Hello! Welcome and thank you for asking on HCM! I understand you concern, and would explain that your symptoms may be related to a cardiac arrhythmia. Anxiety and some metabolic disorders (like thyroid dysfunction, adrenal gland dysfunction, chronic anemia,etc.) could also mimic this clinical scenario. It is normal to have some PACs and PVCs during the day. But what is their frequency in your case? I would like to know more about your past medical history. Do you suffer from high blood pressure or diabetes? What tests have you performed to examine your cardiac function? As far as I understand a resting ECG and a cardiac ultrasound have been performed ( you mention PVCs, PACs and a structurally normal heart) You should consult with your GP for a careful physical exam, a chest x ray and some blood tests (besides resting ECG and cardiac ultrasound) : - complete blood count (for chronic anemia) - PCR, sedimentation rate (for chronic inflammation) - fasting glucose - thyroid hormone levels - cortisol plasma levels (adrenal gland function) - blood electrolytes, etc. An ambulatory 24-48 hours ECG monitoring is necessary to rule in/out a possible cardiac arrhythmia (if you have not performed it). If all the above tests result normal, the main cause of your symptomatology would be just anxiety. In such case, you should consult with a specialist of the field to help you manage your anxiety. Psychotherapy, Yoga, meditation and physical activity are helpful. You should avoid caffeine intake. Hope to have been helpful! Feel free to ask any other questions, whenever you need! Best regards, Dr. Iliri