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heart pac's

I have fluttering or a skipped beat feeling quite often. I've had symptoms since I was in my late 20's and now I'm 52. I've had every heart test possible and passed them all. I recently had a loop recorder installed in my chest to record my heart beat activity and to mark the episodes I'm having. Last week I had a 3 hour long fluttering and skipping beats, then a day later the same thing, three times in one day. Lasting about 3 hours each time. The doctor put me on Sotolol 40mg twice a day a month ago. He wants be to increase it to 80mg twice a day. Quite frankly I'm afraid to take the medicine because of all the possible side effects. The 40mg twice a day didn't seem to do anything, I've had other people tell me maybe it's anxiety. I just don't know what to do this is driving me crazy. I used to love to go on vacation and now I'm afraid to go away from home at all. My daughter thinks I should get another opinion. Does anyone else have this and what are you doing for it???? Please help!
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995271_tn?1312416925
Did you ever find out what the flutter episodes were?

If these were run-of-the-mill benign ectopics I would suggest you try other means to control the ectopics before you start antiarrhythmic drugs.    This is just my humble opinion.    I can't really give any other advise without knowing what was caught on the recent monitors.
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Avatar_n_tn
The doctor says they are pac's. He's increased my sotalol to 60mg and that seems to help but doesn't completely get rid of the symptoms. I still have maybe two or three pac's in a day. (so far). He said maybe we will have to increase the meds to 80mg. I just hate taking medicine especially one that can have such bad side effects. So far I haven't experience any side effects unless some of these pac's are caused by the sotalol. I don't know. I've taken betablockers for the past 25 years and obviously they didn't work cause things got worse.
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1124887_tn?1313758491
I didn't think any doctor would treat completely benign PACs with class III antiarrhythmics. Most of them don't even suggest normal beta blockers.

It's possible that your doctor thinks your long runs with irregular heart rate is something worse than PACs, possibly atrial fibrillation? Did you get those events monitored?

Sotalol is a beta blocker (class II) but also a potassium blocker (class III). I think most people can handle it well, but some people get severe side effects. I think you should ask your doctor if any mechanism behind the PACs is found, and possibly adress that. Just a little advice.

PS: No matter what you are told here, NEVER change medications without asking your doctor first!


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Avatar_n_tn
I currently have an event loop recorder, something like a pace maker with out the heart leads in the left side of my chest. When I have a symptom I use a separate devise held over the recorder to mark that spot then the doctor looks at that with a machine similar to an ekg machine. He's look at all the episodes I've had an kind of laughs at me. He says its just extra heart beats but I'm overly conscious of them. Then he feels when I have an episode like that it gets me all worked up and causes them to be worse. I've been on every beta blocker imaginable and nothing seemed to help. Now I've been on 120mg of sotalol for 12 days and the symptoms were alot less but yesterday they started again. For about 2 hours I kept feeling the extra beats and skipped beats. It makes me sick to my stomach. I was to my gynecologist last week and she thinks I'm having anxiety attacks. Wants to put me on Xanex. I just don't know where to turn next!
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Avatar_f_tn
You don't mention whether or not your current doctor is a cardiologist, in the 20-plus years you've had ectopic beats and have passed 'every heart test possible,' you must have been seen by a specialist at least once (as you should have been)?

That said, since you're wearing a monitor now, and since most docs are perfectly capable of reading EKG strips and spotting the most obvious stuff, it sounds as though you are not suffering from a really sick heart.  It does sound, though, as if you are currently suffering from severe anxiety.

My suggestion is that you continue to wear the event monitor--AND take the Xanax your gyn prescribed.  The Xanax will (a) not harm your heart; (b) it will very likely make you feel much better and less fixated on your ectopic beats; and (c) if it does that, it will also function in a way as a diagnostic test for how big a factor anxiety is in your case.

