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PVC/PAC Intermittent with severe episodes

I began a repeat of past symptoms of severe episode of palpitation(arrythymias) and servere weakness of legs when walking. Had radioactive iodine for Graves Disease 4 years ago. Never have been regulated on Synthroid. Went to ER Memorial day m Monitor stayed with HR around 47-52. Was on atenlol 50mg 2x day. TSH was 11.6. My internist upped synthroid to .88. Began to get little better but not good. Much anxiety, stress going on. Saw cardiologist 2 weeks ago. Had Holter monitor 24 hours from the ER visit. (too much anxiety to ask cardiologist about results). He upped the atenlol to 75mg. 2xday. I just started a 30 day Event Monitor yesterday. Wake up around 3-5am with pounding and extra or skipped beats. Used the monitor and caught one this am. I am so scared, and can have a "worrisome "thought and have the PVC or whatever they are. I am 73. Had a heart cath 3 years ago and pretty good report. Have had Ischemic EKG for years and cardiologist says I do not have Coronary Artery Disease. I am confused and afraid to hear bad reports. Cried when I went for the event monitor yesterday. I think I am also depressed with the atenlol and also have severe personal problems with family situation and worry constantly. Do I stay with the cardiologist and suggest stress management to him.My anxiety and near panic is awful. Get surges of adreneline and can hardly stand up--have to hold to the wall.Cardiologist sent RX. for LIpitor (cholesterol 251). Am afraid of that too.Is this all mental, physical or both.
15 Responses
Avatar universal

It sounds as if you are experiencing an increase in your symptoms of palpitations along with symptoms of anxiety and depression. When confronted with the issue of PVCs one must ask whether or not there are symptoms associated with them and whether or not there is structural heart disease. In the presence of structural heart disease PVCs may represent some increase in risk and without structural heart disease are of very little risk.

Although the recent increase in synthroid may contribute to some of your symptoms it was needed to treat your underactive thyroid.
A beta blocker with a longer half life may help your symptoms at night. Taking nadolol once a day or toprol XL twice a day may help your late night symptoms.  Discuss with your doctor.

Beta blockers and an underactive thyroid may cause symptoms of depression.  I would recommend discussing your feelings with your doctor and seek other professional counseling.
Hope this helps.

