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Potential causes of PVC
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Potential causes of PVC

Is there a correlation between pvc and the amount of adrenaline the body produces and releases?  if so -
1) What tests are available to measure the amount of adrenaline in the body?
2)Is there a drug and would regulate (to normal level) the amount of adrenaline found in the body? or control the amount of adrenaline release in the body at once?


If there a correlation between pvc and hiatus hernia? If so -
1) what tests are available to rule out hiatus hernia
2) do pvc caused by hiatus hernia have a different kind of expression?  That is, begin or increase frequency  after a big meal or after a longer period of going without food? or when laying down?    

Is the TEE or a regual echo a better test to evaluate the size of the right ventricule?

I have had occasional/frequent pvc for over a 1 year and 1/2 and somehow I think that pvc don't just "come on". I am convinced that they are triggered by a chemical imbalance or some other physical changes. I have had more than my fair share of tests including 2 cardiac mri, 1 tee, 3 holter monitors,  1 signal average ekg, 4 stress tests, 3 echos... and what the have found is that my "extra beats" may be originating from the Right ventricular outflow track.  

The option that I have been given are: 1)do nothing 2)try flecanite 3)try an ablation but the success rate is only 60% when ablating pvc coming from the right ventricular outflow. Do you agree with these options?  I am 38 f, currently taking a low dose of Sectral for high blood pressure - otherwise healthy.
Look forward to hearing from you.  
From sunny Italy
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Avatar_n_tn
Dear italia38,

Sorry to hear about your problems with PVCs. It is possible for people who have excess adrenaline secretion to have arrhythmias and PVCs.  The excess is usually the result of an adrenaline secreting tumor. The excess is measured by collecting urine for 24 hours and measuring metabolites of adrenaline.  This is rare and I doubt you have this condition. Hiatal hernias are not associated with PVCs, although hiatal hernias can cause one to experience epigastric and chest discomfort. I would recommend further discussion with your doctor.

If you have a structurally normal heart your risk from PVCs is low and treatment basically improves symptoms and not long term outcome. However, if you experiencing a significant number of PVCs, where approximately 20% of your heart beats are PVCs you could be at risk of a cardiomyopathy. It is at this point that one could consider an ablation. I am not sure how frequent you are experiencing PVCs but I think beta blocker treatment is a good start. Also avoiding caffeine, tobacco, alcohol and other stimulants is recommended.


Thanks for your question,


CCF-MD-KE

10 Comments
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Avatar_m_tn
I also have bouts of PVCs of unknown origin that occur almost always in the early morning and after late dinner with certain foods that seem to trigger them. I have not had good results with betablockers particularly atenolol but was recently recommended sectral which you are presently taking. Before trying it and since I am so symptomatic with BBs, I would like to know if it helps you in antway and what are your recommended dosages and frequency?
Thanks for your comments
ChrisR
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Avatar_n_tn
Hello Chris,
I was given 200 mg of Sectral per day.  I tryed it for a few days but the 200 mg dose was too much. It made me feel extremely tired and by blood pressure was way to low.  The actual drug comes in capsule form (with white poweder inside). What I have been doing is open the capsule and take some the poweder out..I know that it is not a preferred method but I cannot take a 200 mg dose at once. The manufacturer does not make a 100 mg dose.

At first the frequency and strenght of the pvc seemed to have diminuished but now after a while Sectral seem to have lost some of its efficacy.  Not every day and every hour but a few times day I am very conscious of my heart pounding. My heart rate is very slow (54 to max 70. My heart never beats fast. When the pvcs come on it feels like:
-when you are riding in a car and go up and down hills or
-if you take a elevator and it suddenly moves down faster than you expect - my heart sinks  
-if you ever been pregnant - it feels like when the baby flip flops inside your belly.  
Does it feel the same for you?

From sunny italy.

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Avatar_n_tn
I too have had numerous tests. Did your cardiologist tell you the pvc's would progress with time and one day you would need betas.
I am very sensitive to meds and like many prefer a healthy lifestyle and figure the cause vs. taking a pill. At 34 now and 7 years of dealing with cardiac symptoms, However the increase has been too much to handle and hoping potassium and other avenues can help. When I am on my period I will have a increase too. Does your b/p run low and is there any heart disease in your family ?
I have had a slow resting beat and low b/p unless upset in e/r because of chest pain and hundreds of pvc's who wouldn't be ? Lucky for family.........Have been on a very bland diet for a year and noticed I eat alot of potatoes and when I don't my body reacts. Thanks for sharing
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Avatar_n_tn
Hi Karie2, Sectral is a beta blocker with something else in it.  It is designed not only to reduce blood pressure but also to reduce the pvc. It is a drug specifically designed to work on the pvc... rather than a generic beta blocker that as "side effect" slows the heart rate - therefore reducing the pvc....  

