Ectopic Heartbeats Extrasystoles

Hi CSI Mark, I started suffering from missed beats about 6 years ago.  I was going through a stressful time and it was put down to anxiety (ECG didn’t pick one up, blood tests were fine etc).  I saw numerous doctors and they all told me it was nothing to worry about as I had no pain and no black outs.  When they started I was 21 years old and every doctor just told me that you don’t develop heart disease at that age.  I still really wanted to get to the bottom of this as I had recently lost a good bit of weight and started running and didn’t want any nasty surprises, so I asked the Dr to refer me to a cardiologist. I was hooked up to an ECG on a treadmill and put through my paces.  Luckily they caught one of the funny beats and analysed it.  The funny beat was diagnosed as an ectopic beat.  

Her recommendation was that I continue to exercise – she has not known any heart attack or problems to come of them (assuming your heart is in good health otherwise).  She told me if I experience them while running, to step up the pace  - the faster your heart is going, the less chance that it will do one as there is no time!  If anyone is interested (I found it fascinating) an ectopic beat is when your heart beats from another cell.  You have a pacemaker cell which usually controls your heart beat.  However, every cell in your heart is capable of making it beat.  Every now and then, one of these cells (which in my case is in another chamber) gets excited and produces a beat, out of time with the usual rhythm.  The ectopic beat comes before your heart is full of blood, therefore the beat feels weak (and more noticeable as it is in a different place), then the next beat goes back to the pacemaker cell and has a bit longer to fill with blood – therefore when it beats again it has to pump harder to get the extra blood out.  

Hi JMutts,  a very interesting post. Your 'problems' do sound very similar. It's funny how you mention the ectopics becoming noticeable when you slow things down a bit. I often get them when I'm cycling and coast downhill or slow things down so that I can take a drink. Leaning forwards on the bike makes them a bit more noticeable but apparently this is normal.

When you think how the heart responds to exercise over time with increased blood volume pumped per beat, it's no wonder my ectopics are more obvious because of the increased power of the beat. My downfall seems to be a slow heart rate. I should have asked but I assume my heart rate goes very low when sleeping, it's @ 40 bpm when resting at the moment so any ectopics when sleeping could easily lead to a 2-3 second pause.

The echocardiogram on my heart showed the structure was absolutely normal and I have no doubt that my episodes started due to a lot of stress at work. I still believe that once diagnosed, any heart related problem is magnified by thinking about your heart and what it's doing.

One thing's for sure. Most if not all of us on this forum are doing good things for our hearts and it should be the salad-dodgers of the world that worry about their hearts!

CSI Mark..... be very careful. If your heart rate goes below 40 it goes into the danger zone. It is one of the things us healthy people have to be aware of.

This may be of help. In my case it was caused by my HR going down to 38 when at rest one day.

http://my.clevelandclinic.org/heart/disorders/electric/syncope.aspx

A good read in my case...

I thought I would resurrect my post just to round this off as I'm sure people will be looking at this when researching their own issues.

I have now had two lots of ambulatory monitoring, the initial 7 day monitor and then a 24 hour monitor because the cardiologist was 'interested' in my very slow heart at night. I finally went back to the cardiologist in March to talk about all the results etc. I must admit to almost grinding to a halt with running due to losing confidence in my ability to stay alive! going from 5 times a week to almost nothing. (I've just started again, gentle runs every other day).

The cardiologist, in fact the third cardiologist I've now seen, was very reassuring about my issues and said don't worry, get out and run. He said yes my heart doesn't always beat regularly but it's not an indication of anything worrying. Yes my resting rate is very low, currently around 42 bpm but again, if it speeds up and slows down as the result of exercise and rest then it appears to be working!!

My other symptom is occasional sudden increases in heart rate when exercising gently; 'spikes' in my heart rate that more often than not return to normal levels when I ease off to a walk etc. Again, I was told not to worry and get on with exercising. It seems that experiencing 'skipped' beats when the heart accelerates or decelerates is very common. Worrying about it adds adrenalin which makes it happen more.

I feel far better and experience far less of the symptoms now I don't worry so much.

Good to hear that all seems to be good news for you and a reminder for me that I promised to update when I had undergone the exercise stress test. All wired up to the 12 lead ECG and a blood pressure monitor on, they do some base readings and then start the treadmill. Now if any of you have had this before it starts at a very slow walking pace and a slight incline, then every 3 minutes it all increases.  They are trying to get your heart rate to 85% of MHR which for my 58 year old heart is 138bpm.  This should stress the heart enough for them to pinpoint various problems.  You have to bear in mind that most people doing this test will possibly have had a heart attack or may have angina, may be quite elderly or may have some genuinely serious heart problems and they are also probably starting from a resting heart rate that is considerably higher than most of us on here who have run regularly.  So they hit the 85% quite early and actually many won’t get that high before feeling unwell and the test stopping.  It is a worry for people I imagine when they see these people come back to the waiting room looking quite ill and the nurses checking up on them as they recover.

