The PVC crap

[Anghan]

So for the past two years I've been having what I thought was just panic attacks. Come to find out I'm also having PVC's and PAC's. 19,332 on the 48hr Holter monitor to be exact.
Doc gave me trazodone to take it I'd like to help with sleeping. Also called in a beta blocker I've yet to pick up.
Honestly, I'm not thrilled by the thought of taking the beta blocker. My bp is fine, runs around 110/68.
I'm having an echo done this week and a bunch of blood work done as well. Everything they've looked at so far though they keep saying they're benign and it's fine.

Shoot it straight please!!! Am I really not going to die from these? How the heck can my heart be so wonky and it literally have no physical effect on my health?

Also, since I want to avoid the beta blockers, for now. Tips, tricks, anything to help with these. I seriously feel like I'm losing my mind and just waiting everyday to die.
Thanks!

[Serenapuff]

I too suffer from a heavy burden of pvcs.  My echo was normal so my cardiologist was not concerned and related that the possible treatment options might cause more trouble.  I do have thyroid disease and POTS both of which can cause pvcs.  Changing hormones can play a role as well.  Hoping your echo reveals a structurally normal heart and the meds provide some relief.

[2210485]

Nope wont die... Not for a while anyways. Pvc's could contribute to your death in 20 or 30 years from heart failure... Or if you had some other sort of other disease that effected your electrolytes and you got one in an r on t phenomenon. At this time you're not quite having enough for this to be a huge concern, but its a possibility.

Beta blockers will drop your blood pressure a bit but wont do much harm, you can live and function just fine with a lower bp. Anecdotal as it is, my own resting baseline is like 90-100/60-70, which is probably where yours will be and i feel fine.

Basically the strategy is to test out the beta blockers and see if they help. The echo is to ensure youre not in heart failure/developing a serious cardiomyopathy (unlikely given your burden) from the pvc's and to hunt for other structural abnormalities while theyre at it. If beta blockers dont help then ablation is the way to go.

If you dont want to take the meds or get the procedure, theres literally nothing you can do to stop the pvcs.

Sure you can reduce caffeine and stress.. Modify diet, do yoga, something along those lines. Howevet for someone with 10,000 pvcs per , about a 5 - 10% burden, i highly doubt anything you do will put a significant dent in the problem.

Sorry if i sound blunt with this but you wanted it straight sooo.. There you have it :)

[Anghan]

Thank you for both your replies and being frank.
I go in for my echo tomorrow.
Just being on this forum though and reading through everything, I mentally already feel better.
I did notice also the other day, after getting 11 hours of unmedicated sleep, I didn't feel a single pvc for the whole entire day until I went to lay down.
Does that mean I didn't have them? My guess is no. However, I was able to make it through a full day without going into a panic over my heart. It was such a relief. And I know it's in part due to honest and forthright answers I've found reading through this forum.

[2210485]

Additionally i read this again snd i saw your bp.. 110/60 at rest should be sufficient for betablocker therapy.. Thats a map of like 76... You could go down  90/50 as a low reasonably safely.

Flecainide is a reasonable alternative as i mentioned before.. Do a trial of flecainide with a 48 hour monitor placed the next day and monitor the burden of ovc's by comparing the results to baseline.

Honestly if its upsetting you that much something needs to be done to control symptoms, id plead the case with the cardiologist as you have here or go to another for a second opinion.

Dont be shy to express yourself to them, because im certain if they heard the same level of concern and verbage from you in office as you've posted here there would be a greater sense of urgency to aggressively manage the situation.

[2210485]

Flecainide maybe?

[Anghan]

I had the echo done and everything came back clear. I do have a couple "trivial regurgitations". Basically very small valve leaks. Which I've been assured by the cardiologists is completely normal and probably 80% of the population has them. So at this point I'm just doing my best to ignore the palps and will go for an echo again in 10 years unless something else comes up.

The only thing that came back on blood work was low Vit D levels and extremely low progesterone. Thyroid looks fine but they said possibly the low progesterone could be affecting the para thyroid but I'd have to go into a hormone replacement specialist to get more answers on that.

[2210485]

Thats great to hear, what are they going to do in terms of treatments? Medications or intervention?

[Anghan]

Currently I’ve cut all caffeine. I’m taking magnesium and Vitamin D.

I also have an appointment with a hormone therapy doc because my blood work showed my progesterone way way below what it should be.
They said there’s a possibility the low progesterone is causing the para thyroid to misfire causing the PVC’s and PACs.

I also was given trazodone to take if I can’t get to sleep.
They don’t really want me on the beta blockers because my blood pressure runs 108-110/62-67.  So they’re afraid the beta blockers would drop it too low.

[2210485]

P.s. i didnt answer a part of your question.

They have an effect on your health because pvc's are crappy at pumping blood.

So your heart has to work harder in its 'normal' beats to pick up,the slack. The heart muscle gets bigger, chamber gets smaller, meaning it has to work even harder, getting even larger etc. Eventually it just gets tired and says to heck with it and gives up.

How long it takes for that to happen depends on how many of those 'lazy' pvcs you have.

For a non evidence based illustration of the core concept:

Lets say, in your present state, the heart works 5-10% harder to make up for the pvcs. Therefore you can reasonably expect it to kick the can on you 5-10% faster. Take someone whos heart fails at 80.. Throw on a 10% pvc burden, that persons heart would probably fail at 72 instead. No big deal, we give them some medicine, they make it to 78 or 79.

Does that make them completely 'beningn' no.. But should they keep you up at night? Also no. Lots of things reduce your life expectency.

People who drive cars as a whole live less then people who don't for obvious reasons. If we avoided everything that reduced our life expectency we'd all be shut ins.

Now take that same 80 year old, and give them a lifetime of 50% pvc's, now they got till 40.. And by the time a doctor sees them,theyre probably already 30.. That's a problem they need to fix in the most aggressive way possible.