdood]

My advice is to focus on, and treat the root cause.  People tend to get something called "target fixation".  This is an issue where people spot a danger, and they focus right in on it. Say you're driving a motorcycle and all of the sudden a deer jumps into the road.  Most people react by staring at the danger and guess what?  That's exactly where they steer the bike.

Where you are looking is where you are going to go.

And you are staring at your heart rhythm.  And guess what, you are going to scare yourself, get more hormones going that cause ectopic beats, scare yourself more.....

Focus instead on the root cause, the fear, and learn how to manage this.  it works.

[MichelleP_3811]

I agree, it is more likely a run of pacs than pvcs. For me a run of pacs feels like a series of quick beats.  A run of pvcs feels like a series of thumps in the lower part of my heart. Either in a structurally normal heart are not a danger.  Stress and anxiety will definitely bring them on. Other things like caffeine, diets high in carbohydrates and stomach issues also bring them on.  So try not to worry as that will actually cause you to have more.  If you can try to quit smoking.  My cardiologist said it was the best thing I did for my heart.  I know how hard it is to quit but I am super happy to be free from its control over me.  I would work to find other ways to deal with your anxiety.  Have you seen anyone about it?  In any event, from all your tests it doesn't look like you have anything to be concerned about.  Take care.

[is_something_wrong]

Why do you think this was a run of PVCs?

I would say it is at least 100 (or maybe 1000) times more likely a run of PACs, brief supraventricular tachycardia. You have more PACs than PVCs on your Holter test, and when you feel a run of ectopic beats, it's usually PACs.

You must try to listen to your doctor. When we feel a few rapid beats in a row (which, by the way is completely normal from time to time) we fear NSVT but we really don't have any reason to do so.