PAC's and PVC's

[adam blum]

35 yr old male, strong physical condition, resting HB 50, recently given normal on EKG and stress echo and thryoid, had a lone afib some 12 years ago, none sense, but have become more symptomatic wityh PAC and PVC's recently and became concerned. under high desgree of work / life related stress. questions:

1. does stress and anxiety have actual impact on pac/pvc?
2. have had at least one episode where I woke up with seemingly fast beat in throat which resolved quickly upon waking - is this different or should I be concerned about this. if this was tachycardia should it be seen as a progession of the PAC's?
3. taking 25mg zoloft in am and 1mg klonopin at night - could these contribute in any way to symptoms?
4. does ibuprofin have positive / negative effect usually?
5. any known or trusted herbal supplements?
6. do u recommend magnesium supplements?
7. does a bannana per day help - potassium supplements?
8. does waking up or experiencing these many times in sleep-wake transition period mean anything? any conclusion can be drawn?
9. does sleeping on right vs left side help symptoms?
10. are PAC/PVC more prevalent in people with low resting HB?
11. can deep breathing create onset of PAC's or PVC's?
12. can active weight lifting increase risk of these - does it change size of chest cavity and cause some form of instability?
13. can u recommend a link to find a low stress diet
14. can u recommend good books on controlling mind / PAC's
thanks for answering so many varied questions . . . adam

[CCF-M.D.-MJM]

Hi Adam,

1. does stress and anxiety have actual impact on pac/pvc?

it can, but depends on the individual.

2. have had at least one episode where I woke up with seemingly fast beat in throat which resolved quickly upon waking - is this different or should I be concerned about this. if this was tachycardia should it be seen as a progession of the PAC's?

I wouldn't be too concerned.  The only way to know what it was exactly is to catch the event on monitor and correlate it with symptoms.

3. taking 25mg zoloft in am and 1mg klonopin at night - could these contribute in any way to symptoms?

Drugs, sleep, stress, caffine, hormones all effect people in different ways regarding pac/pvc.  the only way to know is to try and correlate your patterns with your symptoms.  The hard thing about pac/pvcs is that they come in cycle and often disappear for months before coming back.  It is difficult to pinpoint exactly what is causing them.

4. does ibuprofin have positive / negative effect usually?

I do not know of any impact.
5. any known or trusted herbal supplements?

I recommend a multivitamin per day, no other supplements.

6. do u recommend magnesium supplements?

Not unless you have a low magnessium on labs.

7. does a bannana per day help - potassium supplements?

Not unless you have a low potassium on labs.

8. does waking up or experiencing these many times in sleep-wake transition period mean anything? any conclusion can be drawn?

Not really.  It does not effect prognosis or treatment.

9. does sleeping on right vs left side help symptoms?
people are more prone to feel them when laying on their left side.  The heart is closer to the chest wall when laying on your left.

10. are PAC/PVC more prevalent in people with low resting HB?

Not that I know off.

11. can deep breathing create onset of PAC's or PVC's?

Not that I know off.

12. can active weight lifting increase risk of these - does it change size of chest cavity and cause some form of instability?

not that i know of.

13. can u recommend a link to find a low stress diet

I am not sure what you mean by a low stress diet.  In general, I recommend a diet high in fruits, veggies, fiber.  Low in saturated fat, almost no TRANS fat.  Aerobic exercise at least 4 times per week for at least 30 minutes.  I do not know of any specific links.

14. can u recommend good books on controlling mind / PAC's

I don't know of any books.  My guess is that you will receive quite a few supportive posts (besides mine) that may help you with books, diet, etc.

I hope this helps.  Good luck.

[momtotwinsplus1]

Hi Adam, sorry you are suffering with these darned things..I can relate. I get approx. 1-2% of all my beats per day are pvc's or pac's (thats around 2000). And I feel most of them. You have a lot of questions, and I can only speak to a few. My cardiologist says that re: palpitations and heart rate, that the slower the rate, the more chance for these extra or skipped beats to slip in. For me that has been specifically true. And I would say a resounding YES that stress and anxiety makes them worse, which is kind of a catch22 situation since, having them makes you anxious!
If you have had a recent normal work up then Ill give you the standard line they give me..its become my mantra. In a structurally normal heart, pac's and pvc's are begnin. So, I guess I would suggest stress reduction, and you could always ask for a 24 or 48 hour holter monitor, this would tell you the specifics on your palp's i.e. how many, etc. Best of luck to you!

