Ventricular Premature Contractions: Symptoms, Treatment, and Concerns

Ventricular premature contractions (VPCs)

At the end of May, I was worried about possibly being diagnosed with COVID-19.
While having dinner and watching the news about "happy hypoxia," I suddenly felt like I couldn't breathe and sensed my pulse stopping, along with a pulsing sensation in my neck.
I went to the emergency department, where they discovered I had premature ventricular contractions (PVCs).
The emergency physician prescribed Ativan to help me relax.
A few days later, a 24-hour Holter monitor test revealed that I had 160 PVCs in one day.
I was started on "Rhythmol" for a week, but I still occasionally experienced the sensation of my heart stopping.
During a follow-up appointment the following week, my doctor noted my blood pressure was 160 and, after hearing about my persistent pulsing sensation, added "Sotalol" to my regimen.
Initially, the combination of medications worked well, but after a week, I still occasionally felt the pulsing in my neck.
I then consulted a psychiatrist specializing in autonomic nervous system disorders, who diagnosed me with typical panic disorder causing autonomic dysregulation.
He advised me to continue taking Ativan and Sotalol for a while before tapering off, and scheduled another 24-hour Holter monitor test for July 12.
The results showed only 30 atrial premature contractions (APCs) and no PVCs.
Additionally, a nuclear stress test of my heart showed normal results, with no signs of angina or myocardial infarction.
I did not undergo an exercise stress test due to concerns about wearing a mask while exercising, fearing I might not be able to breathe and trigger a panic attack.
I would like to ask the doctor a few questions:
1.
I tend to get anxious when my blood pressure is measured by the doctor, so I monitor it myself.
Since starting the three medications together, from mid-June to the end of July, my blood pressure mostly ranged from the 120s to 130s, with a pulse mostly between 65 and 80.
However, since the end of July, my blood pressure has frequently been in the 130s to 150s, and sometimes my pulse is low, especially in the evening before taking my medication, where it can be around 65.
When lying down to sleep, my pulse can drop to between 55 and 65.
Is this heart rate too slow, and should my medications be adjusted?
2.
My doctor advised me not to take medication if my heart rate falls below 60.
I have been doing this for about 10 days, reducing my Rhythmol from one tablet in the morning and evening to just one in the evening.
My heart rate still tends to be slow.
Can the Rhythmol dosage be gradually reduced to the point of discontinuation? What rebound effects might occur from tapering off? Could my symptoms worsen?
3.
My doctor mentioned that I cannot exercise until coronary artery disease and myocardial issues are ruled out, which is why I need to undergo an exercise stress test.
I expressed my inability to wear a mask during the test, and he arranged for a nuclear stress test instead.
After reviewing the report yesterday, he told me the results were normal with no signs of coronary artery disease or myocardial issues.
When I asked if I could start exercising, he said no, that I still needed the exercise stress test, stating it was necessary for further evaluation.
Is it really as serious as my doctor suggests? Can someone with PVCs not engage in light jogging or similar activities?
4.
My doctor has been scheduling various tests, and although the results have been normal, he tells me that this only indicates a certain percentage of normalcy, such as with the angiogram, which he said has an 80% accuracy.
Regarding my condition after starting medication, my mental state fluctuates, and I often feel fatigued or experience a slow heart rate.
However, the guidance from my doctor regarding medication has been unclear, leaving me quite troubled.
Are there no other medications for arrhythmias? Given my situation, should I seek a second opinion from another physician? Thank you for taking the time to address my concerns.

Alex, 50~59 year old female. Ask Date: 2021/08/06

Dr. He Dongjin reply Cardiology

Hello, I believe that you can take medication when an episode occurs or is about to occur.
What he said is correct; it only indicates a certain percentage is normal! No one can guarantee a hundred percent, but constantly undergoing tests for that extremely low probability is not necessary and can be quite stressful.
It's not that serious! There’s no indication that individuals with premature ventricular contractions cannot jog or return to a normal lifestyle.
This way, the autonomic nervous system can stabilize more quickly.
It might be worth considering seeking a second opinion.
Don't worry; at least the reports I've seen are all normal and positive news.
Changhua Hospital cares about you.

Reply Date: 2021/08/06

More Info

Ventricular premature contractions (VPCs), also known as premature ventricular beats (PVBs), are common arrhythmias characterized by early heartbeats originating from the ventricles. They can occur in healthy individuals and are often benign, but they can also indicate underlying heart conditions, especially if they are frequent or associated with symptoms.

Symptoms of VPCs
Patients with VPCs may experience various symptoms, including:
- Palpitations or a sensation of a skipped heartbeat
- Dizziness or lightheadedness
- Shortness of breath
- Chest discomfort or pain
- Anxiety or panic attacks, which can be exacerbated by the awareness of the arrhythmia
In your case, the sudden feeling of not being able to breathe and the sensation of your pulse stopping could be related to anxiety or panic, especially given the context of your concern about COVID-19. It’s important to differentiate between anxiety-induced symptoms and those stemming from a cardiac issue.

Treatment Options
The management of VPCs depends on their frequency, symptoms, and the presence of any underlying heart disease. Here are some common approaches:
1. Lifestyle Modifications: Reducing caffeine intake, managing stress, and ensuring adequate sleep can help decrease the frequency of VPCs.

2. Medications: Beta-blockers, such as the ones you are taking, can help manage symptoms and reduce the frequency of VPCs. If you experience side effects or if your heart rate is consistently low (below 60 beats per minute), your doctor may consider adjusting your medication.

3. Monitoring: Regular follow-ups with your healthcare provider are essential. Continuous monitoring through Holter monitors or event recorders can help assess the frequency and pattern of VPCs.

4. Further Evaluation: If VPCs are frequent or associated with significant symptoms, additional testing such as an echocardiogram, stress testing, or electrophysiological studies may be warranted to rule out structural heart disease or other arrhythmias.

Concerns Regarding Your Current Situation
1. Blood Pressure and Heart Rate: Your blood pressure readings of 120s to 130s are generally considered acceptable, but the occasional spikes to 150s should be monitored. A resting heart rate of 55-65 beats per minute can be normal, especially if you are physically fit. However, if you feel symptomatic (e.g., dizziness, fatigue), it may require further evaluation.

2. Medication Adjustments: It’s crucial to communicate with your doctor about your concerns regarding medication. Gradually reducing the dose of your antiarrhythmic medication (like "脈律循") should be done under medical supervision to avoid rebound effects. Your doctor can guide you on how to taper the medication safely.

3. Exercise Recommendations: While it’s understandable to feel apprehensive about exercise, especially with a history of VPCs, many patients with occasional VPCs can engage in moderate exercise. The need for a stress test is to ensure that your heart can handle increased activity without significant arrhythmias or ischemia. If your nuclear stress test was normal, it suggests that your heart is functioning well under stress, but your physician may still want to confirm this with a traditional exercise stress test.

4. Seeking a Second Opinion: If you feel uncertain about your current treatment plan or if your doctor’s explanations are unclear, seeking a second opinion can be beneficial. A fresh perspective may provide clarity and reassurance regarding your condition and treatment options.

Conclusion
In summary, while VPCs can be concerning, they are often benign, especially in the absence of underlying heart disease. Your symptoms of anxiety and panic may be contributing to your experience of VPCs. It’s essential to maintain open communication with your healthcare provider about your symptoms, medication, and any concerns you have regarding your treatment plan. If you continue to feel uneasy, don’t hesitate to seek a second opinion for peace of mind.

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