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Avatar universal

Palpitations

46 year old female.  Had a short run of nsvt back in 1990 but been obsessed about it ever since. Have at least 10 flips or dropping or skippy sensations a day.  Have had two EP studies and they cannot induce v-tach.  Have a numerous holters that basically show PAC's, PVC's and couplets.  Echo showed very mild regurtation (they say a lot of people have it).

Questions:

- Just went for a stress test with my insistance and it said 1 mm ST depression.  Doctor scheduled me for a thallium test which I just went for and they didn't see the 1 mm ST depression again.  Showed nothing on the thallium test either.  They said that sometimes females have a false positive result on these stress tests due to hormones.

- I hate these skips I get daily and I really want to get over my anxiety over them.  I probably average around 10 times a day when I feel a lull then a big bang or a couple of quick beats or a flutter.  Would that be an average amount for most people?  I know when I had my thallium test the nurse told me that basically 99% of the population gets PVC's and PAC's and they don't worry about them.  Is that true???

Do you think since I have had a full workup on my heart and it basically shows nothing I should just stop my darn worrying about every little thing I feel.  I have even been to a physcaratist to try to get over my anxiety over it.  I just can't seem to get it out of my head that everyone gets these things and doesn't get scared.
11 Responses
230125 tn?1193369457
MEDICAL PROFESSIONAL
Hi Carrie,

Please take comfort in that you are not alone with a history like this.  It is very common and people do very well over the long term – the trick is learning to live with the symptoms.

- Just went for a stress test with my insistence and it said 1 mm ST depression.  Doctor scheduled me for a thallium test which I just went for and they didn't see the 1 mm ST depression again.  Showed nothing on the thallium test either.  They said that sometimes females have a false positive result on these stress tests due to hormones.

It is true that women in your age group have more false positive tests – although I usually don’t attribute them to hormones.  

- I hate these skips I get daily and I really want to get over my anxiety over them.  I probably average around 10 times a day when I feel a lull then a big bang or a couple of quick beats or a flutter.  Would that be an average amount for most people?  I know when I had my thallium test the nurse told me that basically 99% of the population gets PVC's and PAC's and they don't worry about them.  Is that true???

It is trust that everyone has PVCs and PACs.  There is an unfortunate group of people like you that have significant symptoms with PVC/PACs.  The symptoms cause a significant decrease in quality of life.

Do you think since I have had a full workup on my heart and it basically shows nothing I should just stop my darn worrying about every little thing I feel.  I have even been to a psychiatrist to try to get over my anxiety over it.  I just can't seem to get it out of my head that everyone gets these things and doesn't get scared.

If you have an echocardiogram and EKG showing a structurally normal heart, you are at the same risk as the general population for sudden death.  This should not be your concern, although I understand this is what a lot of people fear despite reassurance.

There are several options.

1. An SSRI medication like paxil, prozac, Zoloft, etc are shown to decrease symptoms with PVCs.  It is worth a try.
2. Beta blockers can decrease the sensation of PVCs but not the number of PVCs.  I have seen it help people tremendously – including a post from yesterday.  Some people have fatigue with beta blockers.  Don’t stop them immediately if you can tolerate the fatigue.  Give it a few months and most people feel better after with the beta blockers.
3. If neither of these options work and you PVCs persist, you can try a medication like flecainide.  This medication is only for significant symptoms and is used in conjuction with a beta blocker.  It can only be used in people without coronary disease.  There are some risks to flecainide.  That is why it is the last choice of medications.
4. If these don’t work and the PVCs are frequent, ablation is an option.  PVC ablation can be successful, but is always the last resort.

I hope this helps.  Good luck and thanks for posting.
Avatar universal
Hi Carrie,
A study was published in the journal 'Cardiology' earlier this year in which 625 healthy people (as judged by Echo+ stress test) wore a holter monitor for 24 hours.
8.8% of them experienced couplets during the 24 hours whilst 3.4% experienced nsvt on the day of the study.
There is another study (I can't remember the reference right now) in which 5% of the population got >300 PVCs per day, 4% got > 500 and 2.7 % got more than a thousand in 24 hours. Hope this reassures you.
Avatar universal
Unbelieveable huh.  I totally stress out about my 10 misses a day.  I am going to go back on an SSRI I think.

Are you on meds for 1700 per day?
Avatar universal
Just to add that the aforementioned study in 'Cardiology'included people from 15 years of age right up to 79 and nsvt was found in those under 30, not just older people.

In yet another study they followed 70 men with very frequent and complex pvcs. They had an average of 500 PVCs per hour....yes PER HOUR!. A high proportion of them had nsvt aswell (around 26% if I remember correctly) After 7 years they found that their survival was equal to that of the normal population.

Hope that this reassures you somewhat. I know the dropping/ flipflopping sensation is really horrible. I had that over 1700 times per day.
Avatar universal
So can you tell me that I should have nothing to worry about if my thallium test came back totally normal?  I really want to stop my worrying about this but I still feel the doctors miss something.

I guess I just constantly worry over the first holter I had that caught a run of nsvt and it has ruinned my life with worry ever since.  I worry about every little skip, skip, bang and flutter it does.

Avatar universal
Hi Carrie,
I had the 1786 per day during pregnancy 6 months ago. After pregnancy they reduced to between 250 (good day) to 600(bad day).  I am on a beta blocker at present. I tried propranolol first and this did nothing for them in fact I think it made them worse by lowering my heart rate.
I then found a small study in the literature in which most people had a 70% reduction in PVC's on acebutolol;  in the same people, propranolol caused no statistically signicant decrease. I decided it was worth a try as these PVCs were really affecting my quality of life. I asked the doctor for it whilst not expecting it to work but hoping for a small improvement.  Amazingly within hours of taking it they decreased dramatically in frequency; I am down to a couple of dozen PVCs per day sometimes fewer. It's not that I just don't feel them... I still feel them really strongly as a flip flop in the throat and sinking in the chest but I get so few now that they don't worry me.
Avatar universal
Is acebutol like atenonol?  I took that at one point and it didn't do any good.
Avatar universal
They are both beta blockers, however I think they differ in that Acebutolol has intrinsic sympathomimetic activity wheras atenolol does not.
Avatar universal
Maybe it is worth a try then.  I just hate betas how you heart feels so slow.  When I have been on them I still get the skips and bumps but slower ones.  It is really freaky.  I have very low blood pressure all the time so I know that makes it lower as well.
Avatar universal
I get the impression that acebutolol isn't prescribed much these days and I'm not sure why (my GP had never heard of it and my pharmacy had to order it in). I think it is one of the older betablockers. Perhaps there are issues with side effects or something like that which make the more commonly prescribed beta blockers (propranolol, atenolol) more favorable by comparison.  
I have always had low bp too so I take a low dose.
My worry is that I will adjust to it and it will stop working for me but I am just trying to enjoy the nice smooth heartbeat I have at the moment.

212161 tn?1537898045
i have over 3000 of pac a day i take timolol which is a very old bb been on it for 15 years it seems to work but when there is a break through i dont think it matters what you take , they come anyways. i just go cardio dr ask for a 30 day event montor go home pysh button send in each time they say its ok after week of it i know its all the same pac , i get used to them boom they go away . i dont get mine with stress, never have they just come out the blue for no reason,i have a great life i dont have to work ,my husband is awesome i have great kids life is good , but i still get pac. so why who knows, i get them once a year for about 6-9 weeks than they go away . so yes they are very scarey but they have not killed me yet and ive had them 23 years . so i just try and relax and go with them. hope all has a great night .
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