PVC's

More Research

The nursing staff at cardiac rehab again were concerned about my extra heart beats. As a mentioned earlier, as soon as you arrive at cardiac rehab, the staff places a monitor on you from start to finish. My PVC's were evident, but the concern is a run of the PVC's. The danger of the internet is learning too much, but the good thing is being able to discuss your problems with your physicians in a meaningful & knowledgeable manner.

The nursing staff will try to get me to see my cardiologist sooner than March 8th (my next scheduled appointment. As you read below in the article I found, this seems to be a concern when you have a run of PVC's and I did this at rehab. As stated in the article, "Ventricular tachycardia is a sustained run of rapid ventricular contractions." So, I'm again trying to not do anything stupid & wait till my next appointment. Of course the issues are 1 - the waiting game & 2 - what danger am I in when I am at home or doing things around the house?

What are the dangers of premature ventricular contractions?

Premature ventricular contractions in healthy individuals without high blood pressure and heart diseases do not pose any health risks. Premature ventricular contractions in patients with heart diseases (heart attacks, heart failure, diseases of the heart valves) may be associated with increased risks of developing ventricular tachycardia. Ventricular tachycardia is a sustained run of rapid ventricular contractions. Ventricular tachycardia is life-threatening because: 1) it occurs suddenly with no prior warning, and 2) it frequently develops into ventricular fibrillation. Ventricular fibrillation is a chaotic rhythm where the ventricles quiver rapidly in a purposeless fashion. The heart with ventricular fibrillation cannot pump blood effectively to the brain and the rest of the body. If untreated, ventricular fibrillation can be fatal within minutes. An estimated 250,000 Americans die in this way each year.

Many doctors believe that premature ventricular contractions do not necessarily cause ventricular tachycardias or ventricular fibrillations. Instead, premature ventricular contractions may be merely indicators (symptoms) of serious heart diseases or other serious conditions such as hypokalemia, hypoxia, and on-going heart damage from heart attacks, or medications such as digoxin and aminophylline toxicity. It must be emphasized that many premature ventricular contractions are harmless (benign) and not associated with structural heart disease. If the work up for underlying heart disease is unrevealing, the patient can be assured that their prognosis is excellent.

How is premature ventricular contraction diagnosed?

Electrocardiogram (EKG, ECG)

An electrocardiogram (EKG, ECG) is a brief recording of the heart's electrical discharges.

Holter monitor

A standard EKG and a rhythm strip performed at the time of a visit to the doctor's office may not detect the premature ventricular contractions because they may not be occurring at that moment. Holter monitoring is then necessary to detect the premature ventricular contractions in these patients with heart palpitations. A Holter monitor is a continuous recording of the heart's rhythm for 24 hours.

Echocardiography

Echocardiography uses ultrasound waves to produce images of the heart's chambers and valves and the lining around the heart (pericardium). Echocardiography is useful in measuring the size of the heart chambers, the forcefulness of heart ventricle contractions, the thickness of the heart muscles, and the functioning of the heart valves.

Exercise cardiac stress test (treadmill stress test)

Exercise cardiac stress testing (ECST) is the most widely used cardiac stress test. The patient exercises on a treadmill according to a standardized protocol with progressive increases in the speed and elevation of the treadmill (typically changing at three minute intervals). During the ECST, the patient's electrocardiogram (EKG), heart rate, heart rhythm, and blood pressure are continuously monitored. If a coronary arterial blockage results in decreased blood flow to a part of the heart during exercise, certain changes may be observed in the EKG, including increase in premature ventricular contractions and development of ventricular tachycardias.

Adjuncts to ECST (stress echo and nuclear imaging)

Another supplement to the routine ECST is stress echocardiography. During stress echocardiography, the sound waves of ultrasound are used to produce images of the heart at rest and at the peak of exercise.

Blood tests in diagnosing causes of premature ventricular contractions

Blood tests for diagnosing conditions that can cause premature ventricular contractions include:

• blood electrolyte levels can be performed to detect low potassium or magnesium levels (hypokalemia and hypomagnesemia);
  
  
• blood drug levels can be performed to detect digoxin and aminophylline drug toxicity or thyroid levels, for example, an overactive thyroid may result in premature ventricular contractions;
  
  
• blood oxygenation (oximetry) can be measured to detect hypoxia;
  
  
• blood tests can be performed to detect illicit drugs, such as amphetamine abuse; and
  
  
• blood levels of cardiac enzymes [creatine phosphokinase (CPK), troponins (regulatory proteins)] can be performed to assess for heart muscle damage as a result of heart attacks.

Heart Rehab #5

Today I finished Heart Rehab #5. The nurses again showing some concern with my Bigeminy. Apparently, the extra beats were showing up a little more than they like, one point there were 4 to 5 in a row. So, they are going to send the results to one of my cardiologists, Dr. Worley. My next appointment with him is scheduled for March 8 & they did not seem happy with that.

