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PVCs and sinus tachycardia...again
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PVCs and sinus tachycardia...again

Dear Doctor,
I
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74076_tn?1189759432
Hi Fran,

1. Which symptoms should appear to make a visit to the ER necessary, for someone with a healthy heart confirmed by echo and with a benign arrhythmia confirmed by holter?

passing out or almost passing out, significant dizziness, change in symptoms compared to documented arrhythmia.  You need to learn how you feel when you have your known problem and decide when it is different.  it is always better to be safe.

2. Is it OK to take beta blockers only when needed? My cardiologist prescribed inderal 40mg and told me to take half a tablet when the symptoms get too bad, or suggested a cycle of 2 halves a day for 20 days during bad periods. He didn
26 Comments
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84483_tn?1289941537

That has been my problem sinus tach with unifocal PVCs, sinus tach controlled with atenolol, still get an occasional PVCs but nothing alarming.

My cardio told me that with a normal cardiac evaluation even if the PVCs were complex they would still be considered benign.

Good luck, I know how distressing this can be as mine tend to disappear from months to years then return.
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Avatar_n_tn
Thanks so much for your reply and for your encouragement! Are you on the Betablocker constantly though you don't always have symptoms? My cardiologist didn't even mention the option. It's not that I want to go on the betablocker for life, I just wonder whether other cardiologists agree with this strategy.

You're right, PVCs come and go. There are quiet months when I almost forget I ever had them...Then they come again...Gee!

Thanks again
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84483_tn?1289941537
I take beta blockers every day, 50mg of atenolol daily in divided doses. I suffer from mild hypertension also this is the main reason I take it everyday. Take care.
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21064_tn?1309312333
After taking BB's everyday for years, I asked the doctor about taking them "as needed."  Works for me.

good luck
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Avatar_n_tn
Thanks so much. It works for me too. Half a tablet of Inderal 40mg is enough to make me feel better. The tachycardia disappears and the PVCs decrease. I'm glad your cardiologist agrees with this, let's see what the doctor on the forum says.

Thanks again
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Avatar_n_tn
I for one am sitting on the edge of my seat waiting for these answers.

Just a day or two ago, the doctor answered that the beta-blocker toperol, while a good drug, would lessen the sensation of PVCs, but would not decrease the frequency. So I am wondering what he will say about Inderal since so many of you seem to do well with frequency reduction on that BB.

I am just about to refill my RX for toperol but it hasn't done much to reduce the constant trigeminy that I'm in. So I wonder if I should increase the dose or try something different. Guess I should need to try both options.
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Avatar_n_tn
Hi upbeat63, I'm sorry to hear you're still in constant trigemini. I was amazed when the doctor said betablockers  usually do not reduce the frequency of PVCs, because Inderal can reduce it for me, though I agree it does not eliminate them, as it does with sinus tachycardia alone. However I do notice a decrease.
I'm glad you found my questions useful. I was a bit ashamed asking again about PVCs...but I think we all agree that although they're not life-threatening they can be very very annoying, and there's so much we need to know.

Good luck!
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Avatar_n_tn
Hey upbeat, I started on 100 mg of toprol xl, didnt work and almost gave up, I then asked the doc to try a higher dose, which he did. I now take 200 mg a day and it works great.  Either the pvc's indeed did become infrequent, or te toprol does a good job of hiding them.I tried Atenolol first but had a wierd arrythmia appear from taling it so i switched to toprol. For me it works great. I have alot of those moments when, i hear the words "just ignore them, they wont kill you"  during a bad episode and say you have to be kidding me. Im going to die right now. But I live to remember it every time!
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Avatar_f_tn
I took Inderol(long lasting),toperol, metroprolol, and atenolol, to try and find one that worked the best.........the one that worked the best was Inderol.....because of insurance they switched me over to Innopran XL 80mg........which is the same as Inderol........
My physician says no way should I take it prn that it is not a good idea.......so I don't know what to think about that.
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Avatar_n_tn
In addition to BBs, you might want to ask your physician about omega 3 supplements (fish oil).  I know the CCF docs are skeptical about its efficacy, but there does seem to be a lot of anecdotal evidence out there that at least for some people, it can reduce both sensation and frequency of PVCs.

I have had an increasing number of PVCs for about three years; nothing like your 3500, or the large number so many posters have to deal with. If I felt two or three a day, it was a bad day.  My PVCs were often very painful, however--  like incredibly painful, a stabbing pain on the ectopic beat that literally shook me.  My cardiologist had no explanation as to why these simple, very occasional PVCs (captured on Holter) caused such a strong and terrible sensation.

Anyway, I began taking aroung 1000mg of high-grade omega 3 fish oil four months ago (with doctor's approval) just to see if it made a difference. After about 3 weeks, my PVCs virtually went away, and some other symptoms I had been having also disappeared.  I have had only 3 PVCs that I am aware of during these last 4 months, and none were painful, just the flutter-thump variety.  I have also noticed that my resting HR has dropped from high 60s to high 50s-60 during this time.

