Frequent PACS.....couple new symptoms

[GrantN]

Hey everyone, I posted on here a long time ago, I am 36 year old male, never had high blood pressure, I do take zocor for high cholestorol.  I have been a worrier my whole life....lots of anxiety.  Anyway, last June I started having PACS.  Early on I was not having that many.  I think my first 24 hour holter showed 18 or something like that.  I had a treadmill test done, a very detailed echo to check size and function....everything checked out fine.  I tried a beta bocker for a month or two, it didn't help so I stopeed.  I knew I was having more a few months ago so I demanded another 48 holter.....the monitor fell off about 36 hours in....there ended up being 6,000 PACS during that 36 hours.  I knew I was having multiple ones per minutes, sometimes I'll get 10 or more in a minute...sometimes just a couple.  I've been told by my family doc, and two cardiologists that I'm fine and I have no limits on exercies.  I feel good when I'm active, I either don't feel them or my heart rate is up so they don't happen.  I have played hockey several times and went on several walks/jogs, usually no other symptoms.  Last night though I kept laying down and it would feel like there was a really long pause, made me so uncomfortable to where it felt like it took some of my breath away and I had to sit up.  Not sure what it was but it kept doing it until I fell asleep.  I've had about 3 nights like this over the past two months....I have the PACS every night, multiple ones, but this weird sensation has only happened a few other times.  Anything I should be worried about?  I am wearing a body bugg and trying to eat better to lose about 30 pounds....but then something like this happens and its like I just want to freeze.

Thoughts....comments....suggestions???

Thanks,

Grant

[oceanminded]

I remember talking with you awhile back. I too haven't posted on here in awhile. Our symptoms and triggers are exactly the same. My PAC's always get worse after exercise and eating which ***** because I like to Mountain Bike which really gets my heart rate up high for long periods of time. The weird thing is that my heart seems to stay agitated for hours after exercising. I take an ativan from time to time also which seems to help calm the nerves. I took the long term anti-anxiety meds at one time with no improvement. I feel like they really don't work very well compared to a benzo. If it makes you feel any better I've had these PAC's for about 5 years now and we are the same age. I guess all we can do is learn to live with them and not let them stop doing the things we enjoy. I know it's easier said than done. The biggest mystery for me still though is that I can have periods where I'm PAC free where to my knowledge I'm not doing anything different from when I'm constantly having them.

Good Luck!

[yarrow]

Exactly my experience, Grant:  The meds do not in themselves stop the PVCs, but they diminish one's awareness of them.

Zoloft is the medication my shrink and I have found to work the best for me in this situation.  I'm a fast responder, and within a couple of days (usually), my perception of these irritating ectopics changes.  Within a week or so, I'm far less aware of them--and over time, the actual frequency changes, probably because of lowered adrenaline levels.  This change has been documented on EKGs I've had during these periods, but no, the PVCs never completely go away and stay away.

Normally, I continue the Zoloft about four months and then very slowly taper off if I'm feeling good, but I've learned that another bout of ectopics plus anxiety is probably in the wings, so I just change up the routine when it does come along.  It's a matter of dealing with a lifelong and recurrent condition for me.

[Mom2four85]

yup thats about right...and most doctors have no empathy for patients who have arrhythmia's they just said i don't understand WHY you're worried...well yeah it's just our hearts and it freaks us out makes our lives miserable; even for those of us who stick our heads in the sand like me and forget about them.

don't take your pulse and use reverse psychology on the blood suckers! forget about them; which is easier said than done - I think we all here know what you're going through.

I went from 2004 to feeling some pac's in my throat that increased over the years to having  pvc's daily in 2007 and very frequent pvc's (50,000) in 2009...had an ablation that increased my PAC's and started PSVT after then my pvc's and NSVT runs came back full force with provocation.

There are no easy answers, we have to learn to deal with them the best we can, find what triggers we have because each of us are different, and see what if any meds help alleviate our symptoms =)

[GrantN]

yarrow...thanks for the detailed response, I appreciate it!  To clear up one thing, the xanax does not get rid of the skips or diminish them...they are still there (back when I was checking my pulse anyway), I just don't notice them as much or if I do notice them they don't bother me.  

Also, I am going back onto sertraline (zoloft) to try and not obsess/worry about these things so much.  It *****, it's like a never ending job that you hate that you don't get paid for nor get any vacation from!!!

[yarrow]

Well, you're doing one thing right, Grant:  You've stopped checking your pulse.  That's good, because you won't get any useful information from that habit.

Second, yeah, since you've had a bunch of tests that show you have a normal heart, you almost certainly have a heart as healthy as it was before these odd beats showed up.  I mean, what's the point of having the tests repeatedly if they show the same results, and you don't believe them?

Third, the anxiety and depression over your ectopic beats:  You mention that Xanax either diminishes the number of ectopics you feel or their actual occurance.  That's a good sign, actually; it means you're responsive to anti-anxiety medication.

For people (like me) who have had a strong emotional reaction to benign ectopic beats, I always recommend seeing a counselor or doctor who specializes in anxiety.   For some, a counselor who can teach relaxation techniques offers considerable help.  For others, such as me, it's necessary to move on to a psychiatrist who can prescribe meds stronger than Xanax for longer-term use to 'let the alarm system cool off,' as my shrink puts it.

