Premature Ventricular Contractions: A Patient's Journey

Premature Ventricular Contractions (PVCs)

Dear Dr.
Lin,
My mother had a history of angina several years ago and underwent catheter ablation two years ago, after which she did not experience any further episodes.
However, six months ago, she fainted, and her heart rate was very slow at that time; the paramedics even mentioned that they could not detect a heartbeat.
After arriving at the hospital, she underwent a 24-hour Holter monitor test, and the doctor diagnosed her with premature ventricular contractions, indicating that she occasionally experiences missed heartbeats and has a generally low heart rate, often in the thirties.
The doctor mentioned that if she underwent another ablation, her heart rate might return to normal at rest but could become excessively fast with exertion.
Therefore, they prescribed a beta-blocker (the red one) but did not recommend further treatment.
My mother thought that the beta-blocker was intended to slow down a fast heart rate, while her issue is a slow heart rate, so she only picked up the medication but did not take it.
In the months since her discharge, although her heart rate occasionally rises to the sixties, it often hovers around thirty to fifty.
She has experienced two to three episodes of significant shortness of breath, feeling like she couldn't breathe, and sometimes nearly fainting.
During these episodes, her heart rate was indeed low, in the thirties.
After providing her with oxygen and a towel to wipe her face, she typically recovers in about five minutes, at which point her heart rate rises to the forties or fifties.

These episodes have occurred once due to postural changes—standing up after squatting—and once in a poorly ventilated area.
However, the most recent episode, which occurred today, happened under completely normal circumstances, where she suddenly felt short of breath, with her heart rate again in the thirties, accompanied by tinnitus and a near-fainting sensation.
This episode was the most severe, lasting over 20 minutes, and she experienced a recurrence after initially feeling better.
Regarding her low heart rate, during a previous follow-up, the doctor mentioned that it might be due to the machine's diagnostic inaccuracies, suggesting that her heart rate may not actually drop to the thirties.
Based on the data from the 24-hour Holter monitor taken after her emergency visit six months ago, her heart occasionally stops for a second, but the frequency is not high enough to warrant the implantation of a pacemaker.
I am quite concerned about her condition and would like to ask for your advice.
Should she consider getting a pacemaker? Additionally, is it appropriate for her to take the beta-blocker given her current condition? Since her last follow-up, she started taking half a beta-blocker three days ago, and during these three days, she has experienced two episodes (with today being the most severe), so I am unsure if the beta-blocker could be contributing to this issue.

Thank you for your guidance.

Mr. Huang, 20~29 year old female. Ask Date: 2017/01/08

Dr. Lin Jixiong reply Cardiology

1.
Antiarrhythmic medications can be used to treat tachycardia.
Additionally, for patients with premature ventricular contractions who experience missed beats and whose heart rate monitors cannot accurately measure their heart rate, these medications can help suppress the activity of premature ventricular contractions, leading to a more regular heart rhythm and reducing the occurrence of missed beats.
2.
As for whether a patient requires the implantation of a cardiac pacemaker, there are specific indications and criteria that must be met; it is not simply a matter of patient preference.
Patients must meet the established criteria to ensure adherence to medical ethics.
Regarding the suitability of antiarrhythmic medication for treatment, it is advisable for patients to consult with a cardiologist in an outpatient setting for a more appropriate assessment.

Reply Date: 2017/01/08

More Info

Understanding Premature Ventricular Contractions (PVCs) and their implications can be quite complex, especially for patients with a history of cardiac issues. In your mother's case, it seems that she has a history of angina and underwent a catheter ablation procedure two years ago, which has likely contributed to her current heart rhythm issues.
Premature Ventricular Contractions are early heartbeats originating from the ventricles, which can disrupt the regular heart rhythm. They are common and can occur in healthy individuals, but in patients with a history of heart disease, they may indicate underlying issues. Your mother's experience of fainting and having a very low heart rate (bradycardia) is concerning, especially since she has reported episodes of feeling breathless and near fainting, with heart rates dropping to the thirties.
The fact that her heart rate occasionally rises to the sixties but often hovers between thirty and fifty is indicative of significant bradycardia. This can be symptomatic, especially if she experiences dizziness, fainting, or shortness of breath. The episodes of feeling breathless and the associated low heart rates could be due to several factors, including positional changes (like standing up quickly), environmental factors (like poor air quality), or even the effects of medications.

