#018 What Causes PVCs and How to Stop PVCs

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What Causes PVCs and How to Stop PVCs

Most people get a premature ventricular contraction (PVC) from time to time. Is this something dangerous? What causes PVCs?  How do you stop PVCs?

Lisa’s Experience with PVCs

Lisa came to see me for disabling palpitations. She had always been in excellent health. She exercised regularly and ate a healthy diet. Now at the age of 34 she was having severe palpitations. How could this be?

If you think about it, the heart is an amazing organ. It beats 100,000 times a day. Most of the time, every heart beat is perfectly timed.

Sometimes, the heart fires prematurely. If you are taking your pulse at the time this happens the premature beat is not detected and it feels as if you have skipped a beat. You can see this clearly on the EKG with this article. Every third beat is a PVC which is characterized by a big wide electrical signal from the lower chambers of the heart.

For 99% of the population, they do not feel these premature beats. For others, they feel each and every misfire and it causes them severe symptoms.

You can have a premature beat arise from either the upper or lower chambers of the heart. If the premature beat is arising from the upper chambers of the heart it is called a premature atrial contraction (PAC) and if it is from the lower chambers of the heart it is called a premature ventricular contraction (PVC). Fortunately, 99% of the time, these are totally benign!

In Lisa’s case, she would have chest pains, shortness of breath, palpitations, dizziness, and nausea whenever her heart was skipping beats. Sometimes she would describe this as “hard beats.” It seemed like her palpitations always got worse around the time of her menstrual cycle.

To figure out what was going on, we put her on a Holter heart monitor for 48 hours and scheduled her for a stress echo. A stress echo is a treadmill stress test with a cardiac ultrasound.

The ultrasound of the heart, also known as an echocardiogram, is done before exercise and then repeated at peak exercise. The purpose of the stress echo is to make sure there is nothing structurally wrong with the heart that is causing the PVCs.

I personally like the stress echo because no IV is needed and there is no radiation with this test. It can also be helpful to see what happens to the PVCs with exercise.

In Lisa’s case, the Holter monitor showed that 20% of all her heartbeats were PVCs. Fortunately, her stress echo was totally normal.

Lisa was still worried as she had 3 small children.  Thus, in her case, we also did a cardiac MRI.  Once again, this test was fortunately normal as well.

What causes PVCs?

As you might imagine, Lisa wanted to know what was causing her PVCs. Structural heart disease, like a blockage in an artery of the heart or even heart failure, can certainly cause PVCs.

Most of the patients who come to see me for PVCs, like Lisa, want to know what is causing their condition.  And, as a cardiologist, this is the most important question to answer.  Is there something dangerous causing the PVCs?

Fortunately, Lisa did not have any structural heart disease.  I should point out here that PVCs seen with an abnormal stress echo or cardiac MRI are the PVCs we worry about most.  PVCs associated with structural heart disease are the PVCs which can cause a cardiac arrest.

If there is no structural heart disease then the PVC’s are generally felt to be benign unless the burden of PVCs is significant–like 20% or more of the total heart beats.

For people without structural heart disease, like Lisa, with her normal stress echo and MRI studies, we often do not know the exact cause of PVCs. For whatever reason, one particular cell or a cluster of heart cells, will spontaneously kick off these electrical signals. These PVCs often wax and wane in intensity over the years.

In many cases, lifestyle modification can cause the PVCs to go away or improve.  Of all the lifestyle changes that can be made for symptomatic PVCs, the most important is stress management.

When do you worry about PVCs?

Fortunately, for the 99% of the patients I see with PVCs, this condition is completely benign. As mentioned at the beginning of this article, every living and breathing human being has PVCs.

Fortunately, 99% of the population can’t feel their PVCs.  Thus, regardless of how PVCs are treated (lifestyle modification, medications, or ablations), you will never be able to make 100% of the PVCs go away.

PVCs are a part of the human condition.  The heart will simply misfire from time to time.

We worry about PVCs in the following three situations:

1. Structural heart disease is present.

This could be a weak heart (heart failure), a significant cardiac valve problem, a blockage in an artery of the heart, etc.  Structural heart disease is something that picked up on a stress echo or cardiac MRI.

2. Genetic Abnormality

There are certain genetic abnormalities that can cause PVCs but yet are sometimes not picked up on a stress echo or a cardiac MRI.  Genetic testing has now become quite affordable and is something we may consider in PVC patients with a family history of a cardiac arrest.

As Lisa had no family history of cardiac arrest and her stress echo and cardiac MRI were both totally normal, we decided not to pursue genetic testing as it would most likely not help.  Also, genetic testing potentially opens us people–like from life insurance companies.

3. When PVCs comprise 20% or more of the total heart beats.

When 20% or more of the total heart beats are PVCs, we start worrying that perhaps the PVCs could cause heart failure.

