PVC/PAC and best treatment options

[talylor]

Thankful for this oppurtunity. Both doctors & posters comments on this forum have been educational. I am 37, female, 5' 11", 165, hypothyroid.  

Diagnosed rare PVC/PAC after 7 months of testing & scary feelings out of the blue in chest/neck/throat. Describe as going down a hill, hollow, electric shock, pull in neck, sinking, cramp...etc. Was able self diagnose for sure the other day when I checked pulse during scary sinking feeling in chest. Distinct pause in pulse several times in a row. Never know when they're gonna come.

Prior testing(normal): Feb:chest x-ray. March:6 minute stress and echo. April: sent to pulmonolgist for PFT after mentioning taking Macrobid 100mgs 5 days (stopped due to tingling & tinnitus) and subsequent course (1 400mg tablet)of Tequin for UTI. April:24hr holter NSR 25 Ventricular ectopics(21 single 2pair)66 supraventricular ectopics(66 total,12 single,2 pair,run 5,beats in run 50).Total 0.01% VE beats and 0.05 SV beats.Told normal results. Asked if it matched my log; he said no need to check cause no significant findings. Told might be esophageal.Barrium swallow was normal.June: EP did 14 day loop monitor. NSR,Sinus Tach (Highest HR 155/Lowest 58),PVC/PAC(matched log). However, told anxiety which I feel is secondary.

1. Cardio doc said Toprol 25mg, EP says Lexpro 10mg (cause nothing "wrong" with heart?
2. Feel chest&neck "ballooning", hard to catch air, after cleaning, stairs, etc..Normal?
3. Several beats in a row (I call BIG ONES/so scary). Normal?  
4. Could SOMETHING/ANYTHING been missed?
5. Pulmonary hypertension possible?

[CCF-M.D.-MJM]

Hello,

1. Cardio doc said Toprol 25mg, EP says Lexpro 10mg (cause nothing "wrong" with heart?

Beta blockers like toprol decrease the sensation of PVCs and PACs in some people.  I think it might be true that anxious people notice more PVCs/PACs, but for most people anxiety is not the cause.


2. Feel chest&neck "ballooning", hard to catch air, after cleaning, stairs, etc..Normal?

Not sure what you mean by neck ballooning.  PVCs make many people cough or transiently feel short of breath.  The mechanism is thought to be transient dyssynchrony between the ventricle and atrium and possible increased pulmonary pressures (milliseconds) -- but enough to make you cough.  If you are 37, you should be able to exercise more than 6 minutes on a Duke treadmill test (I am not sure which stress test you had).  You may be deconditioned -- I cannot answer this for certain without seeing your tests and results.

3. Several beats in a row (I call BIG ONES/so scary). Normal?

Everyone gets them -- people have different symptoms with them.

4. Could SOMETHING/ANYTHING been missed?

Medically I don't think so.  I do wonder whether you are out of shape and if this is making your shortness of breath worse.  Do you exercie regularly?

5. Pulmonary hypertension possible?

They should have check it on the echo.  You should be able to look at your report or ask your doctor.  My guess is that if it was there they would have told you.

I hope this answers your questions and I hope this helps.

[talylor]

I did a 6 minute stress tredmill stress test. Showed no ishcemia and reached a max HR of 166 (believe the report showed 88% reached (whatever that means). Was told I was in good shape, good weight and thyroid was in check.

[cupcake37]

Taylor, your feeling just what I am feeling, right this minute as I am writing this . I have that terrible feeling in my throat and goes to the begining of of my stomach. Kind of a sinking feeling or an adrealin rush. I just hate it, it makes me sooooo nervous. I know for a fact it is my heart, when this is going on I feel my pulse and feel the PVC'S and PAC'S. Maybe there is something with my stomach. By the way Taylor, I have been trying to post forever now, how did you post twice in a week ? Any tips when to post ?
Take care

[cupcake37]

Taylor, forgot to mention, I am also 37 feamale? I seem to get alot of PVC'S right before my period. Do you have this problem as well? I have been told that these will more than likely stay with me, and they get worse with age. I am so sick of hearing it is just stress, I am only stressed when these hard thumps start. It is my heart, not a tummy ache.
Take care

[talylor]

Anacyde...while on the loop monitor, I recorded PAC/PVC and Sinus Tachycardia that I felt. Sometimes it recorded ST I didn't feel and sometimes when I recorded something my heart was in NSR. I feel thuds alot. The HORRID feeling, I figured out now cause I checked my pulse during an "attack", must be when I get more than one (couplets or runs maybe) cause I can feel a pause in the pulse a few times until the feeling goes away and the beat goes back to normal. Thankfully, I don't get those that often. Mostly singles. Feel them as THUMPS in the chest or quick jolts in the throat.

