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When is it too many PACs/PVCs?
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When is it too many PACs/PVCs?

Earlier this week I went through a period of 4 plus hours when I was having 15 to 18 PVCs/PACs per minute. I was relaxed, sitting and watching TV. I had no other symptoms and getting up and moving around did not affect them. This was still going on when I went to bed. Typically, I experience 4-6 PVCs/PACs per minute. With a resting pulse of 60-70, this was one every 4th beat, although they were not that regular.

When is it too many? Should I have gone to the ER? Could it have been something other than PVCs/PACs? The next morning, I was below 10 per minute. I made an appointment to see my cardiologist to discuss this but I am now anxious to understand if I should have done something.

Thank you very much for reviewing my question!
Related Discussions
Avatar_n_tn
Dear roys,
There is really not a "limit" as to the number of PACs/PVCs one can have.  The number does help us however in planning treatment. For someone with as frequent ectropic beats as you we would generally recommend some type of treatment be it medical or ablation.  In general if a person is having >10,000 extra beats over a 24 hour period then medication or ablation is indicated.  You may want to ask your cardiologist to send you to an electrophysiologist for further evaluation and treatment.
28 Comments
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Avatar_n_tn
A couple of years ago when I had my first episode with PVCs, I went through a whole battery of tests, holter, echo, thalium stress test, and even a cath. The bottom line is that they really didn't find anything to pin the PVCs to and everything was considered normal. Part of the reason I ended up with all the testing is that the holter did show 2-3 PVCs in a row sometimes. Since that time I've had the PVCs disappear for months as well as come and go in a matter of weeks. However, this is the first time that I've had such a high frequency. So from my perspective, it begs the question when do you assume something has changed? I do have a cardiologist, who I will see later this week. I am currently taking Inderol as a beta blocker. In the past, I've also taken Toprol. Overall, I'm not sure if the beta blocker helps since the PVCs seem to come and go on their own whether or not I happen to be taking a beta blocker at the time. I also don't like taking larger doses of beta blockers because they leave me feeling a bit fuzzy all the time. I do have an appointment with my cardio later this week. We'll see if he sloughs it off. Thanks for the comments! It's good to know I'm not the only one who is frustrated with no root answer.
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Avatar_n_tn
PVCs/PACs are often caused by foci (structural cardiac tissue, normally electrically isolated from the rest of the heart, which have a small population of electrical cells) which interfere with the heart's normal rhythm.  The actual cause of the change from passive to active for these little foci is not clearly understood, however, they have been studied intensively for the past couple of decades...and most recently (last couple of years) they have been the target for ablation techniques which have resulted in cures of many types of arrhythmias.

With a structurally sound heart, they represent no more than a source of anxiety and they are quite disturbing.  Many people live their entire lives with these beasts producing nothing more than mental irritation.  Some people (as the post above suggests) can develop more serious symptoms (notably persistent tachy or AF)...in these individuals, ablation is often the answer...cardios are not eager to treat "simple" cases of PACs/PVCs with ablative techniques because of the risks involved.

Beta blockers really do nothing to stop these skips; they just slow the heart down a bit and may lower you blood pressure to the point of not feeling them as often.  There are other drugs available which make the atria less sensitive (reduce automaticity) to external electrical noise (eg tambocor).  I took both types of drugs and found them unaccepable, as I am an avid soccer player and found that limiting the heart rate was not a useful effect when trying to do sprints for an hour and a half.

Get a Holter done to document the arrhythmia (use an event monitor if necessary...that's one you can turn on right after you feel something and it will record the current symptoms plus about 30 secs previous to the event).  If you can document a persistent type of arrhythmia you may be able to consider an ablation.  It worked for me.
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Avatar_n_tn
Mine stopped when I eliminated monosodium glutimate (msg).

Had them for years.  Read labels.  Eat more produce and
less canned and processed food.  Don't smoke.  

I don't drink alcohol, either.

Good luck.

