Does anyone else get frequent PVCs (bigeminy/trigeminy) ONLY in the evening and before falling asleep?

I've been diagnosed with PVCs. I rarely experience them during the day and never when exercising. I can't even really find a correlation between caffeine/alcohol and them (although I never consume anything caffeinated). I exercise regularly. And I never experience them when exercising.

However, when I do get the PVCs, they come every other beat or almost every other beat non-stop for hours. This bigeminy and trigeminy always occurs in the evening, sometime around 7 or 8 as I'm settling down from dinner and a trip to the gym. As I let my mind and body relax, the PVCs get more frequent and eventually as I lay down to get to sleep the PVCs occur at nearly every other beat.

Lately, I haven't been able to take this at night, so I will jump out of bed and furiously pump out about 50 push-ups without stopping. This gets my heart rate up quite a bit, maybe around 80 or 90 bpm. The PVCs are totally gone in what I understand is called "overdrive suppression". This works every time and sometimes if I'm lucky, will keep the PVCs at bay just long enough for me to fall asleep.

What is really interesting, is that the PVCs don't wake me up, and I'm not even sure they are occurring when I'm unconscious. I have woken up early in the morning before my alarm clock goes off, or even in the middle of the night now and then and have not felt one PVC. It seems that once I'm unconscious, these are also suppressed, or I'm just super relaxed and the heart pumps without anything irritating it to cause a PVC.

Two questions:
1) Has anyone experienced or is experiencing anything like this at all?
2) These facts are always true, and the PVCs are not that random. Don't these symptoms point to a clear cause?? My PVCs occur at slower heart rates so Beta Blockers don't work. And ablation seems extreme still. No other solutions?

Thanks in advance for any insights!

Can't sleep :(
Erik

[yarrow]

You probably have what's called an 'irritable focus' in your healthy heart. This would be a few cells that are a bit twitchy and independent, but which are generally overriden by the heart's Pacemaker during physical activity.  The heart rate set by the Pacemaker normally gets slower at rest, which gives these few cranky cells the opportunity to fire in the interval.

What's going on isn't dangerous, but the adrenalin rush of fear when you perceive the erratic beat makes the irritable cells even more twitchy. I myself find that when I'm calmer, the pvcs, bigeminy, and trigeminy are less numerous. While being prepped for conscious eye surgery some months ago, I could hear my erratic heart rate on the heart monitor, of course, and I noticed that as the anesthesiologist added the sedative to my IV, the PVCs disappeared even though my heart rate became much slower.  Adrenaline surges are just no good for those with extrasystoles.

I'd recommend going back to your doctor to talk about this.  Beta blockers slow the heart rate increase in response to exercise, so if your heart rate is in the normal range at rest, you might indeed get some relief from a little dose of something like propranolol.

But there are other medications that work for anxiety and reduce both your tension and the awareness of what the heart is doing.

[heyerok]

Much appreciated! This has been one of the most helpful answers yet in explaining what may be going on. I have an appointment with a new cardiologist (electrophysiologist) tomorrow and I'll bring up these points and ask about BB / anti anxiety options.

The previous cardiologist was supposed to be one of the best electrophysiologists in the area, however I was not impressed. After explaining this type of information the doctor said this is all random and there is only ablation or beta blockers as a solution. I just have to believe it's more complicated than that and there are other options I can take to suppress these.

[cowgirl8]

OMG, i do exactly the same. Always after 7pm when i'm relaxing watching TV.. At its least, 2 beats, skipped beat, 2 beats..etc, goes on for hours until i'm asleep. At its worst, beating crazy skipping, hard beats and cant get to sleep...Sometimes it quivers(those scare me) but i'm pretty use to it, its been going on for over 20 years and im sure i'd be dead if they were dangerous. I've found that its worst depending on the time of the month. 2 weeks before my period is the worst time, 2 weeks after i never feel a skipped beat and all quiet, but then progressively gets worse as the month goes on. When this started over 20 years ago, i also had this thing where when i was almost asleep i would feel my pulse start getting stronger and faster. After a few times of this happening i found a pattern. First i would get a stomach ache, then i would see a honeycomb pattern if my eyes were shut or the room was dark. My pulse would keep getting stronger and faster. I would then taste copper. Once my pulse raised to almost 300 bpm, lol..its more a hum and not beats at that point. My arms would start to tingle and at that point it would be over, all in about 5 minutes. And every time it followed the same pattern to the T... I would get this about once a month. Doctor told me i was having a panic attack. Although it would happen as i'm at my most relaxed and even though the first time it happened, yah, i panicked.. After that i stayed calm. After a couple years of this and just riding it out..I found out that if i took a deep breath and held it, yet, tried to push the air out without letting it out, the episode would stop. So, if i ever feel it starting, i do holding air thing and it stops. Since then, i just get the crazy evening beats now and sometimes when they are really bad, yes, i'll get up and do exercises, sometimes i'll do the chest pressing thing and that will help some.
I'm 49, normal weight, nonsmoker, nondrinker, i eat extremely healthy and exercise 5 days a week. My only fear with this is what if for some reason my heart just sticks in the quiver? I never ever feel faint, weak or anything physically wrong, i just feel it and it drives me nuts sometimes. Here is one thing that did help and it goes against all medical advice most get. I drink a cup of coffee in the evenings when i usually feel my heart act up. Has it help? yes. I heard a doctor on a news show that said that if your doctor tells you to stay away from coffee, to call him and he will set them straight. lol..Wished i could remember his name, he was some doctor who does a sunday segment on Fox. He's an older fella..But i'll have to say, compared to last year at this time, much better with coffee than without....