They put me on prevacid for 10 weeks thinking it may be esophageal/stomach related but the feelings didnt go away. However, I do have history of esophageal problems (acid reflux) on and off and I do hear this can trigger these beats sometimes.

I notice I get more beats sometimes with adrenaline (aka excitement, exercise, laughing, even singing loud sometimes). I know this is not a conditioning problem because I am in good shape. Good weight. Before all this I exercised regularly and could cardio 45 minutes easy. Now, of course, I exercise here and there with caution. Trying to get the condfidence back. My EP says to exercise cause the fast rate is good for decreasing these beats but yet adrenaline seems to kick them in...its a double edge sword, I guess. For me at least. But I also get them just sitting watching tv or driving. So random.

I asked about the palps with Lexapro and he told me not to worry about side effects. He said that is part of my "anxiety". He told me to IGNORE the beats when they come, I said I cant ignore the BIG ONES so I think he is of the findings that if I take the Lexapro I can ignore them better. I compromised with him and agreed to take it for 4-6 weeks.

And you are right about the "ballooning" feeling. I feel a pressure building up. For me, that happens with exertion sometimes. Sometimes if I stop what I am doing, I find it stops. Other times, I know its leading to a BIG ONE and I brace til it passes. Never feel the need to cough. Just feel that deep pressure, sinking, sometimes choking feeling.


Cupcake...my feelings can radiate to the stomache as well sometimes. Quick flash of adrenaline or jolt or shock is how I describe it. Those are the ones I get most of the time. I know I need to focus on all my test results and listen to the docs when they tell me I am going to be okay. I have been for 7 months now. Still here. I really need to focus on that. I guess I am just very upset and frustrated with this life style change. It's hard to get used but I really need to try.

Don't know how I lucked out with being able to post. Just perfect timing I guess. Tried for two months.

I KNOW STRESS DID NOT DO THIS TO ME. I KNOW THESE JUST STARTED FOR SOME REASON OR NO REASON...OUT OF THE BLUE. BUT...I also know my stress about it certainly hasn't helped me. I dont help myself or my situation when I cry in the doctors office. I dont blame them for telling me I have anxiety. Cause these things made me that way for sure. Plus all my normal tests, to them, and it needs to be for me as well, tells them I don't have anything seriously wrong with me. I still have occassional WHAT IF thoughts. I still have the need to sometimes  to prowl and find what caused these (cause I did feel sick when this all started and I thought I had a virus or reaction to meds I was on)...but after 7 months...I realize I may never.

I did notice this month I had a week of alot of single ones and noticed it was right before my period but never really correlated them the first few months cause I wasnt sure what was going on and wasnt matching anything up to anything.

[DebHasPVCs]

Talylor - Could you be in peri-menopause by any chance?  Hormonal changes can bring about PVCs, as they did to me when I entered early menopause.  I never had them until the day my hormones went awry.  I am on hormone replacement but it doesn't do any good.

Next week I'm going to be tested for sleep apnea, which can cause irregular heartbeats.  

My PVCs flare up when I exercise, laugh, talk quickly or get excited about something, have as little as 2 sips of wine, or eat a big meal.  I feel the pounding in my head when my heart tries to resume a normal beat.  

The scariest thing for me is the runs of PVCs - up to 9 in a row, or every other beat for 20 seconds or so.  

We're told not to worry about these things, but we do, because one day, out of the blue, our hearts are not the same.  It's discerning and scary.  

Good luck.

[talylor]

My doctor says maybe/maybe not hormonal. Says at 37, too young for menipause and not showing signs. I take birth control and one doc says that could might contribute but my gyno doubts it.  

When you said yours flare up with exercise, laugh, talk quickly or get excited about something, or a big meal...THAT IS SOMETHING I CAN TRULY RELATE TO. The talking fast thing always baffles me. Don't know why that happens.  

The scariest thing for me is the runs of PVCs for me as well. I think I got 5 in a row that I was able to feel one day. I get minuts with them being every other beat as well and then as soon as they come...they go.  

And yes. we are told not to worry about these things, but we do, because like you said, to one day, out of the blue, have your heart not be the same and you just have no reason why...VERY VERY VERY discerning and scary.

Thank you for your post.

