PACs, PVCs and CAD

[Duplix]

Thank you for taking my question. I have been reading that PACs and PVCs are benign in the setting of a structurely sound heart. I have CAD and a 5 graft CABG but have had no heart attacks or heart damage. Does that mean that the PACs and PVCs that I have are benign? In other words, is someone who has CAD and no heart damage considered to have a structurely sound heart?
Thanks again.

[Cleveland Clinic]

duplix,

thanks for the post.

By definition, the presence of coronary disease means you do not have a normal heart and ncreases your overall risk of a cardiac event even without PACs and PVCs. What you have to realize is what the actual risk is from though and guide your therapy and focus in those directions.

In the absence of blockages that are leading to rhythm issues or any significant previous heart damage, your main risk of having a major cardiac complication comes from the risk of having progression of your coronary disease, such as with the rupture of a atherosclerotic plaque.  Thus therapies designed specifically to prevent progression of your disease and decrease your overall risk of a myocardial infarction will have a significant impact on that risk.  

In certain subsets of patients with a prior history of coronary disease, such as those with a low ejection fraction, or very frequent ventricular ectopy the risk of sudden cardiac death is markedly increased and those specific patients may benefit from cardiac electrical therapy such as implantable defibrillators.

I know it's hard not to focus on the extra beats, but I can't stress enough the importance of taking care of your overall health. An interesting study was performed in patients several years ago that tries to suppress PVCs in patients with CAD. Interestingly, by using arrhythmic medications, researchers were able to suppress the extra beats. However, the main side effect of the medications was to increase the risk of sudden cardiac death.  Thus, the cure was worse than the disease.

Hope this helps.

good luck

[tickertock]

This is an excellent question and probably one that is worthy of alot of debate.My guess would be statistically speaking someone with known CAD might be at a slightly higher risk with PVCs , but another plus would be no heart damage from the CAD and that is was caught and preventative measures taken. My opinion only.

[CollegeGirl143]

Great question! possibly a topic of debate in the medical community.. Ide also like to add, its nice to see a twist rather than the standard palps question, interested to see the docs reply.

[Al Dente]

I think this is a very good question.  Those of us who suffer from CAD or other goofy stuff with our hearts do take these things with more concern.

My docs do tell me not to worry too much about PVCs or PACs, but do tell me to take note of any changes and to get checked out.  I've leared to pretty much ignore them, but if I get some whacky ones, they do raise my eyebrow.

[jkfrench]

Hey, I have a new e-mail.  ***@****
Netscape crashed on me.   I lost everything.  Hope all is well
Jodie

[momto3girls]

Wow, really interesting question.  My cardiologist always tells me that my pac's and pvc's are not a problem unless I have coronary artery disease.  I always wondered why.  I'm very interested to see what the forum dr. says By the way, what is CABG?  (:

Hi Al,

Just wanted to say hi and hope your feeling well.  Happy New Year to you and everyone too!  Best wishes (:

[Al Dente]

Hi momto3girls and everyone...happy new year.  Thanks, I'm doing ok and getting over a really nasty cold/sinus bug.

Doc bjk had a great post...those of us with heart disease get another opinion on PVCs/PACs.  I've had some nasty runs caught on event monitors.  During a couple caths I had some really ugly kicks that the cardios took a look at...I had few nasty beats in a row, and the doc just looks over and says "you ok buddy"....lol.

I do have some concern of what lurks, but if we dig enough we'll find something.  My CAD seemingly is in check and hasn't progressed.  I keep the 50% in my RCA and 30% in my LAD in the back of my mind...moreso the LAD and it has a tunneled section.  

My CAD is diffuse--it's everywheres so we have to keep an eye out and control all risk factors.  What I've found pretty interesting is the role of small vessel or microvascular disease and angina.  I'm on an intensive treatment with diabetes meds and my angina has greatly reduced.

I won't get another cath for a while.  Like the doc says, take care of yourself and take your meds.

Take care 8 ^)

[momto3girls]

Hey Al,

I'm glad to hear things are going well for you (:  That's good news.  What kind of nasty beats did you have in a row?  PVC's?  I had a little run of them when exercising this past fall (they felt huge) and the doctor said no big deal.  I just don't get why exercise tends to bring mine out.  Weird.  Oh, why can't the heart beat perfectly 24/7??  Or in your case, have clean and wide open arteries (:

My brother-in-law is diabetic also and lately hasn't been taking good care of himself.  He's on metformin and says it works well.  How interesting that the diabetes meds have helped with your angina.  Any idea why?  Geez, you have a lot going on (:  Well, have a great New Year and take care (:  Best wishes to you and your dad too!

momto3girls

[Al Dente]

Hi,

Hope you are doing well...Those are some very good questions that you have--why cant the heart (insert problem here)?  The heart is an interesting machine that throws out alot of complex problems.  We ask questions out of curiosity of what our hearts are doing.

I've had a few ventricular ectopics recorded, as well as bigemy.  Lots of PVCs and PACs.  I don't know what the guys caught during the caths, but the last one caught some very strong PVCs.  My RCA spasmed during one cath--not sure if that was a cath/operator induced event, or something that's been going on.  With medication, the coronary spasm has been dormant, which is good!

