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PVC Treatment
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PVC Treatment

46 yr, female. Brother died,42,heart attack, blocked RCA at airport, 13 yr ago.
I've had skip beats during day and rapid beats (tachycardia, one hour after falling asleep which I think is nocturnal panic attack) since age 30. 4 years ago I had an event monitor (showed pvcs and sinus normal tachycardia - diagnosed inappropriate tachycardia by cardio), an U/S, and thalium stress test (nuc/treadmill), all normal. Ea year have cholestoral, blood panel, thyroid blood test, cholestoral - all normal.

1) How often should the tests and which ones be repeated - treadmill, nuc, ultrasound?

3 months ago I went on atenolol after having a run of 3 skip beats, probably a normal beat and then 3 skip beats, a normal beat and three skip beats on the tennis court, all w/in 30-60 sec. Day 1 menstrual period. Perimenopause symptoms causing more skip beats.

12.5 mg dose eliminated the triple/dbl skips. When I awake 2/3 times/mo no fast beats. Still get skip beats, less severe (2/3 per wk).

2) My sleep disrrupted by atenolol, less now than before. Sleep for 5.5 hours and wake up with difficulty going back to sleep. Will this improve?
Better beta blocker for not disrupting sleep?

3) Can I take melatonin with atenolol?

4)Internist now suggested I take 6.25 Coreg - less interference with melatonin. Is this true?

5)Coreg web site states Coreg not advised for "people with skip beats (heart irregularity)"
Is this true?

6)Is Coreg too serious a heart drug for what I have? People with heart failure take. Lots side effect

7)Try Inderal/Propranlol? I tried Sectral already
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239757_tn?1213813182
c123 thanks for the post.


1) How often should the tests and which ones be repeated - treadmill, nuc, ultrasound?

In the absence of any symptoms some would say not at all. I would probably not repeat your stress unless you developed symptoms.      
Instead I would continue to focus on primary prevention measures of weight control and exercise, tobacco abstinence and blood pressure and cholesterol control.


2) My sleep disrrupted by atenolol, less now than before. Sleep for 5.5 hours and wake up with difficulty going back to sleep. Will this improve?
Better beta blocker for not disrupting sleep?

Beta blockers can have a lot of side effects. Unless the palpitations were really bothering you I dont necessarily know if I would have treated them

3) Can I take melatonin with atenolol?

There isnt much on melatonin or other supplement interactions with drugs published in the scientific literature. Again, I dont usually recommend supplements unless there is specific evidence supporting their use.

4)Internist now suggested I take 6.25 Coreg - less interference with melatonin. Is this true?

There would be no accurate data on this. What you need to decide is -- do you really need either?


5)Coreg web site states Coreg not advised for "people with skip beats (heart irregularity)"
Is this true?

Its an oversimplistic warning and they are referring to patients with heart block.

6)Is Coreg too serious a heart drug for what I have? People with heart failure take. Lots side effect

All beta blockers have side effects and different ones effect different people differently (whew!).  Unless you have a lot of symptoms from your palpitations and notice a marked improvement on any beta blocker that is better than the side effects (you need to sleep!) then I would reinvestigate why you are taking the medications.


7)Try Inderal/Propranlol? I tried Sectral already

If all of these beta blockers arent helping your symptoms, then none probably will. I would look into other methods in dealing with your symptoms such as biofeedback and stress relaxation techniques which avoid medications all together.


good luck
25 Comments
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I think we all want an answer to your question- relief from the PVC's and what meds to use. I am on atenenol and I must say PVC's are less but now getting more runs of them ... so not sure whats better 2000 PVC's per day with some runs couplets or less than 300 per day with the odd 3 beat run? Normal echos etc ... but cant shake them. Sorry to hear about your brother.
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P.S. I ran out of character space....
Clarification on Question #4 above:

4)Internist now suggested I take 6.25 Coreg - less interference with melatonin. Is this true?

What I meant is that internist thinks Coreg doesn't interfere with melatonin already in your body like the other beta blockers. Is this true?

I didn't mean to ask if I can take melatonin supplement with Coreg like I am asking in question #3 with Atenolol.

Thanks.
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Avatar_f_tn
Are you having symptoms?  If not then I agree with the doctor, why take anyting? I had sob, angine and light head
symptoms and so I take Inderol 80 mg timerelease....its been like a miracle for me.
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Avatar_n_tn
Of course I've had symptoms... the bout of three pvc's X 3 within 30-60 seconds. This is frightening when your heart rate is elevated exercising on a warm day and you think about your brother dropping dead of a heart attack.
4 years ago a fast heart rate and skip beats playing tennis again.
All the years since 30 with skip beats in abdomen, throat, lightheaded skip beats, skip beats with a second of pain.
After 16 years of this I tried the beta blockers.
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Avatar_n_tn
Don't know if it will help, but I've tried toperol XL, 12.5mg after much reservation about taking any medication at all. I've had PVCs for 22 years, ever increasing to 24,000/day. I'm now 42.

I've had strings of three, four and more in a row, going back to every other beat, they are all over the board, it drove me crazy. But the toperol stopped a constant bigeminy that my heart went into. I had constant bigeminy for several days with runs of non-sustained VT, boy was I glad to have something work. My brother who is now 47 had open heart surgery 8 years ago to correct a valve defect, he still gets angina, my mother died unexpectedly at age 62 of a heart attack, my father followed her 4 months later with a massive heart attack and he was only 67.

I strongly believe the anxiety causes my symptoms of shortness of breath, dizziness, and fatigue. I'm trying to do the best I can to believe the palpitations are benign, since I get them all day long, but only have symptoms occassionally. My family history weighs heavy on my mind too, but I am not them and I choose to believe I will have a long and fruitful life. What more can we do. I hope you find something to bring you relief.
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Avatar_f_tn
I didnt mean to hurt your feelings.  I was just trying to understand if you were merely feeling palpitations and skipped beats, or if you were having symptoms ie angina, sob etc.....some people are just freaked out by the skipping and it scares them.  They will treat your symptoms is what i was trying to say.  Maybe a med to calm you  would be helpful and settle down the pvc's. Good luck finding the answers for you. I am still working at mine.
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Hello, just wondered if the BB was still working miracles for you? I hope so.

I've been pretty good lately without any toperol (still getting the PVCs but they don't seem to bother me as much). Until yesterday. It's like looking for your shadow, expecting the sky to fall. Well, I've lived through it all before, I guess this will pass too. It might be premenstral--premenopausal related. Did you notice any relationship with your pvcs and hormone issues?
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Avatar_n_tn
Since my ablation about 4 years ago, I've been having lots of PVC's.  I still work and all that, but they are bothersome.  I take toprol xl 50 mg.  Can fish oils, calcium, hawthorn, or any nutritional things help calm down these PVC's?  Even though I am cleared to excercise, I get a little nervous----especially when I have irregular heart beats or PVC's
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Avatar_f_tn
I am still doing well on Inderol.  I have noticed if I try to sneak a wee bit of chocolate the pvc's are back in a shot, only minus the symptoms.....it is really helping me alot....I sure hope it contines. I am past menopause now so I can't say that is a factor, although you never really know I suppose.
I no sooner felt better and I threw my back out,argh....its starting to feel a little better ........I have the luck of the schmuck lately haha
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Avatar_n_tn
I have had brief recurrences of PVC/PAC over the last 3 years. This month I started having more or less consistent skipped beats throughout the day, not really bothersome and only occurring in small clusters. Anyway, I just started Flecainide 50mg twice daily and it seems to have cleared it up. I'm trying to solve a problem with exercise intolerance not really PVC/PAC. I could not take beta blockers. Anyone out there with experience with Flecainide?? I do not like taking any drugs, agreed to this only to see if we (doc and I) learn something about my problems.
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21064_tn?1309312333
I was on flecainide for 3-4 months and experienced some bothersome side effects (central nervous system reaction).  The flecainide worked for reducing my ectopics, but my doctor was reluctant to recommend it until I developed cardiomyopahy.  Do you experience exercise intolerance because of the pvcs/pacs? How are you doing on the flecainide? After a few months on flecainide, I was switched to rhythmol and had fewer sides effects and yet the same positive results.  Eventually opted for pvc ablation which solved the problem best (for me).