[talylor]

The one thing I didnt do too much of was exercise on the monitor. I was active (heavy cleaning, walking (when shopping, going to the park, things like that) but not REAL exericse. I did some leg lifts (machine at home) and squats. 5 minutes here and 5 minutes there. But never a FULL workout. I kind of regret that. Like maybe I should have done that to see what the holter showed. But I hadn't exercised really for MONTHS prior and they told me just to do my normal routine of late and not to try to "bring them on". BUT...since I haven't exercised and I would get them with the little work outs or walking or cleaning...I guess a long workout really doesn't matter. The other day when I get the runs of beats...it was after walking my dog for 15 minutes.

I never caught a run (well my holter showed a run of 5 I think and a couplet)...but never caught one that gave me the HORRID feeling. Mentioned this to my doctor more than once concerned this might be SOMETHING ELSE/ANOTHER TYPE OF ARRHYTHMIA and he doubted it. At this point, I dont think there is any more testing they will be willing to do so I am focusing on the past testing and trying to convince myself I have nothing "bad" and nothing was "missed" and just to move on.

[NurseKagome]

OMG....sooooo can relate. The week before my period is HELL!! Pac's Pvc's the works. And lately exercise has been my worst enemy. So many funny flops during exercise that it has me not doing it now...out of fear, I am guilty of feeding the fear at times FOR SURE.

I am tring also to focus on past good results and tests. I had a holter recently with alot of "funky beats" and it came back as 8 ectopics (pacs) and 1 pvc (i didnt' record it!! didnt' feel it) and oddly enough, for the first time, I recorded events when I was in a NSR. Now that has me weirded out. How can a normal heart rhythm feel like a pvc or pac?? it is sooooooooooooo weird.

so now i feel pvc's (on er monitor) and feel "normal" beats as skipped ones. now i dont' know what i'm feeling when i get the thuds, skips, trasient sortness of breath, fear, adrenaline etc. What is it? who knows, and when the docs say your great go home and only come back if your symptoms change like having 2 or 3 in a row...how can i really tell? I dunno if i'm having them now...it's such a weird sensation to try and figure out. plus, i want to forget them, ignor them ... but the docs say to come back if things change....so some how i have to pay attention to them, yet ignor them...haha it's funny huh?

so far so good as to the ignoring beats, i had a bad night two nights ago when i was sure i was gonna die, but i lived. i hope i never feel like that again. i get a little dizzy sometimes too, does anyone else? I think it's strange how most times the general population all get pvcs and most are asymtomatic whereas those of us who feel them in our chest get all kinds of symptoms. maybe it is the anxiety screwin with us...haha what a rant!! holy moly!! Well ttyl all!

Nurse Kagome :)

[Schmoomcgoo]

Call me crazy, or fixed on a particular perspective (as one with an aortic aneurysm), but as a 5'11" female with a "ballooning" "pull in the neck" "cramping" "electric shock" feeling in the chest and neck, I say insist that someone examine you with a chest CT, chest MRA or TEE to rule out chronic Type A aortic dissection.  Have you ever heard of Marfan Syndrome?  Go check out the characteristics on www.marfan.org and see if you see yourself in them.

[Rambus]

For a 37 yr old, I think 6 mins on a stress test is below average. I'm a 42 yo male (in pretty good shape) with frequent PACs & mild aortic regurgitation. I went 13 mins on the treadmill (Bruce protocol) which I thought was great, but the cardiologists said was only "above average".

Ignore the PAC/PVCs & go on an aerobic exercise program (walking, swimming, cycling, etc.) making sure you sweat. Don't focus on isometric/anaerobic exercise like lifting weights or body building. Once you're fitter, your confidence increases & you notice the premature beats less.

[talylor]

Schmoomcgoo...I already had chest xray and ct scan an echo and several EKG's. Don't know what a TEE test is. I have had MRI's of the brain and spine in the past two or so years (for back and neck pain). All normal. Neurologists said all I had was a herniated disk.

Rambus...I didn't do 6 minutes on a tredmill but that is all I could do. The doctor told me to stop because he had all the information he needed. He said I was in good shape. I also did a nuclear stress two years ago as part of my physical and went alot longer (can't recall the time) and that test was normal as well. I do the leg lifts (5 minutes on machine) and squats because (as a woman) I feel my legs are my "problem area" and this routine hasn't really caused me much problems with the PVC/PAC's. I had stopped my regular cardio (and believe me, I could walk 45min-1hr daily easy) because it seems walking stairs and simply walking (shopping, the dog, etc...) would sometimes bring them on. Before all this, I would wake up early EVERY weekend and go and would pack my stuff to bring to work and drive to the park when i got off and go. I know I need to get back in to that routine. But to be honest, a little weary of going it alone. Need to get someone to do it with me til I build up the confidence to do it alone again.

