Pvc's Chest Pain Everytime You Try To Lower Heart?anyone?

[diamondcut]

This is a similar sort of post to k&ajsmom, in the sense that its about brady,but in my case its only very slight lowering of the heart.

I have come to realise over the last 6 months or so that any type of drug all be it CCB, BB'S, Mestinon, SSRI's anything that even starts to begin to lower my heart rate (which i need as it runs around 100 resting) i begin to get pvc's.

Even if i slowly increase a drug dosage, as soon as it gets into my system and begins to do what i want it to and gradually gets my heart rate to around late 80's or earlly 90's the chest pain is bad.

There is no way i can up the dosage on any of them, when i did try to push through on one particular type drug i almost fainted. I cant understand why i cant seem to get my body to adjust to lowering the heart. It has got me thinking and i wonder if this has happened to anyone else on here and did you find out why?

Obviously when you begin to slow the hearts down, the brain starts to receive less oxygenated blood that it requires, so is the venous return impacted enough by a small drop in HR to set off PVC's and chest pain.

I had a relaxion massage a few months ago and it must have been so good because my HR dropped below what it normally runs at and off went the PVC's, and thats nothing to do with medication! The only way i can lower my heart rate without pvcs is on oxygen.

If this was nuerally mediated chest pain, surely eventually this would ease over time? Mine hasnt, and it means that so many drugs i try, i have to stop, no choice.

I am seeing my cardio soon and although i had ECG done only a few months ago and all was fine, things are not at the moment. My stress test and 24 heart monitor where normal last year too. Could this be MVP? Left ventrical dysfunction?

Or as i am sure many of you on here have been reading, COULD this be due to a blockage of a sort in the neck arteries or faulty valves. Many have spoken about CCSVI, Dr Driscoll speaks about its coalition with EDS/POTs people. Would it make sense that if you had this type of problem all be it a blockage or faulty valve, when you begin to decrease the cardiac output, you are cutting off even more oxygen to the brain and this what makes me almost faint if my HR begins to drop into the early 80's???

Do we have to except everthing is just POTs and just nuerally mediated and no further investigations happens????

[issie]

Diamond,

I'm guessing that your thinking may be right on target. I find this myself. I need my heart rate to be up with standing and I think it is a compensatory thing. There are more doctors looking into CCSVI these days. Hoping to have some answers on that soon.

Issie

[anna]

Myself and my 3 children have PVC's they come on anytime and render us breathless big time! My daughter constantly gets pvc's, and other odd disturbances show up on even the very short ECG's but the cardiologists just keep saying "your heart is structurally normal so this is fine" sorry but I do not buy into this any more I am sure there is a more legitimate reason for all this weird electrical activity. When you look around other EDS communities you can find many more EDSers with these sorts of problems.

[SeattleRain]

I'm glad you brought this topic up. I think you're right with your assumptions and I generally share the same opinion as you.

From everything I've read, POTS patients have "floppy"/loose blood vessels. These are found not just in the legs but (can also be) around the heart. According to Dr. Grubbs, the increase in heart rate is a compensatory response to other problems caused by autonomic dysfunction (in most cases). There's a difference between tachycardia that occurs as a compensatory response and something like "Sinus" tachycardia that's a serious problem needing direct treatment.

It then seems almost redundant - a double edged sword, to be treating the tachycardia with a drug that dilates your blood vessels further making them even more loose. This is undoubtedly what happened to me on Atenolol, with a severe increase in frequency of PVC's and how painful they were.

To my mind the obvious route to take if a BB/SSRI/SNRI is not helping would be Midodrine or Florinef. I see you're already taking that? it seems counter productive to give these to someone suffering from a high heart rate but if tachycardia is coming from loose blood vessels why not attempt to fix that issue that would (help) resolve the tachycardia indirectly? I think I'm a good example. My standing heart rate could be up to 130bpm standing still and it wasn't until I got compression stockings that my HR has gone down to 70 while wearing them and standing.

My new cardiologist acknowledged this when hearing about how bad the Atenolol experience was - and went on to talk about how after I'm diagnosed we'd be doing the opposite - something that would constrict the blood vessels!

I also have suspected artery blockage or something like that (wouldn't mind having 10 angiograms all over my body, ha!) but realistically something like that would show up on an echo and even with a stethoscope. My GP explained in great detail that if I had CCVI/VI that he wouldn't be able to feel my pulses in my legs very well and how when he pressed his thumb against my leg it would leave a more lasting impression because of the fluid that's being retained in the legs. If I had that type of problem then I'd go get a duplex ultrasound to insure the valves in my legs were working properly.

[issie]

Seattle,

That's just shows how we are all so different. I think a good many do have too open veins or lax veins that don't contstrict properly. I think there is a very fine line between how much to dilate and how much to constrict. With me, it appears that anything that internally constricts my veins ---makes me so much worse. But, external compression is a good thing. I did HORRIBLE on any med that constricted my veins. But, had to be very careful on any thing that would open them either. I think there may be more of an issue with the function of the veins. One doc that I'm seeing is of the opinion that there is an internal constriction due to a sort of clogging of the veins. He thinks it is in the veins not the arteries. More later.

