Frequent isolated PVCs and Interpolated PVCs

[FileTrekker]

So I am a 30 year old male who in August of last year was diagnosed with suspected POTS syndrome, I have tachycardia when I stand up and I often feel cold extremities, and other symptoms of autonomic dysfunction.

The big issue has been in the last 4 or so months my PVCs have been getting steadily more frequent. I am desperately trying to find a cause of these ectopics or a way to lessen them but to no avail. I have had an echo done which showed a structurally and functionally normal heart. I've had several holter monitors including a 72 hour monitor which shows that I have around 1,079 ectopic beats per day, with an ectopic burdon of 1.1% and a few instances of trigeminy (although generally only PVC, beat, beat, PVC then back to sinus rhythm so I am not sure if it barely qualifies) - the weird thing is a huge number of my PVCs are apparently "interpolated" - I feel these a lot worse than normal ones as it feels like a beat, beat, beat beat beat, beat, like a big flutter in my chest.

I've tried magnesium and potassium supplements, at best these reduce the intensity of the thudding but do not reduce their frequency by any stretch. I find they are often triggered more when I am talking and also after I sit down from being stood and my heart rate slows right down quickly as it usually shoots way up very quickly due to the pots when standing. I find when standing and my HR is a little faster that the PVCs either reduce in frequency or go away completely, or at worst, stay the same.

I have had tests to rule out Addison's and Cushing's syndrome. The only other possible pertinent thing is that I have a very bad lower back after I herniated a disc about just over 1 year ago (late 2017).

What could be the cause of so many PVCs? Especially so many interpolated PVCs? They're scary and really annoying and although I've never had, as far as tests go, any couplets, NSVT etc. I am scared of NSVT, VT and VF and dying...

Any thoughts?

[dongato17]

As far as I can tell it is trial and error to see if you can find what is causing yours. It's great that you have done the usual testing to rule out underlying issues.

The good news is that there are a lot of us. :-)

Have you tried other things besides Mg and K? Be careful with potassium as it's possible to have too much. Have you tried no caffeine, alcohol, etc. to rule out other triggers? Beta blockers?

[FileTrekker]

I should have mentioned I drink no alcohol, take no caffeine at all, only drink water, try and eat healthily. I have been prescribed propranolol but I've not yet had the courage to take it as I've heard lots of horror stories around the internet that beta blockers are not effective and often make things worse. I also have a tendancy to have resting bradycardia.

[FileTrekker]

With regards to potassium I'm very conservative with the supplements each pill contains about 87mg and I will only take two, spread apart, at most. Would you say its still dangerous to take?

[dongato17]

Haha, no that's not much potassium.  A banana has a lot more than that.  :-)

My doc put me on propranolol "as needed" at first, and I rarely took it.  I'm on 25mg Metroprolol ER now and it definitely reduced my resting heartrate to something in the low 50's.  It did not stop my PVCs but rather just made them less forceful so I felt them less.

Low dosage beta blockers (I'm guessing your propranolol is low dosage as well) are pretty safe.  A lot of folks take propranolol to reduce anxiety for public speaking, etc.  I'd tend to agree that they aren't a cure for PVCs based on my personal experience.  I think they are more for just helping one to cope better...

I saw you were going to try the Taurine/L-arginine supplements.  Please do report back.  Just FYI, I'm doing 1G L-arginine (nightly) and 2G Taurine (split AM/PM).  I do consume alcohol at times and caffeine daily.  So far so good!  But then again, it may be my unique body chemistry or not related to the supplements.  It would be cool to get more data points.  For me, it took about a week for mine to go away - and I was in the thousands per day.  I can't say for sure when they went away though as I had close to zero expectation that they would.

Good luck!

[FileTrekker]

The Taurine and L-Arginine made zero difference for me. Just feel a bit softer. Thats it.