In Lisa’s case, as she had severe symptoms from her PVCs, we knew we had to do something so that she could get her life back. For most of the patients that I see with PVCs, just knowing that they don’t have too many PVCs (less than 20%) and that their heart is otherwise normal (normal stress echo), they can live with the benign PVCs. For my patients with a lot of symptoms from PVCs, like Lisa, we start with the following to stop their PVCs.

How to Stop PVCs

1. Get Stress Under Control

For many patients, just knowing their PVCs are benign takes care of the problem and relieves the stress. I have found over the years that my patients who are most bothered by PVCs are often my most anxious patients.

When you are stressed the body releases adrenalin and cortisol, among other stress hormones. These stress hormones put a strain on the heart and can trigger PVCs. I have seen many cases of severe PVCs that have all resolved once the patient gets their stress and anxiety under control.

One question that often comes up is did the anxiety cause the PVCs or are the PVCs causing the anxiety.  Depending on the case, both are probably true.

There is some fascinating research being done by my good friend, Dr. Shivkumar, at UCLA on cardiac nerves.  His recent studies show that PVCs may activate cardiac nerves which then send signals back to the brain.  These findings could help to explain why some people, who have never suffered from anxiety before, suddenly became anxious at about the same time their PVCs symptoms first appeared.

Regardless of the cause, if you suffer from stress or anxiety the first step is to get this under control. Do something each day to relieve stress.

For example, yoga has been shown to be very helpful in controlling arrhythmias. Daily meditation is also highly effective.  For more information, please read my article (Blog #14), Eliminate Stress in Seven Steps.

2. Eliminate Stimulants and Other Vices

Do you consume a lot of caffeine? Do you take stimulant cold medicines, ADHD medications, or stimulant inhalers for asthma? Do you use any nicotine products, alcohol, or recreational drugs?

Any stimulant can trigger PVCs. Stimulants cause release of adrenalin which can trigger PVCs.

To learn more about the effect of caffeine to PVCs, please read this article I recently published.

3. Get Enough Sleep

Amazingly, many of my PVC patients just do not get enough sleep at night. With sleep deprivation, your stress hormones go way up which can trigger PVCs. Have a set sleep schedule and get at least 7 hours of rejuvenating sleep.

If you are overweight, or have a neck size of 17 or more in a man (16 or more in a woman), you may have sleep apnea. This is a condition where people snore loudly at night and periodically stop breathing. This causes oxygen levels in the body to plummet and can be another cause of sleep deprivation and PVCs.

If your spouse or sleeping partner tells you that you snore, or that you sometimes stop breathing in your sleep, talk to your doctor now about getting tested for sleep apnea. Fortunately, most cases of sleep apnea are reversible with weight loss.

If you are struggling with getting at least seven hours of rejuvenating sleep, please read my article (Blog #16) Ten Ways to Cure Insomnia without Medications.

4. Eliminate Your Triggers

You may have additional triggers besides stress, stimulants, or sleep deprivation.  For example, some people may have the vagal triggered form of PVCs.

Vagal PVCs are triggered by activation of the vagus nerve, like after a big meal or eating certain foods.  Often, by avoiding your gastrointestinal triggers or by getting the gastrointestinal system under control, the PVCs may subside.

5. Eat a High Potassium and Magnesium Diet

Just making sure you are getting enough potassium and magnesium in your diet may be all that is necessary to get PVCs under control. These electrolytes have a calming effect on the cells of the heart.

Fortunately, the foods highest in potassium and magnesium are the healthiest foods. However, people suffering from kidney disease should be careful with high potassium and magnesium foods.

In addition to bananas, other excellent sources of potassium include spinach, beans, broccoli, and cantaloupe. To learn more about which foods are highest in potassium, please visit whfoods.

For magnesium, the best sources are nuts, seeds, and “greens.”  Some examples of foods high in magnesium include pumpkin seeds, spinach, and beans. To learn more about which foods are highest in magnesium, please visit whfoods.

6. Too Little or Too Much Exercise

As with most arrhythmias, not getting enough exercise or extreme exercise (marathon or ultra marathon running, long distance competitive cycling, triathlons, etc.) can trigger PVCs. I recommend at least 30 minutes of moderate intensity exercise or 15 minutes of high intensity exercise AND 10,000 steps, as confirmed by a pedometer, each day for my patients.

For those people who enjoy extreme levels of exercise (marathoners or ultra marathoners, long distance competitive cyclists, triathletes, etc.), it may be that you need to scale back your exercise to get PVCs under control.

If you have not been exercising regularly, talk with your doctor first before starting an exercise program.

7. Keep Your Blood Pressure Under Control

For some of my patients they find that when their blood pressure spikes high they are more likely to experience PVCs. The goal blood pressure, as established by the American Heart Association, is 120/80 mmHg.

