RBBB and palpitations

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Q:
I have RBBB, and occasional PVC’s, sometimes during exercise. Should answer 1 say ‘or you have PVC’s with right bundle branch block morphology on EKG’?? Could you tell me, are there PVC’s with a left and right bbb morphology (and which is visible on the EKG?) The first answer scared me a little bit, to be honest.

Sometimes I have a tachycardia which I cannot explain. It starts with me feeling my heart beating in my throat. It feels like my heart has suddenly shifted 20 cm upwards in my chest and I can feel it beat high in my chest / throat. One time this happened before going to the gym. It started to accelerate to about 160 bpm, then I tried to relax and it went back to about 100 bpm. I refused to give in to anxiety, so I started to work out anyway. However, as soon as I started lifting weights (and thus my heartrate would go up) I would immediately feel it back in my throat. It was so annoying (and still scary) that I gave up working out after 10 mins, because it didn’t feel good.
Could you say anything, based on this story, about the type of tachycardia? I mean, it would accelerate and slow down based on whether I worked out or rested. This let me to believe that it is in fact a sinus tach. Is this indeed correct? And, could this be anxiety, or something like inappropiate sinus tach?

I should note that I have had numerous EKGS (like 12 total), a 24h + 48h holter, normal echo and stress test. Everything was fine according to the electrophysiologist (I had 0 PAC’s and 2 PVC’s during my 48h holter). Thanks in advance.

A:

RBBB, either  complete or incomplete, palpitations etc have little significance in someone with an otherwise normal heart. This sounds like your situation. With all the testing that has been done, you know your heart is OK, and you undoubtedly have been told so by your doctors.
For reassurance read this:
http://www.cardiac-risk-assessment.com/heart-information/heart-arrhythmia/bundle
For palpitations:
http://www.cardiac-risk-assessment.com/ca-blog/palpitations/
http://www.cardiac-risk-assessment.com/ca-blog/palpitations-and-pvcs/
http://www.cardiac-risk-assessment.com/ca-blog/i-am-worried-about-v-tach-ventric
http://www.cardiac-risk-assessment.com/ca-blog/what-are-some-of-the-causes-of-pr
http://www.cardiac-risk-assessment.com/ca-blog/palpitations-and-fainting/
You’ll find these are rather common complaints and most people don’t need treatment, only reassurance once their heart proves OK.
Hope this helps,
Dr T
http://www.cardiac-risk-assessment.com/

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