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What works for eliminating PVCs?
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What works for eliminating PVCs?

I'm a 41 yr old male in reasonably good health other than mild hypertension that I take 20mg Lisinpril daily. I've had occasional heart palps all my life, but recently they've increased dramatically. I don't smoke, drink very moderately (if at all), stay away from all caffeine products, drugs, etc. I also exercise regularly, play sports, maintain a good weight, (5' 10", 220lbs) try to eat well, etc.

I've been seeing a cardiologist and have had all the standard tests (echo, stress test, Holter, event monitor, EKG, bloodwork, etc). He tells me that I have benign PVCs and they are not life threatening. He put me on 25mg metaprolol about 2 months ago. That seemed to work for a few weeks, but the PVCs seem to be increasing again.

Over the weekend I had so many that I couldn't sleep and wound up in the emergency room all night. I saw the PVCs on the monitor, sometimes several a minute. This lasted for almost 8 hrs until they subsided on their own.

The PVCs increase after I engage in physical activity such as long periods on the treadmill, dancing, and even sex. The worst part is I really feel them at night when trying to sleep. I can ignore them during the day, but the nights have been horrible. Unfortunately I'm one of the people who feel them (I understand some of you don't feel it).

I'm asking anybody out there, do beta blockers really take away the sensation, and how much does it usually take to work? They just upped my dose to 50mg.  Is ablation an option?

I'm meeting with another specialist soon. In the meantime, I dread going to bed. I hope I can get this resolved.

Any feedback would be appreciated. Thanks.
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15 Comments Post a Comment
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1616038_tn?1315957703
Hi - sounds like you and I have lots in common! I am 40, and have been dealing with episodic PVCs for the past 6 months. I used to only experience periodic PVCs, but now the episodes last for hours at a time, and I often have trigeminy (every 3rd beat). Like yourself, I also had a bad episode caught on an ECG while visiting the ER - not fun! The sensation is terrible, and I have been working hard to train myself to ignore them, and try and prevent my mind from going into overdrive...Anxiety is not helpful, and likely contributes to the problem. The fact that the doctors witnessed your PVCs on an ECG is positive information, as you can be confident in their diagnosis of benign PVCs. Many on this site, and several doctors I have spoken to, agree that adrenaline is a common trigger. As adrenaline levels increase, so will the frequency of the PVCs. Exercise, sex, stress etc are all common contributers to one's adrenaline levels. As for beta blockers (metroprolol etc), I am not a big supporter. Metroprolol is often used to reduce anxiety levels, and it will slow your heart rate, and lower blood pressure. My experience is that the slower your heart rate, the longer the pause between beats, and obviously the more opportunity for PVCs...Most PVC sufferers find their symptoms intensify at times of rest, and very often can be woken from their sleep. You have to do your research on beta blockers, and there are several useful threads on this site that debate this very topic. For me, exercise is helpful in reducing my PVCs, although I often feel the odd one before during, and usually after a workout. Regardless, my cardiologist has assured me, that PVCs should not prevent or diminish my enthusiasm for running and working out. You have had all the necessary tests, and had a PVC episode recorded at the ER...rest assured you are totally healthy, and have nothing to worry about! I also find staying hydrated, and taking a daily magnesium supplement have helped reduced the frequency of my episodes. Good luck, and know you are not alone!! We are all in this together!
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1701959_tn?1378217130
I was just diagnosed with them recently and do not yet have to take medication to slow them down but I do know that I myself have felt an increase in them as well. Even though you are healthy and active I do believe that we carry a lot of stress and anxiety and those 2 can cause a big increase. It's a vicious circle. The anxiety increases the PVCs the PVCs can increase the anxiety. I have heard that the newer beta blocker Bystolic is a rather good one but obviously I cannot speak from experience. I have also heard that you truly need to try different medications to find the one that works for you.
I understand your anxiety and fear but knowing they are not harmful is a huge help. Sometimes having an irregular heart beat, is totally normal :) Best of Luck!
~Dani ~
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Avatar_f_tn
It certainly sounds as though you are now becoming familiar with all the joys that PVCs bring!

One of the worst of them is that when we're at rest, the heart rate slows, and that often gives the rogue heart cells, who have a faster innate rate, more of a chance to do what they do.  And unfortunately, this is precisely what happens we we're trying to sleep,, alas.

Beta blockers can help, in that they may reduce the frequency of these erratic beats and/or make us drowsy enough that we drift off to sleep.  The dosage is something you have to ask your doc about.  Myself, I have not found  that BBs actually take away the sensation.

Given that your heart is demonstrably healthy, the problem is the anxiety you (we) feel when the PVCs occur, or when we're lying there waiting for the next one.  This fear, of course, does nothing good for their frequency, nor, of course, does it help us sleep.

The best treatment I have found is to make an appointment with a good mental health counselor or psychiatrist who specializes in treating anxiety.  These people have several approaches to this kind of problem:  

They can teach you mental exercises that are helpful to some people (the kind of thing you can find in Dr. Claire Weeke's excellent little book, 'Hope and Help for Your Nerves").

