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Avatar universal

Anxiety and Therapy

What seems to be the number one reason people experience PVC's? I know that Dr.'s can not pinpoint the exact reason but is there a consensus on the main reason for PVC's and their erratic presence in some individuals. If anxiety is a main culprit is therapy the best way to go and have you seen sucess with this?  Thank you.
17 Responses
74076 tn?1189759432

This is a tricky question.  The number one cause of PVCs is not known -- we don't know why they happen in people with healthy hearts. In the majority of cases, we cannot pin point the reason why the PVCs happen.  There is a subset of people that get more PVCs when they are tired, stressed, menstruating, caffeinated, drink alcohol, exercise or recover from exercise.

I am not sure that anxiety causes most peoples PVCs, but I think some of the people that worry about them the most have anxiety issues.  There is no questions that PVCs cause symptoms in some people and other people they do not.  I have seen holter monitors on people with over 10,000 PVCs a day and have no symptoms.  I have also seen a holter on patients with 4 PVCs that are convinced they are going to die from them.  These are two examples of the extremes, but they illustrate that not everyone perceives PVCs the same.  

There is some success in treating people with SSRIs (paxil, zoloft, etc).  There is little downside in trying them and it may be worth a shot.

I hope this answers your questions.  Thanks for posting.

61536 tn?1340701763
Your husband's health being a concern isn't selfish.  My husband's brother suffered a massive near-fatal heart attack at 40.  My husband is now 38, and we just found out he has frighteningly low HDL (in the 20s).  Our cardiologist said that can be the only risk factor a person needs for something like what happened to his brother.  I honestly to my best to feed us right and keep us active and otherwise try not to dwell or I'd probably make myself nuts.

When someone you love has a serious health issue come up at an early age like that, it's normal to feel stress.  When you're trying to be his rock, you also have to remember to take time out to help *you* feel better too.  That is a LOT to carry on your shoulders, especially when it's your partner who is the sick one.  We usually lean on our spouses during the rough times, so it doubled the burden when we can't because they are the one who is ill.  

I know December seems like a long wait, but the good ones usually are hard to get in to see.  My ectopics would probably be in high gear if I were facing your stress level.  Do what you can to relax, and if you need to vent, writing can help a lot of people get some of that out of their head and onto paper (or computer, etc.).
Avatar universal
Yes you should be concerned about your husband's low HDL.  With another risk factor like family history it is a strong predictor of high risk for a cardiac event.

The good news is that, even with current drugs, that can be changed.  I'm also convinced and living proof that correcting your lipid levels and daily exercise can return you to cardiac health after only a few years.  

I suffered a heart attack 7 1/2 years ago, after which it was determined that my RCA had a long standing 100% occlusion and I had a 70 - 90% occlusion of the circumflex.  My total Colesterol at the time was 220 and HDL was only 29.  A year later after a second experimental attempt to open the RCA it was discovered that I had a "cratered" plaque in my left main.  The attending saw it as certain death, but I prefered to see it as a result of successful lipid therapy.

I was only given the option of CABG surgery and was given a 40% chance of death within 5 years if I didn't buy his sales pitch for it.

I had read all of the new study material available on the net back when I had the M.I. and was pretty sure that I could avoid bypass surgery and a future cardiac event if I could correct my lipid profile, control my BP, exercise moderately daily, and eat moderately.  

Over the first year I pushed my cardiologist to get on a good cocktail of lipid and BP meds.  I took Lipitor, which was the best statin at the time, I added Welchol when that came out, and added Niaspan to bring my HDL up.  I ended up on an ACE inhibitor and CCB to control BP.

Bottom line is that I raised my HDL to consistently in the 50's for at least the last 5 years and have maintained a perfect overall lipid and have controlled my BP to low normal levels over that time.

People like myself, who have spent years abusing their body with food and bad habits. don't typical renounce their evil ways and embrace the Ornish diet for the rest of their lives.  I've done some serious backsliding and still eat poorly, from a cardiac perspective, much of the time.  I also drink too much and am a bit overweight.  But I take my meds, walk religiously every day, keep stress low, enjoy life, and try to do something physical on the weekends.

