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Some Thoughts on PVCs (heart skips) and Anxiety
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Some Thoughts on PVCs (heart skips) and Anxiety

Hey all,

I haven't posted in a while on a MedHelp forum but with my recent onset of very frequent PVCs (have had phases of them for over 30 years) and knowing without doubt that mine were triggered, sustained, increased in frequency...etc... by anxiety and stress, I wanted to add some comments regarding these devilish palpitations, that might hopefully help others.

Before I get to my main comments, I’ll mention that a heart murmur was detected in me in my teens and a referral to a cardiologist found that I had a healthy, normal size heart. Twenty years later (now about 10 years ago), I had an EKG/Stress test because of a phase of PVCs I was going through and again, my heart was normal, with no arrhythmias found (my PVCs seldom occur with exercise). Even though my last check up was 10 years ago, it would be silly for me to go the expense of renewed heart tests because if the PVCs were benign then, they are still benign now, especially with the fact that I have no chest pain with mine, or shortness of breath and I’ve never fainted due to one or noticed any dizziness with them. I’ve had as much as several years go by without attacks of PVCs.

First, I agree with the many cardiologists, MDs and medical people who point-out the harmlessness of PVCs, in people with structurally sound hearts but as we who experience episodes of frequency with them know, they are not harmless to one's quality-of-life and emotional well-being. We therefore must develop coping skills and if-needed, take medications that help us deal with them.

The reason I can tie my PVCs directly to my anxiety, is due to the fact that I've suffered generalized anxiety and occasional panic attacks since my teens (over 30 years). My palps have occurred at times in my life of severe stress and anxiety, since youth. Amazingly, I have actually gone years at time, not noticing anything other than a very occasional PVC. Afterward, a phase of them might show up and last for weeks or months.

I feel that people who have posted, saying that stress and anxiety was not involved in their PVCs, have the type personalities that deal better with stress/anxiety than some of the rest of us. In other words they can have significant stress but don't perceive it as others do. I say this because if they had no stress/anxiety, their posts of concern regarding their PVCs would not be appearing on forums. They likely felt a PVC or two and began to subtly anticipate them and also likely experience little adrenaline surges when they occur, that causes succeeding ones or even runs of them. They are fueling them more than they may realize.

I also feel that the fight or flight response becomes so touchy in those of us whose anxiety increases with PVCs, that adrenaline is released in lightning-fast spurts, with each heart skip. This adds not only to the perception of them (palpitation/felt) but also to the strength and frequency of them. While we can at times convince ourselves, saying "this is just part of my anxiety/stress disorder", the unpleasantness of them works in the back of our minds, saying to us "this is going to lead to a serious heart problem or arrhythmia for you if they keep happening like this". This is why I referred to them as “devilish” at the start of my post. They are in-essence "thorns in the flesh" -- little reminders of our mortality, while we try to live life and enjoy it.

Some of the heart specialists I've read on the PVC subject, state that "about half of us have them" (PVCs and PACs). This is why when people post about the "potential deadliness of them" or the "potential for them to evolve into life-threatening arrhythmias, they should not do so, without adding the fact that this is only true in people who've suffered serious heart damage or have significant heart defects. If this were generally true of healthy people, that would mean that 50% -- half of the entire population is at risk for dropping dead at any moment but common sense says this is not true.

My mother for example made trips to the emergency room, 25 years ago when she began having frequent PVCs and runs of them, after a period of severe stress and anxiety (I inherited her anxiety disorder). She is now 75 years old and has kept the PVCs controlled via daily Xanax for all of that time. Amazingly, this same benzo drug is what controls/reduces mine and so I too have begun to take it regularly at low to moderate dose. I was reluctant toward the drug at first, due to information warning of it's potential for dependency however, dependency is exactly what SSRI antidepressants require, as do beta-blockers, neither of which can be abruptly stopped but must be weaned-off of (if situations merit), slowly, under Dr.-supervision.

