pvc and q-wave

[bill81954]

I'm 52, male, 25mg atenolol and 50mg cozaar for HBP, prilosec for GERD, low-dose aspirin, 50mg viagra on occasion due to the beta blocker. I had used 120mg Inderal LA until recently, switched to atenolol when that drug was in shortage. My Dr found my heart rate was too high if she reduced the beta blocker too much. We settled on my current dosage which has kept blood pressure normal (around 120/75) and pulse generally ok 60's to 80's.

I've had PVC's for 20 years also exacerbated by caffeine and chocolate, occasionally alcohol. Never in runs, but the number varies day to day.

Two things in the past year or so have me worried. In my annual physical last year my EKG was abnormal. The Dr noted a q-wave and asked if I’d ever had heart attack, which I haven’t. I had a stress test with imaging which was normal. The cardiologist advised that people do have this type of q-wave, and that it was not then a concern.  

This week I had day surgery for kidney stone. The pre-op again showed abnormal EKG, q-wave possible diagnosis inferior infarction age unknown. The Dr again asked about heart attack. I confirmed I had not and noted the previous EKG and normal stress test.  He said it was ok to proceed. I have noticed over the last couple of days that my heart rate is up in the 90's and I have increased PVC's. I'm taking this as most likely related to having this procedure for the moment. But I had noticed more PVC's the last few weeks.  

I’m concerned about the relationship between these issues and longer term prognosis.  Are PVC's and q-wave related? Do they indicate more serious issues that need further eval?  Should consideration be given to adjusting the beta blocker? Is one beta blocker more effective than another with these types of issues?  Is the q-wave something that resolves over time, and if so on its own or is treatment needed? Is it just an artifact on future EKG's, or again something that needs to be monitored for changes or other indicators.

[bill81954]

Thanks so much for your prompt and informative response.  This is greatly reassuring.

[Michael J. McWilliams, M.D.]

Hi Bill,

These are all very appropriate questions.

Are PVC's and q-wave related?

I haven't reviewed your stress test but it sounds like your doctor ordered an exercise stress test, did not see any ekg changes, you did not have any symptoms during the stress test and the imaging revealed no scar or ischemia.  If all this is true, then you the PVCs are not related to the Q wave.

Do they indicate more serious issues that need further eval?  

I would have to see the EKG but it does not sounds like it needs further evaluation.  There is a saying in cardiology that a "q in three is free" -- this means that some people without heart disease have a q wave in lead three.  If you only symptom is PVCs and you have had PVCs your whole life, I would do no further tests unless you told me about chest pain, passing out or almost passing out, or other cardiac symptoms other than PVCs.


Should consideration be given to adjusting the beta blocker?

If increased beta blockers help your PVCs, then it is a reasonable thing to do.  you can always try to increase the dose and if it doesn't help, back down on it again.  I would not adjust the beta blocker because of a q wave in the setting of a negative stress test with imaging.

Is one beta blocker more effective than another with these types of issues?  

There is no data to suggest that one one is better than others.  Atenolol is good because it is inexpensive.

Is the q-wave something that resolves over time, and if so on its own or is treatment needed?

It depends on why you have the q wave.  If it is a single q wave in lead III (3), I wouldn't even give it another thought (q in 3 is free -- it can be normal).  Believe it or not, EKG appearance can depending on things like lead position, whether or not you are taking a deep breath, whether you are flat or on an incline -- it is possible that it will no show up on future EKGs.

Is it just an artifact on future EKG's, or again something that needs to be monitored for changes or other indicators.

I would repeat an EKG when I saw you in clinic next and / or if you have any changes in symptoms.  One of the problems with PVCs is that they can be a self fulfilling  prophecy -- if have some and worry that you might have more, you probably will.  A common trigger is stress.

I hope this answers your questions.  Good luck and thanks for posting.