If the event monitor indicates that you have benign ectopics and fewer than 10,000 to 15,000 per day, I think the place to turn next is a specialist who treats severe anxiety, don't you?
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1124887_tn?1313758491
Treating PACs with Sotalol is like treating pimples with skin transplant.Of course, if nothing else works and you tolerate the medication, AND it's a cardiologist that initiated the treatment, we can't argue. In my case, a small dosage of Propranolol (the weakest of the normal beta blockers) takes care of it. I strongly suspect that it's the anxiety reducing effect of this nonselective beta blocker that has the effect.

Sotalol is also a nonselective beta blocker (but it has other anti-arrhythmic effects too). Did you try Propranolol (Pranolol, Inderal)? It works for me, and eliminates the PACs that I get when my heart rate is high.

Ask your doctor :)

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Avatar_m_tn
I also have pac's/pvc's, they started when i was 26 now i'm 52. I'v seen so many cardiologists i'm sick of it, and these pac's have put me in the hospital 4 or 5 times with A- Tachycardia, had about every test possible, and this is what i get "you have a healthy heart" YEAH OK...hummmm. i'v had trips, quads +, flops, flutters...so i ask "Doc. do you have this? and if so can you feel them? he said " we all have extra heart beats but no not to the degree you do and no i don't feel them.

I have wished and prayed for many years that i could get relief but no help yet. i'm just tired of it beyond words...
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Avatar_n_tn
I know exactly how you feel, I've heard it all too. Recently my husband and I became self employed and our hospitalization is extremely expensive. Why? Because I have a heart condition!!!!  Well if I do I'd sure like to know what it is besides normal pac's & pvc's. (Normal the doctor says even though he's treating me with meds.) I feel for you too. They are very scary.
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Avatar_m_tn
I just don't understand how something can be broke part time, my thinking is either its broke or its not! I do know that if i change my daily routine, not enough sleep, too much sleep, soda, chocolate,cold meds,sugar,coffee, sudden anger, sudden excertion, hot salsa, mexican food any thing with "cilantro" in it, if i eat too much...omg its almost like if the wind blows i have pac's/pvc's doubles,trips,quads...no help.

My wife has periodic pac's but only when shes exhausted and is suspected to be damage caused by finfin, as for me, well i'v been on a 3 day non-stop arrhythmia spell.

But i have always noticed that a few days before they start i sometimes have a non-stop low grade headache, i'm easly irritable and get mad at the lamest things, i don't mentally feel confident or good and some times easly emotional, all my life i have always thought verry deep about any subject, i have to have learning informational in-put on a daily basis, politics,world, history, musical, and anything in general...thats it maybe i'm just crazy...lol
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212161_tn?1391090750
plz understand they can do that to you . i have had pac since i was in my 20s to and now 50 they were not all that bad when i was young. i have had them for 10 straight weeks over 3000 a day and they are harmless, if your dr says thats all they are than you need to belive him if you trust him. i wore a heart montor for 30 days and thats all they are. so having them for 3 hours i know is very scarey but i had them 24 hours for 10 weeks with no let up. they increased my B-Blocker which is what most vardio drs do give for them. so belive in your dr and try not to worry am here if you need to talk. Barbara
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Avatar_m_tn
I am on 3 straight days so far! almost like clock work every 8 to 10 minutes here they come, my nerves are shot, i'm depressed, i'm tired of of feeling like theres an impending doom coming, among a load of other feelings. I try hard to keep it all in perspective and a positive attitude, but when you have a constant reminder every 8 to 10 minutes you just re-live it over and over. These arrhythmias have impacted the quality of my life for nearly 30 years! i'm afraid to go on vacation, hunt,get my heart rate up,or get to far away from the house, help, hospital, just to name a few downers.

There is people worse off than me and i thank god i don't have the more serious forms of arrhythmias, like i have no idea how you kept your sanity going 10 straight weeks in a arrhythmia attack...hats off to you!

