What should I ask my cardiologist?

[Zoodaloo]

So a few months ago, I started getting clusters of PVCS here and there. It was bothersome, but I knew what they were because I’ve had a couple here and there since I was 18. I am now 40.  Then all of a sudden the frequency jumped to almost all day every day, with very little respite. Usually around 5 per minute. I saw a cardiologist, who precscribed diltiazem. I took 30mg 3x daily for a month and went back to the cardiologist, during that month, the PVC’s started coming every other beat in clusters of about 4 at a time, with multiple clusters a minute at times. I didn’t really notice any difference when taking the diltiazem. Now my cardiologist has me wearing a monitor for 30 days, and continue taking the diltiazem. I work a desk job, and have noticed that when I’m NOT having the PVC’s, the moment I get up to walk around doing my job and sit back down, they start up like crazy, with the clusters every other beat, multiple times a minute and it just feels terrible. It takes FOREVER (sometimes hours) to calm down enough that the clusters stop, and the PVC’s are only a couple a minute, but of course I can’t stay in my seat all day, so I’m suffering. They also start up really badly the same way when I lay down to go to bed at night. When I go back to get the verdict from my cardiologist, I plan to ask to get switched to a beta blocker to see if that helps any, since diltiazem is a wash. I also want to ask for an echo, even though I had a great one 2 years ago. Also, my left ankle is retaining fluid during the day, which worries me. I just feel awful overall.  Tired and like something crazy is going on. Any insight or recommendations on what to ask at my appointment?

[Zoodaloo]

So 6 days ago I broke down and went to the ER, I was just feeling so horrid I couldn’t take it anymore. They did a chest CT mostly to check for blood clots, and did a bunch of blood work for thyroid and d-dimer and BNP. Probably a couple other things. Everything came back normal, but they took me off the diltiazem and put me on metoprolol 25 mg. They also gave me some klonopin. The next 3 days were pure bliss. ALL THE PVCS JUST STOPPED.  I was taking the metoprolol and 1 mg klonopin at bedtime and I could SLEEP. And sleep WELL.  I was happy again. Then, they came back. Not as badly as before, but they are there. A good chunk of the day. I am not having the pressure feeling though, so that is good. And I am still sleeping, thanks to the klonopin, but I don’t know if my GP will give me a script for it. (Hospital only gave me enough for a week). I saw the cardiologist again today. She doesn’t want to do any further tests, and upped the metoprolol to 50 mg a day. She says to come back in 3 months. I surely hope increasing the dosage helps, or at least that I don’t get back to where I was before the hospital. I was sobbing daily, at my wits end. It’s only been 3 days since they came back after my short respite, and each day is a bit worse than the last, so I am worried.  I am feeling a bit like maybe I should switch cardiologists too. I mean, I feel she should at least order an echo since these PVCS are a new and debilitating phenomenon for me, and I’m having such terrible symptoms from them.

[Zoodaloo]

I’m SOOO miserable. PVCS are just getting worse and worse. They are all day everyday, all night every night. They keep me awake for hours. There is so much bigiminy, and now I am feeling loads of weird pressure sensation in my chest, neck, ears and head, especially around the bigeminy episodes. It’s giving me headaches.  Kind of like when you go up in elevation and your ears need to pop. It’s similar to that sensation, only all over chest, neck, ears and head, and more pronounced. Anyone else experience that?
This is driving me batty, and causing major depression.

[tom_h]

5 per minute works out to be 7,200 per day.  I hate to tell you this, but a typical cardiologist will tell you not to sweat it.  3X that, and then they'll begin to notice.  My cardiologist says 4 normal beats in a row is all he needs.

[Zoodaloo]

Well I find that very depressing to think that there is no help for something that affects one’s quality of life so much.  I can’t help but think there had to have been a trigger that caused these things to spike from a couple every couple of months to thousand every single day. I am still taking the diltiazem, and it MIGHT be helping to reduce the hard pounding sensation that occurs often with each PVC, but it doesn’t seem to do anything to lessen the frequency, and I still feel each one as at least a flutter or flop, and they make me light headed and uncomfortable. I intend to investage all possible causes that I am aware of. I have already quit all coffee, tea, soda and chocolate for the past couple months, which did nothing to help, but at the same time I know it is even worse when I partake in those things.  I will ask my cardiologist for an echo, blood work for electrolytes and for BNP, a chest X-ray, to change to a beta blocker, or add a beta blocker... does anyone have any other suggestions for things to try or ask to be checked or done?  I have my follow up appointment on August 30th. I was able to put the monitor back on after 3 days of cortison treatment on my blisters, and I was sent highly sensitive skin electrodes.

[klutzer25]

Zoodaloo,  I had the same issue with thousands of these PVCs a day. It does affect the quality of life. Doctors are not very sympathetic, especially if they have never experienced these irregular beats.  I read a study that said people benefited from Acebutolol.  I asked my cardiologist if I could try it and he said that it was an older drug but worth a try. I am on 400mg twice a day and it has been like a miracle. I might get an occasional PVC in a month, but most of the time I am not aware of any at all.  Previously I had like 10,000 or more a day.  It might be worth a try to ask for Acebutolol. God bless.

[Zoodaloo]

I did ask for Acebutolol. And she gave me Metoprolol instead :(
Maybe she will let me switch if this hasn’t helped by the time I go back in 3 months.

[Zoodaloo]

I’m so miserable. I overexerted myself yesterday at work, and the PVC’s have been nonstop and my heart seems really irritated now. No sign of letting up.  Also, I had to take the 30 day monitor off yesterday because the electrodes caused me to develope open blisters.  Also I have a tender and swollen lymph node in the left side of my neck, and one also in my right armpit. I feel a total mess right now.  Supposed to speak to the doctor on Monday about how to proceed with the monitor.