I was originally placed on a beta-blocker but the fatigue I experienced with it is was far worse than that I experience with Xanax. Additionally the beta blocker causes me sexual dysfunction and worse dizziness when first standing from seated. The Xanax causes none of these issues for me. Please understand this IS NOT a plug for Xanax or any benzo for that matter; I'm simply saying this has been my experience but may not be the case with other PVCers and PACers.

In conclusion: I do feel anxiety is a very common trigger for PVCs and likely the number one trigger. Add to stress/anxiety, some caffeine or other stimulant or even digestive problems (especially hiatal hernia and GERD) or hormonal/electrolyte imbalances and these little devils can really flare and feel nasty. Amazingly, you can have far-less adrenaline in your body when anxiety is reduced and the PVCs are far-less noticeable. The hard thumps for example, feel more like gentle blips (if felt at all) and the head-rush or mild chest discomfort/pain that follows them might not be there at all when a person is relaxed. Of course this varies among us but I suspect this to be true in most cases.

I mentioned my mother but my uncle who recently passed at age 80 from a brain aneurysm (not heart related), was at one of his last Dr. visits when they mentioned that he had lots of PVCs when they monitored his pulse. He was surprised because he said he never felt them. They told him that he likely has always had them. Here again, an example of how relaxed people have them but are not aware of them but anxious, highly-tuned-in people will feel every flipping one of them. Anxiety simply adds to the strength and frequency of them, as mentioned.

In conclusion: Find things through cautious and responsible experimentation that will help you cope with your PVCs (i.e. potassium, magnesium, lots of water, essential fish oil, CoQ10, eliminating stimulants, reducing stress). If you can do-so without prescribed drugs, this is the preferred way to avoid side-effects or possible long-term problems from them. If however, a person needs at-least short term pharmaceutical help; this is nothing to be ashamed of in my opinion. In my case for example, a situation developed in my son’s family, that terribly increased my anxiety/stress level, plus I struggle with other non-heart related health disorders (thyroid disease and mild peripheral neuropathy) and I saw the medication alternative, at least for the time-being, to be the best one for me. At the same time, I exercise regularly (daily walks) and I do work on stress reducing and anxiety self-therapy, every chance I get and at times, I’m pretty good at it.

I hope my comments are helpful to my fellow PVCers – God Bless you all!
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I wanted to add to my previous post, the fact that the cardiomyopathy scare that some people with frequent PVCs have after online search can be easily remedied by asking their doctors for a simple BNP blood test (B-Type Naturietic Peptide). This test detects both restrictive and constrictive cardiomyopathy, which always presents with degrees of heart enlargement, with 97% accuracy. Cardiomyopathy is also called Chronic Heart Failure and Congestive Heart Failure and even mild cases of it can be detected via the BNP blood test, which is also not expensive to have done. Of course an echocardiogram is an even more detailed test for looking at the heart but not everyone can afford to see a cardiologist to have one performed.

The levels they look for in people with mild heart failure is "100" and above in a range of 0 to 100. This would indicate mild cardiomyopathy. If the result comes in at 300 to 600, this indicates moderate heart failure and results at above 600, indicate severe heart failure. I would strongly suspect that the 3% loss of accuracy out of 97% is those readings that are close to borderline because the higher readings are certain for heart enlargement.

BNP is actually a hormone released from the brain, in response to added pressure of any kind on the heart muscle and it will elevate even if there is stress on only one heart valve, such as the left ventricle or even if a person has chronic (long-term) untreated, severe hypertension that has placed added stress and pressure on the heart. If chronic PVCs have done this same thing (likely extremely rare, unless other heart disease is also present), the BNP will elevate.

I had the BNP test ordered by my doctor, one year ago, after I developed adult asthma, that I felt certain was due to my chronic GERD (acid reflux), which I have had most of my life. With the fact however that heart enlargement can also cause breathing problems (cardiac asthma), I had the test ordered, plus a chest x-ray, which showed normal size heart. My BNP result came back at "4", which I was very happy with.

