Beta Blockers and PVC's

[Tanddl]

I am a 43 year old female with a history of PVC's. They were very bad about 23 years ago---especially during pregnancy. I haven't had any bad episodes for approximately 8 years. A few months ago I was diagnosed with high blood pressure and I am now on Inderal---20mg. three times a day. This seems to control my blood pressure. After I had been on the Inderal for about a month I began to have the PVC's again. It seems like these episodes are as bad, if not worse, than during pregnancy. I figured that these were triggered by the Inderal, but my doctor didn't think so. She did order a holter monitor and she called a few days later to tell me that I needed to see a cardiologist. She did not go into detail about the results---she just said that she saw enough to know that I needed to see someone else. It seems likely to me, that somehow the Inderal is aggravating the arrhythmia. I have learned from this website that my PVC's are likely to be vagally mediated. They are worse when I rest from activity and when I lay down at night. Based on what I have told you--Is there a possiblity that Inderal could be somehow causing or aggravating this problem and what would be a good alternative? Are there other BP meds that I should also avoid under these circumstances? Thank you so very much for any insight you might be able to offer!

[CCF-M.D.-RCJ]

Tanddl,

Thanks for the post.  I saw someone very similar to you in my clinic this morning.

C1:"I have learned from this website that my PVC's are likely to be vagally mediated. They are worse when I rest from activity and when I lay down at night."

This statement, that the PVCs are aggravated by vagal stimulation, could be true.  Another possibility, however, is that you notice the PVCs more when you are resting.  This is easy to determine by looking at the holter monitor.  If the PVCs are more frequent at times of rest, then vagal stimulation may be contributing.

Q1:"Is there a possiblity that Inderal could be somehow causing or aggravating this problem and what would be a good alternative?"

It is possible (notice that I am saying possible and not probable) that the inderal could be contributing.  However, one of the risk factors for development of PVCs, or for increasing frequency of PVCs, is hypertension.  So it is also possible that the high blood pressure has created an environment in your heart where the PVCs can form.

We generally use class Ic anti-arrhythmic drugs in the treatment of PVCs, provided the person has no evidence for coronary artery disease or significant structural heart disease.  Examples of Ic agents include flecainide and propafenone.

Q2:"Are there other BP meds that I should also avoid under these circumstances?"

None that come to mind.  Inderal is a beta-blocker, so other beta-blockers might have similar side effects in you.

Please remember to talk to your doctor prior to stopping any medication.

Best of luck.

[sampants]

I am on atenolol and have no more of the fish-flopping sensations in my chest.  I do, however, have a feeling of an accentuated heartbeat- normal beats and then I feel a bigger beat in my throat.  I did not have these prior to taking the beta blocker.  

It could be coincidental, though.  I was not really aware of any heartbeats until recently and may just be aware now of something I had all along.

[Tanddl]

I'm pretty sure that if I get off of the Inderal, I'm going to have blood pressure problems again. I am confident however that there is a medication that will control the BP without this annoying side effect. I would be willing to try to switch over to something else, before going through any more tests, but since I'm being referred, I'm not sure what the cardiologist will want to do. I sure feel like it would be worth a try though. Thanks for the posts and for mentioning your meds and your experience with them.

[CCF-M.D.-RCJ]

Hank,

Some people who adequately control their blood pressure do develop regression of LVH.  So it is possible, but I think unlikely, that your more aggressive BP control lead to less PVCs.  Another possibility is that you have developed an increased chest wall thickness with age, as happens to many of us, which has lead to the regression of the ECG-apparent LVH.  A good way to test our theories would be with an echo.

In athletes, I think they primarily develop PVC syndromes from 2 reasons:(1) increased vagal tone from conditioning leads to increased number of PVCs in some people, and (2) increased heart wall thickness leads to a more vigorously contracting heart during PVCs, which is then felt more readily.

Pregnancy-related PVCs are pretty clearly related to increased cardiac output associated with hormonal changes.

Hope that helps.

[Kristin391]

I read with great interest your conversation about PVCs, fluid overload, LVH etc.  I find that I can tell when I am retaining more fluid by the frequency and strength of my PVC's. I tend to always have some but they are definitely worse when my weight creeps up 2ndary to fluid retention. I think this increase in fluid retention increases the work of the myocardium and results in some irritability thus the PVCs.   Also, I do think that a beta blocker coupled with an ACE inhibitor sich as Cozaar would decrease the frequency and strength of PVCs because both of these drugs will result in some decrease in myocardial workload and thus may decrease some irritability.  At least, this is how I have come to view all of this.  I ignore the PVCs because they are always there and I believe they are pretty much harmless unless there should be a long run of them accompanied by dizziness etc..

[bigmick]

Hi Hank,

I was a bit worried to hear of your recent chest pains - what was the upshot of your visit to the Hospital. Is all OK??

BM

[TITUS]

My electrophysiologist prescribed SECTRAL.  It is a beta blocker, but unlike Inderal, is approved for PVCs also.  It works great.

Best wishes,

kim