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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@713j

Did u try carvedilol?

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I was on Solatol for 5 years and it helped some ., it’s a drug that is used frequently .and can be effective. It wasn’t enough to help my AF but it works for a lot of people . I have learned with that everyone has a different story with AF and what works for them . So try it and see if it works for you . Best of luck .Tara.

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I’m 68 yo male. I started having PVCs about 2 years ago. Never treated. About a week ago, the PVCs got worse, was having runs of trigeminys aka every 3 beats. I’ve counted up to 20k per day. Resting heart rate is 60. Cardiologist recommended a series of tests. EKG sinus rhythm with occasional PVCs. Lipoprotein A elevated at 90 nmols/l. Stress test normal. Echocardiogram is still pending. I’ve stopped caffeine and the occasional red wine. Never been a smoker. One thing I noticed is my PVCs are suppressed by exercise. Even just by walking slowly. The PVCs don’t really cause any real discomfort. Just worried about the cardiomyopathy effect long term. Has anyone experienced this and how did you manage.

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Experiencing the same now. Had Cardiac Ablation on 09/05/23. Hasn’t helped much and left me very fatigued. Very painful procedure. Doctor has put me on Corlanor 7.5mg. Plus I take 25mg Metropolol. My only concern with new med is my resting heart rate is in 50s. Hoping this doesn’t lower my heart rate more. I am 72 and have CHF since 2018. However my Heart fraction rate is still 50-55. Anybody familiar with Corlanor?

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When you say it hasn't helped much, what does that really mean? Are you experiencing PACs or more AF? The blanking period is over, so if you still have ectopy, you are deemed to have a failed ablation. Note that approximately 35% of all first, or index, ablations fail. The patient is almost always invited back for a touchup ablation by truly skilled and interested electrophysiologists.
Corlanor is prescribed to make the heart beat less forcefully and it slows the heart, just like metoprolol. Like metoprolol, is makes one's heart beat slower. You have CHF, so this is what has been prescribed. If your heart rate and/or blood pressure fall into a low zone, you might need to halve the metoprolol, or maybe forego the Corlanor, but that is something you MUST consult your caregiver about. I would urge you to do it soon so that you don't have syncope and a fall.

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@megansims

I have had PACs for years as well and finally flipped into Atrial Tachycardia (SVT) and had an ablation. Unfortunately, they returned a year and a half later and my burden was 18-26% depending in the day. They tried another ablation but was unsuccessful, so I also began the med path. Everything so far has caused side effects. Have you tried Propranolol? That was okay for me but it doesn't work for me any more. Flecainide was horrible. I am about to try Norpace. I did finally meet with a Naturopath and she had me take Magnesium, and Heart Health. She checked my cortisol. Nothing really helped significantly. There is some evidence that Arginine and Taurine can help, but I had no luck with that either. If you haven't, ask about Propranolol (it also helps with anxiety) and if not better, see if they would consider an EP study/ablation for quality of life.

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Good morning,
I have just had a Zio patch with SVT. It was not recommended that I begin medication and ablation was not felt to be an option right now. Did you find out the cause of this? I presume you had an ECHO. I have a normal ECHO but exercise intolerance and wonder if there is anything more to this. The cardiologist and EP both seemed unimpressed. I did push for a low dose B-blocker which seems to help.

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@alspvcs9

I’m 68 yo male. I started having PVCs about 2 years ago. Never treated. About a week ago, the PVCs got worse, was having runs of trigeminys aka every 3 beats. I’ve counted up to 20k per day. Resting heart rate is 60. Cardiologist recommended a series of tests. EKG sinus rhythm with occasional PVCs. Lipoprotein A elevated at 90 nmols/l. Stress test normal. Echocardiogram is still pending. I’ve stopped caffeine and the occasional red wine. Never been a smoker. One thing I noticed is my PVCs are suppressed by exercise. Even just by walking slowly. The PVCs don’t really cause any real discomfort. Just worried about the cardiomyopathy effect long term. Has anyone experienced this and how did you manage.

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alspvcs9, I have cardiomyopathy also. Tons of PVCs. I had one ablation on right side of heart which fixed the PVCs from that side. The ones on left side got worse and worse. I have LBBB which was the start of my PVC problems.

Had a ICD/Pacemaker put in 2006 at Mayo. On my 3rd one now. I also have a reduction of PVCs during exercise. I think one thing is we are doing something that relaxes us and also our minds. Plus I think the heart responds differently when exercising.

I feel mine with a resting pulse rate. It is why my EP raised my normal resting pulse rate from 54 to 70 using the pace option on my ICD/Pacemaker. It did lower the PVCs but still tens of thousands of them over a 3 month period (Pacemaker monitor results).

Had the holter monitor and found 3 areas in LV causing the PVCs. I am 76 with Heart Failure (cardiomyopathy) so EP wanted me to try magnesium but was already taking. EP then decided to try a heart rhythm drug called Mexiletine. I am on the lowest dose to start. We will monitor the PVCs and raise the dose if needed.

Mexiletine is a drug that leaves the body quickly so you have to take 3 times a day every 8 hours. It is not like the other rhythm drugs that are toxic and stay in body for long periods of time even after you stop.

