Attn: Cardiologists/md's

[sirroada]

I am wondering if I might get a little medical advice. When I was 16 (I am now 30), I was diagnosed with a left bundle branch block and a right axis deviation in my heart following a medical checkup. The checkup was prompted because my younger brother was diagnosed with Wolfe-Parkinson-White. Anyway, I had a stress EKG. Everything came back normal. For many years I forgot I had this arrythmia. Well I have been cycling for the last 5 years at a serious recreational level. I have noticed in the last few years that my heart will occasionally skip a beat. It feels like an engine missfire in my chest. I have no other symptoms (no dizziness, no nausciousness, no chest pain/tightness etc). It usually happens once or twice and then it is gone. It has usually occurred while I am riding in the drops. Occasionally, I will get similar symptoms while at rest but it feels more like a fluttering sensation in my throat/chest than anything else. Anyway, I am concerned because I just had a friend die of "natural causes" and now I finally started worrying about what is going on in my chest. It never used to bother me until now. I have scheduled a CT angiogram, trans-thoracic echo and EKG for this coming thursday. Any of you who are medical doctors feel free to give me your thoughts on what may be going on. Thanks, I appreciate it.

[gasman]

Wow- That sounds like an awful lot of tests. Somebody you saw must be pretty worried.
You have what sounds like PVC's or premature ventricular contractions. They are very common and benign, unless you have three or more in a row. I would have thought that a Holter monitor that records your EKG for 12-24 hours would have been a first step to try to figure out what is going on with your heart. A simple EKG isn't going to tell you any more than you already know- you have a LBBB. A transthoracic echo will look for structural problems with you heart, it's simple and noninvasive and cool to look at.
I would give the CT angio a pass unless there is some evidence that it is needed, which I don't think there is from what you tell me. Of course I haven't really heard all your history now examined you so my advice is free and that's exactly what it is worth.

[Jeff N.]

Occasional PVC's are normal. They're only dangerous, for the most part, in the presence of an acute myocardial infarction (heart attack). You may be having PAC's(pre-ATRIAL contractions)too. Only a 12-lead EKG would tell you which, but even PAC's on occasion are considered normal and not really an issue with a healthy heart. They can be treated with certain drugs, like diltiazem, but If your arrhythmias are only occasional, I really wouldn't worry much about it. Most docs nowadays don't even treat 'em. I have PAC's on occasion when I ride, usually when I reach the top of a long, steady climb and come to a stop light. Bottom line, though...if you're asymptomatic in that you aren't experiencing dizziness, shortness of breath or chest pain associated with your "skipped beats", and your stress test didn't reveal any ischemic changes, I wouldn't be too concerned. But there are those on this forum who might disagree. As a side note, over-consumption of alcoholic beverages and caffeine can cause these arrhythmias as well. By the way, I'm just a lowly R.N. (27 years). Theres other guys & gals out there who are far more qualified to answer your questions, so don't listen to ME! Thats why they get the megabucks and own 7 Ottrott's. I'm just going by the information I've gathered over the years. I am by no means a cardiology expert. Just wanna make that clear. Jeff N.

[Ozz]

...As a side note, over-consumption of alcoholic beverages and caffeine can cause these arrhythmias as well. Jeff N.
well that's no fun....I occasionally have similar symptoms and asked my doc about it. He pretty much came up with the same advice here, but without all the tests.

Do I really need to cut back on the raison d'être?

[fg165]

I'm just a lowly R.N. (27 years). Theres other guys & gals out there who are far more qualified to answer your questions, so don't listen to ME! .

It's been my experience as Firefighter EMT-P that most "lowly" R.N.s (especially one with 27 years behind them--sheesh) are as knowledgeable as the M.D.s in their respective departments. The primary differences are: they make far less, work 10 x harder, and M.D.s are worthless without them. IMHO, Jeff falls under that category.

Oh, and Gasman, well he knows a much BUT, makes more than most M.D.s.


BTW-----When I drive the box to the ER for the medics, while I'm awaiting the engine to pick me up, I get free advise from the R.N.s too; that is, when I'm not hitting on the female R.N.s.

[yankeeheel]

Anesthesia guy here.

The real issue here is if you're geting cardiac/cerebral perfusion during these abnormal beats. Sounds like you are. No syncope is a good thing, especially if you're doing 40+ in the drops. Sounds like you had a stress test and it came out negative. The CT angio does seem a little overkill, but it will tell you if there's any stenosis in your cardiac arteries. Bottom line, if you're concerned, get it checked out. Find a cardiologist you trust and listen to them.

PS: There are no lowly RN's.

[dehoopta]

It's been my experience as Firefighter EMT-P that most "lowly" R.N.s (especially one with 27 years behind them--sheesh) are as knowledgeable as the M.D.s in their respective departments. The primary differences are: they make far less, work 10 x harder, and M.D.s are worthless without them. IMHO, Jeff falls under that category.


I am not even going there to start that flame war again. Believe what you want, but the MD, RN, EMT, orderly who actually has seen you or examined you is more qualified than any of us.

BTW, as an MD, I own a "lowly CDA". One I saved months to buy to replace my 18 year old bike!

[soulspinner]

Im no M.D. I have PVCs, PACs and an occaisional SVT run(short in duration). In less stressful times with no caffeine intake I have few if any in a day, but I love coffee and stress is inevitable. Have had holter and echo and heart doc says Im fine. Resting 42 on a good day even though I only have time for 3000 to 3500 mile per year. Im 49. I say all this only because I worried like you. Dont. Odds are youre fine and this is as my doc put it just a nuisance. Worry wont help anyway, it just contributes to more arrythmia. Good luck and let us know how your tests come out.

[Jeff N.]

Im no M.D. I have PVCs, PACs and an occaisional SVT run(short in duration). In less stressful times with no caffeine intake I have few if any in a day, but I love coffee and stress is inevitable. Have had holter and echo and heart doc says Im fine. Resting 42 on a good day even though I only have time for 3000 to 3500 mile per year. Im 49. I say all this only because I worried like you. Dont. Odds are youre fine and this is as my doc put it just a nuisance. Worry wont help anyway, it just contributes to more arrythmia. Good luck and let us know how your tests come out.I concur. :beer: BTW, I don't work all that hard anymore...not since I got OUT of the E.R. Jeff N.

[sirroada]

Thank you all very much for your imput. It put me at ease to read your experiences and advice. I am going to get all the tests done just to be sure. I feel the same as most of you...that I am dealing with premature ventricular contractions, however just to be sure I am going to spend the bucks to get it checked...especially since I just purchased my Legend Ti. I want to enjoy riding the thing without worry. I will keep you posted on my test results and when I get my bike in I will post some pic's of that.

[Ziggurat]

...Do I really need to cut back on the raison d'être?..

Ideally, you can however supplement it with half servings of De Rigeur or a piece de Resistance. Stay away from Bete Noir