Re: PVCs

Posted By CCF CARDIO MD - MTR on May 10, 1998 at 22:24:58:

In Reply to: PVCs posted by Stuart on May 08, 1998 at 01:05:42:






Your site looks great!!  Like some of the other people who wrote in, I have
had PVCs on and off for about 2 years.  I am 36 y/o male in good shape,
though I do not exercise very much.  I have had all of the normal tests
done to the heart, such as EKG, stress test, blood tests, echocardiogram,
all showed nothing abnormal.  I tried various drugs, but I didn't like the
side effects.  
I noticed some pattern, which I will talk about later, which is why I tried
this next therapy.  I also went to a chiropractor from 5/97 - 3/98, and he
actually stopped the PVCs for most of the time, although I noticed my back
was getting too "loose", and any overuse of my arms and upper body caused
back discomfort, which brought back the PVCs at times.  The PVCs actually
came back 4/98, so I decided to give my back a rest from adjustments.
I have noticed and continue to notice the following correlation.  Whenever
I am in a standing position, I generally have no PVCs.  The PVCs are
aggrevated by:  eating spicy (Mexican) or bitter (wine) foods, lying down
in bed, and sitting in a non-supported position (slouching).  I also
sometimes get a slight constant pain below my sternum while lying down;
this is always a precursor to the PVCs starting within a few minutes.  The
PVCs can get as bad as 1 PVC every 3 regular heartbeats for a period of 20
minutes.
My question is this:  could the PVCs be caused by:
1.  Nerves in my spine feeding my heart and are getting aggrevated by
certain postural positions?
2.  Since I have a narrow esophagas and food at times gets stuck, could
there be a weak spot in this that is hitting a nerve going to my heart,
aggrevated by certain foods?
3.  A thorasic postural problem that is compressing either nerves or the
area around my heart that is adding pressure?
4.  A combination of these.
The correlations present are too coincedental to avoid further research.  A
neurologist I saw said the heartbeat is only controlled by the vegas nerve
in the carotid artery, he couldn't explain the PVCs, and mentioned the
postural issue.
Thank you in advance for your advice.



  _____
Dear Stuart, thank you for your question.  As your correctly surmised, PVC's
are a common problem asked about in this forum.  Fortunately for you, the
tests you mention were all normal which excludes any serious cardiac diseaser.
But, I wonder if you wore a Holter Monitor to record how many PVC's you were
having over 24-48 hrs.  The neurologist was correct that the vagus nerve
helps to control the heart rate, but it's not involved in generating PVC's.
Thus, I don't think that your back problems and postural changes in PVC's
are related to any compression of nerves from your spine.  Likewise, I doubt
that your esophageal narrowing is involved either.  The most common causes
of PVC's are tobacco, caffeine, and stress.  Eliminating or reducing these
risk factors can go a long way to reduce the frequency of PVC's.  I've done
some research for you and I found a good review article in a medical journal
which you may find helpful.  You could get a copy of this article from any
medical library, just ask a librarian for help. The article is entitled
"Evaluation of Patients with Palpitations" by Drs. Zimetbaum and Josephson
in the New England Journal of Medicine Vol 338, pages 1369-74, May 7, 1998.
I also suggest that you read some of the other PVC questions in this forum
for some more information.  Also, I would suggest that you see your
cardiologist again to discuss any further tests that could be done.  I hope
you find this information useful.
Information provided in the heart forum is for general purposes only.  Specific
diagnoses and therapies can only be provided by your physician.