[colleendawn813]

I have the exact same problem!!my heart skips pretty much every other beat at night, and its the 2 or 3 in a row that scare me the most.When im moving around during the day it only rarely occurs.And never during exercise.it seems strange but its like as long as i keep moving constantly im alright.the instant i try to relax its ON!Ive had ekg,echo,holter,blood tests, and been to the er about 6 or 7 times...all normal and not life-threatening.just pvcs and pacs, and a little run of tachycardia here and there.but its driving me absolutely crazy.my boyfriend is always asking what's wrong and i dread telling him "just my heart again".because some day i fear he will just get sick of it altogether.I have tried antidepressants, it made them worse.tried beta blockers, made them worse.im on a calcium channel blocker now and it doesnt do anything.im starting to need ativan just to sleep and i dont know what to do.should i get another opinion?has anyone else had them 2 or 3 in a row ALL NIGHT?!?i know this comment is meant to help the person who posted their problem, maybe i at least have made them feel less alone?i hope so.Anyway, if anyone has any advice pls share.Oh and im only 29!

[yarrow]

"its driving me absolutely crazy."

You have hit the nail on the head.  I don't intend to be unsympathetic--having been through all this myself (over the last twenty years at least)--but since you are young and have been repeatedly shown by testing that your heart is healthy, and since you can do all the normal activity that life requires you to do, you have pretty much all the reassurance that any mortal doc can give you that your heart is OK.  Now your job is to find a way to deal with your fear.

You say you have tried antidepressants.  Which ones and for how long?  I ask because several of them do temporarily increase anxiety, but even so, you have to take them for about a month to see the desired calming effect, if it's going to happen.  A  trial of only a couple of days or even a week isn't going to do it.  A good shrink should give you a prescription for something like Xanax to get you over the hump to see if you get a good result.

I use the word 'shrink' advisedly.  Many GPs are capable with antidepressants, but my shrink, for example, is a specialist in pharmacology, and he knows which drugs are likely to have an effect on the heart, the blood pressure, the gut and so on, so he is able to address my specific concerns in these matters.  My GP, though a good guy, doesn't know all this stuff.

[colleendawn813]

I know with all the testing i should be reassured but still...hard to deal with as im sure you understand.I was on zoloft for 8 years for panic disorder, but stopped takin it because it stopped working for my panic attacks.I almost took wellbutrin but it was too expensive.so i tried prozac for 3 months and it made me a psychopath(i dont know how else to describe it) and last i tried lexapro.it seemed to be working okay for a few months, then the palpitations got so bad my dr suggested going off of it.the palps lessened.so i figured maybe after being on antidep for 10 yrs of my life i should see how it goes without them.and my panic attacks have been nonexistent for about a year now, but the palps have hung around.At least they dont make me panic on a grand scale anymore.i pretty much just sit and cry, i have resigned myself to them on some level.Yet i want to keep trying to beat them.is it possibe?I do take ativan in small doses to calm me. and nothing calms me more than this forum!what worked for you?

[yarrow]

"Yet i want to keep trying to beat them.is it possibe?"

Not really.  Just as eyelid twitches happen to some people without any good reason, these heart 'twitches' are probably part of you now--as mine are with me.  The difficulty in dealing with them is a two-parter:

One part is coming to believe that these funny beats are not going to harm you.  The heart is a very strong and adaptable organ, and that it may have thousands of these ectopic beats per day (I have been recorded at over 4000 in 24 hours) really doesn't mean jack in terms of your ability to do the things you like.  As you have probably noticed, no matter how nutty your pulse is, you can do housework, go up stairs, even work out at the gym.  Your heart and circulatory system are compensating nicely for any odd beats, and your life should be physically normal.

The second part of the problem is somehow being able not to be too troubled by your palps, and that's probably harder than the first part.  I have noticed that when I'm in a funk or panicky, I literally hear and feel my pvcs more than when I'm calm (and I think this is true for most of us on this forum).  When I have prolonged bouts of being too aware of my pvcs, like for months on end, that's when I go back on the Zoloft full time.  On the advice of my shrink, I take it long enough to give my internal car alarm a chance to cool off, as the guy puts it.  

Zoloft is the most calming of the SSRIs that I have tried, though Celexa was OK.  Lexapro made me a tad more nervous, and having read that Wellbutrin often has the same effect, I'm wary of that one, although it's fine for many people.  If I were having your problem, I'd be interested in Buspar, but in any case, I know I'd search out a psychiatrist and get further treatment.  You say you're not panicky anymore, but you do say you just sit around and cry.  If you think about it, you can see that this is getting in the way of a life you are physically capable of not only living but enjoying.

My take on it is that you need more professional help from a specialist who treats anxiety.  There are other medications that can help, and talk therapy and hypnosis would be very good things for you to investigate.  What do you have to lose?

[cowgirl8]

Dr. Isadore Rosenfeld is the doctor who said coffee helps with irregular heartbeats. I drink one cup at around 5pm. It doesnt totally stop them, but sure helps. I tried to find his article, but had no luck. But he said, to have your doctor call him and he will set them straight on coffee and its effects on irregular heartbeats.
I laugh at my irregular heartbeats, like i figure, if they were dangerous i'd be long gone...lol. At times they do drive me a little nuts, but kind of like how maybe a noisy person would annoy me, or bad weather. But making me nuts as far as needing meds to help, never...