And shrinks, being MDs, have an arsenal of medications which are specific to anxiety.  Speaking for myself, when I'm going through a spell when these beats really bother me, I have found that the a good antidepressant of the SSRI class (for me it's Zoloft) will  gradually make me less and less aware of the PVCs--and this seems to be linked to a marked reduction of their frequency as well.

The result is that I have quiet, peaceful nights again.  
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1703392_tn?1307454100
Thanks all for the comments, it helps. I have to wonder if the beta blocker is helping me or hurting me now. This is all so confusing! The cardiologist I spoke to mentioned a calcium channel blocker, has anyone tried that? Also, has anybody heard of ablation for PVCs?

With me, it's not a constant problem, rather bad episodes (like Saturday).

To IMFletcher,

Do you notice an increase in PVCs after a workout? With me it's not just 1 or 2, but a prolonged period of PVCs.

To Dolphin8808,

Please let me know how you make out with your treatment and if they go away on their own.

To Yarrow,

When I was at the hospital the nurse mentioned anti-anxiety meds. The thing is, I really don't want to become dependent on all types of drugs. One pill for b/p, one for PVCs, one for anxiety, etc. It is something I would like to overcome on my own if possible.

Last question, has anyone seen these go away on their own or are we stuck in a lifelong battle?

Thanks.

Mark
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1616038_tn?1315957703
I notice them all the time after working out. In fact, my trip to the ER when I was recorded on an ECG with trigeminy, was immediately after a workout with a personal trainer. I find them more frequent during/after lifting weights or doing interval training. My sense is that the post exercise episodes are linked to the adrenaline from certain types of workouts. I don't expect that I will ever be free of PVCs, so my focus has shifted to coping strategies. When an episode flares up, I am teaching myself to stay positive and keep my anxiety in check. It is an unfortunate reality that worry and stress contribute to the frequency of PVCs, so I try and keep as physically and mentally active as possible, especially when I am having a bad day. The worst thing I can do is focus on the sensations, or sit and monitor my pulse, as I know it just exacerbates the problem. As I have said before, if your eyelid was twitching, or your calf muscle, you wouldn't give it a second thought. The issue for all of us is that it is very hard to accept that an irregular heart beat can be totally benign. I asked my cardiologist about ablation, and he told me the best thing I can do is to stop obsessing about the PVCs and live my life. He advised against medication (beta blockers) and said an ablation wasn't even an option for someone with my symptoms. Do your due diligence on ablations, there are many threads on this site that are very informative. Usually an ablation is done when individuals suffer from Afib or other conditions, and I have heard mixed reviews on the incidence and frequency of PVCs post ablation. Remember, you are in good health, so do your best to enjoy your life, especially the days when you are PVC free!! Good luck!
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1703392_tn?1307454100
It's funny, cardiologists and dr's say to ignore the PVCs and live your life. Well, they don't have to live with them! I think we all can deal with a few every day, but when they occur several times a minute for 8 hrs (like on Saturday) it's not easy to "live" with.

Do you happen to notice them more while lying down trying to sleep? That is my biggest concern here. I can handle the occasional PVC during the day, since I am focusing on other things. It's when I am trying to relax and fall asleep that they consume me.

I have an appt mext Monday with a dr who specializes in the electrical function of the heart. I'm hoping he has some different ideas. I really don't want to be on pills the rest of my life, since beta-blockers have side effects (sluggishness, ED!).


Thanks for your imput. By the way, is IMFletcher a reference to the movie Fletch?  
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1616038_tn?1315957703
I have been woken several times in the middle of the night with brutal PVCs...The problem is, when you are relaxing, your heart rate slows, and PVCs are more likely to occur. When I get them at night, I have actually got up out of bed, and run on the spot to increase my heart rate...Sometimes it works...definitely not always! Sounds like you are seeing an EP specialist? You can certainly get more information about the ablation procedure and it's effectiveness with respect to eliminating PVCs. I have had episodes EXACTLY like yours, lasting for hours on end, wondering if it will ever stop...Teaching yourself to avoid the urge to hyper focus on the problem is a very effective coping tool. You have to accept that the PVCs are benign, despite the fact that they will stop you in your tracks when the occur!! Try to stay positive, and take comfort in the fact that there are many who suffer from the identical problem..It is far more common then you may think. BTW - I have spoken to a few doctors who actually claim to have PVCs on a regular basis...they have just trained their minds not to worry, and dismiss the problem. I am trying hard to implement that same response to PVCs myself!!

"IMFletcher" - YES!! Nice call...Fletch was one of the classic comedies of all time...and not surprisingly, the name was available when I became a member on this site! Cheers.

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1701959_tn?1378217130
The EP Doctor will put you at ease I am sure. They see many kinds of irregular heart beats and probably look at ours as just little blips. But they are very disruptive to our lives. My Primary Care also has PVCs. She also suffers from an increased heart rate, and when I told her it scared me that I had them, she looked at me like I was nuts lol..... She said they are so very common and very benign, we are just some of the lucky folks who actually get to feel the annoying beats.  