You mentioned that you cannot take beta blockers. Have you tried several of them?  Do they cause further problems?  

Hope you are feeling better.

Madge,

So happy to hear the Inderal is working!!  Now, if you could just get rid of that back pain....Good luck and feel better soon!

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About a year ago I was put on Toprol since the initial group of EP's I went to thought they saw Afib in a couple of event monitor readings while I was on the treadmill. I took it for a week. It made my exercise problems worse and I felt absolutely dead all day. Rythmol next with the same result, but worse it gave me palps at rest. Have taken flecainide now for 3 days, my current EP in whom I have the most confidence of all the 'shoot from the hip' docs I have seen, wants me to repeat the Holter, during exercise with the flecainide. High time (should have been done 3 years ago) I won't take the drug forever, even if it helps me with exercise (haven't had a chance to check yet).
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Yes I'm trying to solve the problem of exercise intolerance (dizzy if I try to run more than a certain amount). Have had cath to confirm no blocks, atrial ablation, couple of event monitor studies and a Holter (had one incidence of prolonged brady.) I have no problems during normal activities, except for some stray PVC's which now seems to have abated.
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Avatar_f_tn
Hi there.  Yes I am doing well so far on Inderol. Im almost holding my breath haha....the back pain is subsiding except when I sit(like now)......just have to be patient with it.I know it takes forever to go completely away....sooooo heating pad it is....As long as I keep away from caffeine and or chocolate (the usual suspects) I am doing great.....I see cardiologist next month for follow up.
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No more meds or docs who prescribe meds for me!! I took flecainide for 4 days to see if it would help bradycardia that I get sometimes after running/walking. My first trip back to the gym on this med, my bpm went down to 40 at rest and stayed there and for 19 hours I had a pounding (pvc's I guess) heart. I can empathize now with some of you PVC sufferers. Finally stopped after the drug washed out. Despite what they say, this drug does lower your bpm, in my opinion, or at least keep it there.
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21064_tn?1309312333
When the doctor prescribed flecainide for me, she admitted me to the hospital prior to taking the medicine.  I was in a telemetry unit to be sure there were no negative effects from the medicine. Sorry to hear about your bad experience.
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Hello C123. I am 42 and have had ablation for tachycardia about 10 yrs. ago. Was better for about 10 yrs. Here lately having pvcs and some tachy not too bad. I noticed you said you felt something of a symptom in your throat. That is my worse symptom! I hate that feeling. I have never heard anyone say that but me. It is not good to have symptoms but at least someone knows what I am talking about, like taking my breath, not painful just weird, uncomfortable. Are yours that way? I take lopressor 100mg aday at least. Dr. wants me to try Rhythmol cause I showed 6 pvcs in a 10 second ekg strip the other day. Haven't tried it yet (scared to I guess) Beta blockers seem to work pretty good though. Are you taking anything at all now? Thanks mom
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Well, I recently had a RVOT (right ventricular outlay track) PVC ablation. Quite and experience and it took almost a week to get over the procedure (basic malaise).
It basically did nothing. Bigeminy stings came back in less than 10 hours, and now last alot of the day and night. So an ablation is not a sure help (and at a tune of $25,000!). I am scheduled to have a second time, which seems to be the charm for a number of folks I've read about.
I'll let you know, but it is an important option for those of us who have strings continually all day and night. An article in the Amer. Coll. of Cardiologists says that over 20% incidences of PVCs can cause cardiomyopathy if sustained over a long time for RVOT cases. Be aggressive in drug attempts. I've found Setrol/acebutolol to be somewhat effective in symptom relief.
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21064_tn?1309312333
Have you had ANY relief from your pvcs since your RFA?  I had an ablation in August 2003 (RVOT) and ended up with a 2nd procedure exactly 3 months later.  After the first procedure my pvcs had diminished, but not enough for my doctor's satisfaction.  We waited a couple of months to see if things would settle down on their own, but ultimately the 2nd procedure was scheduled.  

Subsequent to the second procedure, I would still relapse into periods of bigeminy (the worst being 6 weeks after the 2nd RFA). After that, things settled down very nicely.  That was in late 2003.