If your blood pressure often reads higher than this, please work with your physician on getting your blood pressure under control. Please also read my article (Blog #12) Lower Your Blood Pressure with These Eight Steps.  Another great article I wrote is 10 Ways to Lower Your Blood Pressure Naturally.

8. Work with Your Doctor in Treating Other Medical Problems

Often PVCs can be triggered by other medical conditions. For example, asthma, sleep apnea, COPD, heart failure, or coronary artery disease can all trigger PVCs. Work with your physicians in getting these conditions under control.

9. Work with Your Doctor to Change or Eliminate Other Medications

Sometimes other medications can trigger PVCs. For example, diuretics or water pills cause you to lose electrolytes. Electrolyte depletion can trigger PVCs.

You may also be on a stimulant medication, such as those used to treat asthma, COPD, ADHD, etc.

Medications that lengthen the QT interval on the EKG can also trigger PVCs. These include many antibiotics, antidepressants, and other medications. For a list of many of the medications that lengthen the QT interval, please check this list of medications.

10. You May Need a Medication to Help with PVC Symptoms

In rare cases, my patients are so bothered by PVCs that we need to try a medication when numbers 1-8 above do not work or when patients are unable to make the necessary lifestyle changes. As 99% of the PVC cases I see are totally benign, I am always hesitant to start someone on a potentially life-long cardiac medication.

Often, the side effects from one of these medications is worse than the PVC symptoms. If we must try a medication, I generally start with a beta-blocker. I find that in about half of the patients I see, beta-blockers help with PVCs.

In rare cases, when beta-blockers don’t work and patients tell me that they cannot live another day with PVCs, I may try an anti-arrhythmic. Anti-arrhythmics always make me nervous as they can increase your risk of a cardiac arrest or premature death.

11. When All Else Fails an Ablation May Be Necessary

For those patients with a high burden of disabling PVC symptoms (more than 20% PVCs on a Holter) that have not resolved with numbers 1-9 above, we may perform an ablation procedure. In an ablation, we go in to the heart with a catheter, map out the source of the PVCs, and then cauterize or freeze the areas of the heart kicking off the PVCs.

I find that the most challenging part of the procedure is getting the patient to have enough PVCs during the procedure. It is for this reason that we like to see at least 20% PVCs on a Holter monitor before even recommending this procedure. If PVCs are happening frequently during the procedure then the PVCs can often be cured in 80-90% of the cases.

In Lisa’s case, her PVC symptoms resolved with lifestyle changes. While the PVCs never completely went away, she was no longer bothered by the PVCs.  Her PVC burden went from 20% on a Holter monitor down to just 1% with lifestyle changes.

It is important to remember that everyone will get a PVC from time to time. When the heart beats 100,000 times each day it is bound to occasionally misfire. This is a normal thing.

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Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.

922 Comments
  1. I am 58 and have had PVCs on and off since my 30’s. I have never had any symptoms. For the past year I have had bigeminy constantly (virtually 100% of the time). It seems like bigeminy is my normal rhythm. I have no symptoms and only notice when I take my pulse. Recently had echocardiogram and cardiac MRI; both normal. Cardiologist feels no treatment required. I hope he is right, but it still bothers me mentally because I worry about cardiomyopathy and the high load of PVC.

    • Hi Dennis,

      For your situation, you need to stay in close contact with your cardiologist. For my patients with a structurally normal heart (normal stress test, MRI, etc.) and no PVC symptoms but yet have a very high burden of PVCs on Holter, I will just follow these patients closely. As long as they feel great and all their tests stay normal, we may decide not to treat the PVCs.

      Hope this helps!

      John

  2. Hello, I am 33 and have been suffering fork PVC’s since I was diagnosed with anxiety disorder and post traumatic stress back in 2011. I have had literally about 50 EKG’s and 3 cardiac MRI’s. About a month ago I was prescribed by my cardiophysiologist to wear a Zio Patch for a week. Everything came back normal with all of these test. I had stress echo and echocardiogram as well in the past. I have had all these tests done because my mom suddenly passed at 44 and they said her cause of death was ARVC. I received the autopsy repairs but wa told that the results were not definitive enough to assume it was the actual cause. I was red to get genetic testing but was told it wasn’t necessary because of all the tests I had and I have a normal heart. My anxiety is strong to flare back up and I started back taking the Buspirone I was prescribed in the past before. Do you think it’s necessary for me to still go through with he genetic testing?

    • Edited version: Hello, I am 33 and have been suffering from PVC’s since I was diagnosed with anxiety disorder and post traumatic stress back in 2011. I have had literally about 50 EKG’s and 3 cardiac MRI’s. About a month ago I was prescribed by my cardiophysiologist to wear a Zio Patch for a week. Everything came back normal with all of these test. I had stress echo and echocardiogram as well in the past. I have had all these tests done because my mom suddenly passed at 44 and they said her cause of death was ARVC. I received the autopsy report but was told that the results were not definitive enough to assume it was the actual cause. I was ready to get genetic testing but was told it wasn’t necessary because of all the tests I had and I have a normal heart. My anxiety is starting to flare back up and I started back taking the Buspirone I was prescribed in the past before. Do you think it’s necessary for me to still go through with he genetic testing? In addition, my grandmother passed at 74 but it wasn’t heart related but she did have leaky valve surgery and a stint was put in place.