[adam blum]

thanks for comments. i only feel them a couple times per day but the sleep-wake transition stuff is new. It has always been hard to shake the fact that I had Afib over a decade ago, and hoping that these "seasonal" pacs and pvcs are not a precursor to another event. My electrocardiologist says "live long and prosper" and in truth i know that stress / anxiety reduction is a huge key. if you know of any good books that relate to meditation or training the mind or proactive steps to eliminating anxiety in daily life i am all ears!

as you pointed out the trouble is the chicken and egg theory - what came first the anxiety or the PAC. my assumption is that underlying anxiety, even if not manifesting itself in a noticeable way, is often the underlying spark to these suckers, but harder to understand that during sleep - - although I can remember dreaming just before being wakened by 7-10 fastest beats and then rolled off my left side to my back and they stopped.

i think the solution must be mind and anxiety control. but im open to tactics and ideas that have worked for others. I appreciate your input.

[stlcard1521]

regular excercise has helped reduce my pvcs quite a bit. i do something strenous like swimming and running 2-4 times a week, and ive noticed a reduction in my pvcs after doing that but everyone is diffrent. sounds like youre already physcially active too. figuring out what your major triggers are can help you avoid them (dont avoid them to the point though where they control your life). if i dont get enough sleep, my pvcs are usually bad for the next day or two. lots of caffeine (a pop here and there doesnt bother me) and stress from finals week or moving between school and home also seems to increase mine for a few days. like the doc said, they often come in cycles. sometimes i dont have any for a few weeks, then all of a sudden i get hundreds a day. when i first started getting them i had several a minute and they scared the **** out of me. i went to the doctor and had trouble believing that feeling my heart stop all the time was harmless, but after a few weeks you just get use to them and they dont bother you anymore. reading through this board helped me realize they wont kill me. i did a lot of reading on them in medical journals and stuff, and learnning about them, understanding what they are, and reading time and time again that its extremely unlikely that they will kill you helped me get used to them. youre probably going to have them the rest of your life to one degree or another. the best thing to do is just not to let them bother you too much, and try to limit your anxiety and stress. they take awhile to accept, but i hardly even notice them any more and they dont bother me when i do feel them.

[stlcard1521]

"i think the solution must be mind and anxiety control."

not so much mind control, but anxiety control. like i said, they suck and theyre scary for awhile, but eventually you'll just realize one day theyre not a big deal and quit caring, no mind control or brain washing required!

One thing i forgot to add in my last post that also helped me when i was trying to get over them was triggering them on purpose. like you said, when you lay on your side it can start them up. to try to get rid of my fear i'd lay on my side to get them to start up and then just try to ignore them and stop thinking about them. it gave me a sense of control over them and i feared them less. anyway, good luck with those.

[dmil241]

I learned biofeedback from a psychologist who was trained in it. It has been an enormous help. The trick is finding someone who is trained in it. This was hard for me. My cardiologist said everything is fine and you don't want the side effects of unnecessary medicine. My primary doctor was bound and determined to put me on medicine no matter what my cardiologist said or what I wanted. (I have since found a new PCP.) I just did alot of calling around to different psychologists, counselors and psychiatrist in my area and asked if they did biofeedback with patients or knew of someone who did. I eventually found one and it has been GREAT for me! After you are trained, you have to actually keep doing it to be beneficial. I know this sounds stupid, but once everything settles down there is a tendency to stop. Keep on doing the biofeedback daily-it is a great part of an overall healthy lifestyle including diet, exercise, etc.