A few weeks ago, I had the BNP repeated after the onset of my most recent phase of PVCs and my result was very low again, at "16" -- still far below the "100" upper-normal cut-off value. This despite weeks of increase in my daily walking routine (doubled my distance) and the fact that the blood was drawn in the afternoon, rather than in the morning as the previous one was. BNP, like other hormones, will fluctuate several points within a 24 hour period and it also increases naturally with age. I'm close to the half-century mark age-wise myself, so I'm very happy with my two low readings over the one-year period I had them done.

For those who may have had a bit of cyberchondria rise up in their anxiety-sensitive hearts regarding heart failure, resulting from online search regarding PVCs, I wanted to add this bit of information for balance. Also keep in mind that literally 100s of posts have been published by PVC sufferers, who have them very frequently, for decades, report having healthy heart check-ups. Those who do develop heart disease following years of PVCs, could have a number of other factors involved (i.e. smoking, obesity, severe untreated hypertension, heart defects, they are elderly etc...) and the PVCs may have had little or no involvement in the development of their cardiac diseases. When heart disease is actually present, PVCs can be of some concern (some doctors state only slightly higher risks), as can many other things that are of far-less concern in people with otherwise health hearts.

I again express my sincere hope that these bits of info were helpful to anxiety/PVC sufferers!
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After I copied/pasted my above article I did a quick search and many medical sources state that the BNP blood test, actually has a 98% accuracy. This includes the Harvard Medical School, at this link: http://www.health.harvard.edu/press_releases/bnp-blood-test

I'm a stickler for accuracy, so wanted to add this small correction.
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I received an email from the HedHelp Team and they appreciated my sharing information from another source but asked that I cite the original location of it.

As mentioned in my posts above, the info is my original authored work that I published on Associated Content Yahoo and it afterward occurred to me that the info might be helpful for this MedHelp Anxiety Community Forum.

I didn't reference my original published-source due to concern that it might appear as self-promotion. I have left off the links because I'm pretty certain those are not supposed to be included however, the titles of my two articles are "What I Think About Those Devilish Heart-Skip Palpitations" and "Heart-Skip Palpitations (PVCs) and Cardiomyopathy".

Thank you MedHelp & Members.
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MedHelp sent the usual email, asking that I select a best answer, so I'll choose this one.
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I enjoyed reading your posts they may help me sleep better at night.

I am currently on acebutolol for my pvc since I had a high number of them.  I dont know if its helping or not I think it just stresses me out more. I still have the pvc's though.  I have xanax in low dose that I can take at night but I have only take 1/2 of one on my way to bed.  
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I'm so glad the info was of help. My PVCs actually diminished and them went awy totally and I've been relatively free of them now for a couple of months or more.

I've experienced this pattern before, in which they would occur for weeks or even months and then suddenly gone. You may see this same thing in your case but if not, just remind yourself often of their harmlessness, especially if your Doc says your heart is healthy. In most cases, even when people with PVCs haven't had healthy heart check ups, they are not dangerous or harmful in the vast majority of cases and usually only a concern if known heart damage, blockage or serious heart valve problems are present. Mitral Valve Prolapse effects lits of people and causes them PVCs but most cases of it are also benign, according to lots of medical sources, including Mayo Clinic.

If you do ever have chect pain (true chest pain, rather than the milder type that anxiety can cause) or fainting with the PVCs, this would point to the need for more extensive cardiac tests, according to medical sources.

Best Wishes to you in coping with those crazy PVCs and I hope you actually see them go away!
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Thank you for posting. This has been one of the most helpful, if not, THE most helpful thing i've read about PVCs. I was prescribed a beta blocker but i dont take it because my heart rate drops to 40s when i have a run of PVCs. Another doc prescribed me Ativan (a benzo) which seems to help most of the time. I hope you are doing better sith your PVCs. God bless..
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