[cowgirl8]

Start documenting you episodes, when they are bad and when they are quiet. I've found it depends on hormone levels in your cycle. I've found when they drop, they get worse. If this is the case with you, wait till your pre-menopausal...lol...Yarrow, im not sure if your m or f? cant tell by your picture

[cowgirl8]

you said..."has anyone else had them 2 or 3 in a row ALL NIGHT"
What does that mean? I dont understand, flutters, skips, blow out episodes? Maybe you are like me and you werent having panic attacks, thus, meds wouldnt help. Next time try the pressure thing, taking a deep breath and holding it while trying to push air out...Stops my blow out episodes easy...

[heyerok]

"has anyone else had them 2 or 3 in a row ALL NIGHT"

I believe by this you are referring to: "normal beat, extra, normal, extra, normal, normal, extra, extra...". There are a few technical terms here like bigeminy (normal, extra, normal), trigeminy (normal, normal, extra, normal, normal), couplets (normal, extra, extra, normal)...
Correct me if I'm wrong though.

Anyway, YES, I get bigeminy and maybe some couplets ALL NIGHT until I fall asleep. Then they go away until I wake up. Then once I get moving in the morning they go away for most of the day until it's 7pm or 8pm-ish.

I'm relieved to see that this isn't uncommon and there are people out there who experience this just like I do. My goal is to suppress the PVCs as much as possible without drugs. Here's some things that may help:

- Exercise (not only does this help temporarily to stop the PVCs, overdrive suppression, but I feel it may be able to help calm down the body long-term. i was doing cardio daily and my PVCs stopped for a few months. there might be a correlation, but i need to get back on regular cardio routine to verify ;)

- Magnesium (some people say this helps, even my electrophysiologist suggested trying it, i haven't noticed much, but i need to give it a trial for a longer period of time)

- Acupuncture (i tried this around the same time i was exercising more regularly and then my PVCs went away for a few months, this may also have helped)

- MORE REST (i know this is hard sometimes, but getting more sleep absolutely helps, i've noticed less sleep really provokes the frequency of pvcs)

...if after a while i get frustrated trying to deal with them i may also look to a shrink to prescribe me some zoloft or whatever.

Please please post more thoughts in this thread! This is very helpful to us who suffer from what I call "bradycardia-dependent PVCs" (PVCs only during slow heartbeat / before bed).

Erik

[colleendawn813]

to cowgirl-i am a 29yo f, and they always come 5-7 days before my cycle, then go away after the first 3 days of it, so i have concluded they are aggravated by hormones for sure.i am NOT looking forward to menopause, it seems to trigger them in lots of women.
to heyerok-that has GOT to be what i have...bradycardia-dependent pvcs, ive never heard it described like that before.
i dont know how anyone else feels but the absolute hardest thing for me to believe no matter how many tests i have done and how many mornings i am actually surprised that i wake up(sad!) is the fact that they are NOT HARMFUL.if i could just wrap my head around that i think i could be ok.but i convince myself every time that THIS IS IT!its ridiculous and i guess i do need to talk to someone. but then theyll go away just like that, poof, and ill just go on about my life, and forget how terrorized they made me feel. tell you what, i never take a palpless day for granted!!

[heyerok]

@colleen - when i wake up in the morning after a tough night, i think about how silly i was acting and how stupid it was that i was thinking this is life threatening stuff. because it really isn't and eventually we will all fall asleep and be fine.

however, lately falling asleep has been quite a while. i wanted to get thoughts from anyone following this thread on Beta Blockers. Any major side effects noticed? are they helping? I guess colleen you mentioned beta blockers didn't help you. my doc suggested propranolol i think. i might try it to help get sleep at night.

[cowgirl8]

Although they drive me a little nuts at times, i look at them this way. I usually feel a little exhausted after bad episodes and this usually equals extra calories burned. This is my reward for enduring them. And yes, there have been nights where i was surprised i woke up...lol....then i laugh.
Dont get me wrong with this comment........I'm surprised at how most people want medications to fix things. Gosh, dont yall see the lawyers on TV commercials begging for you to be represented by them because of drug companies using the public as lab rats...My poor mother in law got breast cancer because  of the drugs she was given, and millions of others, to make her 'feel' better as she went through the natural occurrence of menopause. No thank you. I'll stick with my cup of coffee in the evenings, which yall should try before becoming a lab rat, its worked pretty good for me. If your worried about it keeping you up, drink it at around 4pm, this seems to work better for me..It doesnt stop them totally, but it does reduce them to just minor sputters.
Oh, last year we went up to the mountains on vacation. Once i was up high in altitude, dang those sputters. It really set them off like crazy. But, never once did i feel faint or weak. I ignored them and climbed until i was exhausted no matter how much my heart flipped flopped. It didnt beat normal more than 2 beats for hours. If that didnt do me in, nothing will..lol..

[artp1]

I'm male, 66 years old and have had pvcs for decades, although they were controlled completely by COQ10. About 4 months ago that stopped working and I'm now getting them, like you, in the evenings. Like right now. They're very irregular, follow no pattern. I get them occasionally during the daytime. I've been reading up on too much iron in the blood and stored in the organs. It's called hemochromatosis.Most common amongst Euro descended males (me). It leads to pvcs and diabetes, liver disease and heart disease as well, so it's worth getting your blood checked for too much iron - which I'm going to do tomorrow. I've found that acetaminophen (Tynlenol) helps because it reduces the iron in the blood. My evening pvcs go on all night long. I'll wake up at 3AM to go to the bathroom and lie awake being kept up by this little buggers. But they do seem to go away during the day. I'll keep you all posted on the iron thing.

