PVC, betablocker and Holter

Posted by pbr @pbr, May 5, 2021

I had a heart attack back in 2019 resulting in some myocardium necrosis and 2 stents. Early this year (2021) some PVC were detected on an ECG and confirmed with a 24h Holter (8% vent., 3% atr.). I was originally prescribed Metroprolol (Apo) twice a day after my heart attack, at 50mg first, but rapidly reduced to 37mg by my GP after I complained getting out of breath too easily.
Now, my cardiologist wants to push Metropolol back to 50mg in an attempt to curb the PVC frequency (which are however considered benign if I am not wrong). So I asked her if she planed to have an Holter done few days after this new regimen to see whether this mod had any beneficial effect on the PVC occurrences. She answered no, arguing that monitoring my shortness of breath threshold would be plenty enough.

I have two questions:

1. Should not PVC-positive 24h Holter results be systematically confirmed my a multi-day assessment, since I read that PVC frequency can have a high day-to-day variability?

2. Since her logic of not having me take another Holter once the beta-blocker has been increased completely eludes me, could somebody knowledgeable in this field please enlighten me about what could be her rational for not monitoring the effect of her increasing the beta-blocker on the intended target (the PVC frequency)?

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

Dana, Volunteer Mentor | @danab | May 5, 2021

@pbr Hi and just to let you know we are not medical personnel but are patients and caregivers that share our own experiences to be a help to others. So I can't aswer the why on testing except it may have to do with insurance and some of these tests are restricted to a time period but I would think your Doctor would have said that. Now as to the increase in PVC's back when I had a pacemaker the readings would show those but I was told they were not a concern since they were not lasting very long. I don't know what normal to abnormal threshold is but mine usually would only last a fee.minutes at a time.and felt a bit weird but I was always more concerned with my main issue which was VT. So I would probably ask why She did not want.to repeat the test. You probably can even look at your insurance documentation to see if there is a limit on how many are allowed per year. I personally I was never treated for PVC's so im. not familiar with the med you mentioned either. I was already on anti-arrhythmia meds and my doctor said the PVCs were not bad enough.
I know I wasn't much help but maybe gave you a bit of confidence to not worry either.
Blessings
Dana

pbr | @pbr | May 5, 2021

In reply to @danab "@pbr Hi and just to let you know we are not medical personnel but are patients..." + (show)

Thanks Dana for you comment. Yes, I know I can't expect cardiologists to readily answer my question here. It was just a way (maybe a clumsy way) for me to discourage speculative and random comments from contributors who have absolutely no clue what I was referring to. Of course, I welcome shared experiences.
Anyway, I think I am going to just ask her again, as you suggest. Hope it's not only a pretend measure to make me think she's "doing" something.

Amanda Burnett | @amandaa | May 7, 2021

Hi @pbr, Thanks for sharing with us. I included a few discussions that are discussing the same thing.

What causes an episode of premature ventricular contractions (PVCs)? - https://connect.mayoclinic.org/discussion/pvcs-3/
Premature ventricular contractions (PVCs) - https://connect.mayoclinic.org/discussion/pvcs-2/

I am currently on Metoprolol 50 mg, however, I did a 24 hour holter monitor prior to my doctor upping the dosage.

Have you considered a second opinion?

lumina | @lumina | May 9, 2021

Hi @pbr
Thank you for sharing your symptoms.
My father is also having the same symptoms. A month after a myocardial ischemia and 2 stents, he is experiencing frequent PVCs. Although he has been prescribed bisoprolol the PVCs have become even more frequent.
He used to have the PVCs before the surgery for about a year or so, as a result of coronary arteries disease, I guess. but the matter is they never were this frequent before.
Can anyone please help with the question that why the prescribed medication might not be working?

Amanda Roe | @amandajro | May 9, 2021

In reply to @lumina "Hi @pbr Thank you for sharing your symptoms. My father is also having the same symptoms...." + (show)

Hello @lumina and welcome to Mayo Clinic Connect. I am so happy to read that you have found the information shared by @pbr to be helpful.

As for your question on why a prescribed medication might not be working, I may suggest the information found under the "Treatment" section of this web page. Radiofrequency catheter ablation is mentioned for PVCs that don't respond to lifestyle changes or medications.

- Premature Ventricular Contractions: Diagnosis & Treatment:
https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/diagnosis-treatment/drc-20376762
Does your dad plan to be seen again by his Cardiologist to explore why his current treatment plan might not be working any longer?

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