Thanks for your question,

Avatar universal
I can completely relate to your anxiety!  I have an arrhythmia called Atrial Tachycardia that does not appear to have been cured by surgery (ablation).  I also suffer from PVCs which I have been told are benign.  However, despite the doctors reassuring me that the arrhythmia and PVCs are not life threatening, I still worry extremely about life/death.  So, I am now seeing a cognitive therapist (a psychologist specialized in cognitive therapy, who helps people with panic/anxiety/depression/obsessive-compulsive disorder, etc. by helping them change their thought processes that lead to the symptoms), and this has helped me tremendously.  Most of the people on this website have expressed much anxiety over their heart concerns, and many suffer from PVCs as well as other problems.  Stress and anxiety can indeed trigger such palpitations.  So, my suggestion is that, regardless of what your doctors do medically, that you consider finding a cognitive therapist who can help you with the anxiety.  There is a great website that explains cognitive therapy and gives referrals to certified cognitive therapists - http://www.academyofct.org/.  Once on the website (Academy of Cognitive Therapy), just click on "Referrals" and you list your zip code and miles you are willing to travel and a list of people in your area should appear.  Good luck, and hang in there - many of us know how you feel!
Avatar universal
P.S. What time of day did you post your question?  I have been trying to post a question since January, without luck.  I live in the Pacific Time Zone.  Thanks.
Avatar universal
i AM IN central daylight savings time and posted my question around 5-7 am. I know I awakened around 3:15 with pounding heart ( wouldn't beat fast due to the atenelol) but had the arrythmia. I used the Event Monitor " and called it in around 8:30 but they could not get a strip on it. This was the first event since I had the monitor. Everything has gone fair today but not good. Thanks for the advice re: cognitive therapy. I need something. I am pretty good tonight mentally but still would completly blow with the slightest hint of cardiac problems which I know are going on. I am so glad I found this site. IT is good to have a doctor to drop some encouragement as well as fellow sufferers. I hope you can get your post through. I needed the advice and direction. Was glad to know that the low thyroid and atenelol are contributing to the depression. Makes it easier to accept. Thanks to everyone and would like to hear from anyone. I will report on the event monitor during these next four weeks. Grammy
Avatar universal
For the past three years my PVC's / PAC's have been really bad. I'm on 100mg Toprolxl, 40mg Paxil and Xanax when needed. I'm scared to death. The longest I have gone is three days without a bout of them. Most days they are very close together and continue on and off all day. The test I have had are, EKG and Echo. Now for the biggie, sometimes it gets totally off rythim between 7 to 9 seconds before returning to normal. Nothing has been caught on a monitor but a couple of PVC's and PAC's, was not "lucky" enough to catch the long ones while on a monitor. Basically this worry has ruined my life. Has anyone else suffered these long off rythim beats, and if so, does any medication help or do I just have to accept this and try to do the best I can.
Avatar universal
hi, just wanted to let you know you are not alone in how you feel that this problem is ruining your life at times. i feel the same way. i have been having palpitations for the past 20 years off and on. i went for a long time without any and then last November they started up again worse then ever before. i have seen a cardiologist did all the tests and was told its really nothing to worry about. well i disagree. its extremely annoying and i never know when they will start up. there is no rhyme or reason to what gets them started. anyway i just wanted to tell you your not alone and try to hang in there. deb
Avatar universal
Hi, just wondering what you mean by 7-9 seconds out of rhythm.  When I have episodes of PAC's they could last up to 6 hours.  I also take Xanax when needed and it is always needed when these start up. I Hate it.  It really can do a number on your mental state and ruin your entire day. I'm curious about the 7-9 seconds, please explain.  THanks, Angela
Avatar universal
hi angelapple; it,s hard to explain a lot of times it,s a couple of times right together. then 7,9 all together before it gets back on ryhthm. those long ones are what really scares me to death. i also take buspar 30 mg.a day all i do is worry when the next one will happen. most of the time i feel fine then it happens. not when i feel nervous just watching t.v.  or relaxing. hope you can understand this now.   let me know  missy pat
Avatar universal
I have PAT and I was given Toprol 25 mg a day. After taking the medication for 2 days i started having shallow breathing and the doctor told me to take half the dose. I took half the dose for three more days and could hardly take a deep breath. I felt like i was Sufficating. I had tightness in my throat, neck , and chest. I ended up in the ER twice that week. Now a week has passed since I have stopped the medication and my breathing has not come back to normal yet and still am suffering a great deal. Could the Toprol have done permanent damage to me? Is it the toprol or something else that is causing this? I have had breathing trouble from time to time for many years especially after surgery where general anesthesia was administered. I also have breast implants that I had done 13 years ago and want to know if this could have something to do with this problem I have?

