Heart & Cardiology/Chest Pain

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Question
QUESTION: Dear Dr. Ahmed,

I am a 40 y/o man, in shape, with no known heart problems.  I have lived with PVCs for 20 years, mostly on an on/off basis.  Dr's have told me they are not dangerous--despite reading something online claiming only those with unhealthy hearts have recurrent PVCs.

Nearly 2 weeks ago, after getting out of my car, I did an extremely short (15-20 yards) and slow jog to the grocery store.  It barely elevated my HR as I do far more intense exercises regularly.  But I noticed something I had never experienced before--chest sensation as if someone was pushing on my chest, right in the middle.  This alarmed me as I know that's a warning sign for heart disease/heart attacks.  I believe (95% sure) I was throwing multiple PVCs at this time.  The chest sensation oscillated in time with the PVCs.  It stopped after 15 seconds or so.  

I am very fit and I do cardio workouts 6-7 times per week.  
Since that day 2 weeks ago I've done at least 10 pretty intense cardio workouts.  No problems, not chest pain/pressure whatsoever.  I am able to complete these workouts effectively.  


In your opinion does this sound like I have a heart related problem?  

Or could it be something totally benign, and could the PVCs possibly have caused this chest pressure sensation?  I should note that the chest pressure sensation I experience directly coincided with my PVCs?  Normally I do NOT feel that chest pressure when I get PVCs.  This is the reason I am a bit alarmed.

Thank you,
James

ANSWER: Hi James,

PVC's are basically extra heart beats, they originate in the bottom chamber of the heart, whereas the usual heart beat originates from the top chamber. This results in a slight disruption of the heart rhythm and is often felt as a sensation of a skipped heart beat. Some people have a PVC almost every other beat and don't feel it, whereas some people have just an occasional PVC but are very sensitive to it which makes them anxiety provoking. The good news is that most of the time PVC's are benign. In fact studies of healthy people that have involved wearing a heart monitor showed that not only are PVC's common, but they occur in most people. In studies that followed up healthy, generally asymptomatic people with even frequent PVC's (around 500/hr) the long term outcome of those people was no different to the normal healthy population.

Sometimes PVC's may be a sign of underlying heart disease but rarely do they cause heart disease. There has been a form of heart failure described whereby the PVC's are so common that they lead to heart muscle damage, however in that group of people, we are literally talking about having a PVC every few heart beats over a prolonged period of time such as months.

If the PVC's are infrequent and not causing many symptoms and you are generally healthy then typically no further investigation is warranted. If the PVC's are occurring frequently and thought to be causing symptoms then its reasonable to obtain an echocardiogram to rule out underlying heart disease. This is where you should defer to the cardiologist you see, as they have taken a history, physical and made the determination based on those factors. And if they are fine with it, honestly i wouldn't worry.

As for the chest pain. It's clear it worried you as you have taken the time to come and ask the question. Your chest pain is not typical given the fact that you exert yourself to a high level several times a week without reproducing the symptoms. In fact the fact you do such regular exercise means that  Im not sure since i haven't taken a history from you whether you have a high pre-test probability of having coronary disease. But given your concern, and the PVC's i think it would be reasonable to do an exercise treadmill test next as it could give you reassuring prognostic information about both.

Some links for further reading
http://blog.myheart.net/2014/03/17/do-i-need-a-stress-test/
http://blog.myheart.net/2014/06/08/heart-blockage-explained-with-pictures/


Best of luck,
Mustafa Ahmed
http://blog.myheart.net




---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Ahmed,

I would like to express a great deal of thanks to you for answering my question and educating me on this topic.  I REALLY appreciate it!

I wanted to ask you a follow up question.  Today while I was walking on the treadmill at a pretty fast pace with an incline (heart rate was 135 bpm which is not much for me when I exercise...typically I run between 150 and 165 bpm when I'm biking or playing soccer, etc).  Anyway I was not short of breath and felt perfectly fine.  But all of a sudden there was a very pronounced pain that was very short in duration (1 second) in the middle of my chest (center, sternum area).  Then it was gone and I felt as if nothing had happened.  

This has occurred before but it usually happens when I'm on the treadmill which is why I am concerned.  I exercise all the time (daily) and never notice it in tennis, soccer, or anything else.  It could be a coincidence that it has occurred on the treadmill, but the concern I have is that there was a very pronounced chest pain during exercise.  I know that can be a red flag.  Does it sound cardiac related and if so what could it be?  

Thank you again very much,
James

Answer
Hi James,

The pain you described is what we call atypical in nature basically meaning the character of it is not suggestive of underlying heart disease. If it was related to underlying coronary heart disease then the pain would typically build up as the intensity of exercise increased and lessen as you rested. Given your pain lasted a second only and was typical i would not be to concerned about it, especially in light of the fact you play other sports without issue. If the pain were to recur and continue to be associated with exercise then it wouldn't be unreasonable to perform an exercise treadmill test, although i'm not sure you need one after an isolated atypical incident. The best thing to do is see a physician that can take a full history and physical and determine your risk of heart disease and a threshold for the need for further testing.

As with anyone, it is worth getting a check up with a general physician who can make sure you, as with anyone, are addressing your risk factors for heart disease, in that you have your blood pressure , cholesterol etc. checked. You are certainly doing your part by exercising regularly and taking an interest in your health.

A few useful links
Angina: http://blog.myheart.net/2013/06/18/angina-or-some-other-chest-pain/
Stress testing: http://blog.myheart.net/2014/03/17/do-i-need-a-stress-test/
Heart blockages: http://blog.myheart.net/2014/06/08/heart-blockage-explained-with-pictures/

Hope that was helpful

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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