Vito P

[PVC man]

I have had PVCs since about age 16. I am an age 42 year old male with no heart disease. In that time frame I have had periods of waxing and waning symptoms.  Stress test and echo always normal.  About 3-4 years ago symptoms became very annoying and I was treated with 25mg Atenolol.  This worked VERY WELL for me and I was EXTREMLEY grateful.   I have stress echo every year.  Last year I had some PVCs during the stress but my cardio. said they were NOT dangerous.

Recently, I have increased my excercise to about 4-5 times a week (running 2-3 miles at a slow pace.)  At the same time, I tried to SLOWLY wean myself off of Atenolol.  I did this by increasing the time between doses 1 extra hour PER WEEK.  So week 1 24 hours between; next week 25 etc.  

Well, I was doing VERY WELL with no symptoms (40 hours between doses) when, BAM I began to suffer lots of PVCs.  I have been back on my old schedule of dosage (25mgx 24 hours) but the symptoms have still been pretty bad.  My cardio said to give it another week-- if no better he suggested going up to 50mg daily.Things have improved a little but I still get bouts of a couple of hours straight of PVCs every 4th beat or so.

In your experience, do you think this was my' body's response to tapering/increased activity or both?  Is this common?  Have you seen this in patients trying to taper? Do you think that I will need to keep inceasing dosage?   That's just what I was trying to AVOID. I was fine on the 25mg and basically symptom free for about 3.5 years.

Thank you in advance for your response and God bless the clinic and the website!!

[PVC man]

Thank you for your response--it is VERY reassuring and I will try to hold out with 25mg.

[Michael J. McWilliams, M.D.]

Hello PVC man,

Thanks for the post.

In your experience, do you think this was my' body's response to tapering/increased activity or both?

I hate to always start answer with “to be honest,” but I will anyway….

To be honest, there is no way to know for sure.  PVCs can flare up for a number of reasons – stress, sleep deprivation, hormones, caffeine, tea, etc.  Is it possible that you are feeling them because you decreased your dose – yes.  The half life of atenolol with normal kidney function is 18 hours.  Assuming that your kidneys are normal (atenolol is cleared form your body entirely via your kidneys), after two half lives (2 x 18 = 36 or approximately 40) your serum concentration of atenolol would be about ¼ what it was before and you may start seeing a clinic effect from that.  That being said, PVCs have a mind of their own and sometimes start and stop with no warning and for no apparent reason.  


Is this common?

I haven’t heard a lot people describe it like this but I think it is common.  The one confounder is that you knew you were tapering your drug and may have been nervous about them coming back – kind of like negative placebo effect.


Have you seen this in patients trying to taper?

Yes – in fact, look at the first post from today (or ever for that matter since this a new forum), it is the same scenario but with a calcium channel blocker.

Do you think that I will need to keep increasing dosage?  

A lot of what doctors do is to buy time.  If I increase your dose of medication, I can say lets wait 4 weeks and see what happens.   I will bet in your case that if you restart 25 mg of atenolol, your PVCs will calm with or without an increased dose.  In clinic I would feel you out – if I thought that you needed the an increased dose for your peace of mind, I would increase it.  If you felt well on 25 mg before, I think it will work again.  Your PVCs will calm down again when you least expect it.  What I mean is that you can’t make them ago away and if you try to fight them, you anxiety level will increase and they may stick around a bit longer – but they will decrease again.

“Water is used as a representation of Tao because water always seeks the path of least resistance. It does not compete; it simply spiders out, finds the easiest path and follows it, yet there is nothing stronger. Water will carve through rocks, run around steel or anything which resists it. And it does so by simply rising or using gravity.”

I am not a Taoist, but I do believe that there are times when fighting makes things worse.  


Good luck and thanks for posting.