Could well be a coincidence, and whatever was going on in my heart has "resolved" itself, at least temporarily.  But I made no other changes during this period, just started taking the supplements, and at exactly the 3 week mark when they are supposed to "kick in,"-- lo and behold, it seemes like they did.

Just something to think about; we're all different, but maybe your doc might think its worth a try.
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Avatar_n_tn
I thank everyone of you for your support, and of course the doctor for his very kind reply.

dasobel, I had never heard about Omega3 working with arrhythmia but I'll definitely check into that!

In my question, when I talked of xomplex PVCs I meant doubles and triplets. I do get los of trigeminy and occasional bigeminy! Can anyone of you feel the difference between a simple PVC and a triplet, or a longer run of PVCs? Anyway the doctor said the treatment would be the same, so I guess I should stop worrying about developing more complex PVCs.

Thanks again everyone

Fran
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21064_tn?1309312333
Yep, I can feel the difference.  An isolated pvc catches my attention.  A triplet or incidence of nsvt really catches my attention.  For me, the difference is something like this:  A single pvc FEELS like a skipped beat (it is actually an extra beat...weird).  A couplet, triplet or run feels like a rumbling of heartbeats, like the rhythm is trying to take hold.  I was just telling my husband how I can equate it to driving a car...Say you're driving along the highway and your car starts to stall, but doesn't actually stall, just kinda sputters for a few seconds.  Then, it kicks back into gear and your driving normally again.  That's sort of how a run feels.  Whereas, a single pvc would be like hearing a brief "noise" in the car..."what was that" and it's over before you can try to figure it out...you notice it, but just for a second. Oh, I have never experienced pain with pvcs, but others have.
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Avatar_n_tn
Thank you everyone for the information on your use of beta-blockers.

I agree, even with only 25mg of toperol it sometimes lessens the sensation so much that I think I'm not getting any PVCs, but when I check sure enough they are there--same frequency. I will experiment with a little more and then try another if I'm still feeling uncomfortable.

I second the description of PVCs runs, that they feel like a rumbling, a fluttering in my chest, whereas the single PVC just feels like a pause, sometimes with a compensatory big thump that I can feel in my chest, shoulder blade, throat or all three places.

I also have been told not to worry about the runs, in the presence of a structurally normal heart, they aren't any more significant than single PVCs, so long as they don't go on and on.

And finally, I don't think anybody on here should hesitate to ask questions within the board's limits, we all seek answers to our own unique health situation, if it's significant to us, that's sufficient. Happy day to everyone.
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Avatar_n_tn
I get about 2,000 pvc's a day as recorded on a relatively "good" day on the holter monitor.  I feel only a small fraction of these.  How many pvc's should you be having before it becomes more  beneficial to the long term health of the heart to begin beta blockers?  I noticed that the dr. felt that 3500 was a considerable number and he seemed to be supporting the taking of beta blockers in Fran71's case.  I've never really been bothered by my pvc's but do not want any problems down the road.
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Avatar_n_tn
I hope my personal history can help to answer your question. When I was 30 I had my first holter which recorded 10,800PVC/day. The cardiologist I saw then said the same thing as some cardiologists do now: beta-blockers can decrease the sensation, but may not do anything for the frequency, and possibly, could make the PVCs worse. So he left it up to me. So I declined the BB.

Now at 20,000+ with long stretches (weeks) of trigeminy, some nsvt, and some symptoms that I'm not sure come from the PVCs or not, I've decided to take BBs, sometimes on occassion sometimes for several days. My doctor pretty much left it up to me, again.

Right now I'm on day 7 of toperol in a row and the PVC sensation is less but trigeminy is still my norm. There are people here whose PVCs have decreased though, so it's a blessing for them, and maybe worth a try for you, if you did become bothered by your PVCs.

I don't think there is a "limit", or number which doctors use as their guide to RX BB. There is one thing my GP doc said, BB are heart protective because they lower your BP and lessen the workload on the heart--that might be the best reason to take them if you have high frequency issues--although I've not seen "high" defined--the reason being is that there is a small chance high frequency PVCs can lead to a cardiomyopathy. I don't know what the length or frequency or chance of that happening is. I've had mine for 22 years and so far so good.
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Avatar_f_tn
Hi, guys - I got the results of a 30 day heart monitor I did and it showed only sinus arrhythmia which my doctor says is OK.  Not even a single PAC or PVC.  Yay!  Anyway, the occurrence I was trying to "catch" on the monitor was a weird fluttery feeling in my chest that I thought was NSVT from how I've heard it described.

My question to anyone who's had NSVT - do you know if it's possible to "interrupt" a run of NSVT by say, jumping up off the couch?  My doc says it's unlikely NSVT because I can interrupt the occurences like that and they immediately stop.  He said if anything it may be short runs of SVT.  What do you guys think?  Can you interrupt your NSVTs or do they just go until they get ready to stop?

Thanks!
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Avatar_n_tn
Wow, great news about your holter and not having any PAC or PVCs for 30 days!!

I've had several runs of nsvt, and it's always been that fluttery feeling. I can't say for certain if there is something I can do to stop them. I have moved on occassion when I get nsvt and my rhythm has gone back to trigeminy. I've done nothing but be still and listen and it's gone back into trigeminy. But MY nsvt is usually under 10 beats so it's hard to say if anything is changing it, for me it's too short to know.
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Avatar_n_tn
Hi, from what i've heard, if the symptoms are not bothering you then it's no point in taking anything. Most, if not all people that get frequent pvc's are taking BB because of the unpleasent symptoms that they produce.there are people that get them all the time and not know they have them (oh those lucky people)i feel everyone of mine. hope your having a nice day.
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Avatar_n_tn
Wow ... why are you worrying about NSVT when you don't have a single ectopic in 30 days!  You would be hard pushed to find many people in the general population that don't have an ectopic in 30 days.
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21064_tn?1309312333
Here is a very informative publication on pvcs.

"Frequent" is described at > 30 in an hour!! Sounds like a dream come true for many with very frequent ectopics.  I think I was at near 1000/hr.  

As for the "number" that results in a recommedation of BB's, I had the same experience as Upbeat. They were "suggested" for treating the symptoms, but in the setting of a structurally normal heart, not necessary.

I don't know if I can "interrupt" nsvt.  But, when I was having a lot of runs, an interruption simply meant reverting to bigeminy or trigeminy.  I just rode it out and still do.  Absent any other cardiac problems, and with clearance from the doctor, I'd try not to worry about it.  Not gonna hurt ya...just peak your curiosity and stir your psyche.

Have a great day all!

Oh, I agree....ALL questions are relevant and important!  

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21064_tn?1309312333
Oops....I forgot to post the link......UGH!!  Another senior moment : )

http://www.emedicine.com/emerg/topic773.htm
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Avatar_f_tn
I probably did have at least one ectopic in that time, as I understand most everyone has them.  I just didn't "catch" any on the monitor - it was one of those that you have to push when you're having an episode.  When I thought I was having PVCs, turns out it was only sinus arrhythmia.  I'm just worried about NSVT because I don't have a clue what that fluttering could be (it's more than just a PVC which I've had and had documented before) and it's never been caught on a monitor.  Just didn't want you guys to think I'm griping over nothing as I know a lot of folks on here have LOTS of PVCs every day!
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Avatar_n_tn
Of course, an "event" monitor, well you wouldn't want to push the button and record all those silly "routine" PVCs now would you ? hee hee, that put a smile on my face!

I thought you didn't get a single one, and I thought wow, great for you, 'cause I know in previous posts you were getting quite a few and I was really happy you didn't get any in those 30 days. Sounds like you are managing better now though? I hope.

The nsvt can be hard to capture, because I don't feel all of the runs. I sometimes feel the fluttering in my chest, sometimes it feels like bubbles. Sometimes I'm listening with a stethescope because I've been getting weird sypmtoms and I want to find out if the trigeminy changed, and I'll hear an nsvt run of 6 beats but I haven't felt any sensations at all!

Weird and wonderful thing our bodies!
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Avatar_n_tn
Hi. I have recently been experiencing rapid heartbeats (180-200 bpm) and have been scared to death. It all started one night about a month ago when I woke up at 4:30 in the morning & my heart was racing. I felt dizzy and had an upset stomach. After several hours, I finally managed to fall back to sleep. When I woke up the symptoms had disappeared. However, I've had 3 subsequent episodes...the last one about a week ago. I think it was triggered by a few glasses of wine that I had the night before,but I'm not sure. Anyway, I woke-up again in the middle of the night w/a racing heart. I tried to ignore it but couldn't. Finally, the next day I saw my cardio who put an even monitor on me and gave me an echo. The echo was normal, but the event monitor showed that my heart was beating about 180-200 bpm -- (& all i was doing during that time was walking from room to room in my apt). Anyway, my dr said that while my heart was indeed beating very fast, there was no arryithamia (sp?) and he ended up diagnosing me with sinus tachardia. That was about a week ago---the problem is is I am still having problems; if i walk up a flight of steps or do anything even remotely active, my heart starts to race again. Can anyone tell me what I should do or if i should do anything? Also, i've been reading the posts on this board, can anyone please tell me what PVCs, PACs & Trigeminy means? Finally, should i talk to my dr. about getting on a beta blocker to slow down my heart.  Thanks very much.
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Avatar_n_tn
Hello, I am also a member of the Supraventricular Tachicardia and PVC club...

Does anyone ever have a pressure on their chest associated with this....I'm not sure if it is because of this or just due to anxiety.
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