The speed of the treadmill is actually quite easy, it’s the gradient that does the damage, and it’s very quickly up to 15% and still going up. Eventually I got to a point where I ask the cardiologist and nurse running the test if I could jog because the speed and gradient had become too much to walk.  They seemed to really like this request almost like a couple of excited scientists, saying they don’t get anybody athletic in and can’t remember anybody going so far in the test.  You can see the ECG screen as you are running so can view all the data off the leads and your heart rate, so I watch as we go through my 85% point and they ensure I am fine and we keep going.  With my heart rate steadily rising over 145ish they decide they have all they need and as I am feeling like this endless and increasing hill climb is pushing me to that anaerobic point of having to slow down I am happy to agree.  Down comes the speed, a glass of water is taken and I grab a towel to wipe down after quite a hard treadmill session.  You stayed wired for sometime as you cool down and they check that the heart is joining in the cool down correctly as well.  I wonder what people in the waiting room thought as I went out sweating!

All of my results from the various tests will be looked over but the cardiologist who ran the exercise test gives me a conditional all clear subject to a final,  not sure whether it will consultation or just a letter.  I do have right bundle branch block (RBBB) which is what shows up on an ECG and confused/panicked my GP.  They haven’t seen anything that appears to have caused the original tachycardia (high heart rate) episode I had on the half marathon back in September, and everything else seems fine, actually very good.  The original episode was probably a one off fired by adrenalin.

So what is right bundle branch block or RBBB?  A very small % of the population have this from birth and will never know, that could be me, or you, it is also a possible side effect of remodelling of the heart through exercise and age can be a cause. The other main causes are from damage perhaps during heart surgery and from a heart attack, though generally LBBB is more likely after a heart attack.

Finished here

In basic terms the heart is 4 chambers, two atria which take blood back in from the body and lungs, two ventricles which pump out blood to your body and lungs.  The atria are the first to pulse or pump to send blood down into the ventricles which then pulse to send the blood back out.  All electrically controlled.  Your nervous system controls the body’s natural pacemaker the sino-atrial node and will control the speed of the atria depending on demand from the body. This then passes on control of the ventricles to the atrio-ventricular node which picks up on the changes of demand from the body.  The nodes are connected to their respective chambers by fibrous bundles (don’t you hate it when they haven’t been cut out of lambs heart) which are the copper wire equivalent for the heart’s electrical system.  So in the perfectly performing heart the two atria pulse simultaneously followed by the two ventricles thumping out in synch together.  This is the big thump you can feel when you test your pulse or are measured by your HRM.

The atrio-ventricular node is connected to the ventricles by a bundle of fibres which split into two bundles, right and left.  In RBBB there is a block which means no pulse directly to the right ventricle, it is triggered by a pulse coming across from the left ventricle, and not so much copper wire this time so there is a delay, thump thump.  Not much but enough so that on an ECG it changes the traces on some leads.  A couple of these changes can at first glance be mistaken for a similarity to after a heart attack may have happened.

The good news about all of this is that when RBBB occurs naturally, or more specifically it is not caused by damage of some sort, there are hardly ever any symptoms and it appears to have no effect on anything.  Which again is good news because I just bought another pair of trainers in Sweatshop’s sale.

I will always have an ECG that shows a weird trace but at least next time I will be able to stop the GP panicking.

CSI Mark  - I have very similar symptoms to you - including the low resting heartrate (but not, as far as I'm aware, the 3 second pause). I had ECG, echo and 24 hour monitoring (which caught 373 PVCs).

I saw a cardiologist, and he said (a) these sorts of symtoms are only very rarely indicative of a problem; (b) no problem keeping running; (c) that he is sometimes called by surgeons worried because they're wanting to operate on somebody with an irregular heartbeat - he tells the surgeons to stick the patient on a treadmill (assuming they're well enough), precisely because the irregularity tends to disappear at higher heart rates; and (d) that he spent some time working as the cardiologist for the Briish Olympic team, and that the athletes' ECGs were a "bloody nightmare" - and that many of them barely had a normal sinus rhythm (because their hearts were so well trained, high vagal tone, low heartrate, etc).

I once ran the Mitcham 25km (reasonably quickly, as well - 5:45 miling) with my heart flip-flopping all over the place for the first half of the race (as I became more tired, and my heart started to work harder, it became regular), and although it was a little disconcerting, nothing bad happened. I sort of decided then that if I was able to survive that kind of thing then probably I was going to be okay.

JF50 thanks for an interesting report. My understanding is that INCOMPLETE RBBB is quite common (I've had it for over a decade) but complete RBBB is much rarer, did they say which kind yours is?

Joe, not yet, but still waiting for the final wrap up from them.