premature atrial contractions

[MohsinG]

DEAR SIR, I AM Dr. Mohsin, an emergency physician. About three years back I used to get occasional missed beats for which the cardiologist at my hospital did echo and said i have mild MVP with mild MVR and did a holter for 24 hrs which captured 10 PACs and 4 VPCs and hence he started me on inderal 10mg q8hrs, but since my baseline BP was 100/60, i used to feel dizzy and thats why i myself reduced the dose to 10mg q24 hrs and was alhamdulillah doing fine. but after taking it for about a year i stopped it and was asymptomatic for about a year.
Now for the last 4 days all of a sudden i started feeling frequent missed beats for which once again echo and holter was done. the cardiologist who did the echo now said i dont have a true MVP but only a bowing of MV with trivial MVR. My holter for 24 hours captured 188 PACs 10 VPCs and a short run( 6 qrs complexes) of irregular narrow complex tachcardia with no pwaves(AF). So the cardiologist started me on atenelol 25mg q24 hrs. but the day I started the atenelol my missed beats increased and that evening once again I had a short run of AF. Today is my second day on atenelol , which i took at 8 am and till evening i did not feel a single missed beat but at about 9pm I had the first missedbeat of the day which progressively became very frequent and about 12 midnight it was really scary iwas having rain of missed beats, the ECG showed frequent PACs with some capture complexes and a short run of AF, so I took one more atenelol 25mg and after about an hour of the PACs rain it gradually stopped.
I do not have any risk factor, had started drinking coffee, one cup every two days since 6 months which I had stopped about a week before I started experiencing the missed beats.
I am really scared to what could be the cause of these PACs My CBC, cardiac enzymes,TFT and electrolytes were all normal.

[HangGlider]

I'm sure you're aware that "normal" blood level values are a nice Gaussian distribution, and  that even though a value is within the 'normal' range it may not be 'normal' for your particular body.

I was having frequent PACs recently - onset about 12 hours after exercise. My CBC, cardiac enzymes, TFT and electrolytes were all 'normal' too. But, looking at my lab work later I found my potassium was at the extreme low end of normal, and my chlorine at the extreme high end of normal.

I significantly increased my potassium intake to meet the US RDA of 3.5g/day, and increased my water intake as well. Since doing so I haven't had any PAC's.

It might be worth looking at your lab work one more time.

Best regards,

HangGlider

[Brooke_38]

Hello...

Has your cardiologist suggested an anti-arrhythmic medication in combination with the betablocker? Also, were you started on  anticoagulant therapy to reduce risk of stroke with Atrial Fib?