My doctor at Hopkins has indicated that the extra beats may or may not increase their frequency with age.  When I am close to my menstrual period or at times during ovulation, yes - the increase in pvc in noticeable.  I have been battling with this condition for a while now and I am not willing to give up... the "doing nothing" option it is "not an option" especially during the "bad" times. The flecanite option it also "not an option since the toxicity and side effect of the drug in my opinion outweight the benefits.  The "ablation" option is becoming more and more attractive.  My only concern is what if ablation makes the pvc worst rather then reducing them?"  

I don't think doctors take the symptoms associated with the PVC as seriously as they should... a poor "quality" of life often leads to a reduction in "quantity" of life.

From sunny Italy.


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Avatar_n_tn
Took flecainide (Tambocor)for a long time (over 2 years)without any problems,side effects.It is only recommended that caution be used when there is chronic atrial fib as this can cause a proarrythamic effector those with CHF.The incidence of side effects is less than 19%As long as you are monitored by a good cardio doc on a regular basis it is a safe drug.The potential for toxicity occurs when mutiple antiarrythamics are used at one time.You must really read and understand pharacotherapy when researching drugs.To look at only side effects and make a decision based on info out of context can be detrimental for your well being.If you trust your cardio (from Hopkins)then follow his advice and report all your concerns to him/her and discuss options.Iam afraid you are throwing viable options for care and "feeling normal" out the window based on not liking what youread about a particular antiarrythmic drug.Also,taking only a half of the capsule of current meds can be more dangerous.You create peaks and valleys in the blood concentration levels rather than a steady state which is necessary to control symptoms.
If you still don't want to take meds than have the ablatation done for longer lasting relief from symptoms (this was an option presented to you)The doc you saw is one of the best in the world(as you know from researching). Trust his opinion for your care.
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Avatar_n_tn
Hi debra, good to hear from you again.  I have a personal apprehension about drugs in general...I have always been a healthy individual concerned about whatever I ate and drunk that it feel very uncomfortable to ingest something that can have any serious side effect. I can count on one hand the times I have taken cold remedies or a pill for a headache.  The way I take Sectral was suggested by the cardiologist himself, since there is no other way. He too said that it is not the best way to go about it but if it works at a lower dose, then I need to take some of the powder out of the pill. I wish I had a more precise alternative.  

I am thinking more more about ablation, but as said my concern is that it could make my pvc worst.  I don't have any "scientific reason" to think that, only that whenever any type of invasive procedure is performed, the outcome can never be guaranteed. Also we never know how  the body will react to an invasive procedure. What is your opinion on this?

I have his business card on my desk and every day I look at it and I am ready to make that phone call but I always hope that the "next day" will be better and so I wait and wait... but unfortunately nothing changes.....
Thank you always for your comments.
Take care.
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Avatar_n_tn
For me the choice was easy for the ablation.I always evaluate procedures with the doc based on the following question"If you were faced with this decision to make about yourself or your own child,what course of action (care )would you choose?"That usually helps and also I look at will it improve my quality of life?If you don't like meds go the ablatation route as you are aware that lots of PVCs in a day can cause problems over the long run if not treated and managed.Sometimes it is very good to be cautious about what we put into our bodies and what invasive procedures we allow and other times refusal to do either one or both can cause far reaching consequences for us. You can contact me via e-mail address from our other correspondences if you wish.
Good luck
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Avatar_n_tn
What do you think of Inderal , the generic is Propanolol : I picked it up after a visit with my cardiologist yesterday. The pvc's were around 495 on a day were I only felt some/ He said take 5mg by cutting the 10 mg. in 1/2 only when needed or to see how I react . Magnesium was added to Vitamins for morning and will run blood next week. I too have a healthy lifestyle and want a calm strong heart as a reward. My b/p can run low and the same with my resting heart rate. I am concerned about this and appreciate any input.
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Avatar_n_tn
Hi;
I am new to this site, I have a question for you all.  My pvcs seem to come at the wee hours of the morning after i have been asleep for awhile.  They are constant almost every beat for about 4 hours and then gone.  I have been taking magneisum and just started with potassium. They really scare me at times but like all of you my doc says not to worry easy for him to say. Any help or suggestions would be appreciated
jmkirk
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A related discussion, BENIGN PVCS was started.
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