      ---- Farf
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Avatar_n_tn
I know where you're coming from. I had the same problem for at least 10 years, frequent PAC's every few seconds. Had all the tests, doc told me I was ok, & blew me off.  Here are some things I have tried with great amount of success, you may want to try these:
1.)  Magnesium, potasium, fish oil concentrate tablets( I read obout this in the Harvard Medical School newsletter a couple of years ago) and Hawthorn berries.  This regimen has worked wonders for me.  You can find this in the vitamin section at Wal-Mart, K-Mart , Cvs etc. It may take a few days to notice improvement.
2.)  Take slow deep breaths when they come on.  Easy to hyperventilate when they come on  & may be making it worse.
3.)  I am a runner  &  i noticed the PAC's seem to subside with exercise, you may want to take a brisk walk.
4.)  Prayer doesn't hurt, if nothing else it may put you in a positive frame of mind.
  5.)  Also, & I know this is tough, but try to think of something else when they occur.  The anxiety may create a vicious circle and make it worse.

I hope this helps, let me know how you make out.
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Avatar_n_tn
Hankster, thanks for the comments about the beta blocker. I was wondering if it was making things worse. My logic is that if the beta blocker slows the heart and my resting heart rate is now 60 instead of 75 bpm, a reduction of 20%, then my heart is pumping more blood per beat, 20% more, assuming constant blood volume per minute. Therefore, the next beat following a premature beat should have even greater blood volume and be more noticeable?! So the slower my heart rate, the more noticeable the PVC/PAC. This seems to make sense to me since my most noticeable PVCs/PACs are when I am very relaxed. For me they are less noticeable after excersize and when I am more active. Does this seem reasonable?

SamR, thanks for the comments about Magnesium and Potassium. I have seen that mentioned in other comments in this forum. I am going to get some and give it a try after I ween myself off the beta blocker.

Has anyone heard anything about the effect of CoQ10 on PVCs/PACs?
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Avatar_n_tn
Well, what I've been wondering is where are all of the "old timers" with frequent PAC's/PVC's?  I started having them a couple of years ago and I'm 31.  What's it going to be like when I'm 70?  Has anyone out there had them for over 30 years?  If so, what happens as you get older?  I don't believe that I have ever seen a post by someone who has experienced these arrhythmias for over 10 years.  Now to me that means that either 1) these weren't diagnosed 30 years ago, or 2) These "old timers" aren't computer savvy and thus we don't seem them on this site, or, and I hoping that this is not the case, 3) people with these issues don't generally tend to live long when faced with these issues (hence the opinion that these arrhythmias are a harbringer for something more serious)..... wish I knew...
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Avatar_n_tn
Scott,
I am 43 and have had arrthymias (PVCs, VTs, ATs, AFs) for 9 years.  It's not over ten, but I have a good feeling I will keep going.  (smirk)  But I had to laugh, it is strange that there aren't many older folks with these conditions which we can learn from!

Two years ago I had two ablations, back to back - due to cells surfacing or reproducing after the first procedure, creating a worsening condition. I survived and still have some of the above arrthymias - not as frequent, thank goodness.  It has been recorded that I have had as many as 35K + in a 24 hour period prior to the ablation.  There is no limit to the person who asked in a previous post. :-)  These PVCs were recorded way before they were doing ablations.  

As for the arrthymias indicating an underlying issue - I believe the medical field has determined that they can possibly be associated with other heart conditions, but they can be their own condition, with nothing else happening.  It's like having electrical problems in your home.  

If these persist, I think I'll go the whole nine yards and insist on a pace maker.  I think that may be part of the reason we don't hear about the older folks having PVCs.  

Regards,
- N



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Avatar_n_tn
Hi all - this is my first time posting on this site.  Someone asked "where are all the old-timers" with these things.  Well I don't consider myself old at 40 but I have had both pac's and pvc's for the last 13 years with breaks of up to 6 months occasionally but on the whole they are more or less pretty much constantly around.
My Dad had them from his late 20's when they abruptly stopped in his late 40's (NEVER TO RETURN!!! - hope that gives people hope!!)
I've been interested to read all of your posts Arthur because you seem to know so much about the foci related stuff.  My pvc/pac's are multi-focal and I definitely notice a postural and movement issue with mine.  I can actually bring them on by lying down suddenly on my right side and then stop them again by sitting up which of course scares the hell out of me!!  Hence I never, ever lie down straight onto my right side.  I've heard there are "stretch receptors" in the heart which can bring on this electrical irritation and I guess that's what you are talking about when you mention the foci getting stimulated.
Anyway after having these things and so very many tests for the last 13 years I would like to reassure everyone that I am still alive and kicking and intend to keep doing so.  Having said that though I have been through bouts of sheer depression and misery, anger and my first marriage broke up because of my ex-husbands inability to understand the devestating effect these things can have.  Now that I have had them for so long I've lost my fear of dying from them but still hate them with a passion.  I've found that getting angry is better than getting scared and also have found it's really important to keep well hydrated with plenty of drinks of water during the day.
I'll continue to read all the posts with great interest and thanks to all of you out there - it's nice to know I'm not alone.
From Susan in Australia ("old-timer"  :) :)
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Avatar_n_tn
Hello Susan,

