Mulitple ecotpy on event monitor

Hi, I am a 32 year old female.  I have been having "palpitations" since I was a teenager.  Ive also always noticed that even though I am a good size and appear to be physically fit, I get weak with sore muscles and winded easily when doing physical activity.  

The "palpitations" have increased over the past couple of years.  Some days it is very active, some days not as much.  There have also been new and differnet senstations, not just a painful "off" beat.  So, long story short I went to an EP with these complaints.  She put me on an event monitor for a month.  I expected that the palps were jsut PVC's.  My report came back with sinus tach, PVC's, PAC's, PJC's, atrial couplets, atrial run, ventricular triplet -is this unustained v-tach?.  She said that since they were coming from different areas of the heart, both upper and lower chambers, that there was nothing for her to do.  She prescribed me Zebeta 2.5 mg.  She said the echo showed no problems and a healthy heart.

1.)  Why do I have so many different--would you say foci?--or areas of electrical impulses?
2.)  Is it possible to be just a normal variant for me?  
3.)  When I had the atrail runs and ventricular triplets I fell very anxious and sometimes almost faint with dimming vision--is this of concern?  I did explain this to her
4.)  Do you feel that any further eval needs to be done?
5.)  What are your feelings of Zebeta/beta blockers as a treatment/doseage--what would your recomemdation be?

Thank you so much in advance for your response.  Im just not sure if I should be worried or not, just take the meds, or get further eval.

[Michael J. McWilliams, M.D.]

1.)  Why do I have so many different--would you say foci?--or areas of electrical impulses?

There is not a good, satisfying answer to that question.  I commonly see Holters with similar results but we don't know why some people to do this and others do not.

2.)  Is it possible to be just a normal variant for me?  

Absolutely.

3.)  When I had the atrail runs and ventricular triplets I fell very anxious and sometimes almost faint with dimming vision--is this of concern?  I did explain this to her.

They are common symptoms of fast heart rates.  If you have a normal heart, the symptoms do not increase your risk.

4.)  Do you feel that any further eval needs to be done?

I haven't reviewed the studies, but when I have had similar patients, I agree with her assessment.  There is not much that needs to be done and it does not significantly affect your long term prognosis (which is good).

5.)  What are your feelings of Zebeta/beta blockers as a treatment/doseage--what would your recomemdation be?

I leave it up to the patient.  It may help some people with symtptoms but does not improve prognosis.  If the beta blocker makes you feel better -- great. If it makes you tired, I will often stop it.

I hope this helps.  Thanks for posting.