The issue with PVCs is they cause stress. And have been told stress will cause more PVCs. So when we worry about them will make them worse. Dealing with them psychologically is important also and there are many ways to help lesson the stress. I take a anxiety medication which has helped.

My PVCs don't bother me unless I have a couple in row. That is when I really feel it and thus try to do deep breathing exercises, and try to relax not stress out.
Good luck!

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I also have PVC's and PAC's. My cardiologist says everyone, even he, has them but that I am very aware of all of mine. I have had the stress test, echocardiogram, heart cath and everything is OK. I was told I had a healthy heart with a strong heartbeat and no blockage. He also said that unless you are having other symptoms like...shortness of breath, sweating, passing out, severe chest pain etc, that it wasn't life threatening. He explained that one involves the upper chamber of the heart filling too fast with blood and the other involves the lower chamber. I have found that when I feel these palpitations or stops as I call them, I can either cough very hard or bear down as if having a baby or bowel movement and it returns things to normal. I take metoprolol beta blocker. I did take atenolol but that made them worse. I also have a stethoscope and I listen to them. Sometimes they come every 2-3 minutes and sometimes I have 2 or 3 very close together. I asked an EMT once when I should be worried and he said when I have 10 about every 5 seconds. I also wore a monitor for a month, where you press the thing when you feel them and you can also send an EKG during an episode and it showed that they were occurring about at about 2% even though I had episodes about every 3-4 days. I know one day I must have pressed record at least 50 times. So....unless I'm having other symptoms, I'm not going to worry too much. We are just a couple of the few people that are able to feel the palpitations. Most people don't notice them.

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@carol1024

I also have PVC's and PAC's. My cardiologist says everyone, even he, has them but that I am very aware of all of mine. I have had the stress test, echocardiogram, heart cath and everything is OK. I was told I had a healthy heart with a strong heartbeat and no blockage. He also said that unless you are having other symptoms like...shortness of breath, sweating, passing out, severe chest pain etc, that it wasn't life threatening. He explained that one involves the upper chamber of the heart filling too fast with blood and the other involves the lower chamber. I have found that when I feel these palpitations or stops as I call them, I can either cough very hard or bear down as if having a baby or bowel movement and it returns things to normal. I take metoprolol beta blocker. I did take atenolol but that made them worse. I also have a stethoscope and I listen to them. Sometimes they come every 2-3 minutes and sometimes I have 2 or 3 very close together. I asked an EMT once when I should be worried and he said when I have 10 about every 5 seconds. I also wore a monitor for a month, where you press the thing when you feel them and you can also send an EKG during an episode and it showed that they were occurring about at about 2% even though I had episodes about every 3-4 days. I know one day I must have pressed record at least 50 times. So....unless I'm having other symptoms, I'm not going to worry too much. We are just a couple of the few people that are able to feel the palpitations. Most people don't notice them.

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carol1024, They are very stressful for some. If you have ever gone into LV Fib it can be a very traumatic event. I have a AICD/Pacemaker and been shocked several times back to regular rhythm. Medication and fine tuning my Pacemaker has helped.

I have no issues with them and know they are normal unless get several in a row. My EP says even if you have Ablation to get rid of the area causing them will still have them as a common occurrence.

I have read about the techniques you mentioned about stopping the PVCs, PACs and even one cardiologist mentioned them to me. I am trying to use them but every time I have ongoing ones by the time I start the technique they are gone.

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@carol1024

I also have PVC's and PAC's. My cardiologist says everyone, even he, has them but that I am very aware of all of mine. I have had the stress test, echocardiogram, heart cath and everything is OK. I was told I had a healthy heart with a strong heartbeat and no blockage. He also said that unless you are having other symptoms like...shortness of breath, sweating, passing out, severe chest pain etc, that it wasn't life threatening. He explained that one involves the upper chamber of the heart filling too fast with blood and the other involves the lower chamber. I have found that when I feel these palpitations or stops as I call them, I can either cough very hard or bear down as if having a baby or bowel movement and it returns things to normal. I take metoprolol beta blocker. I did take atenolol but that made them worse. I also have a stethoscope and I listen to them. Sometimes they come every 2-3 minutes and sometimes I have 2 or 3 very close together. I asked an EMT once when I should be worried and he said when I have 10 about every 5 seconds. I also wore a monitor for a month, where you press the thing when you feel them and you can also send an EKG during an episode and it showed that they were occurring about at about 2% even though I had episodes about every 3-4 days. I know one day I must have pressed record at least 50 times. So....unless I'm having other symptoms, I'm not going to worry too much. We are just a couple of the few people that are able to feel the palpitations. Most people don't notice them.

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This sounds exactly like me. Same numbers. Both pvcs and pacs. I also just recently did the event monitor. Crazy similarities. Cardiologist asked if I wanted a referral to an EP for "reassurance" as he put it. And that they did all the tests and he probably wouldn't do anymore tests but that he could maybe prescribe a medication since I tried metropolol and it didn't work at all. I do feel them most of the time so they suck and they just came out of nowhere. I just want to know why they're happening so I can make them less or feel them less.. they're stressful. I started getting concerned more about the ones that are close together since they could happen like 1 after another sometimes ..

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