I often wished i could have a heart transplant, just to not feel my heart pounding hard 24/7 and not feel pac's/pvc's A-Tac flutters and more. My heart pounds so hard even when i'm not having pac's/pvc's to the point i see my chest bump with every beat, i can feel it in my arms, ears...but for me to have a transplant that would mean someone would have died...so i guess i'll have to live with my beast of burden.
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Avatar_m_tn
Well folks, here i am 6 days stright now with pac's non stop...any advice? i'v tried everything i can think of. I have not went to the hospital or even to my Doctor figured it would just be the same ol routine. would "EBLATION" sugery help? has anyone here had this surgery to help stop pac's, and if you have did it work?
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Avatar_m_tn
I can offer my current experience as something for you to think about.  Background: I am 11 weeks post TTM/Five Box surgical procedure to cure afib.  I had been in perfect NSR after several years of paroxysmal afib for 10 weeks up until a week ago, when I stopped taking my normal daily supplements including fish oil, in preparation for a screening colonoscopy.  The PACs started within one hour of stopping the supplements and unfortunately did not go away after I canceled the procedure and resumed the supplements.

My surgeon suggested atenolol, which I began and noticed relief (no PACs) but only for awhile.  Here is what I mean.  I have a cheap stethoscope and can tell the sound of afib vs PACs. I can not tell between PACs and PVCs but an EKG strip suggests I have PACs.

I log the cumulative count of skipped beats in somewhat regular five minute intervals. Look at the following data from yesterday and today:

11/7/2010
9:52am  29  
10:30  take 25 mg of atenolol
11:30   27
1:30  0
2:30  0
3:24  1
5:02  1
6:47  28
9:30  1
11:30 34

11/8/2010
8:18   30
10:31 28
10:45 take 25mg atenolol
11:57  1

If you see the pattern, you can get a clue as to my hypothesis: the atenolol suppresses the PACs but only when the blood level of the drug is high enough.  Take it in the morning and it works up until the evening when it drops and is "used up".  Peak blood concentration occurs in 2-4 hours, half life is 7 hours.  The hypothesis could be true. After I gather a weeks worth of data, I will share with the doctor and see what he suggests.  

So far meticulous record keeping of mgs ingested of potassium, mag, taurine, fish oil, CoQ10 and various antioxidents have shown that they, alone, can not stop the PACs.

Again, not sure this is worth much to you, but it is at least what I am doing and have learned so far.

Ken
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386141_tn?1291400496
Have you thought about asking your doctor to up the dose of atenolol?
25mg in the am and 25mg in the eve as this may help.
I found the 25mg did pretty much nothing for me after a second ablation for SVT that left me with PVC's and PAC's but found the 50mg greatly reduced the weird beats, to the point where I could go weeks without a single one.
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Avatar_m_tn
thanks for your comment.  Exactly what I am thinking.  A few more days of data and I will ask for another 25mg in the evening.  I will keep this thread informed.
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Avatar_m_tn
I am now two and half days on two 25mg atenolol per day.  My records suggest that things have either stayed the same or gotten worse since starting the atenolol.  I can not say it is the result of the increased dose.  I also take potassium, mag, taurine, fish oil all of which could influence the frequency of the PACs.  Very complex set of factors.
Ken
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386141_tn?1291400496
Thanks for updating on this. It took almost a month on the increased dose to notice any improvement. Some days I would feel they were getting worse.

I suggest giving it a little longer.
If you really think no improvement it may just not be a suitable BB and you may need to try something else.
Propanolol was useless for me and I was on a high does of 170mg a day, yet when I tried Atenolol they seemed less intense and after 4 weeks all but stopped. I was then 6 months post ablation.