Issie

[Canadiangirl73]

Diamond, I'm sorry you're going through this. I get the chest pains too whether I'm brady (low 40s) or tachy whilst standing up. Did you check your BP when your HR drops? I went through a period when my pulse pressure was very narrow (under 10) and my HR wasn't really compensating. This coincided with a dose increase of my BB. It took a month for my body to adjust but it eventually did. I get loads of arrhythmias, as I mentioned in my previous posts (NSVT, SVT, bigeminy, PACs and PVCs), and was told they were benign because of their nature or duration and that my heart was structurally sound. UGH! I never had ANY before the onset of my dysautonomia and my resting HR back then, sitting, was in the low 60s. So to me, this is related to my dysautonomia. Being told me heart is structurally sound doesn't help me deal with these nasty beats on a daily basis though. Now, I get bigeminy (normal sinus beat, PVC, normal sinus beat, PVC, etc.) when I get severe brady (lying down) or alter the venous return to my heart by bearing down for instance. My GP and cardiologists explained that the QT interval, the ventricular repolarization (PVCs originate from the ventricles), lengthens when your HR slows down, leaving time for one of those pesky extra beats to sneak in. Impaired venous return is also a cause of those. Since we have blood pooling and stuff, and our vitals organs are too often already deprived of oxygen, this causes chest pains.

[SeattleRain]

Seattle,

That's just shows how we are all so different. I think a good many do have too open veins or lax veins that don't contstrict properly. I think there is a very fine line between how much to dilate and how much to constrict. With me, it appears that anything that internally constricts my veins ---makes me so much worse. But, external compression is a good thing. I did HORRIBLE on any med that constricted my veins. But, had to be very careful on any thing that would open them either. I think there may be more of an issue with the function of the veins. One doc that I'm seeing is of the opinion that there is an internal constriction due to a sort of clogging of the veins. He thinks it is in the veins not the arteries. More later.

Issie

That's really interesting. Did you get an angiogram or something that would signify clogging? I'd really like to see if I'd have this problem, too. I'm worried about trying something that constricts my veins. If the blood vessels around my heart and in my legs are loose - what about all the other ones that aren't? I'll be constricting everything more - not just the loose blood vessels?

[diamondcut]

Thanks everyone

I already half expect that if i do have an echo, chances are it will be ok as the pvc's only happens when my heart is slowed down. It can go high as a kite and feel horrible, but it doesnt beat irregular.

My worry is that it is not just blood pooling in the lower extremities, and veins, artories, valves are more to blame.

Seattle; it was the same for me, the most intense and painful reaction i had was from a BB. Now i simply think it was because it slowed my heart lower than any other drug. Well that and mast cell issues no doubt. The only med that has helped to reduce heart rate when i was first dx was Midodrine and yes i am on it and its ok for me.

Canadian girl; When these PVC's happen, my BP can be perfect and doesnt tend to be low at all when it happens. It is so frustraing though because i cant even get to grips with mast cell H1 AND H2's because they slow my heart too!! Thanks for explaining in simple terms how this allows time for the extra beat to happen. Do you mind me asking are you on any meds?

I know you joke about having 10 angiograms, but i am going to push to have a specialist radiologist take a look at the neck are and i have read even the pelvis can have major artories that can be blocked. Can we try and demand that we have like an entire CT body imaging done, but one that consists or Dopplers, fMRI's to check the neck, torso and legs. The legs was not even an area i thought of for faulty valves.

[issie]

I'm going to post about my experience with this new doc and his ideas. There is a test that he wants to do on me to check for CCSVI - but, insurance does not recognize it yet and it would be out of pocket and I'm not going to be able to do it - just yet. I will be filling you in on this ----soon!

As for constricting veins and/or dilating veins ---there are herbs that can be tried and that will tell you how your body reacts to that sort of thing. Keep in mind, as you mentioned --it would be all over and if it isn't all over that you need it ---there could be other problems pop up.

Issie

[diamondcut]

Issie that sound really interesting

I dont know if you can put links to direct Dr's but i have found what would be needed to have scans for veins and valves etc, in the UK Its called an Itnterventional Radiologist if people want to google it, to investigate this avenue.

I meant to ask on here, i dont know if this effects anyone or if it could have anything to do with my Dysautomomia, but i have a pronounced abdominal aorto. If i press on it, it beats extremely hard and hurts to even apply the slightest bit of pressure, could there be a valve problem there or congetion do you thinks its worth mentioning?

[E Soskis]

PVC's are not always abnormal - we can all have them - randomly and throughout the day - can be especially bad at night when lying down - your body has it's own intrinsic heart rate that it strives to maintain - when the rate slows down, the body says "hum" - better send an extra beat to pick up the slack - hence, a PVC. Dysautonomia, of course, causes the electrical system of the body to go haywire - including the heart electrical system. These skewed electrical impulses often manifest themselves as a PVC or two or three......There are, of course, other strange heart rhythms but, the PVC's are especially annoying because they feel so "different" in the chest - flip flop, bounce bounce, etc....they can even cause tightness and chest pain - especially if there are a lot of them. As long as your MD is aware of them and monitoring the situation, it shouldn't be dangerous - annoying and occasionally painful though.........