Inherited Arrhythmia

Hello, I am under the care of a cardiologist and I'm having some doubts about his diagnosis, so I wanted to post my symptoms and history here and see if anyone could give me a second opinion.

Family History:
Paternal Great-Grandfather:  Fatal stroke caused by prolonged paroxysmal atrial fibrillation
Paternal Grandfather:  Wearing pace-maker due to paroxysmal atrial fibrillation that does not diminish with medication
Father:  Taking Rhythmol and Metaprolol for paroxysmal atrial fibrillation, heart attack at age 43 (before treatment began)

My symptoms/history:
In the past I experienced atrial fibrillation/flutter that was rare (about 10-12 times per year) and lasted for about 30-45 seconds.  The episodes were startling and caused shortness of breath and mild chest pain.  I experienced this phenomenon for most of my life.  About 10 months ago, I totally cut alcohol and nicotine from my lifestyle, and severely curbed my intake of caffeine.  I have not experienced an episode since that time, but I am now experiencing new symptoms.  I have PVCs (brief, sometimes only a single irregular beat) that occur about 10-12 times daily (untreated) and about 1-3 times daily while taking Metaprolol (prescribed by my cardiologist).  Most often these just feel like a wrong beat, but sometimes they are accompanied by pain, sometimes mild, but sometimes sharp.  Since I began taking the beta blocker, I have felt overly fatigued on a near-constant basis, and I can't sleep through the the night at all.  I wake up randomly, even interrupting dreaming, at least 1-3 times per night.  My father had a similar symptom, though my cardiologist has suggested that I have an anxiety disorder.  Additionally, I am experiencing more pronounced PVCs during strain (such as strength training, sexual activity, and sometimes while going to the bathroom).  I wore a Holter monitor for two weeks recently (a follow-up since I had already worn one for a month when first diagnosed with an arrhythmia).  The cardiologist said that he saw the continuing 1-3 PVCs while at rest, but he said that every single time I hit the event button during a period that my heart-rate was elevated (exercise, etc.) I was at normal sinus and there was absolutely nothing happening.  He suggested that exercise was actually suppressing my arrhythmia, and that I was just more aware and conscious of my own heartbeat.  I find this difficult to believe since I KNOW I'm experiencing some kind of palpitations during exercise.  I also seem to have them sometimes just lying on my back (don't know if that's significant).  

Questions:
I would like to know if a simple 25mg beta blocker is adequate and appropriate treatment for these symptoms.
I would like to know if a Holter monitor can fail to detect certain arrhythmias.
I would like to know if I'm in any danger while straining.

Full disclosure:
I'm active duty and my cardiologist is a military doctor.  Is it possible he's understating my condition to safeguard my career, or that he's not properly diagnosing me because he's just not that good of a cardiologist?

[ireneo]

First of all beta blockers are notorious for causing the fatigue and the general crummy feeling you're having. Not sure about the sleep issues.

I'm not sure what you're feeling during exercise but the monitor didn't pick up any abnormal electrical activity. Certain foods, stress and fatigue can trigger more PVC's but they tend to be pretty random with no rhyme or reason. That's part of the frustration of having them. We can't control them completely.

"Straining" is very similar to the valsalva maneuver which is often used to correct an abnormal heart rhythm. I've used it for years to snap my atrial tachy back to normal sinus rhythm. With valsalva I take a breath, hold it and strain as if having a BM. My rhythm may flip flop a bit and then kick back to normal. You see that's not much different than what you're talking about.

I don't think the PVCs are of great concern. I average 1-5 a minute. For a period of 5 months I was having 15-25 a minute, caught on a monitor and the cardio still wasn't concerned. The a-fib needs to be watched. Longer periods of a-fib can lead to blood clots and thus strokes as you probably know. That's why people with a-fib are either cardioverted when it's lasting too long or take medications to manage it.