Suggest Treatment For Premature Ventricular Contractions

Posted on Thu, 6 Nov 2014

Question: I am a 30 year old female. Last year in October I had a random run of PVCs that landed me in the ER. They just hooked me up to some machines and observed me for about 4 hours and they dissipated until they were gone. I followed up with a cardiologist because this was so weird and random. I had an EKG by him, stress test, echo and wore a 24 hour holter monitor. All results came back 100% normal healthy heart. i was fine and then now exactly a year later, I've been getting a random quick flutter year in my chest. Some days I have a lot and some barely any. It was causing me extreme anxiety so I saw the Dr again and wire the 24 hour monitor again. I wrote down every time I felt the flutter in a journal to return with the monitor. Just got my results back and he said 100% normal. There were no weird beats or anything even though I felt the flutters. So..what the heck is the flutter if its not ectopic beats or any heart rhythm issue??

Answered by Dr. Dr. Muhammad Sareer Khalil (1 hour later)

Brief Answer:
Explained

Detailed Answer:
Hello and Welcome

I appreciate your concern.

I have read your history carefully. You mentioned that EKG , stress test, echo and 24 hour holter monitor (twice ) yielded normal results.

The Flutter you are referring to in your case based on your history is an elevated heart rate i.e tachycardia. Normally a person isn't aware of one 's heart beat, unpleasant awareness of one' s heart beat is referred to as palpitations.

Atrial Flutter is an ECG diagnosis and is a serious condition requiring emergency management as it can lead to Atrial fibrillation , if it were present it would have shown up almost certainly on the ecg or the 24 hour holter.

You most likely do not have the Atrial Flutter. I would advise you to get your Thyroid function tests done to see for any abnormality.

I would also suggest starting low dose propranolol to assess for improvement in your symptoms. The Beta blockers like propranolol should only be initiated in consult with your doctor esp if you don't have any contraindications like asthma.

in case you have trouble sleeping due to these symptoms, You may also take 1 mg Lorazepam for two weeks at night after consulting your doctor and then taper it off slowly. Lorazepam is a benzodiazepine and acts as an anxiolytic

Let me know if you have any query

wishing you best of health

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (4 minutes later)

would tachycardia have shown up on my 24 hour holter monitor? I definitely felt the flutters while it was on but Dr said he didn't see anything abnormal happen. I will be meeting with him again at the end of the month and he had mentioned a thyroid test. I have such fear of my heart having problems. am I safe/healthy?

Answered by Dr. Dr. Muhammad Sareer Khalil (20 minutes later)

Brief Answer:
Explained

Detailed Answer:
Hello again,

Tachycardia is just an increased heart rate, if its more than 100 per minute at rest its termed tachycardia.

Yes tachycardia is easily detected on the ECG, the flutters you experienced were most likely palpitations, as they would have been detected if present.

Yes, the history which you narrated and based upon your test results , I can positively say that a cardiac abnormality in your case seems to be unlikely, though you should answer the following and let me know

Do you experience any episodes of

Chest pain
shortness of breath
fainting or dizziness
confusion

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (29 minutes later)

thank you for taking time to answer these questions! I do not have any of those alarming symptoms. just this weird occasional flutter or thump. He did say he'd be looking for a short burst of tachycardia on the holter results and since he said all was normal ..I'm guessing he didn't see it? Could it be totally unrelated to my heart or even a psychosomatic anxiety symptom like I think I feel something that I don't??

Answered by Dr. Dr. Muhammad Sareer Khalil (9 minutes later)

Brief Answer:
You are always welcome

Detailed Answer:
Hello again,

Yes , Psychosomatic association may very well be a possibility as well as anxiety and panic attacks. If the cardiac workup is normal , you may very well consult a psychiatrist to help you cope better and perform a XXXXXXX mental state exam to ascertain any anxiety or depression associated with your symptoms.

Let me know if you have any other query

I will be more than glad to answer.
thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (9 minutes later)

Dr, I took azithromycin in sept (had fluid and inflammation in ears) and was on duricef in august (had surgery). Do you think the antibiotics could have set off something with my hearts electricity? last year prior to my bigeminal PVC episode I had previously taken 2 different antibiotics one and two months before that episode as well. could I somehow be sensitive to certain ones? it was the only commonality my cardiologist and I could find.

Answered by Dr. Dr. Muhammad Sareer Khalil (13 minutes later)

Brief Answer:
Azithromycin causes prolonged QT interval

Detailed Answer:
Duricef has no pro arrhythmia side effects , it can cause an allergic reaction as do many antibiotics.

Azithromycin is also a safe drug but is associated with a prolonged QT interval is some post marketing reports.

The effect of Azithromycin may be particularly dangerous if one has a very low potassium and magnesium level.

Azithromycin is a macrolide, you may choose a beta lactam group antibiotic the next time you have an infection , if you are concerned about its effect on your heart's rhythm.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (19 minutes later)

OK so I guess I can't blame it on those I guess it was just coincidental. My last question is.. could it be related to some type of reflux or indigestion? it doesn't start in the morning until I eat or drink my coffee and it seems to be worse after I eat and when I'm hungry. I've heard people who have reflux say they sometimes feel like they are having heart palps when they are having acid indigestion.

Answered by Dr. Dr. Muhammad Sareer Khalil (9 minutes later)

Brief Answer:
Yes GERD can be an exacerbating cause

Detailed Answer:
Yes,

GERD or reflux can definitely exacerbate the symptoms, in fact a majority of the patients that we see in our clinics that come for workup of a cardiac cause end up ultimately having a GERD issue.

I would empirically recommend a two week course of a
course of A PPI like Esomeprazole and a prokinetic
like itopride to see for improvement, if
symptoms persist then 24 hour ph monitoring
or endoscopy can be considered.

hope this helps.
let me know if there are any more queries
would be more than glad to clear them

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (4 minutes later)

thank you so much!!

Answered by Dr. Dr. Muhammad Sareer Khalil (7 minutes later)

Brief Answer:
You are always welcome

Detailed Answer:
you are always welcome.

You may let me know about your follow up visit with your doctor and discuss your reports if you have any doubts about them.

I am at your service.

Wishing you the best of health

Dr Sareer Khalil

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar