When is it too many PACs/PVCs?

[Roys]

Earlier this week I went through a period of 4 plus hours when I was having 15 to 18 PVCs/PACs per minute. I was relaxed, sitting and watching TV. I had no other symptoms and getting up and moving around did not affect them. This was still going on when I went to bed. Typically, I experience 4-6 PVCs/PACs per minute. With a resting pulse of 60-70, this was one every 4th beat, although they were not that regular.

When is it too many? Should I have gone to the ER? Could it have been something other than PVCs/PACs? The next morning, I was below 10 per minute. I made an appointment to see my cardiologist to discuss this but I am now anxious to understand if I should have done something.

Thank you very much for reviewing my question!

[CCF-M.D.-CRC]

Dear roys,
There is really not a "limit" as to the number of PACs/PVCs one can have.  The number does help us however in planning treatment. For someone with as frequent ectropic beats as you we would generally recommend some type of treatment be it medical or ablation.  In general if a person is having >10,000 extra beats over a 24 hour period then medication or ablation is indicated.  You may want to ask your cardiologist to send you to an electrophysiologist for further evaluation and treatment.

[farfnarf]

Mine stopped when I eliminated monosodium glutimate (msg).

Had them for years.  Read labels.  Eat more produce and
less canned and processed food.  Don't smoke.  

I don't drink alcohol, either.

Good luck.

      ---- Farf

[Sam R]

I know where you're coming from. I had the same problem for at least 10 years, frequent PAC's every few seconds. Had all the tests, doc told me I was ok, & blew me off.  Here are some things I have tried with great amount of success, you may want to try these:
1.)  Magnesium, potasium, fish oil concentrate tablets( I read obout this in the Harvard Medical School newsletter a couple of years ago) and Hawthorn berries.  This regimen has worked wonders for me.  You can find this in the vitamin section at Wal-Mart, K-Mart , Cvs etc. It may take a few days to notice improvement.
2.)  Take slow deep breaths when they come on.  Easy to hyperventilate when they come on  & may be making it worse.
3.)  I am a runner  &  i noticed the PAC's seem to subside with exercise, you may want to take a brisk walk.
4.)  Prayer doesn't hurt, if nothing else it may put you in a positive frame of mind.
  5.)  Also, & I know this is tough, but try to think of something else when they occur.  The anxiety may create a vicious circle and make it worse.

I hope this helps, let me know how you make out.

[Roys]

A couple of years ago when I had my first episode with PVCs, I went through a whole battery of tests, holter, echo, thalium stress test, and even a cath. The bottom line is that they really didn't find anything to pin the PVCs to and everything was considered normal. Part of the reason I ended up with all the testing is that the holter did show 2-3 PVCs in a row sometimes. Since that time I've had the PVCs disappear for months as well as come and go in a matter of weeks. However, this is the first time that I've had such a high frequency. So from my perspective, it begs the question when do you assume something has changed? I do have a cardiologist, who I will see later this week. I am currently taking Inderol as a beta blocker. In the past, I've also taken Toprol. Overall, I'm not sure if the beta blocker helps since the PVCs seem to come and go on their own whether or not I happen to be taking a beta blocker at the time. I also don't like taking larger doses of beta blockers because they leave me feeling a bit fuzzy all the time. I do have an appointment with my cardio later this week. We'll see if he sloughs it off. Thanks for the comments! It's good to know I'm not the only one who is frustrated with no root answer.

[arthur]

PVCs/PACs are often caused by foci (structural cardiac tissue, normally electrically isolated from the rest of the heart, which have a small population of electrical cells) which interfere with the heart's normal rhythm.  The actual cause of the change from passive to active for these little foci is not clearly understood, however, they have been studied intensively for the past couple of decades...and most recently (last couple of years) they have been the target for ablation techniques which have resulted in cures of many types of arrhythmias.

With a structurally sound heart, they represent no more than a source of anxiety and they are quite disturbing.  Many people live their entire lives with these beasts producing nothing more than mental irritation.  Some people (as the post above suggests) can develop more serious symptoms (notably persistent tachy or AF)...in these individuals, ablation is often the answer...cardios are not eager to treat "simple" cases of PACs/PVCs with ablative techniques because of the risks involved.

Beta blockers really do nothing to stop these skips; they just slow the heart down a bit and may lower you blood pressure to the point of not feeling them as often.  There are other drugs available which make the atria less sensitive (reduce automaticity) to external electrical noise (eg tambocor).  I took both types of drugs and found them unaccepable, as I am an avid soccer player and found that limiting the heart rate was not a useful effect when trying to do sprints for an hour and a half.

Get a Holter done to document the arrhythmia (use an event monitor if necessary...that's one you can turn on right after you feel something and it will record the current symptoms plus about 30 secs previous to the event).  If you can document a persistent type of arrhythmia you may be able to consider an ablation.  It worked for me.