      • Hi Tiffany,

        Whether or not you choose to do genetic testing is a discussion that you need to have with your cardiologist. So much is involved with this decision that it is far beyond what can discussed online. For example, the results of the test are often not definitive…how do you deal with the possibility of non-definitive results???

        Hope this helps!

        John

  3. I’ve been having PVC for about two years now my doctor put me on metoprolol it’s not working no more. My PVC’s are worse and harder now accompanied by chest pains that I also feel in the left side of my neck,left arm pain,tighten of my chest with a heavy feeling also pain in my upper back on my left side. I have had every test done and they say normal I wore a hostel and it showed 380 pvc’s within a24 hour span. I feel something is wrong and is being over looked can you help me understand this in some way. The pvc’s wakes me up in my sleep or don’t let me sleep this is how bad they are.HELP ME PLEASE

    QUEENA

    • Hi Queena,

      You definitely need to see a cardiologist. The sooner the better. Until you can get in, it sounds like you need to be seen in the emergency room as soon as possible to make sure you are not having a heart attack.

      Warm regards,

      John

  4. Dr. John,

    Hello. About three years ago I started to notice PVC’s. A year later I went for an ablation, during the procedure I went into VT. The Dr didn’t complete the ablation but implanted a ICD. I had been a runner and continued to run after being cleared. I was also on metropolol. I have had two more ablations with an episode of VT between. I’m taking 125mg of Sotolol twice a day. It has been 8 months since my last ablation and I want to slowly build up to run again but I’m afraid of having another VT episode or having mt ICD go off. One Dr says it’s ok to run slow, one says not to run at all because there’s nothing left to help me. I’m 60 years old and like to be active.

    • Hi Carol,

      I agree, staying active is important. However, if your condition, you want to be active in a responsible way. I would suggest working closely with your electrophysiologist on safe exercise parameters for you.

      Hope this helps!

      John

  5. Hi Dr John, The information about PVCs you have written are wonderful and in fact I should say it has covered almost all aspects.The best in this forum is response from an expert{yourself).
    I also have PVCs which were 81 in one day and 818 on 2nd day( 1 vent couplet,3 vent bigeminy, 95 vent trigeminy, 27 supraventricular ectopy) of holter. I had no symptoms on excercise test with tech scan and perfusion was normal during and after excercise test. the positive findings were st depression of 1.5 in post excercise recovery period which Cardiologist commented as false positive. I was advised to use beta blocker in low doses which is not helping much, I am concerned with PVCs which are severly disturbing my quality of life. Do you think Angiography is the solution in such situations I know it is invasive but is any other way I can be sure that I dont have ischemic Heart disease causing PVCs

    • Hi Tahir,

      Interpreting medical tests can be challenging as the answer often isn’t black or white. Whether or not further testing is warranted, based on your stress test, is something you and your cardiologist need to discuss.

      Outside of an angiogram, you and your cardiologist could also consider a CT angiogram. This is a non-invasive option to look for blockages in the arteries of the heart. However, like an angiogram, radiation and X-ray dye are both used (X-ray dye can be toxic to the kidneys). Unfortunately, CT angiograms are often not covered with many insurance plans in the U.S.

      Hope this helps!

      John

      • Thanks Dr John, one of the Cardiologist has suggested Calcium Scoring but knowing that its not going to pinpoint the blockage, it just is suggestive of how much Calcium is collectively deposited in Coronary vessels and also radiation exposure is there, i am reluctant to go for it,your opinion please?

        • Hi Tahir,

          The coronary calcium score will generally tell you how much “calcium” has been deposited into each of the 3 main arteries to the heart. The lower your calcium score, the better. A high calcium score indicates you have a lot of calcified plaque build up in the arteries.

          You are correct, this test requires radiation.

          Whether or not you do this test is something you and your cardiologist need to discuss. A high calcium score would tell you that you need to be very dedicated to living as healthy as possible to prevent a heart attack (and possibly go on medications to decrease this risk as well). A low score would tell you that your risk of a heart attack is lower.

          Hope this helps!