Honestly another help has been reading posts on sites like this. It helps me keep everything in perspective about my own PAC's and PVC's and to know that I am not the only person to suffer with them. They can still be annoying and at times scary, but I can read about others who have dealt with them alot longer than I have. It can be reassuring and encouraging.

Good luck and God Bless!

[adam blum]

all good advice and much appreciated. thank you.

[momtotwinsplus1]

Hi again Adam, just thought Id let you know a great book about anxiety and how to deal is The Anxiety and Phobia Workbook by Edmund Bourne,its sort of become my anxiety bible, also Ive heard people talk about a great by Clare Weakes, though Ive not read it. Good luck!

[MeARNGwife]

After 4 ablation attempts for extra pathways in my heart which caused tachycardia, I finally had what appears to be a sucessful ablation last Tuesday.  I was on 2 meds, Inderal and Tambocor which controlled the unbearable PVC's and PAC's I also experienced along with the Tachy.  NOW I seem to have some other kind of tachy and PVS's almost steady and I am going crazy and I am only 5 days since the ablation.  I am almost sorry I had the procedure and taken my chance with the Tambocor which the Cardilogists say is dangerous.  I took Inderal 28 years and Tambocor 10.  I am so uncomfortable I don't even know why I am posting except to vent and say no matter how the docs reassure me the PVCs and PACs are benign, they make me want to die.....so what good did it do me?

[MaryRoe]

My sister and cousin had the same expereince you did.  Finally, they got wise and went to the Cleveland Clinic and saw experts in this problem there. You may want to consider a consult with them.  Good Luck to you.

P.S.  My other cousin is headed there next week for this.

[DebHasPVCs]

Hi, Adam, thanks for asking a lot of good questions.

I would like to ask if you get an increase in PVC's after exercising and, also, if you have ever experienced a number of PVCs in a row.  

I am a 42 year old female and have always been in excellent shape.  In the past 4 months, though, my PVCs have increased to about 7 per minute, 24 hours a day.  It takes me a full day to recover from an hour of exercising, and during the recovery time, I have had up to 6 PVCs in a row.  Anything that affects my heart rate -- waking up in the morning, eating, any form of exercise -- sends my PVCs into overdrive.  

Like you, I take an SSRI in the morning which has recently been implicated in heart defects in the babies of women who take them during the first trimester of pregnancy.  Coincidence?  I don't know.

From everything I have read about PVCs they do increase during stressful times in your life.  What confuses me, though, is why certain activities make them almost unbearable.  

Do you have other symptoms with your PVCs?

Good luck to you.  I feel your pain!

[adam blum]

hi - in response to your questions - no - I cannot say I have experienced anything like that. In fairness to some of the severeness being described on this board it seems my 1-5 identifiable PAC's  / PVC's per day pales in comparison. All in the mind of the beholder I suppose.

Sleeping on my right side has made a difference - although I dont much like it.

Im quite confident stress and anxiety levels - at least for me - play a large role. Maybe not in the PAC/PVC frequency itself, although possibly - but moreso in my sensitivity to feeling or realizing them.

Exercise does not seem to intensify or bring them on. Occasionally it seems like about an hour after exercise, as the body is winding down, I will notice one or two. But there may be other mitigating factors to this since exercise typically relieves / reduces stress as I understand it for about 90 minutes post workout.

My current thought is to get more heavily involved in yoga and meditative studies with the hope that this may quiet the underlying sesitivity to the PACs - the anxiety and stress.

For what its worth, I also have found that staying active and busy with my mind - either on a project or reading or anything that stimulates attention away from the PACs - is generally helpful - although I understand how hard that can be to want to do when in the midst of experiencing symptoms.

[skippyheart]

Adam,

As a member of the thousands-a-day league (and still here to talk about it!), I can safely say that if you've had them for years, you'll find that everything you do has been a trigger at one time or another. But there's an underlying (benign) physical cause, and eliminating one trigger will just replace it with another one. It's like an short-circuit - something will eventually jiggle the wires.

That being said, for me overall stress and anxiety increases them, but over long periods (months) - a stressful event itself does not bring them on. Oddly enough, neither does caffeine, so everyone's different.

