PAC's?

  This forum is a wonderful service and I am glad to have found it.  I must confess off the bat that me and my doctor are pretty well convinced that I have a stress-induced hypochondria, i.e., stress events translate to me as debillitating fear of a major illness. Most recently, shortly after 2 close friends about my age (44) had unexpected heart attacks, I developed heart palpitations.  Fortunately, I was able to get to the doctor's office during one of these "attacks" and she got a good, long EKG and diagnosed the problem as benign PAC's.   I did ask about further testing, but she said that it was not warranted given my symptoms, particularly in view of the false positive rates for stress tests in females.  She did prescribe 10mg Zestril for borderline hypertension and wants to talk further about long-term strategies for generalized anxiety, utilizing either Paxil or biofeedback.
  I have also seen her over the past year for chronic swelling of my legs and ankles, a condition which she assured me is NOT cardiac related, but  the result of my weight and obvious varicose veins.  I also had 3 chest x-rays in a 12-month period due to a respiratory infection.  I had no baseline x-rays, and the radiologist wanted to check out a potential "shadow" over an extended period.  All x-rays came back with "normal" heart and lung readings.
  I have a great deal of trust in my physician, but I also read a lot of information on the net about cardiac disorders and would like some reassurance that my physician is not being too casual about things.  Should I insist on a more aggressive approach or is it just the hypo me reacting as usual.
  Thanks in advance for your help and I hope that I have not intruded on your time too much!
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Dear Liz:
It sounds like you and your doctor have a good relationship.  Premature atrial contractions (PACs) are generally a benign arrhythmia.  Caffeine and alcohol are two common precipitants.  Sometimes doctors will perform a stress test to reassure the patient of the benign nature of the problem.  The  problem with performing a regular stress exercise test in a young female with a low likelihood of coronary heart disease is that an abnormal test result does not always mean that coronary disease is truly present.  A stress test  with a concomitant imaging modality (such as a stress echocardiogram) has a much better yield, even in young females.  Again, the reason to get any sort of stress test would be for reassurance.  The problem with getting tests that are not really necessary is that they can prompt further testing, with possible adverse effects.  For example, if the stress test is abnormal, this will generally prompt a cardiac catheterization, an invasive procedure with possible risks.  In someone with PACs, a good history and physical examination is typically all that is required; only if this basic work-up arouses a suspicion of underlying heart disease should further testing occur.
If you wish to be evaluated here at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at desk F15.  Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your doctor.