I found your letter from Australia very interesting (I have you
beat by 5 years in the age department.  I've had PVCs off and
on for over 6 years.  I've read of many who have had them for
30 years or more - yuck.  I don't know if that's good news or
bad, do you?  wonderful to hear your father's disappeared never
to return!  That's my dream!  Mine seem to be connected with
digestion, reflux or something like that (stress doesn't help.)
My e-mail is ***@**** if you want to write.  Thanks,
Henriette.
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Avatar_n_tn
Well I think I can qualify for the old timers category! I've had these buggers(pardon my french) for 21 years and have had to just get used to them even though I still hate them with a passion!Mine are relatively occasional compared to some of you other sufferers.They vary between single "skips" to multiple flutters and are sometimes accompanied by anxiety lasting several minutes.I get them only once or twice per day and sometimes none for several days.In the past ie. when I was in my early 30's I also had bouts of tachycardia usually at night when asleep.These were usually associated with excesses of alcohol and/or caffiene.Once I reduced those significantly the tachycardia has been very rare.My various tests over the years have all been normal(ECG,echo,stress tests).I finally agreed with my physician to wear a 24 hour Holter monitor just last week and I'm still awaiting the results.The main supplement that I've found is helpful has been magnesium at about 400 mg. 3 times a day.I've pretty well accepted that I'm going to have this problem for the rest of my life but it's also good to hear of people who've had spontaneous remissions!Thank you all for sharing your experiences and suggestions.Life still goes on!!!


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Avatar_n_tn
I'm 57 and have had these extra beats, sometimes every second or third beat, sometimes a five - ten seconds arrythmia, for over 30 years now.

I have had most of the tests you can think of (except catheter) and the most recent (Oct 1999) was a myocardial perfusion scintigram - which is a rest/stress ecg with nuclear scan (that's my layperson's understanding) and the result said, "very high effort capacity achieved without symtpoms and mild upsloping ST segment depression"  .... "there is no scan evdience of significant reversible myocardial ischaemia" - all of which means, I'm told, that I have a healthy heart for one my age!

But that hasn't stopped the arrythmias! This last 3 weeks have not been good and my GP has given me a course of Tagamet as he thinks it might be related to a hiatus hernia! I certainly have a feeling in the lower gullet area that is a little uncomfortable (but no difficulty swallowing). I had an operation for a hiatus hernia in 1969 - they don't do them now - and this could be a few of those threads coming loose! The area of an h.h. is very close to the cardiac area and symptoms of an h.h. can replicate heart pain, I'm told.

Yesterday I did a very brisk walk for 40 minutes followed by 20 minutes of weights - my usual every second day exercises - and felt better for it! About once a week a swim for a kilometre.

And I'm still here and, by and  large, enjoying life.

Sure the arrythmias are annoying and occasionally depress me a bit - always have! But I've gradually learned to live with them. And if they're a portent of things to come, well, they've been a long time coming!

I should add that after all the tests I've ever had, the doctors have told me to get on with life and stop worrying about them. I try but it is easier said than done.

So this 'oldie' says take heart! At least you've still got one that's working even if it throws a wobbly now and again!

And happy Thanksgiving. America!