The worst is worrying about the pvcs themselves. Hard to stop, but when you stop noticing them so much, they do tend to decrease (don't get frustrated - it takes some people a few years to get it down). I can tell you this much from experience - once you remove the anxiety, you'll find there are no real symptoms, and there's nothing you can't do. I often have trigeminy (every 3rd beat is a pvc), and was symptomatic from the anxiety that produced. Once I overcame the psychological aspect (not easy!), they had no affect on my life, and subsequently decreased.

Good luck - with a healthy cardiac workup most of us here would be better off worrying about being hit by lightning! You'll get past it, then find yourself scanning the forums just to help the next person out :)

[howiesmom]

Amen! Loved your post! I had my first major A-Fib event about 8 years ago (still wondering if it was triggered by a cold-turkey switch to the Protein Diet which was popular then-coupled with Zanax, first dose) but since then the "heart flippies", as I call them, have been a regular visitor. Being in the middle of 'mid-life' I am sure some of the symptoms are hormone-related, and being a "professional" anxious person :), I know that anxiety plays a huge part as well. After numerous tests, Holters, doctors and cardiologists telling me their "non-life-threatening-jut-ignore-them" advise, I'm finally, little by little, learning to do that. And I pray a lot. And I finally got angry enough at the palpitations to just decide to get on with my life and try not to think about them ALL the time. Once in a while I'll get a version that makes me feel a bit weak and I just want to sit until they pass, but otherwise it really helps to focus on doing something else, or on someONE else - having two kids to homeschool here helps in that regard. Here's a question, though: quite often I have found the symptoms start if I haven't eaten in a while, and they stop about 20 minutes after I eat, usually a glass of milk and some other protein. I'm wondering if there's a hypoglycemic connection - anyone else notice links with food? Here's my middle-of-the-night-heart-weirdness recipe: :)(a sense of humor helps, too!)
small cup warm milk, 1/3 banana, 1/2 cup Gatorade and occasionally about 1/4 tsp. salt, taken with a drink of water. (the latter is from a book by Dr. Batmanjani - Your Body's Many Cries for Water - there's something to the link between water and heart palps, but it hasn't been a cure-all yet for me.) Sometimes I imagine all of us in our own little towns and our own little lives scurrying (and/or crying) around, trying to find something to make these icky sensations go away, and hoping we won't drop dead in the next minute, and trying to remember every calming word a doctor or nurse has ever said, and envying people who don't spend all day or night taking their pulse, and trying to find the magic bullet that will just make our precious little hearts go back to a permanently boring thump-thump-thump, regular as clockwork, and I think God just wants to wrap His arms around us and say, "Relax." Giving up fighting so hard on our own holds a measure of healing in itself, especially since it seeems we're so powerless to make our hearts do, or not do, anything.
Anyway, this site is a blessing - thanks to all of you for posting. Your words are encouraging and helpful and just knowing you're struggling along on the same journey gives me strength and hope. I hope (and almost expect) we'll check back here when we're  in our 90's - with a grateful chuckle.  God bless.

[madgrad92]

The two of you have given me the strength to get through tonight. I admit, some of these PVC posts get scary with people telling you things you don't want to hear, but this thread has really given some sound advice. I have suffered since 1993 with infrequent bouts of SVT and just recently, frequent PVCs. I remember PVCs when I was in collge, but always chalked them up to gas. It was only when I got really concerned that I wore a 24-hour holter and had them discovered. My last holter showed 186 in 24 hours (seems low when I read what others on here experience!). I feel about 20-40 of them a day. I take 25mg of Toprol XL(I have low BP, so more is out of the question), and I wonder - do any of you notice that your PVCs come on like gangbusters when your meds wear off? My Toprol is supposed to be a long-acting drug, but about 18 hours after taking it, I feel almost every single PVC - about one every 10 minutes. It's a brutal 6 hours, I'll tell ya. I'm slowly learning to curb the fear and anxiety. I think like anyone with a chronic condition, there are good days and bad ones. I've noticed they're worse in winter - I live in Chicago. We're all trying to find that "trigger," but like you said, howiesmom, we just need to "relax." Thanks for helping.