[cowgirl8]

Interesting...i looked around on hemochromatosis. I give blood occasionally and i'm always told my iron is really good for my age. Maybe good because if it should be lower, yet is higher, maybe there's a reason?...Its been a while since i've giving blood, maybe i should and see where my iron level is.

[gman648]

I am near the same age as you, artp1. I am 62 and have been plagued with these pvc problems since I was about 14. They used to be infrequent but over the years they have become much much more and more active as well as very much more intense. Bending over, sitting, taking a deep breath as well as at bed time and in the middle of the night. At other times they happen when I am doing nothing in particular. I sure could use some "note comparison" with those who feel that we share the same, or similar, symptoms. I take amiodarone 200mg in the morning and 100mg at night. I also take lorazepam 2mg when necessary and sometimes find some temporary relief as if the med calms the nerve impulses that cause these single and runs of pvcs. Hope to hear from you both as well as others who may read this. You all take care and hang in there!

[gman648]

Being new on here, I haven't grasped all the ways to use this program. I have posted and am so thankful for for all who are involved. I am going to try to keep up with this forum and hope to chat with others concerning this heart arrhythmia problem. Again thank you all !

[artp1]

Thanks for the comeback. Went to the Doc today who says he's been monitoring my iron all along and I'm not on iron overload. It's rare but worthy of checking. many doctors don't.  He then listed everything that would cause PVC's and the list is as long as your arm. He concluded that "Life causes PVC's". I'll second that. He said to learn to live with it as best I can but be careful because if they become too serious they can start a tachacardia that could be very serious.

I've been on Metoprolol 50 mg one in the AM and one in the PM and it makes me dizzy and makes me feel like my heart is squeezing and doesn't do grunt to really control my PVC's. I have a close friend who is a psychologist, my age, who has the same thing. He was on Metoprolol and complained to his doctor who forced the pharmacy to give him the real medication, Toprol. Toprol is the brand name. Metoprolol is the generic. My friend said the Metoprolol made him feel worse and as soon as he got on the Toprol he never had another PVC. Generics have to be something like 60% as effective as the brand name but can have impurities. They are not identical and they frequently come from China, India, the Czech Republic, etc. Who knows what is in them? So I started Toprol today. I'll keep you posted  as to what effect it has on me.

I believe there's a lot we can do for each other if we share information on this site. Keep me posted and be well.

[heyerok]

@artp1 - Any luck with the brand name Toprol? I think that's also what my doc prescribed me. However, I haven't tried it yet. I'm wary of the side effects and for now I'm able to live through the PVCs, but sometimes they're pretty bad at night and I can't get to sleep right away. So I'm interested to hear if i works for you and better than the Metoprolol.

Thanks!

[is_something_wrong]

The fact that you are able to wipe out the PVCs at heart rates 80-90 BPM is a really good sign. I'm really impressed that you are able to do 50 push-ups at 90 BPM too.

It's interesting what you say about not having PVCs in the morning. My heart rate before sleep is usually in the low 60s and this is when I get most of my ectopic beats (PACs or PVCs). In the morning it's in the high 40s, and my heart rate is usually completely regular. If I start to think about all I have to do at work this day, they start immediately.

The reason is simple. If your heart rate is low, you are more "vulnerable" to get PVCs, in other words, less adrenaline is required.

I think your treatment should be some kind of stress reduction before sleep. As I've said before, there are no more significant triggers of PVCs then worrying about PVCs. If you can stop worrying, I think this will solve most of the issue, but "accumulation" of stress through the day tends to be really bad for PVCs too. Possible half an hour of yoga, meditation or light exercise before bedtime would help?

[cowgirl8]

Mine i believe are triggered by hormones. At least the bad episodes are. I do get them under stress, but they are more regular due to hormones.
Has anyone tried coffee? I swear it helps me, I've been testing it for several months now and although it doesn't completely stop it, it does lessen it a lot. If you don't try it because you either don't like coffee or it keeps you awake, think about what the drug you get prescribed is going to do to you, not just now, but even later on. Coffee sure seems like a easy thing to try when you think about it that way.

[alene821]

I  agree with the hormone thing in women. I have had them for the last 15 years, and for some reason they are getting much worse. They are especially bad about 2 weeks before, and usually go completey away by the third day. I have tried beta-blockers, and that didnt phase them. Lexapro made them much much worse. I know that an anti-depressent would probably help if I could just find one that doesnt have any cardiac effects.. Any ideas?? I have had thyroid disease most of my life and I know that thyroid may contribute to this.

[yarrow]

My shrink tried me on four (or maybe it was five?) SSRIs before we found two that agreed with my and my PVCs.  I can't say Lexapro made them worse, but it sure as heck made ME a lot more nervous--and it made chocolate tasteless.  Oh, bad!  Paxil I also found more stimulating than calming.  However, both Celexa (Lexapro's mother) and Zoloft were very calming to me and my twitchy ticker.  Of the two, I prefer Zoloft.

My psychiatrist has a particular interest in the biochemistry of these drugs, and since I have had hyperthyroidism (in the past, not now), as well as PVCs and labile hypertension, his best choices for me are Celexa and Zoloft, because he says they generally have few effects on the heart and BP.

However, as you know, everyone is different, and it would not be surprising if a patient had to try several antidepressants to find the right one.

