Increased PAC's

[cstevens]

I was diagnosed with PAC's about 3 years ago.  At the time I was having maybe 10 or 20 a day.  I had a event moniter for a month.  Just in the last few days my PAC's have increased like crazy.  I can have up to six in a one minute period or I can go hours without feeling any.  I'm driving myself crazy.  I had a nuclear stress test in July.  Everything was fine.  I got a letter from my cardiologist saying my heart was pumping very very well and there were no signs of CAD.  I think I suffer from extreme anxiety.  I'm constantly checking my pulse.  Just waiting for the next PAC.  Praying my heart isn't going to go into some strange rythem or stop beating all together.  My life is consumed by this problem.  It is affecting my marrige and my life with my kids.  I can't keep running to the ER everytime I have one of these epispodes.  My wife and my mother talked me out of going to the emergancy room again yesturday.  The PAC's did improve during the evening.  I have no problem when exercising.  Infact I feel better when I'm jogging.  I should add I'm already on a beta blocker (Ziac).  I just want to know I'm going to be ok.  PAC's are running and ruining my life!  I'm not sure where to go from here.  I guess to the doctor again.  I'm worried I've cried wolf so many times that everybody just blows me off.  Maybe this time they are missing something.  Maybe this time I really do have a problem.  Would something serious have showed up on the nuclear stress test and treadmill test?  And by seroius i mean a rythem problem.  Looking for advise.....so scared of these freakin things.

[yarrow]

The Ativan doesn't work by reducing the number of pvcs.  It is supposed to reduce your anxiety about them.  If it works, the reduction of anxiety will sometimes cause the pvcs to decrease.  However, Ativan is a short-acting drug, and you have to take rather frequently.  Personally, I find it makes me feel a little calmer when I have my 'fits,' but it's not the answer.

I do get some relief from propranolol, a simple beta blocker, which works for some people.

However, in the presence of a basically healthy heart, taking care of the anxiety is the real job.  When/if you are prescribed an SSRI, ask your doc about the one least likely to increase PVCs.  People are different and get different responses to this class of drug.  My shrink is a specialist in the chemistry of psych drugs, and he tried me on several.  For me Zoloft worked best, followed by Celexa.

In the meatime, check this out:  Quite a while ago, a doctor named Claire Weekes wrote a little self help book for people suffering from anxiety--among which crowd you are.  "Hope and Help for Your Nerves" is kind of sweetkt old fashioned, but she does address panic and heart worries, and her approach is very sensible and very reassuring.   One of the things she suggests is that rather than concentrating on how much you wish your symptoms would go away, you instead concentrate on them and try to make them even worse.  She says that with anxiety, you quickly learn that (a) there's pretty much nothing you can do that will make them worse, and (b) even at their very worst, they pass swiftly and you note that you don't die!

The book is out in .pdf form, and here's the link:

http://www.successdept.com/component/content/article/76-anxiety/689-Hope-and-Help-for-Your-Nerves.pdf

Good luck.  Post about how you're doing.

[cstevens]

Had my appointment yesturday afternoon.  They game me an EKG in the office and saw a couple of PVC's on the strip.  The doctor told me it didn't look like anything out of the ordinary.  He wanted to put me on another heart moniter but my wife talked him out of it being I've already had that plus many many EKG's and the Nuclear Stress Test in July that showed my heart to be completely normal with no problems.  He decided to put me on Ativan for 10 days just to see how I react to it.  If that works he will slowley take me of that and itroduce Zoloft or something like that.  I took an ativan as soon as I got them and it did nothing.  Still hundreds of PVC's last night.  I hope I didn't make a mistake not going on the Heart Moniter again.  I'm so worried they are missing something.  The docotor told me if I feel anything out of the ordinary to go to the ER.  Well what if I feel like I need to go to the ER ALL THE TIME?  I know I have to settle down and try and let the Ativan work.  I just want to know my heart is ok.  And I guess the Doctor said he thinks it is healthier than his so I'll roll with that for now.  I have to want to get better I know.  It's just so hard when I'm having these things constantly.  Just trying to vent........My famliy is sick of hearing it.  I just can't believe it's all in my mind.  I never thought I was this weak of a person.  If the PVC's would just quit already.

[yarrow]

CF, when I have serious bouts of ectopic beats--before I put myself back on my zoloft--yes, lightheadedness or faintness (and sometimes it feels VERY bad) is part of the picture.  Like you, I get the impression it must be a heart problem, and yet, like you, I have also had many heart exams, and my heart is basically OK.

Unlike you, I have had my problem with PVCs for about twenty years now, and nothing--nothing--has really changed in that long period of time.  

Now, here's the thing about anxiety:  It comes in at least two forms.  The acute type is called panic attacks.  They usually last ten minutes to a bit over a half hour, but they can return many times a day.

The other form is chronic anxiety--which is constant.  It's way less dramatic than panic, but it does go on all the time, and it can do this for years.

