PVCs need to be cured

To any doctors in the forum,

So many of us suffering from PVCs are very symptomatic, and have tried everything possible to identify and eliminate triggers in out lives. I am an example of someone who has led a healthy life, is a healthy weight, but deals with daily "benign" PVCs. Beta blockers do not alleviate the symptoms (my heartbeat is too slow to take a large dose) and I do not want to risk my life with an anti-arrhythmic - where is the gain in that? I realize that other issues such as heart disease are most important, but those of us with frequent PVCs need better treatment options. We are told that our benign PVCs are not life threatening, but the very nature of having to constantly live with a condition that robs you of the desire to live, can be life threatening. Many doctors do not take PVCs seriously enough. I don't know why- is this because they have no idea how to eliminate them safely? If there are any doctors reading this, is there any near future hope for us? I do not want to live another 40 or more years like this.

[rilesnic]

Well said....and I agree....and would love to hear a response from an MD :)

[babygirlyoyo2002]

Hear...hear..!!
I agree with you totally, I have had 4 ablations for PVC's and they just keep coming back. Nothing is working and the EP doc just says they are not so bad and I just have to live with it. But it is such a miserable existence! I would love to hear from some of the MD's on the board also

Yolanda

[Mom2four85]

I agree and I have malignant arrhythmia's and dr's still act like they're nothing [shrug] maybe one day we'll all have answers...I went from age 9 until 42 being told mine were nothing and then anxiety, stress etc etc...just too many questions and not enough answers

[is_something_wrong]

I agree, but there are no doctors here. Besides, though I understand the frustration, asking for a cure for PACs and PVCs is a bit like asking for a treatment for colds.

I don't know much about this, but I would guess the problems are:

1. Identifying the cause for PVCs. (and PACs but I'll stick to PVCs in this post). There exist a lot of them. It's not just that "adrenaline causes PVCs". Adrenaline can, but through what mechanism? Yes, adrenaline causes so-called increased automaticity "a.k.a upset heart cells". This will mostly cause PACs, though. Not only adrenaline can cause increased automaticity. Infections may affect a small cluster of cells. Lack of oxygen upsets the cells. Adrenaline may also cause so-called triggered activity in the heart cells, the mechanism is that more adrenaline causes higher retention of calcium within the cells, triggering delayed afterdepolarizations. And this is just adrenaline. You may have small reentry circuits in the heart, causing PVCs and runs of VT.

2. Determining where the PVCs occur. If one single spot fires off lots of PVCs, it can be ablated. This is rarely what happens. They can occur everywhere, and you can't ablate the entire heart :)

Another problem with PVCs is they often occur with slow heart rate. If you have a strong vagal tone from your parasympathic nerve system, the heart rate may slow, but if you at the same time are stressed, heart cells may get "upset" and want to fire at a higher frequency than the sinus node fires. In such cases, like right after a discussion, exercise or emotion, you will get a lot of PVCs and this is a normal response.

If this is the case, beta blockers will worsen the PVCs because they slow the sinus node too.

I'm sure antiarrhythmic meds can work but they actually increase the risk, like you mentioned. I would rather have PVCs than a malignant ventricular arrhythmia.

Possible treatment is a pacemaker along with a high dosage of beta blockers. That's fairly safe, but a bit drastic, isn't it?

Sorry to sound cruel here. I hate my PACs just as much as you hate your PVCs. I don't have a good answer, unfortunately. I'm sorry.

[curmudgen]

Life with benign PACs/PVCs is like solving a mystery -  seek clues one at a time....since heart cells are electrolyte sensitive so try adding Mg or K rich foods to your diet, stay hydrated, reduce stress/anxiety (hard to do).  What frustrates me is I can have days that are completely free of PACs/PVC s and then suddenly from no where they appear for 5 minutes or several hours. Like many fellow sufferers  the ones that are most concerning are the ones that cause the heart to skip every other beat (bigeminy) for several minutes.  The dilemma for me is there is no obvious trigger that I can avoid or treat.