[colleendawn813]

you and i have a lot in common lol! i have also tried beta blockers an lexapro and theyve made them worse, my palps come right before my cycle, and ive had thyroid disease since i was 18...im now 29. ive read umpteen different takes on which antidepressants to take on here and almost EVERYONE that has tried them all has said zoloft worked best.i was actually on it for 10 years, and it stopped working. for the last 3 ive tried prozac, wellbutrin and lexapro and none helped me.im thinking maybe now that some time has elapsed maye try to go back on the zoloft?would it work agin?who knows!but im willing to do aything at this point.

to cowgirl-im scared to death to drink coffee because everyone says thats what causes these things, but im going to try it anyway, as you seem to be adamant that it works for you.wish me luck!

[yarrow]

The standard advice is indeed to avoid much caffeine, but the rationale in favor of it might be that since PVCs are more likely to occur when the heart's Pacemaker has slowed things down (as when you're at rest), then taking a little caffeine might speed the heart rate just enough to prevent the rogue cells from firing between the Pacemaker's signals.

[cowgirl8]

I swear, it works. I had been told no caffeine too and that it causes it. This month i was religious about drinking a cup between 4 and 7 and this month i had not a single episode. I sure hope it last :-)

[gman648]

Alene, I take lorazepam when my pvcs start acting up alot and I swear by it! It has always settled them quite a bit, but there have been times where it took more than 1 mg. I am prescribed to take 2mg twice a day if needed but I never take that much. I think they come in 1mg, 2mg, 5mg and 10mg. Can't imagine what that higher dosage would do other than making me very sleepy and slugins, but the lower dose, for me, does very well. Lorazepam is the same as ativan, I think.

[gman648]

Sorry Alene but I spelled sluggish wrong. :(

[pagirl444]

I too, am having trigeminy/bigeminy at rest.  Recently have been tested and am waiting for results.  However, your explanation was very good.  I am going to mention that to my doctor if he doesn't mention that himself first.  Makes sense.  Just wish there was a noninvasive simple way to cure it.  Sounds like it is just something I am going to have to live with.

[heyerok]

Thanks for the advice with the "stress reduction" treatment ideas. It makes sense since they are completely gone when I fall asleep - probably when I have the least stress?

Cardiologists seem to just prescribe either ablation or beta blockers.

Should I seek a psychologist to take a look at more stress-reducing options? Seems to be like the best course of action. Any tips on finding one that might have more of a focus on PVCs??

Thanks as always,
Erik

[yarrow]

It's always a good idea to look for a psychologist to check out stress reduction techniques.  However, if you're specifically looking for someone with a focus on PVCs, you will need a psych doc who has has studied human physiology, since the basis of PVCs is an understanding of cell membrane depolarization.  A number of factors affect that, of course, but it's hard science.

[heyerok]

I'm currently looking for a psychologist that may specialize in PVCs and/or biofeedback / stress reduction.
Should I be looking for:

a) Clinical Psychologist
b) Psychiatrist
c) Psychophysiologist
d) Pysiological Psychologist

C and D seem to be more specialized in how my body reacts to something like PVCs. Thoughts on this? It's hard to find much information, I know it's kind of nit-picky but I feel that finding someone who would understand my PVCs better would certainly help the treatment they can provide.

Thanks!

Erik

[yarrow]

Interesting questions, Erik.  So you wanna go at this rationally, eh?

If you are interested in stress reduction, you might get lucky with a clinical psychologist, though one these people would not be my personal choice in a matter that involved any kind of malfunction of my body.  Requirements vary by state, but in general the educational requirements for licensing are rather low and not at all scientifically demanding.  For example, the dim bulb who (ineffectually) treats my son has virtually no understanding of chemistry, biology, physiology, or indeed, anything related to science.  He went into the business because he was incapable of getting into medical school, but he was able to pass the tests for clinical psych.  It is possible, however, that even without understanding anything at all about the human body, a gifted practitioner could teach relaxation techniques or biofeedback in a way that would help a tense person deal with PVCs.

Psychiatrists, as you know, are medical doctors who take the usual medical courses that teach how the body works, and then continue into the mind/body connection.  Unlike most general medical practitioners, they will have taken specialized, in-depth courses in physiological psychology.  Unlike clinical psychologists, they will have studied pharmacology intensively and can prescribe medications that--in my experience--are tremendously helpful in dealing with stress.  My own shrink is a specialist in this particular field of biochemistry, and the guy knows which psych meds affect the heart, and why and how they have their affects.  As you have probably read, the practice of psychiatry has become increasingly medical (as well as cost-driven), so fewer of them practice talk therapy along with medical therapy.  I suspect the majority would first assess the mental health of an otherwise healthy patient with a cardiac neurosis, and would give him primarily medical treatment--but would refer the patient to a clinical psychologist if the patient declined medications and preferred only behavioral techniques.  

Since I have had good results with my psychiatrist and can talk with him about the way the body functions, and since I favor a medical rather than a behavioral approach, a psychiatrist would be my current first choice for dealing with PVCs.

Psychophysiology is an interesting educational development.  As you have probably read, the courses these people have to take are generally much more rigorous than those for clinical psychology, especially in the sciences.  Though they receive education about meds, they are not MDs and generally cannot prescribe, but they’re not Joe Average off the street, working blind, either.  I know of no such practitioners in my city, but if there were such, I would be interested in checking them out for anxiety about ectopic beats.  It seems to me that they could be very helpful in this particular area, and would be a great deal more qualified to deal with it than your average talk therapist.

