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PVC's and PAC's
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PVC's and PAC's

Thank you for taking my question.  I am a 51 year old female.  I have had PVC's and PAC's and salvos since my early 20's.  I have had every test they can possibly do and they find nothing wrong with my heart.  These still scare me to death though.  Some days I will get only a few and other days I will get a couple of them an hour.  I was laying in bed this morning and got a few of them within a minute and they scared me so much!  It either feels like a drop in my heartbeat or it is like a kick in the chest because they are so strong.  My questions are:

1. Would it be possible they missed something with my heart when I have had all the testing done?
2. How many of these things are a normal amount to have each day?
3. Would everyone have these abnormal beats and just not feel them (that is actually beyond my believing because they are so strong and so uncomfortable I can't see that people would not feel them).
4. Sometimes when I just "think" about them I can bring them on?  Is that normal?
5. Any amount of stress or anxiety brings them on as well.  I always know that when I am stressed about something I am going to get a good bout of them.
6. Am I just worrying myself about nothing if they truly say I have normal heart and there is absoloutly nothing wrong with it?  I do recall when I had an EP study 14 years ago the EP mentioned I had a "slick sinus node".  He said that was a good thing.  He said something that it was like a 20 years old sinus node or something to that effect.  

Thank you for your advice!
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PACs and PVCs are typically not something to worry about. PVCs, if they are frequent enough, can rarely cause decreased heart function (heart failure), but this needs to be a burden of something like 35% or more (meaning that 35% of your heart beats, all the time, have to be PVCs), not a few per hour. If you have had your heart evaluated with EKG to evaluate for other abnormal rhythms, and with echocardiogram to rule out any structural abnormalities of the heart, and those were normal, then further evaluation is not necessary. You should rest assured that things appear well. If they are symptomatic (palpitations) then sometimes medication such as beta blockers can be used to decrease the frequency.
1) If they did the above tests, it is unlikely that they missed anything.
2) There is no normal amount. Most people should have none, or a few total per day. However, if someone has PVCs with frequency, as long as their heart structure and function are normal by the above tests, and electrolytes appear normal, then it can still be normal.
3) Some people do not feel their PVCs (or PACs). However, it is common to feel them. Actually, what you feel is the first normal beat after a PVC. A PVC is early (Premature Ventricular Contraction) so is actually weaker than a normal beat. However, it is followed by a pause, called a compensatory pause, which is slightly longer than your normal interval between normal beats. This longer time allows more blood to fill your heart and actually causes the heart to beat stronger thus a thump or palpitation sensation.
4) When you think about them you are probably just actually focusing on them and thus noticing them.
5) Stress can stimulate your heart and make it more irritable, thus making the premature beats more frequent.
6) If your testing previously has been normal, then you are likely stressing yourself over nothing. Regular follow up with your physician is all you need. If you need further reassurance, seek a second opinion, but again, ECG and Echo are about the only tests you need to make sure your heart structure and function are normal. A Holter monitor for 24-48 hours can be useful just to give you and your physician a number of how many PVCs and PACs you have over that period of time.
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