Exercise Induced PVCs

Simusid

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Let me start right off by saying that this is not a case of "hey I'm sick and I want the internet to diagnose it" I'm calling my PCP tomorrow and I'm going to see if they think I need a cardio stress test. I thought my symptoms and the results might be interesting to those here and I also thought I might get some good suggestions about what to ask my doctor.

Scenario: A 49 YOM in generally good shape who exercises twice per week regularly for 18+ years. No prior cardiac history other than a resting heart rate that is often 45 and below, occasionally below 40. No cardiac history in family. A notional 12 lead one morning that he took while bored on shift indicated "borderline 1st degree block". Pt denies any resting symptoms of palpitations, dizziness, SOB, chest pain/ache, etc.

During prolonged exercise (say 1 hour into a run) pt checks carotid pulse and feels a regular skipped beat. Every 6th beat is dropped. This is at target heart rate of about 135 and completely resolves within about 30 seconds to a minute of rest. While beats are skipped pt is still asymptomatic (no pain, no SOB, no palpitations).

Once the pt discovered this, it was confirmed to happen at every vigorous workout and skipped beats may be every 6, every 7, every 10, every 10 and as often as every 5.

I'm told by my smarter medic friends that this could be "exercise induced PVCs" which are not uncommon. I've read about it and it seems that it may or may not be a marker for future problems and it may or may not require me to modify my workouts. So that is why I'm going to the doc.

comments and suggestions welcomed. If anyone is interested, I'll try and post a 12 lead.
 
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Simusid

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No replies to this. Probably because you all knew what I now know. I had my appt today and he said "it's absolutely nothing to worry about". I guess turning 50 just makes me want to be sure!
 

Hunter

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Uh how can a skipped beat indicate a pvc? Isn't that a second degree block, probably type 1, specially when the patient has a history of Borderline 1st degree, it probably progressed to a second degree. A pvc would be indicated by a random extra beat not by a skipped one.
 
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Simusid

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Uh how can a skipped beat indicate a pvc? Isn't that a second degree block, probably type 1, specially when the patient has a history of Borderline 1st degree, it probably progressed to a second degree. A pvc would be indicated by a random extra beat not by a skipped one.

No idea, and that is why I went to the Dr!
 

Aidey

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Not all PVCs cause a palpable pulse, thus they feel like a skipped beat.
 

Handsome Robb

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Uh how can a skipped beat indicate a pvc? Isn't that a second degree block, probably type 1, specially when the patient has a history of Borderline 1st degree, it probably progressed to a second degree. A pvc would be indicated by a random extra beat not by a skipped one.

Not all PVCs actually generate a palpable pulse. It could be a block but he has no history of a first degree block and the fact that it's induced by exertion points at PVCs.

Hell if you drink enough coffee or energy drinks you can throw PVCs while just sitting around in class during medic school...don't ask me how I know that one :ph34r:
 

46Young

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Uh how can a skipped beat indicate a pvc? Isn't that a second degree block, probably type 1, specially when the patient has a history of Borderline 1st degree, it probably progressed to a second degree. A pvc would be indicated by a random extra beat not by a skipped one.

Non conducting PVC's can register as a skipped beat and may be followed by a compensatory pause.

PVC's don't have to be random. You can have bigeminy, trigeminy, etc.
 

46Young

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No replies to this. Probably because you all knew what I now know. I had my appt today and he said "it's absolutely nothing to worry about". I guess turning 50 just makes me want to be sure!

I'm 36 y/o, and I get them occasionally; it's been that way for years. There's no rhyme or reason, but usually it's at rest and not duiring exercise, curiously enough. I can feel it - my heart stalls for a second, then I feel a powerful beat. My resting is 44-48 BPM, so it's probably an escape complex.
 

Hunter

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Not all PVCs actually generate a palpable pulse.

Didn't know that thank you makes sense.

It could be a block but he has no history of a first degree block and the fact that it's induced by exertion points at PVCs.
Well he said he had a borderline first degree so that's why I concluded more of a second degree than a pvc. But the exertion makes sense also.

Hell if you drink enough coffee or energy drinks you can throw PVCs while just sitting around in class during medic school...don't ask me how I know that one :ph34r:
Sounds familiar
 
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