Cardiologist advice for PVCs: 50 mg beta blocker and lose 20lbs

[richvetter]

I recently saw a preeminent cardiologist at Brigham/Women's Hosp. in Boston for diagnosis/treatment of PVCs.  Had holter which showed about 500 PVCs (and I thought it was a good day!).  Very distrupting on a physical level as you all know.  They mostly hit late afternoon/evening, then taper off before bedtime (so I guess I'm lucky in that respect).  With exercise it varied.  Usually they went away during vigorous exercise (ie. full court basketball) only to come back for several hours after then taper off.  One time they hit during basketball and I felt dizzy so I stopped.  I didn't pass out or have a heart attack or anything.

Echo was completely normal.  Stress test was also good.  PVC's went away during test and remained away.

So, cardiologists treatment plan is to take 50 mg atenolol, once in the morning, then midday.  

Other advice is to lose 20lbs, going down from about 195 to 175 (I'm a male about 5'9").  He said that getting in the best shape possible leads to the best heart environment possible which will decrease the indicence of PVC's. I thought that was interesting.

I will see him in 12 weeks and hopefully with 10lbs off my waistline.  He said if situation doesn't improve they would take more drastic action which I assume would be heavier drugs, possible ablation.  

Interestingly, the doctor himelf had a bout with PVC's in his 40's which "inspired" him to lose a bunch of weight and get into better shape.

I'm curious as to folks' take on this treatment plan.  I'm all for losing weight and getting into better shape.  However, I just want these PVC's out of my life, as you all do.

He also said that PVC's are completely unrelated to anxiety on a causation level.  They surely cause anxiety but anxiety does not cause PVC's.  He described PVC's as "renegade cells" in the ventricle which are misbehaving and doing what they want.  Interesting analogy as well.

Well, that's my story for now.  Appreciate any thoughts.

Rich
***@****

[Jerry_NJ]

Delta..  on the left atrium shrinking my heart surgeon doing the repair on my mitral valve and a mini-maze said:  it is possible my left atrium will shrink some as the repaired mitral valve has stopped the high ventricle pressure from reaching the atrium.  He also gave the mini-maze a 60% chance of curing my AFib.  Well one month after the mini-maze I was back in AFib and 3 years after the surgery there is no indication from my echocardiogram that my left atrium has shrunk - so I loose on both points.  I'm up for another echo in 6 months, I think Medicare puts limits on how often it will pay.  I don't expect any improvements, hope only there is no new bad news.  My mitral valve seems to continue to work properly, the echo will confirm (or not) that.  My cardiologist says my valve sounds fine to his "ear".

[itdood]

I agree with this Doc.    I Also suffered my worst bout of PVCs in my forties.  I was 41-42 at the time.  I've read about other guys going through it in their 40s too.   The doc's analogy of "renegade" cells is spot on.  I can give you more info around this that I've learned over the years

1.  The ventricles are essential for life.  The atrium can be in complete fibrillation and you will survive.  If the ventricles fibrillate, it's lights out.  Hence, nature built in a backup in the ventricles to make them beat in the event they don't get a proper signal from the top part of the heart to beat.  Every cell in the heart can become a pacer.

2.  If the ventricles don't receive a signal to beat from the atrium, the ensuing backup systole from the ventricle is called an "escape beat".  A systole is a pulse of pumped blood through your body, the pulse you feel.

3.  The cells in the ventricles have a longer wait period to fire a beat then where the normal beat signal comes from (sinoatrial node or SA node).  The SA node will fire on average about 70 BPM at rest.  Ventricular escape rhythm is at about 40 - 60 BPM.  Now DON'T use rate to interpret where the rhythm is coming from.  My rate can dip into the mid 40s and be in normal sinus rhythm and I'm perfectly fine.  I'm just trying to show you that the ventricular pacer cells SHOULD be naturally slower than normal sinus rhythm.

4.  When ventricular pacers start to fire at a faster rate than the SA node you get a "PVC".    This is also called "enhanced automaticity".

So those are the basics.  I hear it all the time on this board that a food causes PVCs, anxiety causes PVCs, medications cause it, blah blah blah.  

The BOTTOM line is that it is ventricular pacers that have enhanced automaticity that cause PVCs.  That is the root cause.  period.  Yes, body chemistry and other outside factors can make enhanced automaticity worse, but the ROOT CAUSE is the rogue ventricular pacer cells.

From what I've seen benign PVCs in males usually originate in an area of the heart called the Right Ventricular Outflow Tract (RVOT).  The docs can tell by seeing the shape of the PVC on your EKG.

Mine started really bad on 1-2009.  I was 41 and in good shape, 5'8" 165lbs.  Many many many tests.  I wasn't getting any sleep because mine were worst around 2-3am.  I averaged about 2-3 hours of sleep per night for about 9 months.  I was getting about 5,000 per day.  I had reached rock bottom and was in a very bad place.

Beta Blocker made them worse for me.  Calcium Channel blockers wreaked havok.  I gave up on meds.  slowly I started to get better.

