Managing and Living With PACs and PVCs

Posted by rr1967 @rr1967, Aug 14, 2023

Hello all. I have posted in this forum before and I thank you for your advice. I appreciate more support please.

I am about to turn 56 and I have dealt with PACs and PVCs for the past 20 years. The come and go and now they seem to be getting worse. My cardio, regular doc, and electrophysiologist all say that I am fine and that I have too much stress and anxiety (which I do..I suffer from GAD and depression.) They all say that PACs are benign and that most PVCs are benign.

I had an exercise stress echo in 2019 (all normal). Several EKGs this year...all normal. Another Zio Patch Heart Monitor that I wore for a week. Normal sinus rhythm with PACs. My PAC/PVC burden hovers between 1.5 to 1.8 percent. I have had a recent chest xray and plenty of blood work. All normal. I am borderline type 2 diabetic and my cholesterol and triglycerides are all normal. I do take blood pressure meds and it is well controlled. I try to be active almost every day and I do practice CBT for my anxiety. My resting heart rate is about 55 and my cardio says that is normal.

What else can I do to reduce the PACs and PVCs or manage them? Some days they are fast and furious and some days they simply come and ago. But they are ruining my daily life and causing more depression and fear. They are awful in the morning, reduce a bit in the afternoon, and reduce a bit more in the evening.
My cardio again states that they are fine and to not worry.

I have tried a beta blocker (made my heart rate too low and I was too tired) and a pill called Diltiazem. Really had no effect and made me too tired. I don't qualify for any procedure and the one pill they are still offering me is Flecianide but that one has WAY too many side effects and I have had at least two cardiologists warn me from taking it.
What are you experiences, advice, etc?
Thank you!

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@janepaskvan

Thank you for the advice. Is the patch you're talking about, the one where you push a button when you feel something? I wore one for a few days, but it was difficult. Maybe I can get one again, but it seems like there's little to be done about them. I need to eat protein every meal. If I was to just eat sweets I would have palps immediately. I'm working on eating every 2 hrs like I need to. Hard to do when you're never hungry and have GERD!
I'm sorry about your child. It must have been hell.

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@janepaskvan kid is and was fine. Point was that testing blood sugar can become routine! Good luck with a dietary approach. It helps me too. Luckily I am drawn to protein. I have GERD and stop eating at 5!

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@janepaskvan

I know I'm hypo, but not enough to treat. I had been on Synthroid and it worked fine for a year or so. Then I started getting palpitations, so stopped. When I tried to go back on it I ended up in the ER with palps.
Then a couple years ago I tried it again, in small doses. After 6 weeks or so I developed double vision. Everyone kept saying that couldn't be the cause, cause that's a symptom of Hyper. Anyway, I stopped the meds and 3 weeks later my vision was back to normal. The human body is a strange machine.

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Dr. Rob Cywes, the 'Carb Addiction Doc' on YouTube has a channel with his name. About three weeks ago or so, he posted a video where he talks about the inappropriate treatment of thyroid problems. You might with to take a look.

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@cappcoach

I don’t know. He also doesn’t believe that postural ectopics are a thing. He thinks people just don’t know what their heart is doing until they lie down at night. My Primary said he’s 1000% sure postural ectopics are real and he thinks they are related to a vagal phenomenon. Specialists of all stripes get locked into what they learned in med school and many are just not aware, or interest in things like supplements. It’s rare to find an open minded doctor. So I do my own research. And my primary physician ROCKS.

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I'm having issues with my cardiologist, also. I'm having some scary beats that only come occasionally. The few days he let me have a monitor of course they didn't happen. Now is telling me I'm fine. But my primary is very into listening to me, and will do what I ask, within reason. He is here (Minnesota) on a visa from Canada, where evidently they treat patients better!

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@janepaskvan

I'm having issues with my cardiologist, also. I'm having some scary beats that only come occasionally. The few days he let me have a monitor of course they didn't happen. Now is telling me I'm fine. But my primary is very into listening to me, and will do what I ask, within reason. He is here (Minnesota) on a visa from Canada, where evidently they treat patients better!

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The scary beats are almost certainly PACs, or 'premature atrial complexes'. What they are is a missed beat, but the heart compensates with an extra beat in the next rhythm cycle, and the first of those two successive beats is a doozy because the heart has filled with blood in a way it doesn't during normal rhythm...so you get a strong 'hydraulic' boost that courses up your aorta and beyond.

PACs are benign, mostly, and cardiologists and electrophysiologists are loath to do anything about them. Instead, they WILL, or SHOULD, attempt to allay one's fears and to manage symptoms, which are the two worst things about PACs. However, when PACs come so often, which is usually the evolution of most/all cardiac arrhythmias, their total numbers present what is called a 'burden' that might be excessive. Further, PACs do have a negative impact on mortality; a burden higher than 3% for more than months or a couple of years is predictive of an earlier death than might otherwise be the case for the same patient with a healthy heart free of arrythmia. (I hope that makes sense). Note that there is a lot of variation between patients due to other factors such as the presence of other comorbidities, overall health and heart condition, age, and genetic factors, so don't go running off fearful that you're headed to an early grave. Our hearts are robust organs that can take some abuse, and they'll often return to their natural size and morphology after successful treatment.