          John

          • I sometimes get pvc’s. I am in my 60’s. My blood pressure now is ok at 130/75, but goes higher if i eat too much salt. I was tested for heavy metals and found that i have a very high level of lead in my blood/body. I was told by a nutritionist to take EDTA as it removes the lead. It also removes other heavy metals, but the best thing is that it will dissolve calcium and plaque out of the arteries over time. I am taking a powder form a tiny bit 2x a day for four months now. It took less than 2 months for my blood pressure to go down. I could not get the bottom down even tho i took a Lisinopril pill everyday. After 6 wks of the EDTA pd my bl pr went from 145/95 to 130/75 or 130/80. I now take a half bl pr pill for the last 2 months. I do believe that the EDTA is removing the calcium and plaque from my arteries. I don’t know if i am allowed to name the product here so i won’t. Just google it. The pd is supposed to work faster when put under the tongue. Swanson vitamins does sell a capsule too which i have and am saving for when i run out of the pd. I would just put the capsule pd under my tongue too. I really believe the EDTA is helping me. It was discovered in abt 1950 or earlier and they found out that it removes lead. The pd works slower than intraveinus, but a whole lot cheaper. It is made from food., and is not a chemical. The pd is supposed to take 6 months to a yr to work, but for me started working in under 2 months. Prob depends on how clogged the arteries are. I even tried L. Arginine for 4 months before EDTA, and it never worked for me. Only the EDTA worked, and i tried every single herb and vitamin in the book and nothing else helped.

          • Hi Marie,

            Thanks for sharing your experiences.

            For other readers, while EDTA has been approved for treating lead and mercury poisoning, it is important to know that EDTA has significant risks. You should definitely check with your physician first before taking this drug. Many cases of cardiac arrest and kidney failure have been reported with EDTA. Also, there is no clear scientific evidence that EDTA prevents calcium and plaque build up in the heart or arteries. Likewise, there is no proof that the supplement versions of EDTA have any beneficial effects.

  6. Hi Dr. Day,

    Thank you for all of the articles and information you share! In this article you mention that Lisa’s PVCs would worsen around the time of her menstrual cycle. Can you elaborate if that was actually the case or just perceived by Lisa? I am curious if there has been a study on the correlation of sex hormones, specifically, and PVCs.

    I am 30 years old and started having PVCs seven months ago. I had two heart transplants as a child, see a cardiologist regularly, and have been reassured that they are benign (not caused by organ rejection/failure). They vary in frequency (a few per day to 15-20 per minute). I’m still trying to narrow down what exactly triggers them, but I feel like they increase in frequency during the week or so leading up to my menstrual cycle starting. It could just be a coincidence, but I thought it was interesting that it was mentioned in the article.

    Thanks!

    Audrey

    • Hi Audrey,

      Both situations can be true. I have some patients who feel their PVCs more at different times during the month (even though the total number of PVCs is unchanged) and other patients who truly do have more PVCs at certain times of the month as documented by event monitors. The same is true with pregnancy.

      Through mechanisms that aren’t fully worked out, some women seem to be very sensitive to hormonal changes when it comes to PVC symptoms or frequency of PVCs.

      Hope this helps!

      John

  7. Hi Tammy,

    If you don’t mind me asking, how long again did you have your third baby? I had my second baby November 2014, and I’m still having the PVCs, they are completely driving me crazy, and I’m making everyone miserable because every day I have them and can’t function like I used to. Do you feel skipped beats every day? I do and don’t know how much longer I can handle this. Thanks,
    Gina

    • Hi Gina, have you tried magnesium intake? I noticed a BIG difference when I started the supplements and eating more nuts. When I was pregnant with my second 2 years ago I had very low potassium in my 6th month. It was terrifying because I thought it was causing her lack of oxygen but it wasn’t and I started eating more bananas and nuts and drinking orange juice. See if it helps!

    • Hi Gina, let me know when you’ve set up Facebook and I will send you my ID or you can let me know yours and I will find you, take it easy 😊 Tammy

      • Hi Tammy,

        Ok, that sounds good, I will let you know when I set it up. I’m hoping over this weekend. Thanks, take care! 🙂

        Gina

        • Hi Gina,

          If you have set up Facebook here is my name Tammy Powell, you will see a picture of 2 boys & from Australia.
          Hope you’ve been ok

          • Hi Tammy,

            I’m sorry with the Christmas rush I have not had a chance to set it up yet, but I will soon probably after the holiday, I just have too much going on. I am still getting them, yes I take 500 mg magnesium a day for over a year now, not sure if it helps, how many mg do you take? I eat one banana a day and eat nuts but not every day. What kind are you eating? How are you feeling? I also have a doctors appointment tomorrow and I guess am nervous about that because I am switching primary doctors. Write when you can, and thank you for your info, I will do it I promise, sorry it is taking me forever. Thanks and talk to you soon:)

            Gina

    • Hi Gina, yes I have them most days especially lately, yesterday I had them from the morning until I went to bed & when trying to fall asleep, I feels like skipped beats & sometimes it feels like 2 or 3 irregular beats at one time, I had my baby in Sept 2015 & only started getting more pvc’s in Dec 2015, at first they were just around my cycle but now it’s at anytime, I know how you feel they have made me thoroughly miserable, I cry alot & I don’t go out because I’m afraid, I’m trying to loose weight as my cardiologist said that will help, same I don’t know how much more I can take, take care 😊

