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PACs, Arterial Hypertension, Anxiety (Male, 22)
Hello and thank you for having this forum available for us.
First off, I'm a male 22 years old. I have arterial hypertension for years already (130/80 earlier in childhood and recently 140/90 are the average figures BEFORE using BB for the treatment). I also have elevated levels of triglycerides that I'm compensating with high quality Omega 3s and once went for medicine to lower them for a bit. I believe it's all because of my genes that is, unfortunately, causing this all.
For almost a year now I'm on a beta blocker (Nebilet - Nebivolol) for my hypertension and this medicine is definitely working for this. I have minimized my average numbers to 125-135/70-80 and I'm glad to see I'm controlling my BP, at least for slight figures. Other than that, I have had EKG, stress EKG and two ultra-sounds for the heart and all came normal at that time. To add, this is all because my father passed in his early 40s because of untreated heart disease. So I rather pay attention to all that instead of ignoring my genes and family history.
Here comes now my question, I'm sorry for the long introduction though. Recently I have noticed that when resting (and only when at resting) my heart rate is having premature beats (I believe these are those PACs). It's like Beat-Beat, then pause, then Beat-Beat. It can stay for this like for minutes and only will be back to normal when I stand up or start doing something physical. The pause between Beat-Beat is like 0.5 seconds and between these "double beats" - like 1.0-1.2 seconds. I'm concerned about whether this rhythm won't result into any other not-benign arrhythmia.
Like most of us, I've read tons of articles regarding this matter. Most guidelines say they are benign, some say they might be a sign of underlying heart disease. But then again, those PACs were not cought on EKG at that time and when I tell them about this, they usually say not to count my pulse, not to worry about them and think about them. They also connect it to anxiety, that I cannot disagree. I get anxious about this feeling sometimes and it just triggers more those sensations of PACs involved.
An professional comment on this question would be very much appreciated. Maybe I have to give a try to some potassium, calcium and magnesium supplements to see what happens. Other than that heart rate, I have no other symptoms. But I'm worried that later they can involve some symptom.
Thank you once again.
First off, I'm a male 22 years old. I have arterial hypertension for years already (130/80 earlier in childhood and recently 140/90 are the average figures BEFORE using BB for the treatment). I also have elevated levels of triglycerides that I'm compensating with high quality Omega 3s and once went for medicine to lower them for a bit. I believe it's all because of my genes that is, unfortunately, causing this all.
For almost a year now I'm on a beta blocker (Nebilet - Nebivolol) for my hypertension and this medicine is definitely working for this. I have minimized my average numbers to 125-135/70-80 and I'm glad to see I'm controlling my BP, at least for slight figures. Other than that, I have had EKG, stress EKG and two ultra-sounds for the heart and all came normal at that time. To add, this is all because my father passed in his early 40s because of untreated heart disease. So I rather pay attention to all that instead of ignoring my genes and family history.
Here comes now my question, I'm sorry for the long introduction though. Recently I have noticed that when resting (and only when at resting) my heart rate is having premature beats (I believe these are those PACs). It's like Beat-Beat, then pause, then Beat-Beat. It can stay for this like for minutes and only will be back to normal when I stand up or start doing something physical. The pause between Beat-Beat is like 0.5 seconds and between these "double beats" - like 1.0-1.2 seconds. I'm concerned about whether this rhythm won't result into any other not-benign arrhythmia.
Like most of us, I've read tons of articles regarding this matter. Most guidelines say they are benign, some say they might be a sign of underlying heart disease. But then again, those PACs were not cought on EKG at that time and when I tell them about this, they usually say not to count my pulse, not to worry about them and think about them. They also connect it to anxiety, that I cannot disagree. I get anxious about this feeling sometimes and it just triggers more those sensations of PACs involved.
An professional comment on this question would be very much appreciated. Maybe I have to give a try to some potassium, calcium and magnesium supplements to see what happens. Other than that heart rate, I have no other symptoms. But I'm worried that later they can involve some symptom.
Thank you once again.
First, your blood pressure isn't very high (you are in the high normal range).
Second, yes, as you correctly pointed out, PACs are not dangerous. As mentioned above, a cause is always present, but the cause is usually a benign one and nothing to worry about. In your case, however, with a blood pressure in upper normal range, you may ask your doctor to rule out if the PACs and blood pressure share a cause. Such a cause may be, for example, excess adrenaline in the body, chronic stress, anxiety, hyperthyroidism or other hormonal disorders.