Physiological psychology is an academic, research area devoted largely to the relationship between the brain’s physical function and the responses of the body (and vice-versa).  It is the research area where brain imaging and split-brain experiments occur, for example.  Although it is of course in the field of psychology--and it is fascinating--I do not know of any ‘practitioners’ who work with the public.  You will find the results of their work in medical publications and books, in the practice of MDs who have taken classes in these subjects  (and possibly also psychologists with enough education to understand it).  However, if you are interested in having your very own brain/body interactions studied, it is possible that you might, if you wish, become a subject of research studies if there is such a department near you.

[yarrow]

One more thing:  You sound like an intelligent, thoughtful person, and I think you would enjoy a human physiology class.  If you have a community college or teaching institution near you that offers nursing programs or radiological tech programs, for example, it is often possible for the general public to take medically oriented courses.  If you have studied a little biology and a little chemistry, after one semester of physiology, you'd have a fine background for understanding your ectopic beats.

[heyerok]

As always, yarrow, thankyou for your insightful recommendations!
Everything you described was very clear and I plan on looking into a psychiatrist. I've been to a clinical psychologist and I just didn't feel like that was the correct approach for me.

I'll give this a shot, along with my increased exercise and meditation lately and report back in the next month on how things progress.

Thanks everyone for keeping an eye on this thread! So very helpful!

Erik

[cowgirl8]

Since Sept, I've almost completely stopped mine after so many years of enduring them.....and it was pretty easy. A cup of coffee between 4 and 7. Just one....I get a sputter now and then when I'm real upset. But, as far as the full blown episodes in the evenings....nothing...Sounds pretty easy and cheap, no drugs either....and it taste good. I think that the coffee almost has to be the reason, its the only thing I've changed. I had this around 20 years and i did have times where they went away for maybe a month, but they always came back and i always had them this time of year, always. Seems yall could save yourself a lot of trouble and money if you would just try this very very easy solution. It worked almost instant too...

[gman648]

I have been re-reading a lot of past posts and try to realize I am not the only one with this PVC problem. It does give me some relief until the PVCs strike me again. I too used to have, at times, a period of time without having any noticeable PVCs. But any more I have them every day, Some days they are not all that many, except they seem to come back with a vengeance and increased intensity. Today was pretty good but at around 5 pm, they struck and struck very hard. When the PVCs stop I am okay other that being nervous about the next siege of them. I know I shouldn't ponder on when the will reappear but, for me, I have a very hard time letting the PVCs pass. Being PVCs happen when I am sitting, laying down, sleeping, bending over, raising my arms over my head, eating or drinking something with caffeine in the food or drink, I just don't know how to handle myself. After almost 48 years of this, one would tent to think a person would just get used to them and go on with life and not letting the PVCs rule your life. At times when I am sitting in a chair and just stat to doze, often, I have a PVC. And as well as all of us know these single or multiple PVCs can happen at any unannounced time. I know the hard PVCs make me jump and people ask what is wrong. If you tell them what PVCs are they are apt to get hesitant about being around you. Well that is my 2 cents worth for tonight. I wish you all a very Merry Christmas and a Happy New Year, and hopefully without PVCs. Just pray they will disappear and never come back! Gotta be a fix for them some day.

[cowgirl8]

Since i first commented on this thread in Sept, when i started my coffee therapy, i've upped my evening coffee to 2 cups mainly because i just love coffee..It does not keep me up now, before it would, maybe resistance. Anywho, other than just a few occasional flutters, my evening episodes have stopped. I've almost forgotten how they felt, 20 years of anything should be ingrained in your head right. I'm going to say, coffee cured me.

[FP1]

I started this trigeminy, bigeminy irregular heartbeat after I had an angioplasty.
I suspect maybe some nerve damage from the blockage during the procedure.
I get the same symptoms as you described. I found sleeping on my right side somehow eliviates the symptoms.After enduring this for one year I got used to it by now.  

[tazgymuk]

This is a fantastic thread i've learned so much from all of you, i've been on the forum since 23-11-10. When i had my first episode of A Fib;

My heart beat stays around 60 beats when i go into A Fib, the only symptom is the heart  quivers.

I don't drink
i don't smoke
i don't do drugs
i don't do steroids
i watch what i eat,very clean lifestyle
1) 23-12-10 at 1am A fib 35 mins heartbeat caused slight breathing problem. Placed on warfarin for 2 weeks then taken off as was told was in sinus rythm no need for cardioversion.

Completely Stopped the gym for 4 weeks, no exercise at all. Then started again.

No running, No Boxing. Only Light weights!

                                    8 weeks later

2) 17-02-11 at 0730 A fib 35 mins heartbeat 60 beats per minute.

                                       5 Days later

3) 22-02-11 at 0730 A fib 35 mins heartbeat 60 beats per minute.

                                       3 Days Later
4) 25-02-11 at 8 am A fib for 4 hours heartbeat 60 beats per minute, Take to hospital and given Bisporol and injection in stomach to prevent clots. Given Flecainide 50 mg tabs for future episodes. I tablet on onsett then another after 30 mins if symtoms (symptoms) persist. Then to hospital if symptoms are still there.

                                    
                                                          
                                                17 Days Later

                                         Started Running and Boxing again

Did 3 workouts last week ran 5 k in 25 mins as oppose to the 18 mins i normally do. Also hit the bag for 5 3 mins rounds did abs and stretch felt great.

5) 12-03-11 at 1am A fib for about 40 mins hospital said take Flecainide 50 mg tabs . Converted back to sinus rythm without it.

Waitimg for hospital Appointment to see Cardiologist for Medication and Ablation. My question is, do i need meds, do i need Ablation my episodes are only 30 mins?

