Dear Dr. Roach: I am a 75-year-old man who recently experienced three episodes of lightheadedness. After testing, my cardiologist determined that these were not likely to be cardiac in origin. My concern is with the result of my 24-hour Holter monitor, which showed a little more than 1,000 isolated PVCs — premature ventricular contractions — in 24 hours. I have been told that this is either “dire” or “not an issue.”
I would appreciate your comments on the issue and any discussion of treatment for frequent PVCs.
J.G.
Normally in the heart, the electrical impulse starts at the sinoatrial node, often called the pacemaker of the heart. The impulse proceeds down clearly defined pathways — think of them as wires — to the atrioventricular node, where it waits for the mechanics of the heart to catch up with the electrical system. The electrical impulse then travels down the bundle of His to the Purkinje fibres, which stimulate the ventricle. (That’s not a spelling error; you can Google “bundle of His” if you want to.)
Occasionally, in everybody, an electrical impulse will come from a different part of the heart before the normal SA impulse. If it comes from the atria, it is called a premature atrial contraction; and if it’s from the much larger ventricles, a premature ventricular contraction. These are clearly distinguishable on an EKG. A PAC is early and narrow (since the impulse will go through the AV node), while a PVC is early and wide (since it does not, and must travel cell to cell).
My opinion is that frequent PVCs at your level is somewhere between “not an issue” and “dire.” One study showed that people who had no known heart disease but more than 30 PVCs an hour (720 in 24 hours) have an increased risk of heart disease over people with fewer than 30 per hour. The overall increase in risk is not large in absolute terms, however.
Although there is treatment that can reduce PVCs, it’s not clear that this reduces the risk of heart disease, and some treatments actually increase mortality risk.
I recommend treatment for frequent PVCs only if there are very bothersome symptoms that are clearly related to the PVCs, or in the very infrequent event of someone with so many PVCs that the fast heart rate damages the heart.
Dear Dr. Roach: My husband is very clean in his personal hygiene and takes great care for safety in health-care matters on his job as a plumber. My concern is that when he perspires during the night, it leaves a brown residue on the sheets, sometimes down to the mattress pad.
We don’t know if it is something to be concerned about, and we fear something may be going on inside. He is 41, physically fit, but works very hard. He is under a lot of stress.
V.S.
Abnormally coloured sweat is a rare condition called chromhidrosis. The sweat may be green, brown, orange, yellow or black. It may occur on the face, armpits, groin or other areas. The colour comes from an excess of pigment in the sweat glands. Occasionally a medication can cause it, but usually it has no known cause and does not represent any kind of disease (one exception is in people with jaundice).
It sometimes can be very bothersome cosmetically, and treatment, including botulinum injection or capsaicin cream, has been effective.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu
