Palpitation and irregular heart beats

I am always awakened (4-5 am) by palpitations which are followed by slower irregular beats and these are accompanied by a BP of 140-150/80-90. I have had CABGx3 and AVR (St.Jude) with aneurysm repair all at same time 2 years ago. Echo showed slight LVH and mild tricuspid regurg. An EP analysis a year ago diagnosed sinus tachycardia but a recent holter monitor came up with occasional PVCs and some PACs which were mainly at about same time I awake with palps. Have tried atenolol which made the irreg beats worse and had no luck with cardizem. Certain foods seem to worsen the attacks especially when taken late. Altace 2.5mg appears to lower BP and I also take Glucotrol xl for diabetes. I am also on Coumadin 5-5.5mg and any level higher than these are sure to precipitate the attacks. Restoril sleep tabs help to prolong my sleep but I am concerned about taking this fot too long. Do you have any advice on what other tests I can take or other meds I can try? Appreciate hearing from anyone else with this problem. Thanking you in advance.
ChrisR.

[CCF-M.D.-RCJ]

ChrisR.,

These episodes sound like vagally-mediated PVCs/PACs.  Vagally-mediated rhythm disturbances usually appear in the early morning or after large meals.  Furthermore, drugs such as atenolol and diltiazem (Cardizem) frequently worsen the attacks.

For patients without coronary or structural heart disease, disopyramide (Norpace) is an option, but I would be very reluctant to prescribe this medication for you given your history of CABG/AVR.

Two drugs that might be effective would be acebutolol or pindolol.  These are both beta-blockers with intrinsic sympathomimetic activity (ISA).  They tend to not decrease the heart rate as much as does atenolol and might prevent the parasympathetic surge at early hours leading to the PAC/PVC.  I would recommend consultation with an electrophysiologist before initiating either one of the medications.

Hope that helps.

[keefee]

Hello,
For the last three days I have been experiencing a "fluttering" in my heart-beat.
I've never had it last so long before. My heart rate seems pretty normal (60 bpm when resting). I'm a 39yr old male and am in pretty good condition. I work out regularly and my diet is very good. I don't smoke.
I do drink coffee & tea, about 5 cups per day in total but have never had these "palpitations" lasting so long before.
I'm concerned....should I go to my doctor straight away??

Regards

KEith.

[Sulekha]

My father experienced palpation yesterday evening. He was operated on CABGx3 and renoplasty a month ago. The doctor says it could be due to a couph syrup Suprivent which he was talking 2tbsp trice a day. He is on cordorone now and feeling relaxed. However, before palpations, our cardiologist had prescribed him Dilzem to be taken daily (of course if BP & heart rate is normal). Start of this medicine was delayed by 2-3 days as he was on higher antibiotics for his wound was not healed. In Chris's case I read that  Dilzem could further worsen the case of tachyarrhythmias. I would like to know if my father had started the dilzem earlier....was there any chances of sever arrhythmias?

[marines44]

A related discussion, palpitations was started.