I do urge you to consider seeing a more sympathetic and determined/open-minded cardiologist because you do need an accurate measure of your PAC burden (I'm assuming I'm correct, but really I'm not a health professional and am only guessing that what you are experiencing are PACs).

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@gloaming

The scary beats are almost certainly PACs, or 'premature atrial complexes'. What they are is a missed beat, but the heart compensates with an extra beat in the next rhythm cycle, and the first of those two successive beats is a doozy because the heart has filled with blood in a way it doesn't during normal rhythm...so you get a strong 'hydraulic' boost that courses up your aorta and beyond.

PACs are benign, mostly, and cardiologists and electrophysiologists are loath to do anything about them. Instead, they WILL, or SHOULD, attempt to allay one's fears and to manage symptoms, which are the two worst things about PACs. However, when PACs come so often, which is usually the evolution of most/all cardiac arrhythmias, their total numbers present what is called a 'burden' that might be excessive. Further, PACs do have a negative impact on mortality; a burden higher than 3% for more than months or a couple of years is predictive of an earlier death than might otherwise be the case for the same patient with a healthy heart free of arrythmia. (I hope that makes sense). Note that there is a lot of variation between patients due to other factors such as the presence of other comorbidities, overall health and heart condition, age, and genetic factors, so don't go running off fearful that you're headed to an early grave. Our hearts are robust organs that can take some abuse, and they'll often return to their natural size and morphology after successful treatment.

I do urge you to consider seeing a more sympathetic and determined/open-minded cardiologist because you do need an accurate measure of your PAC burden (I'm assuming I'm correct, but really I'm not a health professional and am only guessing that what you are experiencing are PACs).

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Thank you for your advice. Yes, I'm really needing a better doctor, but there seems to be such a shortage. Maybe it's just this area.
I am not sure what my burden is. It is why I want one for more than one day. I get no attempt to allay my fears, other than "you're fine". Nor do I get advice on managing them. I know I have PVCs and PACs. I also have had a heart attack and have three stents in my heart. I would think that would bear watching. I have found that eating every 2 hrs, mostly protein, helps with them. But never had that problem before. I really don't expect to live a whole lot longer, but the time I have left I would like to be worth living.

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@janepaskvan

Thank you for your advice. Yes, I'm really needing a better doctor, but there seems to be such a shortage. Maybe it's just this area.
I am not sure what my burden is. It is why I want one for more than one day. I get no attempt to allay my fears, other than "you're fine". Nor do I get advice on managing them. I know I have PVCs and PACs. I also have had a heart attack and have three stents in my heart. I would think that would bear watching. I have found that eating every 2 hrs, mostly protein, helps with them. But never had that problem before. I really don't expect to live a whole lot longer, but the time I have left I would like to be worth living.

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@janepaskvan around here they put me on a month long monitor (which I did for two weeks). Google "Zio" ECG monitor. It is a patch worn on the chest. Maybe ask if a longer monitor is available for you.

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@windyshores

@janepaskvan around here they put me on a month long monitor (which I did for two weeks). Google "Zio" ECG monitor. It is a patch worn on the chest. Maybe ask if a longer monitor is available for you.

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Thank you. Where is "around here?" maybe I need to go there!

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@janepaskvan

Thank you. Where is "around here?" maybe I need to go there!

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I posted info on the Zio ECG monitor on another thread. It is a patch on your chest and you press a button when you feel something going on in your heart. Can be seconds. You keep a log either on paper or in the app of what you were doing at the time. A detailed report is generated. I am in the Boston area. The Holter monitor is bulky but does the job, though the Zio is often worn longer.
https://www.irhythmtech.com/patients/why-zio

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@rr1967
Medications when you first go on them can cause physical and mental side affects. Some get some minor and some serous side effects. It like life will be different for each person.

When I first went on Entresto and Carvididol it made me very very tired and achy. I was not sure I could stay on it but my cardiologist asked me try to as the benefits of the medications were very good. He advised me it will take some time for you body to adjust to it so give it a chance to adjust.

So I stayed with it. A couple of weeks later it started to lesson and then more and more to the point it is no longer a side affect. I am not sure that will happen with you but if your doctors are saying the benefit is high just know (and this was what was told to me by cardiologist and PCP) that the body will slowy adapt to it.

I am seeing a heart failure doctor. My blood tests showed more inflammation and wanted me to go on a medication that could help. I was not told about side effects. I started taking and got pain in lower back, my breasts became sensitive to touch and my nipples hurt. I told my wife my nipples hurt. But I thought was from my shirts getting sweaty (exercising) and rubbing on them. I looke up the medication and it listed all the side effects and the serious ones you should advise your doctor of.

The serious ones where the ones I had and notified him. He said that is a sign of allergy to the medication and put me on something else and the side affects went away. So knowing the side affects are common and the side affects that should be reported is something you can to by looking up on medical wet sites.
Good Luck

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