Found some interesting questions about what they call a Run of PVC's at the Cleveland Clinic.

Many people seem to suffer from different types of PVC's or a "run of extra heart beats" Right now I am confused & do not know what to expect. Also, it has hampered my cardiac rehab. I am not walking much at home & have not pushed myself at rehab. Today I got my heartbeat up to around 100-103 and did not feel stressed, but the extra bears were in there & I do not what to push beyong that heart rate. Of course, it is back to the waiting game, I will still be going to rehab next week, but now wait to see when I can see the cardiologist again.

Here are a few interesting web site on Bigeminy & PVC's:

Heart Rhythm Community

Premature Ventricular Contractions

Medicine Net - PVC's

Heart Rehab #4

Today I had two heart rehab sessions , 1 - the regular exercise program at the Health Campus & 2 - a session with two of my "zipper club" buddies! Let's start with the best one first!

Heart Rehab from "Zipper Club" buddies.
Around 10 AM I received a call from my "Packer Backer Buddy" Terry Engleman from Ephrata. Not only have we spent many great times at Green Bay cheering on the Packers, but now we are comparing notes about our "open heart bypass surgery"! We both agreed that our discussions are fruitful because we have felt the same physical & emotional pains after heart surgery. Today we discussed our diets, our physical rehab, and our medicines! It is great to compare notes! We discussed the challenge of going out to eat & what to order, missing the foods that got us into trouble, and having two great wives that will cook "heart healthy" dinners for us! Terry also has the double whammy of being diabetic! We agreed that after surgery is so different and focusing on changing behavior is almost as hard as the surgery itself. (I think I got Terry to relax and maybe even enjoy a brats for the Packers & Super Bowl Sunday!) The medications are also a juggling act - what we are taking, how much we are taking & how our body reacts to the meds!

And my other Terry & Zipper Club buddy, Terry Shuman. We had a "heart healthy" lunch together at the Silver Spring Restaurant! We also compared notes and caught up with our recovery from our surgeries. Since we coached together, sports came up & we agreed to travel to some league & district high school basketball games! This therapy is also so critical to recovery, sharing our love of sports and stories from our past. Cardiac Rehab is a lot like getting ready for the big game! Working out, eating right, planning your next week or month and helping each other reach a goal - the big goal of "Happy & Rewarding Life after Open Heart Bypass Surgery!"

And my other rehab, at the Health Campus, also went well today - did my normal warm up & cool down, with 32 minutes of machine work - 12 minutes on the bike, 4 minutes of arm work (pull downs), 6 minutes in the rowing machine, & 10 minutes on the treadmill. Still had my extra heart beats(bygeminy), but seem to be able to exercise through it! I am now beginning to feel it when it is happening. Next rehab is tomorrow - Friday!

Activity Guidelines For Post Open Heart Surgery

Well, I really thought I was doing a good job after my open heart surgery. But, just received this paper yesterday at Rehab! Should have received this about 7 weeks ago! Now, remember this is my seventh week out from surgery on December 13th, 2010. Here are the guidelines and my comments. Blue comments mean I'm good & Red comments mean I screwed up!

Activity Guidelines For Post Open Heart Surgery

1 - Car Washing (after 3 months)
(the only washing I ever do is drive through a car wash!)

2 - Car Waxing (after 3 months)
(see above)

3 - Climbing Ladders (after 3 months)
(no problem, it's winter time & ladders are somewhere in the garage)

4 - Driving (Physician to approve driving. Airbags not an issue. Push front seat back completely.)
(I was good here, waited for doctor! But if I push my front seat back completely - cannot reach the pedal!)

5 - Golf (Putt after 10 weeks. Driving after 3 months)
(OK, messed up here! I was putting in the family room after 4 weeks! - Will be OK with driving the golf ball after 3 months - first golf outing will be Easter Monday - April 25th! -4 months & 12 days)

6 - Mowing the lawn (Push, self propelled after 10 weeks, riding mower when driving.
(No problem with this, 8 inches of snow on the ground & it's February!)

7 - Raking leaves - (OK after 3 months)
(see 6 above)

8 - Snow Blowing - (OK after 3 months)
(Do not own a snow blower, but I know what I'm getting for my birthday)

9 - Snow Shoveling - NEVER
(OK, I confess I already messed up on this one, but I have been careful!) And what does never mean!!! Am I allowed to shovel in my garden? Could I use my pitching wedge from my golf bag to move snow? Need to discuss with my cardiologist!)