      • Hi Tammy,

        I’m sorry to hear that, but I know exactly how you feel. These PVCs are horrible, I get them too when trying to fall asleep, and last night I had a horrible night of insomnia, and had to push myself to come to work today, its awful. Are you taking any meds like beta blockers for them? I am, but I feel that now it is not really helping. I don’t know what to do, but I don’t understand how having a baby can do this. I didn’t have this with my first daughter, but that was 14 years ago. I am 38 now, and got pregnant with my 2nd at age 35, so I’m thinking maybe it was my age. I don’t know. I cry a lot too lately and am afraid to go out, can barely even go to the mall because it feels so awful. I can definitely relate. My anxiety is so bad because of the PVCs. Take care, and write when you can:)

        • Hi Gina,
          Hope you’ve been fine, no problem with the Facebook (whenever you can) hope all went well at the Dr, my Cardiologist told me to take 600mg twice a day of Magnesium, but the suppliment I take also has CoQ10 in it, I don’t think it’s helped alot with the pvc’s but I have noticed I have more energy. Take care & write when you can, if it’s not before Xmas hope you & your family have a happy holiday ☺
          Tammy

        • Hi Gina,
          Sorry I don’t have instagram, perhaps you could set up facebook? I think it might be the safest way as I don’t mind putting my facebook ID on here for you to find me, they haven’t been too bad today but still there, hope we can sort it out soon, take care 😊 Tammy

          • Hi Tammy,

            That’s ok no problem, yes I can set one up, I hope to do it this weekend sometime in between the holiday shopping! That sounds good and we can keep in touch and get this all sorted out! Same here, felt more this morning, and throughout the day it is here and there. Hope you have a nice day, Take care:)

            Gina

        • Hi Gina,
          I think there is a link between the pvc’s & hormones, I’m 37 now, I am on beta blockers (propranolol) that my doc has recently increased to see if it helps I’m on 100mg a day, I also take a magnesium suppliment that was suggested by a cardiologist but I haven’t seen any improvement, have you tried magnesium ? Hope you don’t mind me asking but are you on Facebook? If you are did you want to talk there? If not that’s fine, also anxiety makes the pvc’s worse, I said to my doc I I didn’t have these pvc’s I wouldn’t be anxious so it’s like going around in circles, 🙂

          • Hi Tammy,

            Wow it sounds like we are in pretty much the exact same situation. I don’t feel alone anymore and would love to talk to you off here as well. I do not have facebook, but I do have instagram. Do you have instagram? I was thinking about getting facebook soon though. Let me know if you can chat on instagram. How are you feeling today? I slept better last night but am still feeling the PVCs this morning which of course is making me crazy. I’m just trying to get through the day, as hard as that is when you feel like your heart is not beating as it should. I just wish I was normal again. I would even talk on email if that works. How can we do this? Take care, talk soon,

            Gina

  8. Exactly a year ago I started getting alot of skipped beats after having my third baby, I was fitted with a holter monitor for 2 weeks around 7 months ago & it showed occasional VEB’s I also had an ultrasound done and was all good, in the last few days my skipped beats are alot worse around 50 per day, it’s uncomfortable & makes me panic, I would like to know if I should be checked again? Or is this normal? Perhaps now there is something wrong?

  9. Hi Dr. John,

    I am still feeling my PVCs on a daily basis, I have been to both the cardiologist and EP and they both said that they are benign PVCs, I am taking 25 mg Metoprolol succinate Extended release, and my question is do you think this could be making me feel them more now, I have been on it since Feb 2015. They initially were better after about a year taking it showed 45 PVCs in 24 hrs, and now they seem to be worse. I’m planning for another monitor. I’m just wondering why after the birth of my 2nd child this all started. I have had all the tests, all normal, thyroid, labs, Echo, etc. It is causing me a great deal of anxiety, and my cardiologist said that I am not a candidate for ablation. Also, since I am having them every day would this be harming my heart longterm? It is very frustrating, any advice would be appreciated, thank you,

    Gina

  10. Thanks for the information. I had to go to the ER when I felt lightheaded and had strong irregular heart beats. I was diagnosed with having PAC’s. I get anxious whenever I get PAC’s. I noticed lately that my PAC’s are triggered when I eat certain foods.
    It’s so frustrating whenever I get PAC’s. I’m currently not taking any medications for PAC’s or SVT which I get once in awhile. Will an ablation help with PAC’s too?

    • Hi Vivian,

      Like a PVC ablation, A PAC ablation can be challenging. In order for it to be successful, you have to have frequent PACs while lying on the procedure table in a sedated state (the PACs must be constantly firing during the procedure if you want any chance of mapping them). Also, these PACs must be coming from just one, or a few sites, otherwise it is impossible to ablate everything. Thus, a PAC ablation is generally only successful in the patient with an extreme number of PACs (about 20% of every heart beat or about 20,000 PACs daily) and the PACs have to be localized to just a few places.