Your description of PACs is according to the textbook and there shouldn't be much doubt about what you are suffering from.
Please avoid the electrolyte supplements unless your doctor tells you to take them. "Self-medication" with electrolytes is usually just a waste of money and in some cases actually harmful. Ask your doctor for some blood tests to check hormones and to see if you are actually lacking any of the substances.
A possible exception is magnesium, but even that is usually not necessary in healthy young men, unless, again, it has effect or your doctor tells you to take it.
Second, yes, as you correctly pointed out, PACs are not dangerous. As mentioned above, a cause is always present, but the cause is usually a benign one and nothing to worry about. In your case, however, with a blood pressure in upper normal range, you may ask your doctor to rule out if the PACs and blood pressure share a cause. Such a cause may be, for example, excess adrenaline in the body, chronic stress, anxiety, hyperthyroidism or other hormonal disorders.
Your description of PACs is according to the textbook and there shouldn't be much doubt about what you are suffering from.
Please avoid the electrolyte supplements unless your doctor tells you to take them. "Self-medication" with electrolytes is usually just a waste of money and in some cases actually harmful. Ask your doctor for some blood tests to check hormones and to see if you are actually lacking any of the substances.
A possible exception is magnesium, but even that is usually not necessary in healthy young men, unless, again, it has effect or your doctor tells you to take it.
Okay, first of all your story is pretty much my story. I'm 21, male, and have the exact same problem with hypertension and ectopic beats.
Now, given that you have been through all the tests (stress test, echos, EKG's, etc) we know your heart is structurally normal, and we also have very good indications that aside from these benign palpitations it is electrically normal.
Here is where the blood pressure aspect comes in. Hypertension, especially when inherited at a young age due to bad genetics is likely the result of the RAA system. Here's how it works:
Renin is secreted in the kidneys. The renin produces angiotensin I, which then goes to the lungs and is converted to angiotensin II via an enzyme. Angiotensin II restricts the blood vessels, thus increasing systemic pressure. The presence of angiotensin II also promotes aldosterone secretion in the adrenal glands. Aldosterone does more of what angiotensin II was already doing. If any part of this chain is off (too much renin, or too much of the renin becomes angiotensin I, or too much angiotensin I is converted to angiotensin II, or the angiotensin II and aldosterone are overactive) then blood pressure will go up.
They don't quite know if it is the high BP or the high angiotensin II and aldosterone (which essentially create the high BP) that does it, but one or both of them help to create conditions that promote wall thickening and cardiac fibrosis. Wall thickening in the left ventricle (LVH) can end up producing the same affects of HCM (hypertrophic cardiomyopathy), while the increased cardiac fibrosis makes the ventricles stiffer, meaning they don't fill up with as much diastolic volume as they should, which is known as diastolic dysfunction. In time this can progress to diastolic heart failure. Furthermore, if enough cardiac fibrosis develops then left over scar tissue can create re-entrant circuits that may lead to lethal arrhythmias much like those that would be seen in ARVD (arrhythmic right ventricular dysplasia).
But there's some good news. For one, the hypertension and the wall thickening and cardiac fibrosis it creates develop slowly over time, which is why young people with hypertension generally don't develop heart failure or lethal arrhythmias or full massively thickened LV's. It takes time and early recognition is key. The even better piece of news is that this is very treatable. Not only can you prevent further damage, but you can reverse previous thickening and fibrosis damage. Your diastolic function and exercise capacity will improve as well.
Now, the problem is that you say you are still feeling these arrhythmias but your BP is down now that you are on beta blockers. Well, here's why: You are on a beta blocker, which essentially just slows the heart down. You are being given something that takes adrenaline out of you so the heart has to work less. It brings the BP numbers down and makes you feel a little better, but it's really a band-aid. The arrythmias are still occuring because the wall thickening and fibrosis that come with hypertension are least effectively reduced by beta blockers compared to other types of anti-hypertensive drugs. The two most effective kind of drugs are ARB's (angiotension receptor inhibitors) and ACE inhibitors. The former simply blocks the affects of angiotension II, which will reduce the hypertensive fibrosis and thickening process from continuing, and the ACE inhibitors prevent the enzyme in the lungs that turn angiotension I into angiotension II from working so angiotension II never even gets produced at high quantities and can no longer do damage in terms of fibrosis or thickening. In comparative studies ACE inhibitors and ARB's are twice as effective at getting rid of the LVH and fibrosis associated with hypertension vs. beta blockers, which really just bring the BP down, but do little else. I would talk to a doctor about getting switched to an ACE inhibitor or ARB.