                      Thank you so much for your time
Avatar universal
Hi, I know what you mean, try not to worry (Funny for me to say).
I worry and wait for the next ones also.  Not a fun way to live.
Do you feel the medication is helping you at all.  I take 25mg of Toprol xl for the past 4 weeks and I really have noticed a great improvement.  I hope they never come back.  I will tell you I've had 1 or 2 here and there and I clench my fists in panic.  I think if we all who get these things learn to relax when they start we would probably be so much better off.  Easier said than done.  It really can be very debilitating.  2 months ago these extra beats woke me at 2a.m.  had them until 8:30.
I also notice a connection with PMS, do you?  I hope you're feeling better. Let me know. Angela
Avatar universal
Hi the pms for me is over due to a operation.These skips flips and flops are really hard to explain.You didn; say if yours has done this. 7seconds isn;t long except when it;s going on then it feels like minutes. I haven;t been lucky enough to catch them on a moniter. so have no idea whats going on at that time i feel like i'm  the only scared as much as i am person here in small town Virginia.   Missypat
Avatar universal
Hi-I do get skips, flips and flops.  I honestly think that's what most of us in this forum get.  It was explained to me by my cardio dr. that these are extra beats, even though they feel like skipped beats.  Did you ever put your finger on your neck when you feel them.  ON your artery is where your pulse is.  YOu can count them.  When I was getting episodes of them it would start with 1 (I call it a bloop) you call it a flip, skip and then in a couple of minutes it would start.  I would get 2 normal beats then an extra, then 7 normal beats, then an extra and so on.  No real rythmn.  Usually no pattern.  That lasts for a few hours.  One day I had it off and on the entire day.  That's when I decided to try the toprol.  I know what you mean about being scared to death.  Believe me.  I haven't had an episode since June 17th.  Thats when i started on the toporol.  I have had l or 2 bloops here and there.  Were you diagnosed with Mitral Valve Prolapse?  I was for years and now a new cardio dr. did an echogram and said absolutely not.  Oh well.  Take care try and relax, yah right).  Good luck.  Let me know how you're doing. P.S. We have to keep reminding ourselves they have told us repeatedly that they are harmless and a benign nothing.  I know it's hard to but what choice do we have.
Avatar universal
You may want to try wearing an holter monitor (24 hour continuous heart monitor) or an event monitor (for weeks to a month) - ask your cardiologist.  That way they can accurately diagnose what you have.

Also, you may want to look at the medications you're taking.  I took Buspar for a short time and had more palpitations/PVCs then.  Are the palpitations better or worse since starting on Toprol, Paxil and Buspar?  Maybe a different beta blocker (other than Toprol) would help - you really need to talk to your cardiologist.

I have been on Atenolol for Atrial Tachycardia and I used to have lots of PVCs - I know how you feel.  I have major anxiety and panic disorder as a result - the Atenolol helps to calm me down while keeping the arrhythmia at bay, but I do still get PVCs.  Hang in there.  Maybe seeing a therapist (as I do) would help with the anxiety, especially if you've had all the tests and are told everything's okay. My recommendations - have more testing, then see a cognitive therapist (someone who can help with the catastrophizing thoughts that come when our symptoms emerge).  Good luck to you - there are many people here who empathize with you.
Avatar universal
I've been on 25 mg of atenolol for 7 or 8 years to help control PACs which I've had my entire life. Recently, due to the scare about hormone replacement therapy, I quit taking Premarin & Provera, and within only a week or two began suffering from many PACs througout the day and night. I had heard that if you cease taking the hormones all at once that menopausal symptoms might return. I was aware of the night sweats and mood swings, but figured I could handle that. I had no idea heart irregularities and palpitations were associated with menopause until I saw it on Oprah! I have now increased my dosage of atenolol and began taking Activella (hormone), and I feel somewhat better, but not well enough!!

Is anyone else in the same boat?? Thanks!
Avatar universal

Yes, I am in the same boat, and I know from this site and others, many women along with us.
With all the symptoms you describe.
I am ok with the hot flushes and sweats and bad sleeps and so on, but the heart-thumps and bumps I cannot get used too.
Had them all my life but not that bad, just once in a while.
These ones come when they please .
Done everything I could do to prevent them (well almost everything) including avoiding caffeine, much suger, nicotine, alcohol, and everything else that's bad.
Take magnesium-pills, calcium, Q10, flaxseed, B-complex.
Had all the tests and was ok'd.
Just a little bit of high bloodpressure, and a valve that leaks a bit.
Dr. gave me beta-blocker.
That helped with the bloodpressure and the palpitations, but the PVC's are still coming.
One day can be more worse than the other.
The nights I find rotten.Sleepless.
I am very nervous and inside my chest it is quivering (feels like it is my heart trembling, and that makes me anxious more).
Oh well, I am still alive and kicking, and I want to be alive and kicking in about 40 years, that's my promise to myself, so I have to make the best of it all and I DO!!
I love life and laugh alot. That helps.
Have a loving family, that helps too.
And I read that one day when this is all passe, you'll feel like a new person! So what we need is patience. (I don't have a lot of that) and keep the stress out as much a possible!
Yeah right.....
Wish you well -    ***Ianna***

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