My EP doctor did say Beta Blockers were an option to not only help with the PVCs but with the Anxiety as well... should it get out of hand. He did also say that Albation was an option as well but he really doesn't feel the need to do either.

So maybe we should feel blessed that these annoying little buggers are just that, annoying and nothing more :)

Would love to know how your EP appointment goes!
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995271_tn?1312416925
I went through a similar bout back in 2009.  I was about your age at the time.  I averaged 2-3 hours of sleep per night for about 7 months.  It started to get slowly better on its own.  I haven't gotten them at night in a  while.  I was very healthy, 5'9", 160.

I tried all sorts of stuff.  

I tried benzodiazapenes like xanax and klonopin.  that didn't really help.

I tried stuff with magnesium in it, that seemed to help.  I was taking magnesium glycenate.  I also took Maalox maximum strength right before bed.  that seemed to help sometimes.  When I would get a really bad swarm in the middle of the night I would sometimes take a bath.  That would sometimes make the swarm stop.

I also started a statin at that time, called zochor.  There's a chance that this helped me as well if I was having reversable ischemia.  I have significiant family history of MI in my family starting in the 40s.

For me this was the worst thing I ever went through, I started to get depression over it.  When I stated to get better it was amazing.  When I do physical things I couldn't do back then I feel 19 again.

I never did find out what was wrong.  I had every test you can imagine, including a cardiac MRI.  I saw 2 different cardiologsts and an EP.   I tried BBs and CCBs.   I was considered for ablation because mine were unifocal orginating in the RVOT which has a higher success rate for ablation.  The EP wanted to wait it out to see what happens.  He was right.    If he was wrong I would have ablated.
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1703392_tn?1307454100
Thanks for the encouraging words. I am really bummed out. The BB seems to be working, but I feel like I have the flu. It's like a bad dream that I want to be over with.  

I meet with the EP next week. Can you think of any good questions I should be asking?

Thanks again.  
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Avatar_f_tn
I understand what you are going through. I've had them for over ten years and have been on practically every med available for them. I also wake up at night, which is frustrating and then find it difficult to go back to sleep. I have some other issues too which led me to have an ablation last Fall. Unfortunately it didn't work for me as they were multifocal and in a difficult area of the heart. I'm glad I tried it though otherwise I would have always wondered if it would help. Usually they do work, I am just an unusual case! I usually have over 20,000 a day so that causes other problems. I have found the BB's can help, for me in the past they would work for a few months or a year, then have to change to another type. It's not that I am worried about dying from them, they just keep me awake! It sounds like that is what you are experiencing.
I hope you find a med that works for you and I think it is a great idea to see an EP dr. They should be able to help you and if they do suggest a BB, stick with it as it takes a little time to get adjusted to the side effects. Of course if they recommend an ablation I would do that instead as I don't like being on meds either. Best of luck to you!!
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Avatar_m_tn
I'm a 47 year old male who has been dealing with PVC's off and on for years. Recently they've become increasingly stronger and more frequent. I've had every test done that can be thought of... Holter, Event Monitor, Echo, MRI, Stress, Tilt Table, Angiogram, EP study, blood work, etc. I've spoken with two Cardiologists and have been told that my heart is structurally normal and that the PVC's are benign. Fine, they're benign to you, but they're not benign to me!! I'm the one that has to deal with them. When I get them two, three, four times in a row, I feel like it's time to "check out". Hard to get to sleep when you're not sure if your heart is going to continue to beat erratically or at all.
I do try to keep in mind what the Cardiologists say as they see cases like mine each and every day, so they have more real life experience to draw on, however I still freak out slightly when it feels like there's a soccer game going on in my chest.
Anyone else share my concerns or have similar stories?
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Avatar_f_tn
Same here. They went away for months. Now back again, sometimes 8 per minute,last for hours on end. I am currently increasing potassium in diet. Dr. hesitant to run tests as I don;t have health insurance,which infuriates me.  Says most likely benign as no other symptoms, but he doesn't have to live with these things. You just don't feel "right" when they are happening.  If my Dr. would at least run some tests it might help, at least I would know for sure they were benign.
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Avatar_m_tn
An update... I just got home from the hospital. I woke up in the middle of the night with beat..thud..thud..thud..thud..beat..beat..thud..beat..thud..beat..etc. It went on for almost an hour before I decided to Once Again go back to the E.R.
As I said, I just got home. The doctors there did the EKG, blood work, an X-Ray, and said... (drum roll).. They're benign PVC's. Argh! Not sure how much longer I can stand this. They once again gave me a Holter monitor so that my cardiologist can see if there's anything different going on. I really hate to think that this is how I'm going to spend the rest of my life...
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1703392_tn?1307454100
I stopped going to the ER. They always do the same thing: check you for a heart attack. Then, when they see it's just PVCs, you go home. Your insurance gets a big bill and you get a co-pay.

If it helps, my PVCs have slowed down since November. Just one here or there, nothing too bad. It took 2 miserable years though, and I know they can come back.

But atleast for now I'm getting a break. Maybe that gives you all some optimism that they will eventually pass. Hopefully in less time than it took for me!  
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