Seven plus years out from the M.I., and some time after my predicted expiration date, I feel normal and in good vascular and cardiac health.  I've been doing some hard hikes with 3,000 to 4,000 feet elevation gain with no cardiac complaints.  I hate to tempt fate, but I feel that the disease is in full remission.  I still have a few artifacts in my coronary arteries, but they won't kill me as long as I keep them dry.

Much of the stuff that I have done for the last 7 years is common knowledge now.  Even the cardiac docs, who are in a culture influenced by the big cash flows from stenting and CABG surgery, now know that the course which I have taken generally gives better outcomes and lower risk.

Now is the time for your husband to address his lipid problem.  He may think the bullet will miss him, but it probably won't.

Good Luck

61536 tn?1340701763
Forgot to add...cognitive behavioral therapy can work WONDERS for anxiety.  I studied it extensively in college.  In some cases, it beats medication for effectiveness.
Avatar universal
Thanks for your answers.  I have started having these just about 6 weeks ago and the only thing I can really see different in my life is that my husband had quad by pass in Feb.(51 yrs old) and I think I have bottled it all up and tried to be the rock.  He is doing well so I should be relieved but I think I just plain feel sorry for myself that I have this constant worry about him at my age(45).Sounds selfish- And now I am having these PVCs-set me over the edge.  The cardiologist has me set up to see a psychcologist but can not get in till Dec.  I burst out crying in her office when she asked me if I was under any stress.  Thought I was under control but I guess not!
61536 tn?1340701763
Couple things.  That subset that Dr. MJM mentioned, I fall into that.  Many things trigger my ectopics, among them: lack of sleep, stress, caffeine (I abstain completely), exercise, deconditioning, recovery from exercise, alcohol (I don't drink much or often, but when I do I get these), hormonal changes (pregnancy, periods, ovulation).  Those are the big triggers.  These things do not always trigger them, only sometimes.  When I first was diagnosed at 16, I asked a lot of questions.  There don't seem to be answers.

The SSRIs are a good bet for some people.  For my husband, they made his ectopics worse.  It can be a side effect, so be aware of that possibility.  My cardiologist said he suspects adrenaline is causing mine and offered the option of a beta blocker, which works on the adrenaline response...but I declined.  He says he prefers I try to do without since there is basically no risk to the ectopics but all medications carry some risk.  Knowing I have a backup plan if needed is nice though.
Avatar universal

Hi again, Mels.  I see things haven't changed much during the last month.  You've seen quite a few doctors, including several specialists, all of whom have given you an amazing number of tests, and who have told you your heart is OK.  The doc here told you that you were at very, very low risk for heart problems.  Yet you still wonder if your pain is of cardiac origin and if you are at risk for a heart attack.  

Why do you not believe your doctors?

I recall from your previous posts that you have been encouraged to get treatment for your anxiety.  Have you done that?
61536 tn?1340701763
I like the name you chose.  Being a BIG believer in the body's ability to heal given the chance, I agree wholeheartedly with everything you said.  

My husband doesn't exercise.  At all.  His job as an engineer has him sitting most of the day running the plant from a computer screen.  It's high stress, though he loves his work.  His diet, though he cut out trans fats on my advice (which dropped his total cholesterol from 190 to 135 in three months) still leaves much to be desired.  He frequently eats red meat, greasy foods and he salts EVERYTHING to the point it would disgust most people.  Makes me want to scream.  He has agreed to a treadmill, he did walk with me all summer, and I cook healthy at home.  Still, unless he stops salting everything to death and starts getting active, I am so worried he's going to face major problems.  His brother's heart attack did scare some sense into him.  He is currently taking Niaspan (Niacin) and Avapro.  They had him on something with HCL, but it *raised* his blood pressure, so they took him off of it.

I'm hoping he can see results as good as yours with his HDL.  His re-check is coming up soon.  I'm going to forward him your post so he can read it for himself, I think it will help and I thank you for taking the time to write it.

Glad to hear you're doing well, and that you've disproved the "expiration date" ;)  Stay healthy.
Avatar universal
People just don't change those longstanding bad habits very often.  After my heart attack, I ate much better than I do today because of the fear of death, but I don't eat as carefully any more.