[talylor]

Need to edit my last post..I meant to say I only did 6 minutes on tredmill not because thats all I could do BUT because the doctor told me I could stop. Said I was fine.

[mom4cem]

Hi,

I'm 40 F and been having these for years. It is scary still when they happen, especially those that come few in a row, or singles but all day long. I also get runs of sinus tachycardia,,been documented on holter monitor. My rate just starts to speed up and takes it's time going back down. Been through echo/stress test as well as ekg and blood work, endo work-up.

I feel it is partly some type of adrenal problem. Adrenaline shooting out inapproppriately. I believe also hormonal can have a big influence on it also.  Nervous system surely plays a big part. An imbalance can cause all these problems, and I don't mean that it is physcological but truly a dysregulation of the nervous system. An overactive sympathetic nervous system can cause many of these symptoms and the key is to find the way to balance parasympathetic and sympathetic system. Take a look at dysautonomia and see what I am talking about. It may offer some self help with dealing with these symptoms.  Especially if you find that you have other symptoms with it.

A positive attitude is very important as tough as it is do. I still have problems with that one. :)

[Starguy]

Just my 2 cents... just went through the 24 hr monitor, echo, thallium stress test, etc.  Essentially normal except for a slight amount of Mitral regurge but no prolapse demonstrated.  Wouldn't you know it that the week between my echo and stress test I was PVC free, but that night after my stress test those critters returned... been having them regularly for the last two weeks, including the chest heaviness and the big thumps! :-(  Worse after a big meal and laying down or bending over.  Yet I can play two hours of tennis without any symptoms. I've been on 25 mg of Toprol with some slight improvement, but tonight they've been coming fast and furious.  It is a bid hard to ignore, especially at night... seems like my whole chest is pounding.  Yet, the more I read of it the more relaxed I am about it... or at least I am not freaking out about it as much.  Still, there's always that thought about what is triggering all this..... Saw the comment about Magnesium... anyone have any success with this?

[oldagepensioner]

56 year old male with same symptoms. PACs since 20 years old and just developed PVCs.  Same feelings, the little pit just at the base of the neck seems to puff out and many times the sinking feeling lasts minutes.  When I get PACs every other beat it winds me.  I need to stop whatever I'm doing.

I wore a 24 hr recorder when I was in college and during a Calculus exam the PACs increased dramatically, so I'm a firm believer that stess is a factor, irrespective of medical opinion.  

I had a fairly significant event yesterday after having to eat a sandwich fairly quickly before my ride arrived.  As soon as I finished the sandwich, I got chest thumps, light headed and could feel my pulse very erractic.

I've had two Thallium Perfusion stress test on treadmill lasting the full 12 minutes the first time and terminated at 6 minutes recently due to PAC and PVC activity going crazy.  The doctor acutally looked worried and said "Be ready to give me a very deep, diaphram cough when I tell you."  Luckily they stopped on their own.

My cardiologist is considered one of the best in the world (he performed the first angioplasty in California) and his advice was "the PACs are nothing to worry about and the PVCs,while a little more worrying, are not going to harm your heart." "Try to ignore them is my best advice.".

Since the age of 20, that has been the advice from every cardiologist I've seen.  But, try as I may, it's hard to ignore a breath-taking, thumping, sinking feeling of doom.  Sort of like trying to ignore a fly crawling around on you face.

My method of coping is too try coughing a few time and sometimes that stops them.  I also read that pinching your bicep sharply on the inner side can stop PACs.

[arthur]

IN MY OPINION (based on all the scientific evidence to date)
PACs and PVCs are generated by a combination of two things:
(1) the proximity of a focus near a legitimate cardiac depolarization circuit, and
(2) the state of your nervous system

The focus is an electrically active island of cardiac tissue.  We all have them scattered throughout the cardiac muscle and connective tissue.  These foci are forever going to run through a depolarization cycle on their own, resulting in a constant pulsing of ions at and near their locations.  If one happens to be close enough to a normal cardiac circuit, it can result in a premature depolarization of that circuit.  When it's near an atrial circuit...PACs, when near a ventricular circuit, PVCs.
It's these foci that rf ablations target either for destruction or isolation.