Now, given that you have been through all the tests (stress test, echos, EKG's, etc) we know your heart is structurally normal, and we also have very good indications that aside from these benign palpitations it is electrically normal.
Here is where the blood pressure aspect comes in. Hypertension, especially when inherited at a young age due to bad genetics is likely the result of the RAA system. Here's how it works:
Renin is secreted in the kidneys. The renin produces angiotensin I, which then goes to the lungs and is converted to angiotensin II via an enzyme. Angiotensin II restricts the blood vessels, thus increasing systemic pressure. The presence of angiotensin II also promotes aldosterone secretion in the adrenal glands. Aldosterone does more of what angiotensin II was already doing. If any part of this chain is off (too much renin, or too much of the renin becomes angiotensin I, or too much angiotensin I is converted to angiotensin II, or the angiotensin II and aldosterone are overactive) then blood pressure will go up.
They don't quite know if it is the high BP or the high angiotensin II and aldosterone (which essentially create the high BP) that does it, but one or both of them help to create conditions that promote wall thickening and cardiac fibrosis. Wall thickening in the left ventricle (LVH) can end up producing the same affects of HCM (hypertrophic cardiomyopathy), while the increased cardiac fibrosis makes the ventricles stiffer, meaning they don't fill up with as much diastolic volume as they should, which is known as diastolic dysfunction. In time this can progress to diastolic heart failure. Furthermore, if enough cardiac fibrosis develops then left over scar tissue can create re-entrant circuits that may lead to lethal arrhythmias much like those that would be seen in ARVD (arrhythmic right ventricular dysplasia).
But there's some good news. For one, the hypertension and the wall thickening and cardiac fibrosis it creates develop slowly over time, which is why young people with hypertension generally don't develop heart failure or lethal arrhythmias or full massively thickened LV's. It takes time and early recognition is key. The even better piece of news is that this is very treatable. Not only can you prevent further damage, but you can reverse previous thickening and fibrosis damage. Your diastolic function and exercise capacity will improve as well.
Now, the problem is that you say you are still feeling these arrhythmias but your BP is down now that you are on beta blockers. Well, here's why: You are on a beta blocker, which essentially just slows the heart down. You are being given something that takes adrenaline out of you so the heart has to work less. It brings the BP numbers down and makes you feel a little better, but it's really a band-aid. The arrythmias are still occuring because the wall thickening and fibrosis that come with hypertension are least effectively reduced by beta blockers compared to other types of anti-hypertensive drugs. The two most effective kind of drugs are ARB's (angiotension receptor inhibitors) and ACE inhibitors. The former simply blocks the affects of angiotension II, which will reduce the hypertensive fibrosis and thickening process from continuing, and the ACE inhibitors prevent the enzyme in the lungs that turn angiotension I into angiotension II from working so angiotension II never even gets produced at high quantities and can no longer do damage in terms of fibrosis or thickening. In comparative studies ACE inhibitors and ARB's are twice as effective at getting rid of the LVH and fibrosis associated with hypertension vs. beta blockers, which really just bring the BP down, but do little else. I would talk to a doctor about getting switched to an ACE inhibitor or ARB.
Im not a professional so probably can't help much but I get pacs as well. Everything that I've been told by numerous health professionals is that pacs in a structurally sound heart are benign and needn't be treated unless hampering your lifestyle. Sounds like youve got evidence your heart is in good shape so I can only imagine a professional would recommend not worrying about them and controlling diet, stress, and anxiety.
I was told by a cardiologist that pacs and pacs always have a cause (trigger) but we cannot always find what it is in each individual. Perhaps you could try tweaking your diet in an effort to pinpoint what triggers your pacs. The other thing would be to relax, but that's easier said than done.
I was told by a cardiologist that pacs and pacs always have a cause (trigger) but we cannot always find what it is in each individual. Perhaps you could try tweaking your diet in an effort to pinpoint what triggers your pacs. The other thing would be to relax, but that's easier said than done.
Any ideas of the above? I'm still getting those premature/double heartbeats where first is more powerful and second not that strong. They can continue for minutes once I lay up/stop resting.
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