I'd love to figure out whether it's my aorta or superior vena cava that throbs with each beat (kinda annoying).  One doc said during a cath, "gee your heart pumps hard."

----

There is quite a strong connection with diabetes/insulin resistance and heart disease.  It all falls in step with cholesterol, hypertension, and all those neat chemicals that constrict or dilate our vessels.  Endothelial dysfunction and coupled with a problem in how the cells use insulin has an influence on how the heart's muscle uses oxygen...this stuff gets pretty complex.  

Good cardios are up on how insulin restistance plays a role in small vessel disease.  Along with the cardiac meds, the diabetes stuff (Actos, Metformin, Januvia) seems to making a big difference.  I haven't taken a sublingual nitro tab in 4 weeks, which is a massive improvement over last year at this time.  I do take 30mg of Imdur (long acting nitro) which seems to do the job.

One of my cardios told me that only 15% of their patients actually exercise (I was amazed).  It takes a combo of meds, lifestyle/diet, and exercise to keep heart disease in check.  Patients that acutally take an interest in their health are the oddballs--I guess with our research and work we do to understand the heart puts us in the minority.

Take care!

[momto3girls]

Hey Al,

Ya, why can't the heart work perfectly??  I've always been fascinated by the heart, ever since my dad started having issues years ago.  When he had his ablation last Christmas, I was all over this forum looking for possible side effects and what to expect post-op.  I do take an interest in my own health because it's been so screwy since I had my last baby 3 years ago.  I love being able to go into my cardiologist's office and have them use terminology that I actually understand.  I hope that doesn't sound vain!  I do remember reading about diabetes and the long term effects on your cardiovascular system.  You're right then, about taking charge of your lifestyle and keeping healthy!  A friend of mine has a 3 year old who is severely diabetic.  Her little pancreas doesn't do squat for her (poor baby) and so my friend says that she is her walking pancreas!  She's had a couple of scares with her blood sugar plummeting and being unable to bring it up.  I can't imagine how hard it is to be a diabetic.  

Anyhow, I'm very glad to hear you're feeling better.  You should've been a doctor yourself with all the helpful advice you've give many of us here on the forum.  Take care and best wishes to you!

momto3girls

[redrocker]

First timer on the forum.  I have had PVC's for 25 years, which have increased in frequency and severity over the past couple of years.  I am convinced that anxiety and stress are the largest component of my problem.  My cardiologist has put me on 120 mg of propranolol for the PVC's, and also to reduce the growth of an aortic dilation. The PVC's seem to be improving with the use of propranolol, but I may be having side effects.  I have read of others on the forum speak of wierd, fainting type sensations while falling asleep that jolt you awake.  I am having the same problem--they can be frightening--like I am losing consciousness.  Once I fall asleep, I'm OK. Anyone hear of this?  I have done some research on the web, and I see that propranolol is linked to bronchspasms--which kind of feels like what I'm experiencing.  My doctor is considering switching me to 50 mg of atenolol.  Has anyone with PVC's tried both drugs, and if so, which did you have the best luck with?  Thanks.  Peace and wellness to you all.      

[tickertock]

I have tried both propranolol and atenolol, I would definitely rate atenolol the better of the two in controlling PVCs and tachycardia in my personal experience with both drugs, but then again we are different and respond differently.Others might rate propranolol the best or even another beta blocker.

[karie]

Holter monitor showed 1,518 ventricular ectopic beats, Supraventricular ectopy 3 beats these palps have increased since first symptoms in early 20's,I follow all the Heart Health guidelines with no caffeine, alcohol, sugar and exercise daily . Mitral valve prolapse, cardiogenic syncope and heart murmurs with a family history of heart disease.
How many are to many and are the meds risky or helpful?
Have run low in potassium so increased with diet. Appreciate some feedback

[redrocker]

Thanks for the info.  I was wondering if you could give me your opinion on a very perplexing problem.  I have switched from propranolol to atenolol (25 mg/2x per day) per my cardiologist's orders, because of his concerns over bigeminy they observed on a recent EKG.  I had been on 80-100 mg of propranolol for over 2 years, for PVC's and GAD (general anxiety disorder).  I think the atenolol is doing a better job of controlling the PVC's than the propranolol, but my anxiety level has shot off the charts. My GP warned me that going off the propranolol may cause a large increase in anxiety, and boy was he right.  So I am stuck with a dilemma--do I stay with the drug that reduces the PVC's the best, or the drug that reduces the anxiety the best?  Last night, I had a public speaking engagement, and I thought my heart was going to stop--I had severe bigeminy and anxiety.  So I don't know what to do now.  One of my doctors told me that pharmacology is a very inexact science--more of an art really, and that you just have to experiment with the different choices.  Is there a doctor on the forum who could also give an opinion?  Thanks.          

[tickertock]

I take atenolol 25mg 4 times daily, it works better for me that way. Propranolol, from understanding and also experience has a more central calming effect than atenolol, atenolol is more cardioselective than propranolol, therefore that might the cause of the anxiety rebound, maybe your doctor might prescribe an anti anxiety medication short term to help you through the transition of medication. I am not medical doctor and is speaking of my personal experience only. Check with your doc and tell him your concerns and see what he says. Good luck and I hope you feel better soon. PVCs are the bane of some persons existence.