[is_something_wrong]

A couple of questions concerning electrolytes, this is a real puzzle to me:

1) If antiarrhythmic drugs (class III) works by blocking K+ channels (and prolong QT), why does it help to increase intake of K+ (to reduce benign arrhythmias, not torsades de pointes)? It does help, but I just can't understand why.

2) What is the function of Mg? Is it a Ca++ blocker? And can an elevated Ca++ cause arrhythmias via delayed afterdepolarization mechanism?

[Mom2four85]

Is_something_wrong...i'm curious if a pm and bb's would treat pvc's pac's why are there those of us who still have them in the thousands even with those treatments?

to everyone...I'm still so baffled that dr's really don't know more about arrhythmia's...why isn't there more research done?

[is_something_wrong]

Point is, this is the treatment for sick sinus syndrome - where the doctors puts you on a really high dosage of beta blockers (200-300 mg) along with placing a pacemaker to artificial maintain the normal rhythm. Such a dosage would likely "knock out" the ectopic spots, but you still have a normal heart rate. Without a pacemaker, you would have a heart rate in the 30s and that wouldn't be good.

Problem occurs when the sinus rate is too low relative to the adrenaline levels (due to vagal activity). Then, the ectopic spots say "hey, let's fire!" and the sinus node say "oh well, I don't care to beat any faster because something is pushing the brake pedal here"

PS: It would be nice if you removed me from your blocked list, I can't remember saying anything bad to you ;) Just wanted to send you a tell asking how you were doing and welcome back :)

[curmudgen]

The answers to those questions are for a cardiologist/nephrologist/muscle physiologist to answer and are way beyond my previous knowledge base. Very hard trying to understand and then explain neuromuscular homeostasis  and based on what I have managed to relearn in the past year about my arrhythmia (not very much) Ca, Mg, Na, and K levels are important to maintain.  We might be low in just one of these and that is enough is some individuals to alter the synergistic role of the others. It seems as if my symptoms go away after eating a banana...or is it coincidence.
As I mentioned, even though all my tests show no evidence of coronary heart disease or electrolyte deficiencies I am always looking and testing for the trigger that sets off my random episodes benign PACs/PVCs.

[Mom2four85]

is_something_wrong...I blocked everyone from PM's as well as everything thing else for a few weeks; however you can leave me a note...I'm sorry I can no longer accept personal messages - it's a personal decision and I have to keep it that way...not meaning to sound rude or anything.

curmudgen - you bring up alot of good points...I had nothing they could point to either and only developed CM after I had an ablation but yet I had malignant arrhythmia's...I'm wondering what part my untreated Hypohthyroidism plays in the picture and can't get a clear answer from dr's - frustrating after 2 years and tons of dr's and tests

[curmudgen]

Not to seem like I am avoiding answering your question as to the role of untreated hypothyroidism but due to the complexity of the role the thyroid and it's endocrinology it is a hard question to answer. ...even with a web search all I could come up with that seemed reasonable was on this web site -- www.drlowe.com/QandA/askdrlowe/heart.htm.  The delicate balance of cellular activity just baffles the imagination and anything can tip it out of balance.

The unknown here is what is causing your hypothyroidism?  There are many reasons for hypothyroidism. If I might ask - why is it untreated?  Your arrhythmia may be a secondary issue to it or be coincidental.  

[Mom2four85]

Curmudgen I was just throwing out there other things that dr's over look such as hypothyroidism =)  since Hypo seems to go misdiagnosed and under treated because so many dr's only go on TSH levels and won't do free T3 or T4 levels.

Since it seems many of us have unknown causes of arrhythmia's, thyroid is one thing that keeps coming back to mind since I've been through the ringer with mine and dr's refusing to test my T3 & 4. I wish dr's would test FT3&4's along with magnesium & potassium etc.

My particular case was caused by Group Beta Streptococcus and blood sepsis; back in Nov 1997 which my dr said had started to destroy my thyroid.  I was treated for over a year until I had to switch primary's when we moved to a different city, he didn't think I had a thyroid problem and wouldn't prescribe Synthroid.

