Tests for PVC's

  Here is my problem.  I've had SVT with PACs for one year, not a big problem though.  However, for the last three weeks, I have had PACs & PVCs everynight without fail starting when I go to bed, sometimes starting about one hour before bedtime.  I phoned my cardiologist, who sat me up with an event monitor (again) that showed of course, PACs & PVCs.  He keeps saying there is no need to worry, but I can't help worring because of the increase in frequency of the PVCs.  The only tests I've had done were the Holter back in June when I wasn't having many problems with premature beats, the event monitor, and an EKG.  My questions are:  1)  Everyone on the forum seems to have had a Stress Test & Echo to rule out any heart structural problems.  What do doctors look for with these test in regards to PVC's & do you feel it would be a good idea for me to have these two test done to r/o any underlying problems?  2)  Can an MD say with a large amount of confidence that if a person's EKG was o.k,. that there is no danger in their PVCs?  (I had a completely normal EKG about one year ago)  3)  If I were someone close to you, having the above problems, and have a doctor who I feel isn't interested in persuing the PVC issue, would you recommend a second opinion?  P.S.  A MD friend of mine says sometimes doctors should do test on patients to put the patients mind at ease, even though the doctor is pretty sure there is no problem.  Agree?
  Thank you for your time.  I regard your opinions very highly.

[CCF Cardio MD - MTR]

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Dear Kim, thank you for your question.  
1) A stress test (which could be a stress echo or a nuclear study called a stress thallium/cardiolyte) is done to rule out significant blockages in the coronary arteries that could be causing a reduction in blood flow to certain parts of the heart muscle to cause PVC's.  Generally, in young, otherwise healthy patients, the risk of coronary artery disease is so low that a stress test is not necessary when PVC's are present.  An echocardiogram images the heart chambers and valves to look for a structural heart problem that could also cause PVC's.  If no coronary blockages are detected and/or no structural heart disease is present, then the PVC's are deemed benign and are thought to not be harmful.  I can't determine whether you need a stress test or an echo in this forum - only your own physician can make that decision.
2) Generally, with a normal resting ECG, the risk of PVC's is quite low.  But, every patient is different so I can't give you a specific answer to your question.
3) I don't necessarily agree that unnecessary tests should be done just to give a patient "peace of mind" if there is no clinical indication for the test.  That is where you have to trust your doctor's clinical judgement.  If you are young and healthy, then I suspect you have benign PVC's that will not pose a threat to you.  However, you must ask your own physician these questions or seek a second opinion which you are certainly entitled to.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
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