[upbeat63]

hello, sorry to hear of one more person whose life is affected by PVCs. Just to let you know, I have approx 22,000 to 24,000 PVCs per day as recorded on a 48hr holter monitor. Right now I'm in constant trigeminy (a PVC on every third beat of the heart)so it's probably even a little higher right now.

I have been taking toperol occassionally (12.5 mg/day) and while it doesn't decrease the frequency of the PVCs very much, it will sometimes make them less noticeable. The toperol, as I understand is long acting, but I believe it starts to "wear-off" after about 12 hours. Maybe you could ask your doctor about dividing your 25mg dose into two (12.5mg) and taking it morning and late afternoon to give you more "coverage" throughout the day.

Also, for me, since the BB doesn't really diminish the frequency (maybe a little), I just power through most of the time without it. You get to be very good at distracting yourself when you have thumping PVCs, but as you said, there are good days and bad. Hang in there.

[stlcard1521]

i dont take meds anymore. only did atenolol for about a month, then i quit because i didnt like feeling drowsy and i didnt think it helped much (thought they were worse at times). once i got used to them and quit fearing them they dont bother me that much. i still get annoyed when they get bad and i feel several a minute, but they dont scare me anymore so they just havent seemed like a big enough deal for me to take a daily med. really they dont bother me at all anymore, i usually dont think anything of them ive just stayed on this board to give other people advice bc i remember when i got them i appreciated the support here

[Skippy L]

Hi,

I have had this porblem for about 9 years now and have never been to the doctor. I am now 25 years old and still feel this funny beats..like a skipped heart beat and a extra heart beat followed. It has reaaly ruined my life, I no longer workout or do anything were it cause my heart to work hard. PLEASE HELP!

[adam blum]

to the last poster - I can tell you that working out, particularly a good aerobic exercise regimen that is consistent, helps me. Lack of stress and anxiety (duh) helps me. No question that the chemical and mental benefits from a nice workout soothe the body and mind alike. So I would tend to make exercise a part of your solution - not problem - assuming your doc finds no underlying organic cause for the beats - and as you have seen here, chances are better than not that your symptoms are benign.

personally - my biggest mental struggle is getting to sleep -and not thinking about them or whatever else is keeping me awake. I think often times unrelated stress and anxiousness can keep me awake at night but then I might feel a PAC and that only serves to intensify the sleeplessness.

good luck to all and thanks to the many people who posted in response to my original question to the doc.

I agree with the poster that mentioned underlying physiology and frankly it is pointless to sit and hope that a miracle will occur and they will all disappear. But by focusing attention elsewhere and namely not on the body or these symptoms the number of these pacs and pvcs that we all may FEEL can come down considerably.

good luck to all - - AB

[madgrad92]

I'm petrified....truly petrified. I have heard over and over and over that these are benign...but I sit here and cry over them constantly. They're ruining my life. I fear so much that these really aren't benign. I feel like a heart is supposed to beat a certain way, and mine isn't beating right. Therefore, it feels really wrong. I've gotten to the point where I can't get past them. I'm so, so scared.

stlcard1521, please help me understand how you got to the point of realizing that these are not going to kill you. When you get one (or two), how do you cope at that moment?

upbeat63, do you feel every beat you have? That would be horrible. I would love to hear how you manage, as well. I want to be able to trust my cardiologist's words when he says this is "benign." It's like I want to call him every day for reassurance....I really need help here.

[madgrad92]

sorry to post again, but I know threads close to new comments...my email is ***@**** if anyone wants to contact me directly. I need to get past this, and I've already made an appointment with a therapist to help me with the anxiety.

[upbeat63]

Thank goodness I don't feel every beat. People don't expect to feel any heart beats at all, really, we think our hearts are supposed to be in this nice perfect rhythm, I guess that is what takes the most getting used to, that our hearts aren't always in perfect rhythm.