The exercise habit is important as 1/2 hour of exercise removes a lot of toxins from the body.  Your cells are made to work.  When they don't, all kinds of problems develop.  I was lucky to find a nice park with a 1.5 mile hilly circuit right on my way to work.  I stop there on the way to work religously - rain or shine.  That's a habit that I developed which has served me well.

As far as salt goes, we get so much in all of our food, that I just don't add it to anything.

Your husband may already have significant Coronary Artery Disease with lipid rich plaques at high risk for rupture.  He can save himself by acting now:

*  Restore and maintain a perfect lipid profile with meds.
*  Get in the habit of daily exercise.
*  Reduce stress
*  Reduce weight
*  Eat better consistently

Of course none of us think the bullet will hit us, but it does, and then it's much harder to recover after the heart is damaged.

Avatar universal
Hi all...I am 25 year old female with a 6 month old baby. My echo came back normal.  No family history of heart disease  Therefore I've had a normal myoview stress test, 8 EKGs, chest x-ray, CT scan, echo, MRI and physical check up...normal blood tests, BP and cholesterol.  The only thing that came back abnormal was my liver blood work.  Here is my question...could I still have a heart attack?  I just don't know what to do.  I still have left arm/shoulder/chest pain.  I've been to 2 regular MDs, cardiologist and neurologist and now they are saying maybe fibromyalgia.  If anyone has any suggestions, I would really appreciate it!  Do you think my pain is of cardiac origin?  I also have terrible ingiestion, burping and upper stomach pain - have had it for 2 months.  Is this normal?  Do you think I'll have a heart attack?  I'm scared everyday of this.
Avatar universal
Hi woodruff,
Yes I go to therapy and take prozac and they just added Elavil too.  They think I may have fybromyalgia?  I am not much better.  I still fear heart attacks every day especially since I read that women have different, more subtle symptoms than men.  I woke up early this morning with pressure pains in my right shoulder, underarm, and chest.  Could this be cardiac?  It kind of feels like when I work out only I did nothing.  Its not the typical shooting pains I've been having.  What do you think?
Avatar universal

It's good that you're in some kind of therapy (what kind, exactly?), but it sounds as though it's not working as well as it could.  May I ask if you're seeing a psychiatrist, or just a general practitioner for the prozac?  The reason I ask is that the best psychiatrists know the differences between the SSRIs, and know that some people may get more anxious on one than another.  For example, Lexapro makes me nervous, and Zoloft is calming.  I think you need to ask your doc for a re-evaluation of that med.

I have mild fibromyalgia myself, and elavil is often prescribed for the condition, since it improves sleep, and poor sleep is related to fibro.  HOWEVER, ask your doc about Elavil plus Prozac.  I don't know anything about that combination, and your doc should confirm that it's safe.

As to your cardiac symptoms:  You are 26, in good health, with a negative family history, and you passed all your cardiac tests with flying colors.  You have been given a clean bill of cardiac health by a slew of doctors.  Doctors are smart.  They can get into to medical school, while we mostly can't.  Their challenge and delight is finding illness.  They have found none in you.  Read the next two sentences out loud six times:

The doctors know more than you do.  Your heart is fine.

If your heart were compromised, you would be very sick.  Trust me--really sick.  Heart patients are very, very ill.  They cannot do the ordinary stuff of everyday life.   You can--and you do.  You don't get blue, sweaty, and barfy.  Also, the discomfort you are experiencing is NOT a warning of a heart attack in the future.  Remember, your tests came back fine.

Your shoulder and chest pains could be fibro.  They could also be related to the fact that you gave birth not long ago, and your hormones are making your ligaments way more elasic than normal.  I know about this, because after I gave birth to my son, all my ligaments were incredibly stretchy; I could bend and stretch so far from normal that I hurt myself.  It is also true that your chest/shoulder/etc pains could be a sign of anxiety and panic.  When nervous people know about heart symptoms, they tend to experience them!

So, I'm going to go out on a limb here and tell you that you need to lose the heart fixation.  You need to ask your doc for a new antidepressant, like zoloft.  And you should have him check on the Elavil/Prozac combo.

If changes are made in your medications, and a month from now, you still are hung up on your heart and dying, etc., then it will be time to find another psychiatrist.  Really.
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