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Managing and Living With PACs and PVCs
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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thatoneguy01, I have an ICD/Pacemaker and my device is remotely monitored every 3 months. It allows my EP (who reads the report) to have the number of PVCs and PACs.
I see you mentioned the PVCs in a row. I had about 20 of them over a 3 month period that were 3 in a row. These like you I feel more as it feels like a fast flutter. It is those that bother me the most like you. However after being on a new medication it feels like the PVCs are stronger feeling that before. I have hundreds of thousands of PVCs over a 3 month period.
Regarding PACs I have several episodes of AFIB but they are listed as non sustained meaning they last only a few seconds and reset back to normal. I think I feel this but does not last long enough to really bother me.
Basically I am a mess but have been dealing with this for decades. One thing I read over and over is the stress of the PVCs and PACs. My cardiologist, heart failure doctor, and EP all concur that the stress caused by the PVCs and PACs can lead to more PVCs and PACs thus the stress needs to be treated as well. I do take a low dose anxiety medication and I think it really helps.
I am an avid exerciser and that helps also. I think exercise and the endorphons produced allow you do deal better with the stress the PVCs and PACs. I pushed my EP do to another Ablation but he told me that it would NOT stop PVCs as they are normal and will continue but not as many.
I have a pacemaker so the PVCs interrupt the pacing of my heart. They want my heart paces at 98% and with the PVCs I get only 92%. But it has no impact yet on my exercise abilities so they are reluctant to do ablation. I am on Mexiletine which is suppose to help reduce the PVCs. Don't think that is happening but unless my pacing % goes down will not up the dosage. What bothers me more than the amount of PVCs is that some of them seem to be stronger and I feel them more.
I was not given any recommendation by EP for metropolol (have seen the name though a lot) just to try Mexiletine low dose and if needed can up the dosage.
My EP (Mayo Jacksonville) recommends the Mexiletine as it a short lived medicine in your body and does not have the similar toxic affects of some other heart rhythm drugs. I have to take it every 8 hours though because of it not staying in body nor building up like other medications.
Good luck!
@jc76 does your cardiologist prescribe the low dose anti-anxiety medication? Most won't. I find Klonopin to be really helpful in averting the worst of my arrythmias and my neuro prescribes it for other issues.
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2 Reactionswindyshores, I see a psychiatric medication specialist at Mayo Clinic. She recommended the Escitalophram to help with my anxiety.
However she told me before she could she needed to confirm with my medical doctors their approval. She then got back to me and said that my electrophysiolgist (EP) and heart failure doctor said they concurred and approved the prescribing of the medication.
My EP about a month ago put me on Mexiletine (low dose) to help reduce PVCs. Before EP did this they coordinated with my heart failure doctor and again heart failure approved the medication.
I think I mentioned is a post about a team approach by mental health and physical health specialist and this was what I was talking about. I can get any better care that I get from Mayo Clinic.
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1 ReactionFast or irregular heartbeat is a listed side effect for escitalopram (Lexapro). I have some on the shelf that I never took because I saw that on the list of side effects. I am not aware of being anxious but a trigger for me is movement of my diaphragm upwards (from lifting or reaching) and the Klonopin helps it relax back down. Hot shower helps as does Reiki. I was considering Lexapro for post-COVID inertia but if it helps your heart, I will look into it!
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3 ReactionsI am on flecainide and the side effects are worse than the afib. In, fact l think flecainide causes more arrhythmia.
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2 ReactionsDoes anyone get a pounding g heart? Last for 5 to 8 sec. What medication do you take for it?
Have any of you tried Dofetilide? It works for some for rhythm control.
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1 Reactionwindyshores, what my medication specialist said was a concern before prescibing was there was some delay in a electrical signal that could come from the medication. That is why the EP and heart failure had to be contacted and approve it.
I have been told by my EP (Dr. Kusumoto Director of Pace Clinic at Mayo Jacksonville) that indeed stress can trigger AFIB and also cause more PVCs/PACs. He also warned me about weight as can also be a trigger.
I guess you and your doctors have to weigh what is best for you versus side affects. I think though that what side affects are listed it is "IT CAN" cause this in some individuals but some may not be affected. So it did help me and had no increase. However I have a ICD/Pacemaker and my heart is paced at 70 BPM. So like always everyone is different and what is good for one may not be good for another.
Being anxious is stress and a known cause of PVCs/PACs and being able to reduce it can be a benefit to those affected by it and gain some are affected more than others.
I had not heard about diaphragm. I do know I do not like raising my hands above my head as don't like the feeling and also seems to aggravate my pacemaker making it move.
Good luck and I wish you well.
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1 ReactionWhat is the diaphragm you mentioned?
713, what windyshores posted to a post of mine. Below is a copy of that post.
windyshores | @windyshores | 3 days ago
Fast or irregular heartbeat is a listed side effect for escitalopram (Lexapro). I have some on the shelf that I never took because I saw that on the list of side effects. I am not aware of being anxious but a trigger for me is movement of my diaphragm upwards (from lifting or reaching) and the Klonopin helps it relax back down. Hot shower helps as does Reiki. I was considering Lexapro for post-COVID inertia but if it helps your heart, I will look into it!
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