Please let me know how you get on.
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Avatar_n_tn
Went back to the doctor yesterday. Have had several episodes my cardiologist reviewed from my loop recorder. I'm getting this recorder out soon. The doctor says all the pac's/pvc's I have is nothing to worry about. He says I need to learn to deal with them, Maybe some sort of self calming methods. My gynecologist suggest anxiety medicine which she gave me a prescription for but I haven't taken those yet. I hate to take medicine. The cardiologist wants me to quit take the sotalol and go back to Propanolol, I've been having Migraines again and the propanolol kept those away. Neither of the medications was helping the pac's. Most days I have a few a day. Other days are bad where I have several in a minute. How does one deal with this???? I'm about at witts end and the cardiologist just laughs at me. Says "Your okay, don't worry".
Easy for him to say.
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Avatar_m_tn
I just came from cardiologist and he told me the 3 things that usually cause PAC's are 1. stress 2. caffeine, alcohol, etc. and 3. dehydration. He really nailed the dehydration to the point that he told me to stop taking the water pill that I take along with blood pressure pill as it was dehydrating me. He feels dehydration is the most common cause. Now I have to change blood pressure pill to keep pressure down. None of you mention dehydration. Has anyone ever told you that could cause it? He also said it was all benign and not to worry about it. I have had these since I was in my 30's and am now 72. He also told me that EVERYONE has PAC's. They don't always realize it.
I too, have done all the tests, echocardiogram, EKG, Holter for week, etc.'
He also said they come in clusters. Sometimes for months, weeks  or go away for decades then come back. Sometimes if I take 1/2 a 5 mg valium, that will lessen or stop them.
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Avatar_n_tn
I have to start off telling you that I'm not a medical anything. I'm a patient who has been dealing with these annoying PAC's. Until recently. I felt all the same things you feel about having them, including the frustration of not getting a solution. I woke up with afib two years ago. I had all the test an electro physiologist gives to be sure there wasn't a problem with my heart. He told me that I have the heart of a 25 year old, I was 47 at the time. I will add that I'm in better shape than most 30 year olds anyway.

He then said he had no idea why I got afib. He gave me a prescription for atenolol and Flecainide to carry and use only if I needed it and sent me packing. I had PAC's previous to the afib. I figured the two were related.

I don't want to drag this out too long so I will get to the point. I was having some nerve problems I put down to an old neck injury. My neurologist gave me gabapentin, also called nuerontin to deal with the pain. It worked for the pain and also got rid of the PAC's! The best part is that gabapentin is pretty benign. I only have to take 300 mg before bed and that seems to do the trick.

I have no idea if this will work for you, and I won't bother running it by my electro physiologist. But I will say that I asked my electro physiologist last fall if it’s not my heart causing the PAC's and it's not my circulatory system or my respiratory system, could it be my nervous system? He smiled and said yes.

From what I gather, the gabapentin helps improve the nerve impulses in some way. The autonomic nervous system that allows the brain to talk to the heart is exactly that, nerves. So it made sense that gabapentin would work for me.

I know what you're going through and it's terrible. I empathize with you. God Bless!
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Avatar_m_tn
Hi,   I was reading your post, and was wondering how the nuerontin was working for you. I have a mild case of PAC's, and was given a rx for metoporlol, but never started it because the side effects seemed too scary.
I have also thought about the connection between my PAC's and the nervous system and the vagas nerve. Would love to hear how things are going for you.

northidgal.
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Avatar_m_tn
Are you familiar with the Vagus nerve. If not, look it up. It might be part of the problem.
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Avatar_f_tn
Hi,
Reading all these posts, I believe dehydration makes very good sense for the causes of palpitations.  I've never been good at keeping hydrated (my husband calls me a camel:)).  I started having these PAC's and PVC"s in my 40's, for which my doc ordered a number of tests (EKG, echocardiogram, and the Holter Monitor).  Everything was normal (he even said I had the heart of a 25 year old!).  So I basically ignored them since then.  As of 3 days ago, I started having them non-stop.  They began after a restaurant meal that was high in carbs and protein, but I had very little to drink.  Having read your post, I will take extra care to keep hydrated, to see if that helps.
Thank you
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