Regarding the use of a pacemaker, it is essential to consider that if your mother is experiencing symptomatic bradycardia, a pacemaker may be warranted. A pacemaker can help regulate the heart rate and prevent it from dropping too low, especially during exertion or when she is in a position that may exacerbate her symptoms. The decision to implant a pacemaker typically depends on the frequency and severity of symptoms, the underlying cause of the bradycardia, and the results of any monitoring (like the 24-hour Holter monitor).

As for the medication she has been prescribed, it is crucial to have a thorough discussion with her cardiologist. If she has been prescribed a medication to manage heart rate, it is essential to understand its purpose. If she is experiencing more frequent episodes of bradycardia after starting the medication, it may be worth discussing with her doctor whether the medication is appropriate for her condition or if adjustments are needed.

In summary, given your mother's history and current symptoms, it would be advisable to consult her cardiologist to discuss the following:
1. The appropriateness of continuing the current medication, especially if she is experiencing adverse effects.

2. The potential need for a pacemaker, considering her symptomatic bradycardia and episodes of fainting.

3. Regular monitoring of her heart rate and rhythm, possibly with a Holter monitor, to better understand the frequency and triggers of her symptoms.

It is essential to ensure that her concerns are addressed, and her treatment plan is tailored to her specific needs. Regular follow-ups and open communication with her healthcare team will be vital in managing her condition effectively.

Similar Q&A

Understanding Premature Ventricular Contractions: Causes and Treatment Options

Hello, Doctor. At the end of last year, I felt uncomfortable due to palpitations, and a cardiologist performed an echocardiogram and a 24-hour Holter monitor test. The doctor said the echocardiogram showed no issues, but the 24-hour Holter monitor indicated early contractions, an...

Dr. He Dongjin reply Cardiology
Hello, the echocardiogram showed no issues. The occasional VPCs over 24 hours are still within a reasonable and acceptable range. At your age, approaching menopause, you may experience more palpitations. The medication is intended to help stabilize your autonomic nervous system a...

Understanding Ventricular Premature Contractions: When to Seek Medical Advice

Hello, doctor. Previously, I felt a missed heartbeat and went to the cardiology department at Shin Kong Hospital for an examination. I underwent an electrocardiogram (ECG), a 24-hour Holter monitor, and an echocardiogram. The doctor said I have premature ventricular contractions ...

Dr. Huang Yinghe reply Cardiology
Hello: Premature ventricular contractions are related to autonomic nervous system activity and physical stress. They may occur more frequently during states of anxiety or fatigue. If there are no significant issues found in cardiac structural and functional examinations, there is...

Understanding Premature Ventricular Contractions: Causes and Further Testing

Hello Doctor, I have been experiencing premature ventricular contractions (PVCs) for the past six months, and I can feel almost every single one of them, accompanied by palpitations and brief episodes of dizziness. I wore a 24-hour Holter monitor and recorded about 80 occurrences...

Dr. Huang Yinghe reply Cardiology
Hello: Premature ventricular contractions (PVCs) are a common type of arrhythmia that can be triggered by emotional stress, physical stress (such as infections), the use of tobacco, alcohol, and caffeine, or even changes in temperature. Isolated PVCs usually do not indicate any s...

Understanding Ventricular Premature Contractions: Expert Opinions and Treatment Options

Hello Dr. He: I have experienced palpitations and chest tightness for a while, and this year they have become more frequent. Additionally, I have asthma and a compromised immune system (frequent allergies and urticaria). I have consulted three doctors and would like to know which...

Dr. He Dongjin reply Cardiology
Hello, your episodes seem to be more frequent. We should determine the treatment based on your symptoms. Since you have experienced palpitations and chest tightness more frequently this year, it may not be appropriate to completely disregard treatment with medication. If your sym...