High diastolic BP and junctional heart rythm...too many PAC's..advice please..

[momtotwinsplus1]

Hello and thank you for your time. I am a 37 year old woman, 5'6" 258lbs. My main complaint is palpitations which have taken me to the ER more than once. My BP is generally 122-139 over 89-103, most recently 122/98.In the last 9 months I have had 2 episodes of SVT, this finally got me to a cardio who did a an echo and treadmill test,48 hr holter, and EKG.
The echo was normal except for mild mitral regurg, and pac's/pvcs. The treadmill was also good except for my heart rate rose too quickly, obviously due to being obese. My EKG showed inverted p-waves. The holter showed I was having about 1-2% of total heart beats being PAC's.
My cardio explained that I have what is called a junctional heart rythm, that my heart has created an extra pathway which he says is causing the PAC's. He talked to an EP , who said he would consult with me if I wanted to but it was up to me.
My cardio put me on ToprolXL 25mg.for pac's but it doesnt seem to be helping the diastolic reading ,still cant get it below 89, though the systolic goes down at times to 115 and pulse 52. Also the PAC's seem worse. Im wondering and worried as to why there is such a discrepency between the diastolic and systolic numbers. I did have a Kenalog (steroid) shot recently due to walking pneumonia.
I have dropped 20lbs and am using the treadmill 45 mins per day, every day. Im on a very low carb diet.
Since I am losing weight and excersizing, Im wondering if Ill be able to go off the Toprol. Also do you think ablation should be considered with a junctional rythm? Any other thoughts? Thanks for your time!

[Cleveland Clinic]

momtotwinsplus,

thanks for the post.

There are several reasons to use Toprol including arrythmias and blood pressure control. Generally, beta blockers as a class are not the best agents for hypertension.

If you are asking can you come off toptol for blood pressure if you lose weight, quite possibly.  A few people, especially with marked obesity are able to come off their antihypertensives or cut the doses by getting into shape and losing weight.

Some people have less palpitations from PACs and PVCs on beta blockers. If this is the reason you are on the beta blocker, and its not having any effect I would discuss coming off of it with your physician.

Generally, pacs are not treated with ablation.  

I think your best bet to feel better is to continue on the course that you are on of weight loss, diet and exercise with your physicians supervision.

ggod luck

[Momto3]

"The echo was normal except for mild mitral regurg, and pac's/pvcs. The treadmill was also good except for my heart rate rose too quickly, obviously due to being obese. My EKG showed inverted p-waves. The holter showed I was having about 1-2% of total heart beats being PAC's."

Don't assume that your HR rose quickly because of your weight. I had the exact same thing happen and I am not overweight.  After years of excellent BP, last year I had repeated readings considered "prehypertensive" - 130/140 over 70/80.  Dr. put me on lisinopril and it is under excellent control now.  Not sure what will happen with the HR on the next stress test.  When we discussed the possibilities, one of them was "deconditioning," a very real possibility.  I'm trying to increase the amount of exercise I get and it really seems to be helping with shortness of breath and quick rises in HR.  

Keep up the great work!!  How do you stand it on the treadmill for 45 minutes...After 15 minutes, I'm sooo bored - even with the TV on : )  At one point I was up to 25 minutes.  I actually much rather walk outside, but it's still too cold : (

[uptowngirl]

It's STILL too cold to go outside?????  Please come down.

[Momto3]

YES, it's still cold and I'm getting real tired of it!!  A whopping 36 and overcast today, and a Northern wind to make the temps feel even colder : (

Uptown, headin' down next week : )  YEAH!!!

[Bromley]

Ladies, I hate to butt in here, but please realize that exercising in the cold weather can be safe and great fun --- the trick is to dress right for it.

Go to the running section of a modern sporting goods place --- you will have a nice time visting, and while you are there you will find lots of garmets made from light weight materials that let the moisture out and keep the heat in!!!

This year I jogged outdoors all winter through temps as low as 15 degrees with 5-10knts of wind.  As long as the snow does not exceed a couple inches unpacked, or I can get my shoe onto pavement free of ice, I am good to go.  Yes it is cold, but with the right clothing, it is no problem at all, and is in fact very enjoyable.

No more excuses!!! Above 30 degrees is starting to get balmy. I am in cargo shorts and a wind breaker at this point!!!  

[Momto3]

Thanks for the upbeat comment : )  Loved it!!

But, even us winter weather folks tire of the long, cold winter seasons of the northeast.  Especially, since we have not seen much of Ole Sol for a long time.  Although I am not a runner, I was walking regularly until January, and then.....120+ inches of snow fell and I was grounded.  We are just now seeing our grass since the week before Christmas.  We have had near record snowfall and I am soooo ready for spring.  Maybe I'll be ready for some cold weather walking again in November : )

Thanks again!!

Connie

[uptowngirl]

Bromley,
You go girl, good word.

momto3,
Yeah, Come on, should be in the 60's next week!!

[Bromley]

Uptowngirl-
I named myself Bromley after our Stuffed Bear.  For future reference,  Bromley is a soft spoken boy bear...

Mom -
I see what you mean.  That sounds like a lot of snow to deal with.  Ours has melted now and I am thankful for it.  Perhaps you could try snowshoeing, or cross country skiing next winter. For warmth, maybe try ****'s sporting goods...

[uptowngirl]

My apologies to you for my presumptuous comment.  Forgive me.  What I meant is "you go guy".

All the best,
uptown