So, it boils down to this:  Generally speaking, doctors really are fairly smart people who study stuff way too difficult for most of us.  That's why so few of us become physicians--we know we could never get through medical school.  The docs who have checked you out have spent years studying and have a lot of experience with sick hearts.  They have no vested interest at all in sending you away if you are sick; after all, a patient admitted for treatment represents money.

So it seems to me that there's no rational middle position here:  either you have to figure their studies and experience amount to something, or you have to decide it's entirely quackery and there's no point in believing them at all.

You're young, and if you've googled heart disease and ectopic beats, you know the odds that you have cardiac problem--when you've been checked out thoroughly--are very, very small.

Having had tons of PVCs for years, I can tell you that a psychiatrist's treatment for anxiety not only made my mind easier but actually quieted down both my perception of my ectopic beats as well as their actual frequency (because the adrenalin of anxiety makes them worse).

Why not give that approach a shot?  Do you have anything to lose?

Take a look at this website and see if you see anything relevant to your own condition:

http://www.livingwithanxiety.com/anxiety-physical-symptoms.htm

[Detours211]

This question is really for all of you.  Do your PACs or associated problems cause lightheadedness?  I am very lightheaded with repeated tachycardia and my doctors have no idea what is going on with me.  My cardiologist told me my heart is normal right now but I have an appt with a second cardiologist to further go over the echo results b/c there are some things in there that were troubling to me.

Either way I've been living like this for 4 weeks now - can't work b/c of it.  light headed.  Short of Breath all the time.  I'm 29.  mild HTN, mild high cholesterol. Don't smoke.

cardiologist and internist want to blame anxiety but since i'm feeling like this ALL the time and the pain/lightheadedness/short of breath are not going away and are worse when i lay down, i think something else is going on.

Do you all really think this could be anxiety?  I'm convinced it's a heart problem, or the beginning of one.

Please share your comments with me!!

[CFS56]

I did the same thing you are doing.  I was in the ER 5 times in a 3 month period.  All my tests were ok but I couldn't believe that all the problems I was having were caused by anxiety.  But I got a very frank talking to by a nurse in the ER the 5th time I was in there and finally convinced myself that I was causing most of my problems by my constant worry and obscessing about my heart and what it did.  I still have to make myself not take my pulse....I did that constantly.  But it has gotten better.  You are doing the right thing.

[yarrow]

I do understand how beyond-uncomfortable this is, because I also am apt to 'get' cancer and other diseases at the drop of a weird symptom!  ;-)

But I really admire you for thinking of your wife and family as well.  That is very generous.

When you see the shrink, just be as honest as you have been here, and if medication is prescribed, go ahead and give it an honest month-long trial, being aware that you may have to try more than one to find what works best for you.

Things will get better.  Good good luck to you.  

[cstevens]

thanks for your comments.  I hope it's only axiety and nothing serious.  I'm going to the doctor today and my wife is coming with me.  I'm going to get checked out and get refered to a phyciatrist.  I guess that is what I need.  I can't believe these palpatations are normal but if they are I need to get help.  I can't live like this anymore.  Thanks again for your words of wisdom and experience.  I just want to live a good life.  I'm almost sure I have an anxiety issue because.  I go from one problem to another.  If i get a muscel twitch it's ALS.  If I get a bad headache it's a Brain Tumor.  A fever I have cancer.  If I have a bruise I worry about it going away Luekemia.  I could go on and on.  I'm a mess.  It's enough to do this to myself but my wife is feed up with all of it.  I have to get straight.  

[yarrow]

Every few years, I suddenly have bouts of close to 5000 unifocal PVCs per day, and they are always accompanied by panic attacks.  To tell the truth, I cannot be sure which is the chicken and which the egg here, but the end result is the same.  My panic and anxiety grow worse at the same time I become more and more aware of the ectopic beats, which in their turn become more frequent.

So, I fool around for a couple of months, trying to will myself out of this state, and then finally take the prescription I was given years ago for just this situation.  It's Zoloft, the SSRI my shrink and I have found to work the best for me.

Within a week, the panic begins to quiet down, and by three weeks--get this!--the sound of the pvcs, and my awareness of them, fades.  And as that happens--who could have guessed--the actual frequency of the ectopic beats diminishes to virtually nothing.  On the advice of my shrink, I stay on the Zoloft for a number of months.  He likens it to giving a hyperactive car alarm a chance to cool off and get re-set.

If you're like many of us, including me, the thought of needing psych meds is distasteful.  But I can assure you that there are situations with benign ectopic beats when this kind of medication is a blessing and it gives you your life back.

Since your heart has been repeated checked out, I think your suspicion that you are suffering from anxiety is justified.  The point now is to do something reasonable about it.  For anxiety, you don't need another heart doctor.  The logical place to go is to a nice shrink.  This is not to suggest just talk therapy, although that can help.  Psychiatrists, unlike counselors, can prescribe medication to get you into a calmer, rational state from which you can decide what longer-term approach to anxiety is best for you.