10 - Swimming - (Laps after 3 months, casual swimming once scabs completely off & incision well healed)
(Good on this one, do not like to swim laps & the only swimming I do is on vacation)

11 - Tennis - (After 3 months - start with doubles)
(Have not played tennis in years)

12 - Hunting - OK after 8 weeks
(see #11 above)

13 - Outside Bicycle - OK after 8-10 weeks if using an upright position. Minimal weight on arms.
(see #6 above)

14 - Crunches - OK after 12 weeks
(I cannot work on my "6 pack" for another 5 weeks)

That is it. That was the handout I received yesterday. I have been pretty good, except for the snow shoveling! I will try to stop this activity, but ask my doctor why this is the only activity that listed NEVER!!!!

Back at Rehab!

Just arrived home from rehab and here is the latest:

1 - Still had a few extra heart beats at certain times, but they were not as concerned. I did not push myself and started working on upper body. Here was my routine:

Place monitor on chest for nurses to monitor
Warm Up
Walk two laps
Rowing machine for 6 minutes & wash hands
Take blood pressure & wash hands
Treadmill for 12 minutes & wash hands
Take blood pressure & washed hands
Arm & Shoulder workout for 6 minutes & was hands
Walk two laps
Cool Down

The entire workout takes about one hour. One thing I will do is buy stock in the company that sells the hand wash - you do that after every machine that you workout on!!!

2 - Today we also had a learning session that covered the following:

a - a detailed discussion on the human heart & its function
b - a look at methods of repairing heart issues - angioplasty, stents, & open heart surgery, along with a look at the heart cath devices, heart pacemakes, and other heart toys!
c - a video of the "emotional" side of heart issues & recovery

It was a great session & the nurse, Sue, did a great job of answering our questions. One thing I have noticed is that most of the patients are male! Need to do a statistical look at heart disease!

Next rehab is Thursday.

Seven Weeks After Open Heart Surgery!

Today I will be 7 weeks out from open heart surgery. Here are some observations:

New Meds: - after surgery
Metoprolol
(me toe' proe lole) Still taking one a day - 25 mg
Amlodipine
(am loe' di peen) Still taking one a day - 5 mg
Clopidogrel - Plavix
(kloh pid' oh grel) Still taking one a day - 75 mg
The meds before surgery have been changed slightly:
Old Meds - before heart surgery
Singulair - 10 mg a day (same)
Aciphex - 20 mg a day (same)
Lipitor - 10 mg a day (my cardiologist told me to double dosage again - 40 mg a day)
Low Dosage Aspirin - 81 mg

Incisions:
I am continuing to heal. Here is a detailed comment on all:
The artery from my leg(from my groin to an inch below my knee) has healed completely. Still have the numbness in my lower shin area.
The artery from my left arm (from my left wrist to my elbow) has also healed, the pain is not very noticeable when I stretch my left wrist.
All the surgical holes in my belly & neck are looking good, and the ones in the neck are hard to even see.
The major incision(10" zipper) is still sore and is is tender at least 2 inches on either side of the incision. It still has a numbness on either side of the incision.

Sleeping:
I am now taking 1 tablet (500 mg each) tylenol PM, around 10 PM to sleep through the night. Last night I tried to not take the pill and I was up around 3 AM & could not go back to sleep. so I will probably take one tablet tonight.

Eating:
Still working on eating low cholesterol & low fat. So far so good. Sue and I are reading labels & eating "heart" healthy. Since the surgery I originally lost about 15 pounds, but I now put 5 pounds back on (I NEED THE EXERCISE!). Super Bowl Party will be a special menu, we got the ideas from Sue's Willow Valley job that had one of their chefs do a special night dedicated to the Super Bowl! GO PACKERS!!!! (I will have one brats!) More to come later in the week about our Super Bowl Menu!

Mental Approach:
Still trying to stay positive and on a routine! Getting back to cardiac rehab will be great - starts Tuesday! We will see how the heartbeat reacts to exercise and I will not try to race the other rehab patients!

PROGRESSIVE WALKING PROGRAM

Found a good exercise program on the web & it also has other tips for people recovering from open heart surgery. The web site is: http://www.heartsurgeons.com/ed5.html

The part that I was interested in was the walking program, here was their schedule:

PROGRESSIVE WALKING PROGRAM

Remember, your heart rate and Rate of Perceived Exertion should be monitored at midpoint during your walking. Your exercise heart rate should not exceed 20 beats above your resting heart rate and your R.P.E. should be in the very light, light (1-2) range. Your walking should be done indoors or outdoors (weather permitting) on flat, level ground.

Week 1 Walk 3 - 5 minutes three to four times daily. Total 12-20 min.

Week 2 Walk 7 - 10 minutes two-three times daily. Total 21-30 min.

Week 3 Walk 10 - 15 minutes two times daily.

Total 20-30 min.

Week 4 - 6 Walk 15 - 20 minutes* one-two times daily. Total 30 min.

I tried to do this up till I had the little bump in the road. So now I am probably two weeks behind schedule. I would put me at the week 3 level right now. That is where I will pick up this week. One of my issues has been the snow and cold! And I hate walking around Park City!