I've had PVCs at high frequency for 22 years, but only just this year they went really high and I freaked out, again. That's very easy to do. But knowing what my cardiologist said 10 years ago, and reading all these posts of people who have been to the "top doctors in their respective countries", and reading the replies from the doctors at the Clevland Clinic who are also top, well, at some point you have to just let it sink in. It sometimes sinks out on bad days ha ha, that's why I'm still here and talking. The point is, I'm still here!

I've had just about all the sensations you can imagine with PVCs, you describe it, and I've experienced it. That being said, if you experience something that's changed it's worth talking to your doctor about. That's why they are there. When you find a compassionate and understanding doctor who doesn't just pat you on the head, then I think you start to trust. Hang in there.

[madgrad92]

Did your PVCs gradually get worse every year? I think that's one of my greatest fears - that I'm at the low end of what's going to get really bad eventually. If I can't handle it now, how am I going to handle it then??? I'm at 186 in 24 hours right now - my doc said many were probably due to anxiety, but still, 186 is about 184 more than the "average" person. When you say you've always been at a high rate of them, how did they start out? I can't believe you've dealt with these for 22 years. I'm 35 - I think I've had them off and on for about 13 years. My worst fear is that I'm going to drop dead, leaving my two beautiful children to grow up without me. I wish someone could help me understand just why this is happening. I exercise, I've never smoked, don't drink alcohol or caffeine, avoid MSG, chocolate, etc. Is 35 too young to be in peri-menopause? I'm not sure if you're a male or female, but I know hormones can play a part - I think I'm just constantly looking for the "trigger," even though I know there may not be one. These are truly terrifying. How many beats do you actually FEEL in a day? My heart goes out to you (no pun!) for what you've had to manage - I've read many of your posts before and have been amazed at your stamina in dealing with these. I feel one every half hour and feel like I'm dying...

[Momto3]

Hi

I have had pvcs for over 25 years and I'm still here too :)

Like Upbeat and some of the other Forum participators, I had thousands of pvcs (20,000+/24 hours) for many, many years.  In 2003, I had two ablations for the pvcs and now, I only get them periodically. They don't scare me, but sometimes, they get my attention (probably more now that I only have them once in awhile).  

The key to getting through the anxiety is finding a doctor that you can really talk to, one that understands your fear.  It wasn't until I found a doctor that I felt completely comfortable with, that I truly believed I was in no danger. And, that was after having dealt with pvcs for about 20 years.  

Please try not to worry.  Live your life, hug your girls and march on :)  (You're just marching to the beat of a different drummer).

connie

[DebHasPVCs]

Regarding peri-menopause, I think that could be a big part of it.  I didn't have PVCs until I went into full blown menopause at age 38.  They have never been as bad as they are now, sometimes I get up to 6 in a row.  I understand your fears.  All the doctors say they're benign, but how do they really know that?  People who die of heart attacks -- how does anyone know the attack wasn't the result of PVCs?  I struggle with all of this daily, especially after hearing that women's heart problems are not typically taken seriously by doctors.  

I can just say hang in there, and be comforted by the fact that there are so many out there that have the same problems and are doing just fine.  Also, do not hestitate to undergo testing and talk to your doctor.  And keep in touch with people in this forum, like momto3, who have provided reassurance to me in the past few months.

[bumpercomma]

I recommend the anxiety and phobia workbook by Edmund Bourne. Excellent.  

I suffer from hypochondria and general anxiety disorder.  These PVCs/PACs started Oct. 04.  Every day, sometimes 20/min all day, or a few on and off.  

Just this Sept. I started waking up btwn 5 - 6:30 a.m. w/ tachy (about 160 bpm).  I felt my heart do a flip flop (I thought PAC/PVC), then it did it again and went crazy.  Had an event monitor for 2 months, and no event was caught.  Doc says likely SVT.  Just when I thought I'm starting to get a grip on the PVC/PACs and let go of my fear, bam, tachy.  They are sporatic. I've had 5 episodes of tachy since Sept.  Doc wants to put me on diogxin and he said magnesium wouldn't hurt.

If someone out there is suffering from SVTs also, are you on drugs or are you living w/ it?