Questions for my EP and Cardiologist for frequent PVC's

I'm having some significant issues and need the forum's advice.

I'm a 52 yo male with a lifelong history of hypertension (treated), along with recently diagnosed heart disease and kidney disease.  About a year ago, I had a blockage in my circumflex artery that was successfully stented.  However, I started to get quite a few PVCs around that time.  I did not have an infarction.  Typically, I'd have 3-5 PVC's per minute all day long. Sometimes I'd have a few more or a few less, but always present.  I had a holter test late last year and there were about 3000 PVCs, several hundred PACs, and a few runs of SVT.  In January, I went in the hospital for a Electro physiology test, but my heart was behaving and they couldn't induce any irregular beats.  

Then, for 3 months, I've only had a couple hundred PVC's per day.  Three weeks ago, the palpitations started to come at a rate of 15 to 20 a minute.  Primarily it was bigeminy.  Last week, I had several significant runs of PVC's (25-30)a minute.  I got dizzy and passed out at work.  This happened twice, so I went to the ER.  They admitted me to the Coronary care unit.  On the EKG, they saw multiple runs of PVC's, PAC's, Bundle Branch blocks, and short runs of A-fib.  An echo showed minimal left ventricular hypertrophy and a normal ejection fraction.  I was also low on potassium and magnesium which can happen very easily with kidney disease.  The docs gave me potassium and magnesium supplements along with a beta blocker.  This slowed the palpitations down to 1-2 a minute.  Yesterday, the frequency increased and I nearly passed out again....

Needless to say, this is a little bothersome.  I'm not a hyper person, and I don't panic.  I'd really like to get this under control.  I don't drink, smoke, do illicit drugs or use caffeine.  I sleep 7-8 hours a night, and exercise vigorously 3 days per week.  So now, I'm requesting your help.  If this was happening to you, what would you ask your doctors?

Thanks,

Jim

[canihelp]

I've heard that TOO much potassium can also cause problems.  Since you are taking prescription strength, I agree that you should have your levels tested again to see where they are.  (why do we sometimes have to remind the doctors to test certain things??)
Also, I think I would cut back from "vigourous" exercise to "moderate" exercise until you have the problem under control.    I don't have your problem (mine are somewhat different) , but my brother kept insisting on playing tennis matches with buddies because he wanted to exercise, and because he has atril fib, it gave him a heart attack.  He now has a stint & still has A-fib all the time, but the Dr. told him aerobic exercise/moderate.  He went back to playing tennis matches again this week & had heart pain again.  So, please know the difference in what your body can really tolerate. He was also weight lifting, and winning competitions & that is a no-no also!!  

I told him to get some new hobbies!!

[Celeste07]

Hello Jim, sorry to hear about the recent escalation in your PVC's etc.

With a fairly normal ekg and echo, the first thing I would do is have your doc order another Chem Panel to recheck your potassium and magnesium levels. Either one or both levels becoming low again can cause an increase in your symptoms. You may need to increase your dosage until you reach and remain at a consistant level.
My mother, myself and my daughter have chronic low potassium levels (hypokalemia)  of unknown cause ( possible genetic ion channel disease) and we all have a pretty severe worsening of our arrhythmia's, mainly PVC's and NSVT, when our potassium drops below our normal lows of 2.8 to 3.3 mEq/L. (normal population lab values are 3.5 to 5.1mEq/L )  I also have low serum magnesium from time to time.
A good hemotologist will tell you that optimal health levels for potassium are felt  around 4.5 mEq/L. Testing for true magnesium cellular levels can be difficult and costly, but you can bet that if your serum magnesium is low, your true cellular levels are much much lower. Most people low in magnesium will also struggle with maintaining normal potassium levels.
Unlike potassium, magnesium levels can take a few weeks to months to become stable and remain in the normal values once one has become deficient and then began supplements.

Be well, and I hope you get some relief soon.

[Arizona Jim]

Celeste,

Thanks so much for the info.  During my last three blood tests, my potassium levels have been around 3.0.  I keep taking potassium pills, but evidently it's not enough.  

I'll certainly ask my EP about it next week.

Jim

[Arizona Jim]

Thanks much.  I wish I'd read your message before I just finished an hour long weight lifting session : )