      John

  11. Hi how do i get enough sleep as i know how important sleep is but when its the pvcs that are keeping you awake in the first place and made you have severe insomnia what do you do to ensure you get the sleep back

    • It can be tough. I struggle with sleep as well (different sleep challenges). Work with your local cardiologist to find solutions. For many of my patients with PVC insomnia, yoga and meditation can be incredibly effective.

      Hope this helps!

      John

  12. Thank you so much for this info. I noticed my PVCs 10 years ago when I divorced. Every now and then, I feel them. A new convenience store opened up recently down the street with fantastic iced tea. I’m addicted to it, LOL, but honestly, I better stop drinking 32 ounces a day. I need to lose 20 lbs. I have hardening of the arteries, but my doc said probably most of my friends do, too. Better go get checked.

    • Hi Vicky,

      32 oz of anything but water is probably too much. Regarding “hardening of the arteries,” yes it is true that most people in Western countries have this problem with age. However, in cultures where they live a traditional lifestyle (eat real foods, physically active outside, socially connected, embrace stress, get restorative sleep at night, etc.) you don’t see hardening of the arteries, or atherosclerosis, even with age. Don’t give up hope on healing your arteries!

      Best,

      John

  13. Thank you! I was diagnosed with them in 2010 when I turned 39. There was an increased amount of stress in my life at the time. I had all the tests done and tried to change my lifestyle a bit. They went away as mysteriously as they appeared. Now, six years later, I am experiencing them again. I am convinced that my stomach, stress and hormones play major roles in their recurrence. I am also about to turn 46 and have begun entering menopause. Because my stress level is up again, my stomach becomes very acidic. I have hereditary GERD issues and manage them with a mild diet, Gaviscon and GasX. They started showing up about a month ago. I was just at my doctor’s for a physical and we discussed the early menopause and stressful year issues. I do not drink or do drugs. I have Valium for sleep and use it occasionally for discomfort with the PVC’s. Last night after I ate, I had a particular bad incident. I had just had a small dinner and was at the grocery store when It felt as if someone was squeezing my heart and esophagus tightly. I could still breathe during this incident. I took a Gaviscon and half a Valium and by the time I returned home, it was better. I looked up the symptoms of Angina but feel like this is very much stress and hormone related. Any other suggestions?

    • Hi Mary,

      Unfortunately, it is impossible for me to identify what might be going on over the internet. I would suggest finding a cardiologist near you for a full consultation.

      Hope this helps!

      John

  14. Hi Whitney,

    Thanks so much for your email! I am so glad to hear that you are feeling better with the PVCs. I am still getting them, I just had one while I was eating lunch:( They come and go…I’m trying so hard not to let them bother me, but it is so hard sometimes! I’m going to give yoga a try this weekend and see how that goes…I found a studio not too far from me and spoke with them yesterday. How are you feeling this week so far? I just still can’t believe that after having my second baby this has all happened! I just don’t understand, but hopefully things will get better. Today I’m trying to stay positive. I do agree with you that the more you think about them, the worse they are…but sometimes I don’t even think of them, and they come out of nowhere! Do you get it like that? I actually just had another one, so I’m trying to breathe it through. Can you let me know the pvc facebook page, I actually don’t have facebook, but am thinking about getting it now. Thanks so much! Take care, and write when you can:) Have you had luck with yoga?

    Gina

    • Hi Gina!

      I’m sorry to hear you are still struggling with pvcs! I have really goood days, but some days they bother me more. Still trying to ignore them the best I can. I’m the same way! When I think about them, the more frequent I get them. But sometimes, they aren’t even on my mind and I can get them.

      Yoga has helped with my anxiety, which has helped with my pvcs! I recommend checking out yoga with adriene on youtube! The Facebook page is called PVC Ectopic Cardiac Arrhythmia Support.

      Thinking and praying for you!

  15. Hello Dr. John,

    I have been diagnosed with benign PVCs. I’m a 27 year old female and have had the following tests. Blood work, chest x-Ray, multiple ekgs, echo, and an event monitor. I don’t have any risk factors other than my father having a heart attack at 50. I still get PVCs every day. Sometimes at rest and sometimes when I’m very emotional/stressed. I worry because I have not yet had genetic testing or a stress test. My cardiologist doesn’t think these are necessary due to my age and results. Are these necessary or should I just trust his recommendations? Also, I now have a cold or infection I’m concerend to take any antibiotics or decongestant. For people who have benign PVCs, are there any antibiotics or decongestants that you would recommend staying away from? I would greatly appreciate any insight you can provide!

    • Whether or not to do stress or genetic testing in a young woman is a judgement call that only your cardiologist can answer.

