treatment or not for PVC's

Posted By  CCF Cardio MD-SGM on November 14, 1997 at 10:10:36:

In Reply to: treatment or not for PVC's posted by Elizabeth A. on November 11, 1997 at 18:19:29:

: Hello,
  I have read several questions and responses here about PVC's and I know
  that they are generally only a nuisance, and fairly common.  My question
  is, at what point do you suggest treatment such as beta blockers?
  I have been experiencing PVC's for at least a year, but have been treated
  only in the last 2 months.  A 24hr. holter revealed that I am experiencing
  up to 21 in a minute, and about 6000 over the course of the day.  Prior to
  the holter, I had given up caffeine, alcohol, chocolate, etc. for 6 weeks.
  I am not a smoker.  My doctor has advised that I now go off my birth
  control pills (Demulen 135) on the off chance that they could be a
  contributing factor.  I have not been checked for electrolyte imbalances
  or hyperthyroidism...though I don't have any recognizable symptoms.
  I have not had an echo, but I have no known heart disease.  I am a member
  of an HMO.
  Do you think this level of PVC's warrants further treatment?  Do you think
  I should be receiving more treatment than I am currently receiving i.e.
  blood tests and echo?  I would like to avoid the use of any unneccesary
  drugs, such as beta blockers due to potential side effects.
  Thanks for any information you can provide.
  Liz A.

[CCF Cardio MD-SGM]

Dear Elizabeth,
First, I would kindly refer you to the response to "PVC's and pressure in my head - Jennifer 11/04/97" for general information regarding this question.  I gather you may have already read this, but think that it provides an excellent summary of the background the therapeutic options regarding PVC's.  It appears that you have a high frequency of PVC's, and I'm assuming that they are producing uncomfortable symptoms.  At this point, I think it would be wise to rule out structural heart disease such as Left Ventricular dysfunction due to any of a number of causes, as well as rule out coronary artery disease.  To do this, one could obtain an echocardiogram and a stress test(ideally a stress-echo could do both jobs in one test).   If you have structural heart disease or coronary artery disease, treatment for these conditions would be recommended. If not, then your prognosis is excellent, except for the annoying symptoms that PVC's produce.  
If these symptoms are troublesome, I believe a beta-blocking medication would be a reasonable choice.  Other medications to consider if beta-blockers aren't helpful or well-tolerated, are outlined in the other response I noted above.    A test for thyroid dysfunction is prudent, as are measurements of electrolytes such as magnesium and potassium.  
Hope the answer is helpful.  Information provided in the heart forum is intended for information purposes only. Please consult your physician for specific diagnoses and recommendations.