As I have often said on this board, the right meds can take away hyper-awareness of ectopics, as well as reducing their number.  The result is that you can enjoy the good in life once again.

[GrantN]

Thanks for the responses.  It's just frustrating....here I've never had any problems....always been healthy and active.  Then on June 26th of last year I start noticing skips...I freak out and go to the hospital...they tell me it's normal.  At this time I was having them daily, it seems like once I started noticing them I started "looking" for them....which in turn made things worse.  I have been checked out thouroughly....two highly respected cardiologists here in Wichita....a great family doctor who is also a close friend of mine.  Echo, treadmill test, two holters, numerous EKG's....only issue I've ever had is high cholesterol which I take zocor for, never had high blood pressure which is actually kind of amazing to me because of how much I worry about things I can't control and because high blood pressure runs in my family.

Anyway....I'm just fed up with this.  Usually in the past when something is going bad or you hit a bad string of luck there is an end in sight.  With these, they haven't gone away...they are steady, it's an everyday thing and I don't know that it will ever end.  That is flat out depressing.  I have mine pretty constant all day....I especially have them after lunch (caffeine or no caffeine...eat healthy or not healthy), it's like as soon as I get someting on my stomach they multiply...or at least they are more noticeable.  

I am too afraid to check my pulse anymore, it just stresses me out to feel the skips.  So I have stopped completely.  Again, when I'm up moving around I never feel them (if I'm even having them)....did yard work yesterday...mowing, raking, pulling weeds, etc....if I had them I didn't notice them.  I play ice hockey on Sunday nights...no issues and have never felt any of them while playing....but they are there when I cool down.  

Everyone just keeps telling me they are normal....they won't hurt me....but I sure would like to know what the heck caused it...how it started???  And is my heart just as healthy now as it was pre-June 26 of last year???  

Sorry for my rant...I'm just tired of this....it's like a stressful job that you want to take a vacation from...yet if I go on vacation they come with me :)  I do take a 1mg Xanax every now and then, it doesn't make the skips go away, but I don't notice them as much...or if I do notice them I don't care.  I don't do this too often...maybe once every 4-5 days on average.  I don't like taking meds otherwise I would do it more often!

Anyway.....end of rant....I'll go back to skipping now :)

[Mom2four85]

I have both pac's/psvt and pvc's/nsvt, I don't think I get really long pauses with pac's just pvc's.  Pac's I feel more in my throat and don't bother me nearly as bad as pvc's do, but that's just me.  
I think what my dr called "palpitations" back in 2004 were actually pac's but I had shortness of breath and chest pains with them and I felt them in my throat like I do now, but monitors in 2009 didn't find any significant pac's until after my ablation in August 09 - then I had 1,000 pac's and psvt along with my pvc's.

My last ICD interrogation showed I'm now having 1,000 pac's and 10,200 pvc's daily...both bother me and for me, meds and ablation just didn't do much...Inderal does help with my high HR's but only for a short duration.

I wish there was some magical cure =)  make sure you keep a log/journal of dates/times/symptoms etc and ask your dr about switching meds if you're on them and if not, you may need a med to help control your symptoms.

[is_something_wrong]

I can.

It seems PACs are really overlooked by doctors, probably because they are completely benign. The problem is, they are bothersome, I think they are at least as bothersome as PVCs. I don't know how you experience them (skipped beats? double beats? triple beats?), but I have from 30 to a couple of hundreds a day and I really hate them.

At 4.000 symptomatic PACs a day, I think more aggresive tests and treatment is warranted. Some useful info you may want to give your doctor is:

1. What's making the PACs worse? It's a good thing they reduce with exercise. Stress? Coffee?
2. What heart rate do you have when they are worsening? This is important when treating them. If they increase with slow heart rate, beta blockers will NOT help.
3. What is your sensation of them? (see above).
4. Do they trigger any other arrhythmias, like runs of rapid regular or irregular heart rhythm?

Your cardiologist may try to determine where in the heart they origin. A 12 lead EKG is good but a trans-esophagal EKG is better. Holter isn't very useful. If they all seem to origin from one spot, ablation therapy may cure you. If your atria aren't enlarged or structurally changed, it's more likely the explaination is benign.

PACs will not enlarge your atria. Atrial fibrillation can, but I doubt PACs will.

[GrantN]

Can anyone relate to any of my feelings above?  Does anyone get that feeling of having to sit up sometimes when laying down just because you feel weird, or it seems like a pause is longer than normal.  No pain or anything, just more uncomfortable....I am so sick of these stupid PACS, no break from them, everyday since June 26 of last year.  

I've had a normal treadmill test, I've had a normal echo, I've had numurous EKG's and a couple holter monitors.  I was told I was having about 6,000 PACS (never been told I've had PVC's) in a 36 hour period.....which ends up being what....4 to 5 k a day?  If that keeps up can it enlarge my heart or cause other health issues?  When I'm active and exercising I don't feel them at all if I'm having them...but afterwards it seems like when my heart rate comes back down they are stronger or at least more noticeable....

Anything anyone wants to comment on would be greatly appreciated.  Thanks.