Someone gave me a link to a great article on another website because I've been searching high & low for almost 2 years for answers...most of this is way beyond my comprehension but I've been told it fits what I've described accurately - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693545/ The Effects of L-thyroxine Treatment on QT Dispersion in Primary Hypothyroidism  (it's in my journal under documented symptoms if the link doesn't show up)

embarrassing as this sounds, when I went to my GYN in Feb he asked how my thyroid was doing and I didn't know what he was talking about...he refrehsed my memory that he dx me back then but I thought he was treating "female" hormones [crawls in a hole] lol

[curmudgen]

Have you been tested for or diagnosed with autoimmune thyroiditis? Thinking back a dozen years or so when I use to teach basic human biology it is possible that your thyroid feedback mechanism is screwed up and you have high levels of TSH and low levels of T3/T4.  You are absolutely correct in wanting those tests done....I'm surprised your doctor wouldn't do it.  You could go to a walk-in clinic and ask to have it done?  Such an obvious series of tests and on the grand scheme of things I don't think they are that expensive or out of the question to do.  A loose end to tie up?

[Mom2four85]

most doctors only want to do TSH but not do the Free T's, luckily my dr did FT4 but neglected a FT3 which is equally important - my TSH was high FT4 low so I'm assuming Ft3 may be low also...but the biggest thing is she doesn't want to treat the hypo with meds since it can cause AFib...going to ask my cardiologist and then find a good endocrinologist.

seems thyroid has an important role in arrhythmia's so I don't understand why dr's do test for it more often...

[curmudgen]

What if treatment didn't cause AFib?  What do they call the person that graduates last in medical school?  A doctor!

[Mom2four85]

I chuckled at that :P  

That's my thoughts too; how can a dr treat or not treat on what if without even trying it? I think I know to call her and discontinue the meds if I feel anything abnormal...so I made an appt with a Endocrinologist to get their opinion since they deal with thyroid problems since I'm still dealing with arrhythmia's with a pm/icd meds and had an abltion - I'll be intersted to see what effect it has.

I would love to find some info on thyroid levels and how many arrhythmia patients dr's either don't test or only go on TSH levels to see if there's a connection.

[baltimorejay]

Its great to hear from so many of you about PVCs, etc. I do believe there is an answer/answers out there that can improve life for all of us. I have hypothyroidism that is under tight control by an endocrinologist. I also have have Mitral Valve Prolapse with trivial or no leakage. MVP has been linked to PVCs by some doctors, though I do know there are many who have PVC that do not have MVP. Its the day to day battle of dealing with symptoms from PVCs that exhaust me. My brother, who is 20 years older than I am, has heart disease, but lives his life to the fullest, never feeling any heart problems, though he has them. Its the constant reminder that something's wrong that is hard for those of us with PVCs, even if we have no heart disease, etc. Beyond that, what are we to do if we do get heart disease. I eat like a monk, exercise, etc, to try to avoid getting heart disease, but I cannot correct genetics. My fear is for my future. I do not want to have to deal with feeling PVCs daily while battling heart disease. How do others deal with this reality? Can PVCs even be treated in someone with heart disease?

[curmudgen]

Have you seen tis web page...there are many more like this one....
heartdisease.about.com/od/lesscommonheartproblems/a/thyroidheart.htm

[Mom2four85]

curmudgen yes thank you for the link; I've read some on about.com and thyroid most of the articles show how important thyroid is in heart matters...that article even says dr's overlook it and should test more

anyone with heart problems & arrhythmia's should ask your dr about TSH, Free T3 & Free T4 to see if you're producing enough hormones and are converting those hormones well enough; can't wait to see my new Rheumy to address mine...probably need an endocrinologist also

[dragongirl1967]

Just want to say thank you to all the peeps who have posted. I felt my first pvc when I was a teenager...had it checked probably 15 years ago and was told not to worry but like everyone it's a terrible feeling to walk around with "something" wrong with your heart whether the doc says it's fine or not. I've been going through an especially bad bout lately. It's amazing that I can go through an entire year with next to nothing and then out of the blue it's everyday and every hour. To me there is no rhyme or reason it just is and I hate it as much as everyone but seeing eveyone here really does make it better so again thanks for sharing I'm sure I'll be back on a weekly basis.