@davidew
First know that you are not alone with dealing with PVCs. I too have had them since 2001. They are very common and a lot can be done to help you with them.

First you mentioned seeing a PCP (primary care) and not a electrophysiologist (EP). Do you have access to a EP in your area? If you do I highly recommend seeing one to get their opinion on your treatments for PVCs.

Cleveland Clinic is outstanding and great place to go for cardiac conditions. Asked to see a EP. Cleveland Clinic can work with your local EP or cardiologist but you need a cardiologist or EP locally (per my history with this and what recommended to me).

I can tell you (my own experience) that taking heart medications can cause your pulse and blood pressure to drop. This is not abnormal and happened to me.

In my case I was being treated locally when my cardiologist suggested a ICD device because I had heart failure and low EF. I decided to go to Mayo Jacksonville for second opinion and first saw a EP. He agreed needed ICD but also wanted to do a pacemaker. Why? Because with my medications my pulse rate was very low, I was having PVCS due to LBBB and believed my heart could benefit from a pacemaker to keep my pulse rate higher and improve electrical signal to heart.

My EP also had me see heart failure specialist while I was there who changed my medications. I have been seeing both specialist now for 20 years. I had a ICD/Pacemaker put in in 2006.

Please if possible see a EP and give full information on your low pulse rate and BP. My pulse rate got down into 30s with medications. That low pulse rates add to possible more PVCs.

Now your PVCs. I have then and take medications for them. They are quite common in todays world. One thing that adds to them is stress and anxiety. You can see the way you are feeling is most likely going to cause more PVCs. There are medications for helping with this anxiety.

But you can also do things lifestyle like I did. Do you have and exercise (check with your doctors if okay) and enjoy that exercise which will help you both mentally and physically. Not into exercise? How about hobbies. Anything that brings joy to you is going to help you mentally and physically. They will also help reduce your stress and anxiety which can go a long way to reducing PVCs. How are you sleeping? How is your weight?

Talk to your doctors and if at all possible see a EP. Talk to your doctors about magnesium (my EP recommended I take it for PVCs). It has been shown to help with PVCs. But with any supplements check with your doctors as they are the medical professionals and have your complete medical and mental health information.

I know long post. But right now if I checked my pulse most likely would have a PVC every 10 beats. But my pulse rate will be 70 bpm because that is what my pacemaker is set at. That also helps keep my BP up which can get quite low.

If my weight goes down my BP (caused by medications) can be 90/60. Causes some dizziness when I stand. But have learned to deal with it. My HF doctor says if stays low like that he changes the time of day I take each of my medications.

Please try to see a EP locally. They are experts in electrical functions of your heart. When trying to get Cleveland Clinic referral ask to see a EP.

A technique I learned from yoga and a pulmonary breathing expert at Mayo was deep breathing. Try not to hyperventilate like you say you do. Breath as deeply in (from your stomach outward and sideways) through your nose and slowly breathe out with purse lips from your mouth. It will help you relax. Close your eyes think of something relaxing and do those deep breathing. I do them all the time when I get stressed.

For me my exercise and hobbies really help reduce my anxiety and stress over PVCs. I feel my PVCs act up and I will instantly tense up. But then will do my deep breathing to help. I will then try to get to my or do my exercise classes and hobbies.

Medication can also help you greatly along with lifestyle changes.

@davidew my first suggestion would be to reduce that beta blocker dose. I was prescribed beta blocker mainly to treat the arrhythmia and also to help on high blood pressure, but even my first 25mg was way too high a dose IMHO, and I worked with the doctor who said I could cut it in half. It is likely enough (again IMHO) that whatever it's going to do about arrhythmia, it may well do on a very small dose. And I suppose different people react differently to standard doses.

Once you're on a high dose it may be difficult to cut down, check with your doctor and plan to do it over some period of time, gradually.

The tendency of many/most doctors may be to overdose on this stuff, I was lucky to get a doctor who started with a low dose - and even that was too much for me!

I guess I'll repeat one other thing, I know with these problems it's hard to think about exercise, but are you doing any? Just a walk for a mile or so is enough time for other circuits in your system to adjust your heart rhythms, and I've often found it immediately helpful at the moment and perhaps for the rest of the day. But when things are at their worst this may not be advisable or even possible! Have to balance all these factors.

Hope that helps.