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episodic PAC's/PVC's

I get episodic PAC's/PVC's usually starting about 11:00 am and they can last for minutes to up to five hours. Never during the corresponding evening hours.  There are many many days-weeks when I get none to a few brief episodes and there are other days when they are more numerous, stronger and last longer.  ECG, echo, CTA scan all normal..no evidence of coronary heart disease. Only symptoms are can of worms feeling in heart during an episode.
I take 75mg Toprolol-XL 2x/day, Norvasc 5mg am, benazepril 20 mg 2x/day, lipitor 10 mg am, metformin 1000 mg 2x/day. I seem to get more palpitations if I increase the dose of beta blocker. Both PCP and cardiologist have said they are benign, not to worry and that many people live with them. Easier said than done!
My question is - Does any one have idea what would trigger episodic PAC's/PVC's?  Doesn't make any difference if I am sitting reading or out walking, onset is out-of-the-blue.  There is no rhyme or reason I can think of.  Any ideas out there??  Thanks for any and consideration.  
4 Responses
1124887 tn?1313758491
First question: How low is your heart rate when the palpitations occur?

I'm now referring to my personal experience with premature beats. I don't think Toprol helps me at all (metoprolol). Remember, with a slower heart rate, premature beats can occur easier (the lower frequency of sinus beats increase the possibility that they occur). I use a nonselective beta blocker when they are at the worst, which also reduces adrenaline levels in the body, that works better for me.

That said, you should definitely not change medications unless your doctor tells you to do it.

By the way, did you monitor one of the "bag of worms" events with EKG? Remember that in some hearts, PACs may actually trigger short runs of atrial fibrillation and they are hard to differ just by the sensation. They both causes a lot of irregular heart beats but atrial fibrillation is usually more rapid unless it's controlled by meds.

If you can pinpoint exactly what's causing PACs/PVCs in each setting you will probably win the Nobel Price in medicine. My closest approach (which actually some doctors agree with) is that they probably occur most often if you for some reason is stressed, though your heart rate is fairly low (high adrenaline, though vagal activity keeps your heart rate slowed). Other heart cells are stimulated and may easily fire off premature beats.

In addition, PACs and PVCs often triggered by different conditions. PACs are often easier to explain, often purely caused by adrenaline and the effect mentioned above. PVCs are more complex and more often they have a reason other than only adrenaline.

There are no "cure" for PACs and PVCs except accepting them as normal phenomena. To cure them, you need some medication that stabilizes the heart cells without slowing the sinus node (beta blockers do both. Ivabradine is a drug that only slows the sinus node, so that's twice as bad). They exist to a certain degree, but ventricular tachycardia is a side effect and you certainly don't want that.

By the way, is your blood pressure properly controlled?

My only advice if this is really troublesome is: See your PCP and get a new explaination from him, as he's a medical professional. Just by some reassurance you can get a lot better.
Avatar universal
I've been thinking along the same lines as you.

Heart rate remains between 80-90 beats during episodes of palpitations, rarely over 90 bpm.  While I agree slower rates encourage PVC's I really don't think that's the cause.  I did an event Holter monitor and captured several episodes that allowed the cardiologist to diagnose benign PAC's/PVC's.  My BP is reasonably controlled -  between 120/70 and 140/90.  I do suspect vagal nerve irritation as a possible cause but since the onset of episodes is so variable it is hard to pinpoint cause.  My PCP and I have discussed slight alterations in beta blocker dosage and we agree if I can find the dosage that works for me then do it.  Both my PCP and Cardiologist are unable to explain the episodic nature of my palpitations.  Both have reassured me that they are benign and with no evidence of any coronary heart disease they pose no problem.  While reassuring it is not comforting during an episode.  Appreciate your input and will remember you when I win the Nobel. :)
1616038 tn?1315957703
I just read your post. Sounds like we have the identical symptoms/issues. As per my post earlier today, I have been experiencing episodes of pvc's lasting for hours at a time...they come out of nowhere, any time of day...it is brutal when it happens, and despite all my recent tests (all clear), I can't ignore it and accept that it is benign and normal. Sometimes  I will go weeks between episodes. My recent trip to the ER was somewhat productive because the pvc's were actually captured on the first EKG...I figured I finally had proof that something was truly wrong!! The irony is that the doctors were not phased by the pvc's at all, and all the tests that have followed have validated their perspective....I have been given Metroprolol 50mg tablets, to be taken when symptoms appear. I tried once, and the pvc's still persisted for a few hours, so I am skeptical about the effectiveness of this particular beta blocker. I have been advised to cut out caffeine, perhaps you should do the same. I have also read quite a bit about the use of magnesium to curtail palpitations. Currently I am trying a daily magnesium/calcium supplement. I know stress is considered a huge trigger for pvc's, but I have had episodes when I wasn't in a stressed frame of mind. Regardless, the subconscious can be carrying baggage that may trigger the pvc's when you least expect it. During an episode, it is impossible to feel confident that all is well, and you will be ok..I sympathize with you on this one...it is awful. Try the caffeine reduction, drink lots of water (dehydration is a trigger), add some magnesium to your diet, and see if that helps. I wish I had the cure, because despite all the reassurance from doctors, I still find it hard to manage when I get hit with an episode. The good news is, you are not alone, and the more you talk about it with other sufferers, the more you realize it is far more common, and all indications are that they are totally harmless. Hope this helps a little. Good luck.
Avatar universal
Missed your original post.  mirror image situations...no caffeine, chocolate or any known trigger in diet.  Yes, I do try to drink more water but then have to go more often.  Can't imaging anxiety is trigger.  I don't take magnesium and have considered taking some - everything about Mg is anecdotal, but worth a serious try.  I would like to transfer my strong episodes to my doctors and then ask them if they feel that they are "normal."  I know I am not alone but that is little reassurance during an episode.  Thanks for your comments.
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