Managing Premature Ventricular Contractions: Medication and Treatment Options

Ventricular premature contraction (VPC)

Hello Doctor, I had a 24-hour Holter monitor that diagnosed me with over 200 ventricular premature contractions (VPCs) and more than 50 atrial premature contractions (APCs).
The doctor prescribed Dronedarone and Concor 1.25 mg (once in the morning).
After taking it for a month, I didn't feel any VPCs, but recently I've started to experience occasional missed beats again, although this began before I started taking Chinese medicine for adjustment.
I take the Chinese medicine and Western medicine an hour apart.
I would like to ask if it's advisable to take an additional Concor 1.25 mg since I've been experiencing these missed beats again, or should I consider increasing the dosage? Previously, when I switched medications, some caused dizziness, but Concor 1.25 mg had minimal side effects.
Would you recommend taking an extra dose or do you have other suggestions? Thank you.

Yang, 20~29 year old female. Ask Date: 2020/09/02

Dr. He Dongjin reply Cardiology

You can either eat more or observe, as having over 200 premature ventricular contractions (PVCs) is considered mild and can be monitored.
Changhua Hospital cares about you.

Reply Date: 2020/09/02

More Info

Managing Premature Ventricular Contractions (PVCs) can be a nuanced process, especially when considering the balance between medication efficacy and potential side effects. PVCs are common and often benign, but they can cause significant anxiety and discomfort for patients. In your case, it seems that you have been experiencing PVCs and have been prescribed a beta-blocker (康肯, or Carvedilol) to help manage these symptoms.

Understanding PVCs
Premature Ventricular Contractions are early heartbeats originating in the ventricles. They can occur in healthy individuals and may not always indicate underlying heart disease. However, frequent PVCs can lead to palpitations, anxiety, and in some cases, may be associated with more serious cardiac conditions. The fact that you have had a Holter monitor (24-hour ECG) that recorded over 200 PVCs suggests that your healthcare provider is taking your symptoms seriously.

Current Management
You mentioned that you have been on Carvedilol (康肯) and have not felt PVCs for a month, which is a positive sign. Beta-blockers are commonly used to manage PVCs as they help to reduce the frequency of these ectopic beats and can alleviate associated symptoms. The fact that you have not experienced significant side effects from Carvedilol is also encouraging.

Recent Symptoms and Medication Adjustment
You noted that you have started to experience occasional PVCs again, particularly after beginning traditional Chinese medicine (TCM) treatment. It’s essential to consider that while TCM can be beneficial for many conditions, it may interact with Western medications. Since you are taking both TCM and Western medications, it’s crucial to monitor how they affect each other.

Regarding your question about increasing the dose of Carvedilol, it’s important to approach this cautiously. While increasing the dose may seem like a straightforward solution, it’s essential to consult your healthcare provider before making any changes. Here are some considerations:
1. Consultation with Your Doctor: Before increasing your dose of Carvedilol, discuss your symptoms with your healthcare provider. They can assess whether the increase is warranted based on your current health status and the frequency of your PVCs.

2. Monitoring Side Effects: You mentioned experiencing dizziness and other side effects with other medications. Increasing the dose of Carvedilol could potentially lead to similar side effects, especially if you are sensitive to beta-blockers. Your doctor may suggest starting with a lower increase or exploring alternative medications if necessary.

3. Lifestyle Modifications: In addition to medication, consider lifestyle factors that can influence PVCs. Reducing caffeine intake, managing stress, and ensuring adequate hydration can all contribute to a decrease in PVC frequency.

4. Follow-Up Monitoring: Regular follow-up appointments are crucial. Your doctor may recommend another Holter monitor to assess the frequency and nature of your PVCs after any medication adjustments. This will help in determining the effectiveness of the treatment plan.

5. Alternative Treatments: If PVCs persist despite medication adjustments, your healthcare provider may consider other treatment options, such as antiarrhythmic medications or, in rare cases, catheter ablation if PVCs are frequent and symptomatic.

Conclusion
In summary, while it may be tempting to increase your dose of Carvedilol due to the resurgence of PVCs, it’s vital to consult your healthcare provider first. They can provide personalized advice based on your overall health, medication interactions, and the specifics of your PVCs. Managing PVCs often requires a comprehensive approach that includes medication, lifestyle changes, and regular monitoring. Your proactive approach to your health, including the use of both Western and traditional medicine, is commendable, and maintaining open communication with your healthcare team will be key to effectively managing your condition.

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