3 years later I still get these mini flare ups here and there but they're nothing.  I started back to exercising on 1-12-2012.  I had developed an exercise phobia.  I worked through it.  In a month, I went from barley being able to jog .25 mile to being able to jog for 3 miles and I could go longer if I wanted.  in a month!  and I'm 44.  I'm about 10 lbs overweight right now, trying to get back to normal.I hope it continues in this direction but who knows.

[DeltaDawn23]

I have been told my Afib would possibly lessen if I lost weight and, therefore, improved my sleep apnea (which is being treated appropriately) but that the Afib would not go away.  Another EP told me that my left atrial enlargement might shrink and I might be able to go off my anti-arrthymic meds after a year without an episode.  I know weight loss should help my acid reflux, my diabetes (already is helping) my sleep apnea and a mutlitude of other problems.  I am 66, but my Afib started in 2003, even tho I'd had pvcs since my early 20's.  Hope some of this helps.  Good luck.

[MichelleP_3811]

You have posted in the members forum.  If you need more professional advice you might want to post your question in one of the doctors forums.  That said, I might go back to the doctor and try and get an echo.  An echo is a good test to determine the overall health of the heart and how it is functioning.  If all is good with that then you might have some sort of structural meaning muscle or tendon or cartilage issue but a doctor is the only one who can diagnose you and it is doubtful anyone can do it over the web.  Good luck, I do hope you can get to the bottom of this and feel better soon.  Keep us posted on how you are doing.

[atiq746]

Hello,
I am 27 year male with normal weight and I need advice as i am having pressure,burden or burning effect on my chest left side. its almost around and above abdomen and after that pain or burden, i feel pinching or pain when i press my left nipple a bit. i am really worried about it.
My ultrasounds for liver,kidneys,spleen etc reports normal. doctoe also advised for chest PA view X Ray which shows normal studies for both lungs and heart position. My ECG reports ok. but triglycerides are at 250 with LDL of 101 and HDL of 48. Blood pressure is 140/82 and also red blood count of 14,200 in CBC which is above then normal range.
regarding acid reflux, i dont have any considerable indigestion or constipation problem.
Can anyone here please help as i feel this burden through out day and even sometimes it  continue for many days.
Should i take antibiotics course to heal my problem.will it help??
Thanks in anticipation..waiting for experts opinion.

[jkfrench]

I dring 1 big tablespoon of organic ACV in my first glass of water in the morning.  I have been doing this for years.
Although it is great for many things (including reflux) it hasn't helped my pvc's at all.  Good luck to you.  Everbody is different.  I hope it take yours away!!

Frenchie

[toxicshock21]

I have had a major bout of PVC's recently, they are getting better, I had an echo stress done, it was good. I read on another message board about  this guy who started taking Apple Cidar Vinagar (Braggs) from the health food store. It helped with his acid reflux, which in turn took his PVC"S away, which I believe is causing mine. I am starting my second day on the cidar, and it sems to be helping. Also does anyone have a vibration feeling in your heart sometimes?
Thanks, Toxicshock21

[jkfrench]

Losing weight does not help with pvc's.  As a matter of fact, my doctor told me that thin women tend to get more and feel more.  I work out almost every day.  Weights and cardio.  I eat extremely healthy.  I weigh 105 lbs and am 5'5".  Of course it is better to be in shape.  It does help with hdl levels and heart strength.  BUT getting rid of pvc's...no way.    
:)  Frenchie

[dolfnlvr]

Well....I'm not sure that losing weight will do anything specific to stop PVC's (didn't work for me) but it does help with that general overall health thing.  Better health=feeling better=less stress/anxiety=less PVC's.  

I went from 220-118 lbs when I was a teenager.  Generally I've kept the most of it off evening out at a healthy 150 at 5'7" for the past 15 years.  I went up to 185 while pregnant and it was when I LOST the baby weight that I started HAVING the PVC's, so I'd have to say that from a weight management perspective...loss of lbs doesn't = loss of PVC's.

[ireneo]

So if arrhythmias are rogue cells firing off at inappropriate times (I get that and how ablation would help), how would losing weight affect PVC's? Does the weight stimulate the cells some how? This is just a question. I can't see the connection other than general overall health which we all want.

[richvetter]

Thanks for the comment Brooke.  Have you been happy with your treatment at BWH?

I read about your brother.  My prayers are with you.  I have 2 little kids...I can't even imagine....Puts things in perspective, getting all pissed off about a few PVCs....

Was it purely accidental or was there some fault on MassPort's part?  They don't have a good track record as far as construction site safety goes.  (I'm an attorney).

[Brooke_38]

Interesting...I'm a Brigham&Woman's kid too. I have been under the care of Dr Bill Stevenson since Dec 06'.

Losing weight is a step toward living a healthy lifestyle and eating heart healthy foods. Even if it does nothing to reduce your PVC's you will feel better having shed the excess weight, which would certainly reduce you risk of developing CAD.

I'm glad to hear that he's not pulling out his "big guns" first. It is always concerning when I hear of Dr's using very potent  antiarrhythmics as first line treatment.

I hope that you find this beneficial to your problems:)