Sudden onset of PVC's and lightheadedness

I wanted to see if anyone else has experienced anything like I have with PVC's.

For background, I am a male in my 40's. I have always been in very good health, with no chronic health issues. I have been an avid runner and weightlifter for over 20 years. I average around 30 miles running per month, and my 2 mile run is around 15 minutes at my best effort. So, I've always felt that my cardiovascular system was in good shape.

This past December, I had a short bout of sinus and chest congestion. Shortly after it cleared, I began noticing "skipped beats", or what I know now to be PVC's. I have worn a Garmin watch for years, so I am very familiar and in tune with my HR. My resting HR tends to be around 55bpm. Around this time, I began noticing my HR on my Garmin watch dropping into the 40's, 30's, and even upper 20's at times of rest. I would have heavy bouts of PVC's during these times, which I now know to be bigeminy and trigemeny. During these times, I would often get lightheaded, requiring me to bend down or hold on to something. The periods of lightheadedness would only last a few seconds, then go away. I was still able to run and exercise as always. The PVC's seemed to go away at higher HR.

My GP conducted an ECG, which showed frequent PVC's (approx. 20%), and 2nd degree type 1 heart block. He didn't seem overly concerned, but referred me to a cardiologist. The cardiologist conducted another ECG and 48 hr. Holter monitor. The Holter showed much of the same, with the addition of extreme bradycardia during sleep (30's and 40's HR at times) with a few seconds of ventricular standstill. He told me that his guess is that I have increased vagal tone of my vagus nerve due to running, which has also resulted in the bradycardia. He wasn't very concerned either, but due to the lightheadedness, he referred me to an electrophysiologist for further investigation.

The EP put me on a 30 day Holter monitor on my first visit. On the follow-up visit, he mentioned the same results (bradycardia, extremely low during sleep with a few seconds of ventricular standstill at times, 2nd degree heart block). He also noticed a few runs of non-sustained ventricular tachycardia at times (3 - 4 beats in row), as well as couplets at times. Due to the combination of bradycardia, VTACH, and v. standstill, he wanted to conduct an EP study to further investigate, and also mentioned the possibility of a permanent pacemaker. I never dreamed that I would be discussing a pacemaker at my age, especially with my current level of fitness.

Toward the end of the 30 day monitor, I stopped taking pseudoephedrine for periodic sinus congestion, as I had read about the possibility of it contributing to arrhythmias. I also stopped drinking energy drinks entirely (I previously averaged around 3 - 4 per week). After doing this, I noticed the PVC events being less frequent, and my lightheaded episodes totally went away. I mentioned this to the EP prior to the EP study, but he still wanted to conduct it to look for any underlying conditions of abnormalities. Plus, he seemed very concerned over the ventricular standstill, even though the cardiologist felt that it was a normal symptom of increased vagal tone.

The EP study was inconclusive, as he was unable to stimulate or reproduce the ectopic ventricular beats. He said that he did not find any area to ablate, and a pacemaker would not be required. However, he now wants me to have a loop recorder implanted, which will stay in place for years. I plan to talk with my cardiologist about taking a wait-and-see approach since I no longer have symptoms. I respect the EP's professional opinion and recommendation, but I also don't want to continue additional testing for what the cardiologist thinks is simply increased vagal tone, which is now asymptomatic other than feeling PVC's periodically. I understand that this isn't where to look for medical advice, but I wanted to see if anyone experienced anything similar that was due to increased vagal tone.

0 likes, 1 reply