PVC Episode; 20k+ / day; what should i do next?

[jammy21]

Over the last few months i have been in a horrible PVC spell, that seemed to have been triggered by a stressful time in life which has since past; the PVC's however have not.

I do get breaks here and there but the vast majority of days i am experiencing PVC's in the 10k+ range (20k+ on bad days) and i feel every one. I have had pvcs since my teenage years but nothing even close to this in a day (<1000 / day)

An ER visit officially diagnosed them as Pvcs which led to several other tests at the cardiologist. I thankfully have been shown to have a normal functioning heart. The holter monitor given by my cardiologist happened to fall on a rather unevenful day of 'only' 500 pvcs and to my surprise 700 Pacs. He was very quick to tell me to not worry, and say that they were 'normal'. He didn't seem to take me serious/ or be worried when i told him i usually get 10k or even 20k; almost like he didn't believe me. i think he only using the data he had which said '1000 ectopics'.

Do you think he would be treating the situation much different if my holter showed 20k ectopics? Has anyone else been in a similar episode as mine, and gotten out? i need advice on what to do to achieve relief from these; they are really effecting my quality of life.

Cheers

[EatFruit]

Hello,

I have PVC's as well but nowhere nearly as many as you. I consulted my cardiologist who said that when you get to around 20k PVC's, which is about 20% of all your beats being abnormal you most likely need some kind of intervention. I would suggest getting a 30 day Holter monitor and a second opinion.

[Occupant]

I can only tell you that my Holter monitor showed 38,000 per day and my cardiologist pretty much said the same thing as yours - so no, it would not have been any different in your case if you would have had 20k..

[researcher09]

38,000 PVCs per day means you are on your path to heart failure and transplant in the future unless your life expectancy is low.  You cardiologist is not doing you any favors.

[Occupant]

I just want to clear something up: With Metoprolol ER 50 mg they are in the ~18 to 20,000/day range and my heart rate does not go over 70 BPM unless I exert myself.

[researcher09]

Here is a chart showing the relationship of the risk of developing congestive heart failure and PVC burden in terms of percentage of total heart beats.  Our heart beats around 100,000 per day.  The study was sponsored by AHA and conducted over several years by UCSF. http://www.onlinejacc.org/content/66/2/101

[Occupant]

I looked at that study and one of the graphs. My present ratio of approx. 25% ectopic heart beats isn't even on the graph, but if we go by what's there, the risk of CHF after 5 years goes up to 38%. However at ~5% ectopic heart beats it's still at ~34%. Is my interpretation correct that my risk, therefore, is only 4% higher that with people with 5%?

[researcher09]

Referencing figure 2, baseline is 16.2% risk at 15 years for zero PVC but specificity is low meaning other factors such as BMI, age and CAD can be the cause.  Specificity goes up past 90% once someone exceeds 1000 pvc/day and goes up to 30%.  Risks plateaus around 36% probably the other factors BMI, age, CAD takes up limiting values.  The plateau starts around 6% or around 6000 pvc/day.   So now you have a better understanding that the old rule of thumb of don't worry about anything under 20,0000  pvc is OK is not really.  It is just that doctors didn't really have good tools in their tool boxes.  Life style modification to lower potential risk factors and stress reduction are important first steps.  

[researcher09]

The curve stops at 100% specificity or 17.7% as there is no further insight to gain above that point.

[Occupant]

In my case I don't believe life style changes are the whole story. I am saying this because I blame all of my extra heart beats on excess Adrenaline that my glands produce. I know that because years ago I found out that I can't take Novocain shots at the dentist without going into shock. I start shaking like a leave, I almost fell of the chair in the dentists office and he said: "From now on we are going to give you Novocain without the added Epinephrine" and he did. But that doesn't solve the problem with the added heart beats.