Has anybody experienced this with a low pulse of 60?

this was my original post, however after reading this thread i wanted to mention that this happens to me either the first thing in the morning when i wake up, also late at night when going to sleep.

I've been advised to take it easy as not to trigger it. But how is that possible when my heartbeat is at around 50- 60 beats per minute when this happens. The only symptom is the heart quivers. I think it is every 2nd or 3 rd beat it happens on.
After reading all these posts i feel really confident in going back to the gym and sprinting on the treadmill and doing my 5 k in 18 mins again. What would you guys suggest?

[curmudgen]

I read your original post where you noted that your episodes begin in the evening...mine seem to occur around noon and can last for minutes or hours.  I have episodes of PVC's  with bigeminy and trigeminy, some days they are few and far between and other days when they remain constant until early evening. I have had every non invasive test - no cardiovascular disease!  I don't believe I am under any stress or have anxiety that could be the trigger. I am clueless as to cause.  Any new information to add?

[pam550]

Hi everyone I have been having bijeminy and trijeminy for 8 years now. I am a 42 year old female with Celiac and hypothyroidism. I have seen two different Cardiologist and both have said my heart is structurally sound. I was given Metatoprol( Spelling) which I could not take as it lowered my blood presser so low. As I have read a lot of the posts, I also have pvcs when I am trying to relax and fall asleep at night. I always have bloating and take meds for reflux which have not helped at all. I have had these pvcs for so long I have for gotten how it feels with out them. Has anyone had ablation surgery to fix these life reckers? I was tested for hormone deviancy and was told that they were low. Has anyone tried any form of birth control pills and if so did they help?  

[petra04]

A cardio told me back in 2009, to lower my intake in caffein after being diagnosed with ventrigular trigemy.I have done this however have battled with these palpitations.Like most of you,there scary when really bad and I deff cant sleep when so.However fish oils are good to take and relieve it a little,enough to sleep anyway.I had surgery nearly 3 weeks ago and just before I went under,everyone stopped and said,listen to her heart.They even put pads on my chest and back incase they have to defibrulate.They hooked me up to a ECG and came in nearly every hour.A doctor said,you need to go back to a cardiologist.So now I'm back on 24 hr holter monitor and have an appointment with a cardiologist.Not to concerned however if they can put me on something to ease this,i'd be more then happy.

[ptadvoc8]

I had an ablation for WPW (accessory pathway that causes tachycardia) a couple years ago and according to my docs the procedure actually CAUSED me to have PVCs — about 5,000 - 10,000 PVCs per day. This complication of ablation, is a well known, but generally not well understood complication, of ablation.

I also tend to be worse at night and have problems sleeping since it's like the jumpin' frog jamboree in there! I have found Ativan (lorazepam) works great for this at night, but it can be highly addictive, even at small doses, and there are withdrawal symptoms that can include a worsening of PVCs.

I do know of a few people who say ablation did cure their PVCs, but from what I have read, the "cure" rate for those is not generally that high partly due to the fact that ablating PVCs is sort of a sub specialty of EP docs and not all EP docs have enough experience with PVC ablation to have high success rates, so if you decide to go the ablation route make sure you have a doc who specializes in ablations for PVCs since they can be quite different to isolate and ablate than an accessory pathway, such as for WPW. Theroretically, ablation should be highly effective, especially if they are documented to be "unifocal", from only one area in the heart, but occasionally they can be "multi-focal" or from several areas in the heart.

PVCs are said to be "benign" in an otherwise healthy heart, but I have found when I am in trigeminy or just having a really heavy PVC day, that I I am short of breath, extremely fatigued and even get nausea. I have tried every kind of supplement with little relief, but oddly enough during a 3 month bout of dental problems I was given several doses of amoxicillin and while taking that, and for a few days afterwards, I had very few PVCs and felt much better. Unfortunately, the docs could not account for the relief I got from the amoxcillin and it's not a drug people tend to stay on for long periods so I am just having to learn to life with them.

Good luck and please post if you do decide to have the ablation!

[twinkmedic]

WOW i learned alot thanks to you all.

[Bass1172]

Ask your Doctor about Bystolic, It is a new beta blocker with less side effects, or you can take a calcium channel blocker (Diltiazem) i am taking it and it reduced my PVCs

[Suzie1947]

Hi I have just been diagnosed with transient bigeminy but previously had a couple of episodes of A/F. I too have been very scared, it is a very frightening experience and also difficult to comprehend that it is not dangerous.
Having read all the previous threads from you all I feel loads better! The best piece of advice is that of drinking coffee when experiencing a bout of "the flutters" I tried this this evening and hey presto within a few minutes my heart responded and has been in normal sinus mode ever since! I hope it works every time, will let you know. Thanks.

[cowgirl8]

Yay, someone listened to me. My only problem with it is, it gets rid of them so well, that when i do have a major hormonal shift, they do come back a little and i'm no longer use to them. So i try to remind myself at how bad they use to be and this is nothing. Instead of them lasting months and years, i'll get maybe an episode 3 times a year that may last a couple hours. But i can usually predict when i'm going to get them because i'll be having hot flashes and mood changes.

[heyerok]

Wow - fun checking in on this thread again. I've really come to grips with having PVCs so frequently and just basically getting good at ignoring them and realizing they're harmless.

However over the past couple days they've kept me up at night and I went back to thinking: "hmm I get tens of thousands of these and I remember hearing at some point that could wear down your heart".