From Eebee in New Zealand
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Avatar_n_tn
This is my first post. I am a 40 year old male and
have had bouts of PVCs for 15 years. Sometimes they would
go away for months, sometimes i would only have one or
two a day. But the last two months I have had several
episodes a day with pressure in my chest. Also in the
last two months I have had a Treadmill test with Thalium
pictures and just yesterday I had an arteriorgram that
all tests showing no abnormalities which relieves some
of my anxiety about them. Now im endevoring to loose
about 40 pounds and stop smoking. Im also easily stressed
out about work and other things. I will post again in
one week and we will see how diet and reduction leading to
quitting smoking will act upon my PVCs. Now if I can only
assure myself that PVCs alone will not kill me. I have
been told many times they wont but as all of you know,
they are very bothersome. We all like our heart to run
nice and smoothly and when it jumps around it's very hard
to ignore. Thank you and talk to you soon.
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Avatar_n_tn
I am 55 have had PVC's etc since I was 22( 33 years) and am still exercising 4 to 5 times a week. I must admit though they have got worse, from occasional arrithmias at night to non stop 24/7. I also get migraines and think there is a connection. Anyway I am still around and have had and raised 3 children, emigrated from the UK to the USA, divorced, had several successful careers and am now working in IT analysing computer programs. Hope this is encouraging. Still get freaked out sometimes though. Do I win ther longevity prize?????
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Avatar_n_tn
Hi - which way do you have me beat - are you 5 years younger or older?  If it's younger then lucky you :) :)
It's been nice to read the further comments from the "pvc Old-timers".  It just goes to show it's not really viable to die from these silly things.
Do you have anything that makes yours worse or better?
Thanks, Susan
p.s. where are you from?
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Avatar_n_tn
Hi Susan,

I have you beat by being 5 years older (actually I'm 3 weeks
shy of 46).  Things that make it worse for me are eating and
activity afterwards, stress (big one) and sometimes different
positions.  I don't know what that has to do with anything,
though.  If you want more info, my e-mail is ***@****
It's easier to write using e-mail then here.  Are you worse
during different seasons?  Or aren't you bothered by those in
Australia (ha ha).  New England has many changes in tempera-
ture - I seem to be worse in the fall Oct-Dec.  Maybe it's the
holidays, or school starting, or, ... I don't really know.
Summer seems best - maybe because I get more exercise and go
outside more.  Oh well, take care.  Henriette.  PS  I live in
New Hampshire.
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Avatar_n_tn
I am 49. Been having pvcs for13 years. I found it interesting the person from australia can trigger them on laying down on her right. Me too but also occasionally can get one on left side. They also go away when I sit up. I walk every day for an hour eat as healthy as possible get good sleep . I live and work at the beach so stress should not be a factor.I usually have 5 to 15 pvcs a day with an occasional flutter here and their. Today I got back to back flutters on the stationary bike which never happened before . It made me stop and got me alittle concerned. Usually i do not feel anything while exercising only an occasional pvc. Does anyone out there get anything like this. I love to exercise . I called my cardiolgist and said for me to try a event monitor
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Avatar_n_tn
Arthur said; "I only wish I knew what substances may actually affect the foci in the opposite direction...now that would be nice."

The "substances" that-might-just-do-that, are probably illegal! <G>

Since the blood flows through the Pulmonary Vein [from lungs] to the heart, one just may have to "smoke" something?! <BIG GRIN>

wilson-wilson

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Avatar_n_tn
Hello all,
Please anyone that can give advice , please do. I am a 24 year old new mom and have experienced PAC's and PVC's for the first time last night.
I have never had anything like this before and it scared me so much that I did ALOT of praying and then went straight to the ER. Where they promptly told me that I had PAC/occasional PVC's.
The PACs are fairly often maybe 1 or 2 a minute with the PVC's one about every 10-20 minutes. Compared to what some of you have put down this seems to be a low amount but I am still TERRIFIED.
I am already suffering from Post Partum (my daughter is 3 months old) and I am trying my hardest not to freak out but I find it difficult to accept that this is a normal thing.