One of the facinating things about all this, is that the general nervous system activity (an entirely separate ion-mediated system) can indirectly affect how easily the focal ions travel in cardiac tissue.  That's why it's so difficult to pin down a "trigger", or a "cause" for PACs and PVCs.  It's why anxiety seems to produce more of them.  It's why certain foods, sudden physical activity, fright, digestion, etc...all seem to cause these skips, at times, for some people and not others.

Totally not a mystery.

-Arthur

[talylor]

Well been on Lexapro for two weeks now as per my doc's orders. Noticed I am a bit "calmer" but that's it. Still get the beats and they still set me on edge. I went swimming yesterday and felt okay except for the achey (achy)/sore feeling that I am constantly had on my left side since January and occasional bouts of hard to take a deep breath. Sure enough, last night, watching tv, I had a couple of some of the feelings I hate. The ones in the throat, that feel like something is "moving or thumping" right in the pit. HATE THEM. Have had a few today as well. Wondering if the activity from yesterday is bringing them on. Hate this type. I say "type" cause I get different feelings, different places. Of course, the ones in the chest are the worse, but the ones in the throat come a close second. The little "thumps" I feel on the left side are the only ones I can handle without consequence. Those I can get all day long and just ignore. The others I simpy can't. And I am still weary that I seem to get them alot after exertion. Like the same day or the next day. I really want to get back to my exercise routine like my doctors tell me to but if my "trigger" is exertion...than maybe thats not such a good idea.

[arthur]

If you've been checked out by the cardio as good to go, exertion and exercise are fine.  These foci get souped up when exposed to adrenaline (just like normal muscles), and they churn away at an abnormally high rate.  When you cool down, and your normal heart rate slows back down, the "souped up" foci signalling can get through a bit easier, resulting in premature beats.  So a typical scenario is that during the first part of your exercise you'll get some skips (adrenaline up, heart rate still slow), during the exercise very few skips (heart rate up, adrenaline at some slightly lower level), and during the warm down, more skips (adrenaline still elevated, heart rate slower).

Again, nothing to worry about for folks with otherwise normal hearts.

-Arthur

[talylor]

I was reading your posts and trying to get a fix on what you were saying regarding these beats. Had to try to put it it laymen terms. :-).

I have been told that "you are not going to die from these beats but I know they can feel like you are" and that's just it. Knowing I am fine...great. I get all that. But the FEELING is just so hard to deal with. I know what they are. I know I can't do anything to prevent them (accept listen to my docs advice about different meds to try). I know I will probably be dealing with this on and off for a long time if not longer...and I understand all that. Again...I just hate the feelings. I hate going about my day and having dinner, or sitting at my desk, or driving or watching tv, or walking, or anything and getting this feeling "like I am going to die" EVEN THOUGH I KNOW I WON'T. It's just hard. I am WAY better than I was when this all started. More angry than upset.

[woodruff]

It would be fair to give the Lexapro a couple more weeks.  After that, if you don't feel markedly calmer about all this, you might want to talk to your doc about a different SSRI.  I found that Lexapro made me feel quite a bit more nervous, whereas Zoloft and Celexa were very calming.

Different individuals have very different responses to these drugs, and some work better than others.  It's often a matter of giving one a decent trial, and then another.

[arthur]

You're in the same boat with the rest of us humans...ie, we all tend to get anxious about skips.  I was there too.  Very anxious about even getting out of bed.  Our nervous systems (one half of the problem) tend to learn from our behavior.  So, when your are anxious about skips, they will occur more frequently (because you cranked up your nervous system with fear).  Of course, the more skips you get, the more fear there is, and the spiral goes on.  Add to this, that with a higher level of anxiety you will tend to feel the skips a lot easier.  

What worked for me:  I noticed that I would check my pulse quite often, and that the excuse was that "I was just checking"...but, the result of this form of biofeedback is that you maintain a level of anxiety you don't need.  I stopped checking my pulse.  This was really more difficult than it sounds.  But the results were dramatic.  It took a couple of months before I really weaned myself off the pulse check, and I found that I could hardly feel the skips anymore, even when trying to sleep (which was a problem before).  At this time I can say that PACs and PVCs which are at least in part due to heightened levels of anxiety (even when you don't think you're anxious), definitely will come down when you ignore them.  In my case, I went from about 1-3 skips a minute to basically little or none detected (of course, this is a catch-22 since "how can I be sure if I don't check my pulse?")...so, I check maybe once every couple of weeks;  That's not enough to restart the cycle of anxiety.

btw... no drugs.

-Arthur