I did develop cardiomyopathy as a result of chronic pvcs. Tests revealed that 24% of my heartbeats were ectopics (pvcs). I should mention that I had pvcs off/on for over 20 years.  Up until this diagnosis, they were considered "benign" and merely a nuisance or discomfort for me.  When CM was diagnosed, I was initially treated with antiarrythmics (a myriad of doctors determined the pvcs were the cause, hence the RX).  I underwent serial echos and stress tests so that the doctors could track any changes.  

Although the antiarrythmics were effective at significantly suppressing the pvcs, I elected to try RFA.  Within eighteen months of the 1st procedure, my ejection fraction had returned to 60% (up from 40%).  At each 6 month interval (post RFA), the EF had increased in approx. 5% increments from 40-60%.  

Please let us know how you're doing.  I hope you have great success with your 2nd RFA!!  Take care.

Connie

P.S.  Do you have the link for the article in the American College of Cardiologists that says when over 20% of heartbeats are pvcs it can cause cardiomyopathy?  I know it's true, but I'd like to read the article : )

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Hi--I'm new here. Have had afib,PVC AND PAC's  for ten years. I have been on Cardazam, toprol xl, digitek, Flecadine (sp) and now back to Cardazam--nothing really has worked and am considering Dr.Wolf's minimaze procedure--has  anyone reading this had it done??? I am just beside myself, I read everyone's post and just keep saying "that's me" that's me--I am  driving my wife crazy--anymore suggestions for relieving pvc/pac's? (PUTTING MY HEAD IN A BUCKET OF ICE WATER DIDN'T WORK LOL--BUT WHAT THE HECK, IT FELT GOOD)!!
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The skip beats I feel in my throat are occassionally (not daily or even weekly). They sometimes come with a slight pain and seem to feel more from the upper chambers of the heart (just a guess). My skip beat sensations can also be in different locations such as my chest wall, upper stomach below the rib cage, and a light headed feeling in my head.
I am on a transition to Coreg, 1/4 of 25mg of Atenolol and 1/2 of 6.25 Coreg. My sleep has already improved and I'm convinced the Atenolol was interrupting my sleep. It's known to interfere with the melatonin in your body and somehow the Coreg and a new drug waiting final FDA approval, Nebivolol, doesn't interfere with the melatonin (i.e. your sleep) in your body.
The Coreg has a longer list of side effects so I don't fully understand if this drug will have long term damage to other organs. I am having some water retention just on this little amount of Corgeg. Right now I'm just seeing if the drug can make me feel better and get me back to normal sleep. The atenolol really did a number on me. I was foggy headed and fatigued either from the drug or the drug effect of limiting my sleep to 5 hours.
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21064_tn?1309312333
Hi and welcome!!  Sorry to hear about all your arrythmia troubles....Many of us here can really relate to the disruptions they can cause.  It is such a difficult feeling to describe to someone who has not had to deal with its comings and goings.  Has your doctor mentioned ablation?  Are you near Cleveland?  CCF has a lot of great docs who specialize in ablative techniques.  I know there are people on this board who have experienced the maze procedure.  Here's hoping they can elaborate.  You can also go to www.heartcenteronline where you may find others who can relate.  There are a lot of great folks over there too.  Good luck.

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Yes, please let us know how your second procedure goes. I hope very well. I've always held out hope that if my PVCs come to the point I can't stand them (they are now estimated to be 20% of my heart beats), that I could always do the ablation.

But if you continue to have PVCs after an ablation, that scares me more than the current 1000/hr that I'm getting now.

ps. I'm on 12.5mg toperol xl as needed, because, right now, the PVCs don't bother me too much. I hope that sense of "calm" lasts, and its not just the calm before the storm. hee hee.
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I have had PVCs for approx 6 years and I take Toporlxl I have taken as much as 200mg I now take 50mg,  Anyway I just lost my job because of them the only way I can get them to stop and slowly go away is to lay down for approx 1 hr then they will stop I have no control over them when they start.  I am to the point that I do not know what to do about this I need to work and take care of my family but no one will hire me with these things.  Can PVCs be considered a disibility?  Please give me some input on this you can E-Mail me at ***@**** I would really appreciate any help anyone could provide I am at a loss Please give me your input thank you and god bless
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