Anyway - I know what provokes them more lately: drinking and hangovers, lack of sleep, lack of exercise.

I guess I never tried the coffee thing at night. Cowgirl, if it's 11pm and I want to get to bed within the next hour would you say too late for the coffee? Tomorrow I'll try between that 4 and 7 window you speak of ;)

Will report back soon.

-Erik

[austind219]

After countless hours searching the web, day after day, I *finally* found others in the same situation as myself.  I've had heart issues since August 4th 2010.  Since then it was mainly A-Fib, waking up to it at 4:50-5:00 every morning (which was weird, why the same time?) But since lowering my cholesterol a bit, the A-fib is now extremely rare, but EVERY MORNING I wake up with PVC's, every other beat, every two beats, two in a row, whatever.  It's real random but starts when I lay down at night.  I'll lay in bed, watch TV and it will be fine for 10 minutes or so then the PVCs start.  I can breathe in/out deeply and try to relax and they'll slow down and eventually I can just pass out from being so tired from the day.  But I'll wake up in the morning feeling the same PVC's, etc.  When I get up, get a shower, get ready, they're still going on and driving me CRAZY.. I feel light headed, etc.  I used to be a major alcoholic, toned that down to around 2 drinks a day. I smoke (trying to quit) but here's the funny thing, and I haven't found anything about this online: When I drive to work, still having PVCs from overnight, I will have a cigarette and within a minute or so of finishing, the PVCs will STOP for the rest of the day.. I'm currently on the typical vitamins/minerals, magnesium, potassium, taurine, vitamin C, etc. and have just started trying Berberine HCL.  Anyone have any thoughts as to why this happens or anyone else going through the same?  Any info would be extremely helpful as y'all know.  Thanks and hope you all find a solution too.

[michellepetkus]

I can't say for certain but I believe that ectopics have a tendency to be worse at slower heart rates.  It is possible when you start smoking during the day you speed up your heart rate subsequently halting the ectopics.  It is also possible you may still have them but don't feel them at the higher heart rate.  From what I understand from my doctor you don't truly ever get rid of pvcs though I have heard of people who say they come and go.  But I suspect as your heart heals from the afib episodes you may find that your ectopics settle down as well.  So keep on doing whatever you are doing to get your cholesterol down and start thinking about quiting smoking and drinking.  I smoked for 25 years and it took me a number of years and a number of trys to be successful at quiting but it was worth the effort.  But until you stop those activities they will likely give your heart trouble.  I wish you much strength and courage as you work to get healthy.  Take care and keep us posted on how you are doing.  

[austind219]

Thank you michelle! And congrats on quitting smoking :)

[cowgirl8]

After controlling my irregular beats with coffee, they came back. But this time it was all day and all night. I also had tightness in my chest, pain on the left side of my ribs, my blood pressure went way up and i just felt, weird. My husband is a fireman/first responder. I told him i thought i was having something going on with my heart that wasnt normal. My first thought was heart attack, but one thing was missing. I could get up and move and it would get a little better but i wasnt out of breath, he said he has never gone to a heart attack call where the person wasnt out of breath if they tried to move. I decided to just wait and see if it would clear and it did. A few days later, it did it again. I started to connect the dots on what was happening when it did this. I had strained my back a few days before and slipped a disc between my shoulders. And guess what the symptoms of that are...lol...all of the above. I started to avoid anything that would make that disc slip, and heart palpitations stopped. Who knew? Coffee still works for the other palpitations.

[Fitty4117]

My cardiologist recommended Slo Mag because some magnesium absorbs better than others. I have found that it works just as well as the atenolol and pretty fast. Just a suggestion

[drKP]

im a doctor. i get them too. just like yours. same pattern. its harmless..as of now. avoiding caffeine would be wise..an occasional coffee wont hurt :) no beta blockers indicated. do not treat it on your own. because if you take the wrong drugs (even beta blockers without supervision) you might end up with worse types of  arrythmias. PVCs are the best deal you got,keep it there. hopefully your thyroids are checked? hyperthyroidism, anxiety etc increase them. best thing to do is, forget about them for most of the day. try. stop working out at odd hours..its not good for you. (tip: sleep on your right side when you feel them at night.) if you experience any palpitations at rest, get yourself checked (Holter ECG monitoring). live healthy,laugh a lot. :)

[drKP]

to everyone,
this is a request..no offense..please do not spread info you are not sure of.. pls just remember that some of these arrythmias kill before even reaching a hospital. its not like suggesting tylenol for pain.. before "help" comes "first do no harm"..

[Fitty4117]

If your heart rate is getting up to 300 you are more likely experiencing SVT. It is often mis diagnosed as panick attacks, but the arrhythmia causes anxiety and panick. I would go see a cardiologist. I went through an SVT ablation and it was a piece of cake. I just wish he had done the pvcs when he was in there.

[Fitty4117]

I have found that half of a 25 mg atenolol is all I need to stop my PVCs almost completely. I only take it on really bad days and it works for 24 hours. Some people need a little more.

[Fitty4117]

I have to say I was in no way recommending that anyone start taking a prescription medication without a doctor prescribing it to them. That would be ridiculous. There is a reason why they need to be prescribed. Also I am in no way recommending that a person self treat an arrhythmia and not see a physician to be sure they are throwing PVCs and not some other dangerous arrhythmia. If I in any way came accross that way I am sorry, but it never occured to me that a person would illegally take a medication prescribed to someone else since I would never consider it. I am just a PVC sufferer sharing my experience but nothing can replace the doctor.