My heart thumps in my chest, if that is a PAC (which the DR told me was just an extra heartbeat) then why cant I feel my other regular heartbeats? And if this is disrupting the normal rythym of our hearts then why cant it cause our hearts to stop?
I am seriously not sleeping because of the fear that I will not be able to get to a phone or help before I die.
Maybe I have an overactive fear of death but this scares the heck out of me!
Any advice or suggestions would be greatly appreciated! Thank you sooooo much to anyone that can help or respond....my email is ***@****

PS they seem to become worse when I lay on my left side. I am overweight but I have given up caffeine (tea soda choclate etc, I dont smoke and I dont drink coffee or alcohol) because I dont want to do anything to aggrivate it. Is there anything else that makes it worse? I cant help the stress because I have a new baby but I will try like hell =)
Does anyone know anything about Prozac's effects on it? My DR is considering putting me on it for depression. What about alcohol? I am going to a big New Years party, need to know what to avoid.
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Avatar_n_tn
Try magnesium, potasium, fish oil capsules and hawthorn berry capsules ( it's a herb you can find in the vitamin section at any store).  This combo did wonders for me. Hope you have the same results.   (and please calm down)
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Avatar_n_tn
Hi everybody,

I started having PVC's about 10 months ago.  I went to 2 doctors, had all of the tests done and just about drove myself crazy trying to figure out what was worng with me.  The doctor's didn't seem concerned, but I was.  It has taken me this long to get them to completely stop.  Here is what I did that may help you:

1)  Cut out all caffeine.  I MEAN all (even chocolate)!
2)  Do not do strenuous weight workouts.  Avoid chest press, shoulder press, and lying tricep press with heavy weights.  For those of you who do not lift weights, avoid strenuous activities at work/home.  Taking a 2 week break from lifting weights REALLY helped me.
3)  Drink plenty of water.
4)  Eat your fruits and vegetables (or get a juicer like I did).
5)  Get plenty of sleep every night (at least 7 hours).
6)  Start a light cardiovascular workout and build up from there.
7)  Sleep on your back.
8)  Take a multi-vitamin or herb supplements that have been mentioned.
9)  RELAX!!!!!   I used to worry myself into PVC's.  You are going to be fine.  The more you think about it the worse it gets.

I can't stress enough the importance of cutting out all caffeine and limiting heavy weight lifting.

Good luck!
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Avatar_n_tn
Hi!  This is my first time commenting.  I have had PAC's for about 15 years.  I was put on 25 mg. of atenolol after a 24 hour holter monitor was put on and I had over 2000 PAC's.  The atenolol worked real well for a few years but the past three weeks I have been having PAC's constantly.  If I get up and walk or do anything as light as housework they really seem to come on.  The other night I was having runs of them, one right after another.  I would get up, change positions, whatever I could do and then it would revert back to a normal sinus rhythm for a few minutes and then it would start all over again.  It is really driving me crazy.  Even sitting here at the computer I can feel 1 about every 20 seconds or so.  I just did another holter yesterday but won't have the results until next week. It's not very comforting to know I have to wait more days to find out somelthing.  Has anyone had to have the ablation therapy for PAC's?  I've read a little on it.  The doctors always say don't worry about it, PAC's are harmless yet PAC's are usually what triggers other arrythmias such as PAT's, Atrial tach, etc.  Then they say well, as long as you are not symptomatic, (dizzy, lightheaded, etc.) go on with business as usual.  Well, it is not very comforting just waiting to see if today is going to be the day you get symptomatic.  Any suggestions?  I'm tired of my heart thumping, flipping and flopping!  Thanks!
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Avatar_n_tn
HI,

I'm a 34 year old male with your EXACT same symptoms. I too, am recently a new parent and the episodes came around just about with the arrival of our little bundle of joy! Let me tell you something...kid's are stressful!! Especially babies. Stress brings on these PVC's and PAC's and I'm sure you're getting plenty of stress. You've seen a doctor, he gave you the diagnosis...now you have to learn to live with it. They don't kill you, they're just a nuisance. The anxiety that comes along after an attack can even mimic a heart attack. It's no fun feeling like there is something wrong with your heart! Just remember, it happens to a lot of people...we're all still here and breathing and we'll be here for a long time! When you're having an "episode" of PVC's just get your mind on something else. Go somewhere and walk around. Go to the mall or beach. Drink lots of liquid. No caffeine or chocolate or coffee or soda or alcohol or cigarettes. Take your vitamins. RELAX!!! And as far as thinking that you're going to die, I bet you'll bury us all!! (Please make sure we're dead!!)

