PVC/PAC breathless

[michael3763]

42 year old male, bad fam history. Since 2004-05, I started to feel fluttering, and I have had chest pains that my cardiologist insists aren't cardiac related.  My wife and I had our first child, switched jobs, moved, and went off my anti-anxiety medication . In June of 2008, I felt very flush, a bit breathless, and went into tachycardia.  I went to the ER.  They gave me metoporal and I stayed overnight. They put me on a small dose of propranalol.  Since then,  the palpitations happen every day, accompanied by constant tension in my chest and throat.  Recently, I stopped the propranalol as I felt I was getting worse.  My internist put me on 25mg of toprol xl.   A month and a half ago, I tried a 30 day event monitor, and I captured lots of PVCs etc..  I also captured a 9 beat episode of ns monomorphic v tach.  An echo was normal. My cardiologist increased the toprol to 50mg, started zoloft, 50mg and will increase soon. I am taking cozaar for bp, lescol xl for chol, prilosec and 81mg aspirin. My kids are 2 and 5, and last week we went to Disney.  From Sunday until Friday, I had 1 episode a day of flushness and breathlessness that lasted up to an hour...my heart rate remained normal for the most part.  Yes, there was heat and humidity, but the first episode happened at rest.  Mostly, this occurred before we were supposed to go somewhere(event, breakfast etc.). I contacted my cardiologist and my uncle(who is a cardiologist and they talk about me), and they told me to stay the course, and that everything indicates that I have a structurally healthy heart.  I asked about more invasive testing, and my uncle told me that most men my age have blockages and that if I had one, they would stent it.  He says that is a road that I don't want to go down.  Can I have a blockage and still have a structurally normal heart?  Can PVC/PAC cause these episodes?  Is it possible that I had panic attacks? The episodes ended when the trip was winding down   Should I get anymore testing?  

[Lee Kirksey, MD]

Hello
Theres a lot of information and Ill try to answer all of your questions. You have had a long history with a complex problem and it is difficult for me to speak specifically without having the same clinical information that your cardiologist and uncle have.

With regards to your question about panic attacks it sounds like you have had a history of anxiety so clearly there may be some component of anxiety. However a problem like yours can be multifactorial with a number of contributory components. Anxiety might be one part but I would be reluctant to rush and attribute all of these issues to anxiety.

I disagree with your uncle that most 42 year old men have coronary artery disease.  He may have been referring to your situation specifically if you have a family history. If you have had a normal echo and stress test it is relatively unlikely that there is any ischemic component to this problem (ie blockages unlikely the etiology). Yes you can have mild blockages and have a structurally normal heart

There are a number of conduction disturbances that can cause arrhythmias and it may be helpful to be evaluated by a conduction specialist if you have not already done so.

PVC can cause epidsodes that sound like yours

My suggestion is that if you have two cardiologists, both who know your case well, suggesting that nothing else should be done and you have ongoing concerns--you should consider seeking out another opinion to put a fresh set of eyes on your problem. collect your records and visit your regional expert university for consultation.

Good luck and best of health

For more detailed information on the role of anxiety and stress in the development of chronic illness like heart attack and stroke read exerpts from my book Your Guide to Optimal Health at www.personalwellnesswheel.com

[michael3763]

A related discussion, 2 stents and 1 angioplasty later... was started.