Take care and good luck,

Piper
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Avatar_n_tn
I'm in everyone's debt for sharing.  Am 36, male, and exercise almost diaily.  My PVC's started out of the blue 3 weeks ago.  Went to the Dr., had 2 EKG's, both of which were fine.  Did the Halter last week.  Hadn't been that frequent prior to the Halter, but went nuts when I was wearing it.  I'm concerned b/c I had several runs of 4 and 5.  Still been getting them, mainly in the evening.  Several sleepless nights over the last few weeks.  Is there a book to read, any other on-line places to read up on things which may help?
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Avatar_n_tn
I guess you would call me the "oldest of the old" since I am a 70 year old female who has had episodes of PVC's on and off since my 20's.  I won't bore everyone with all the tests I have had, but I am still here and still not enjoying the episodes at all.  I try very hard to ignore them, but it's not easy.  I have had periods when I have not been pestered with them hardly at all.  Although, even during those nice periods, I still experience several each day.  I have learned to say a little prayer each time they occur; try to keep them in perspective.  I sure know from experience, however, that it is easier said than done.  I have gotten a lot of information and solace from reading the comments in this column and I thank all of you for them.
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Avatar_n_tn
I just found this forum site a couple of days ago.  Wonderful site.  Almost like a support group/confidence builder.  Anyways just a few comments about my "little problem" and myself. I am not an old timer (35), but have had PAC/PVC for over 20 years.  The only thing that I have noticed over the years is that they seam to have increased a little over the last 4-5 years.  They are annoying and I hate them probably even more now than I have ever before.  I do not take any medication and never have.  I do exercise.  I weightlift 4 days a week for an hour a day, walk briskly (4-6 mph) 40-60 minutes four days a week.  And part of the problem is that since 1993 I have gone from 170 pound running and weightlifting fool to a 240 pound slug (I was 260+ not too long ago- OUCH) trying to get back into shape.  (how did it happen, just got lazy).  So I think the lack of exercise over the last several years may be an underlying reason why my PVC/PAC have increased.  I will say there is no rhyme or reason for when I have PVC/PAC's.  There are very annoying at night and sometimes, majority of the time, I have trouble falling asleep.  Other than that, I have learned to live with them.  They are not going to kill me, and they are not going to kill anyone else.
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Avatar_n_tn
I've had these doggone palpitations forever. I'm 55 years old, female, thin, don't smoke, don't drink alcohol, don't drink caffiene. In fact, I don't do anything that should bring them on I've have EKGs, stress test, echocardiograms, halter monitors, the works......normal results. Sometimes I feel like I have a strange fluttery feeling in my throat even when I DON'T have the palpitations. It feels like it's heart related, but I'm not sure if it is. It's just a funny, heart-like feeling. Hard to describe. I worry about this, so I suppose that doesn't help much either. I've had episodes where the things have lasted for a week or more. Usually, though, I have 10-20 during a normal day and have kind of come to just live with them. Sometimes walking brings them on....sometimes it doesn't. Sometimes exerting myself shoveling snow or working in the garden brings them on.... sometimes it doesn't. There is no set pattern to these things. All I know is they are  miserable and scary, and I wish I could say, "Begone," and they would go. Does anyone else get that funny feeling in their throat? Sometimes it's a quick, temporary one. And I've had it come and stay for a week already. Woke up in the night about a month ago with it. Called my doctor in the morning and he told me to take Valium. I did, but it didn't help. After a week, it eventually just left again.
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Avatar_n_tn
Hello! I want to thanks everyone for all of the sharing! I have had PVCs PACs since I was a small child 9-10 years old. I am now 37. Yup, I'm still around! My concern is the fact I ma as dizzy as a loon and feel like passing out on a daily basis. No one seems to conerned, I suspect I will have to konk out before these silly things are taken seriously. I do not have as many as most of you folks only a little over 200 PVC's and over 50 PACs daily, according to Holter monitor. Also had 128 heart rate and 46 heart rate in the 24 hours it was on. Hmmmmmmmm 46 seems low to me! But I think sometimes the Docs think we are all looneys, complainers, whatever.... and to think I used to avoid Docs like the plague and now that I think I need one they seem to be avoiding me :)

Thanks again to all for your stories, at least I am not alone!
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