      Decongestants, or any other stimulants, may trigger PVCs. Some antihistamines, like Benadryl, can lengthen the QT interval which could trigger PVCs and life-threatening ventricular arrhythmias in susceptible people. Also, some antibiotics also lengthen the QT interval.

      To know whether or not you may be at risk for QT prolongation issues, ask your cardiologist. Every ECG you have had done reports your QT interval.

      To find out whether any medication lengthens your QT interval, you could ask your doctor, pharmacist, or do an internet search on any medication you are considering taking or have been prescribed.

      Hope this helps!

      John

  16. Whitney,
    Also, I think the same way, I pray that they are gone when I wake up, then when they start, I get discouraged, and usually have a bad day. I had a visit with my cardiologist last week, and everything checked out ok, but still get PVCs. Have you taken the Lexapro yet? I am on buspar,and valium for sleep or as needed for anxiety. Ambien was a 2 night thing for me, not taking it again, because it made me feel very sick. Can’t wait to get home after work today, and just try to lay down! It has been exhausting, I hope you are well, write when you can,

    Gina

    • Hi Gina,

      Sorry to hear you are still getting them! Sorry to hear about your friend’s passing. I have not taken lexapro, but here’s a couple of things that have helped me! Please note, I have no medical backgroup, but these have helped me with my benign PVCs. Basically everything Dr. John included above 🙂 Hope they can help you too!

      1) Get checked out by a cardiologist. If everything looks good and he/she is not concerned, then believe him/her

      2) Expect getting PVCs everyday. When you do get them, just try to ignore them the best you can. Easier said then done, right! I just had a terrible one, but am shugging it off. I think this is key!!!! The less you pay attention to them, the better!

      3) Identify your triggers and try to eliminate your triggers as best as you can. Mine are stress, anxiety, lack of sleep, caffeine, sugar

      4) Exercise 30 minutes a day and introduce yoga to help with posture and anxiety

      5) Check out a pvc support group! There’s actually a facebook page support group for PVCs

      6) Let go, Let God.

      I’m not letting my pvcs control my life anymore! I have had the appropriate tests to ensure its nothing serious. Now I’m just trusting the results! Best of luck to you and your pvcs struggles!!!!! please know that I still get anxious with them, but have gotten a lot better due to the action items above.

  17. Hi Whitney,

    Sorry I just noticed your post now after all this time! I’m sorry, I am still getting them here and there, having a hard time now with insomnia, bc this past Tuesday found out that a family friend passed away, so my anxiety is in full gear and I cannot sleep good at all. Ambien worked one day and not the other. How are you feeling? Again, I apologize I just noticed you wrote back. How has the job been? I have considered that as well, but sticking to where I am at right now, but I believe it is the source of the pvcs for me too. I completely understand. Write if you can, take care,

    Gina

  18. Dr. Day
    Thanks so much for this article, I am yr old man and recently been diagnosed with benign PVCs.
    I’m determined to get rid of them, but with everything I read, it may not be possible.
    Again I appreciate your input.
    Thank you

  19. Hi, my name is Brian, I and a slightly over weight 46 year old with high blood pressure and high cholesterol which I take medications to correct. I have many Pvc’s more than 10 a minute, I have had all the tests done, EKG, Electrocardiogram, x-ray, stress test ect, they can’t find anything structurally wrong with my heart, I have been diagnosed with Afib after wearing a holter monitor for 1 month, My Pvc’s come with dizziness, shortness of breath, head ache and cold hands and feet. I have an appointment to see a Electrophysiologist on December 2nd, but that’s 3 weeks away, sometimes I have up to 15 pvc’s in a row,2 normal heart beats with a long pause after. I have been to the ER many times, where they don’t do anything, I am on Atenolol, my cardiologist just wanted to keep bumping up my med’s but that isn’t working, he recently prescribed me to take a hefty duty anti-arhythmic medication but I am very reluctant to take because of the toxicity of this medication and the long term impact it could have on my health, I need some relief, the last 5 days have been a living hell. I have tried all the dietary plans, mag, and potassium, I don’t drink smoke or use caffine, I exercise regularly, at least 30 minutes a day, nothing helps, 3 weeks is a long time to go and I’m worried I might have a cardiac event and even sudden death, please help, I even have many pvc’s during sleep, don’t know what to do, getting desperate……..

    • Hi Brian,

      So sorry to hear about your struggles. Call your new electrophysiologist and see if there is any chance your appointment can be moved up. In the meantime, keep in communication with your general cardiologist and see if you can reverse your high blood pressure and high cholesterol by getting the extra weight off and eating as cleanly as possible.

      Hope this helps!

      John

  20. Thanks Dr. John,

    Sorry all of the questions, I am just trying to find an answer to these pvcs…do you think it is worth it to get checked out by an endocrinologist regarding adrenal function, have you ever heard of pvcs due to something off with the adrenals? My gynecologist mentioned this after everything else checked out normal, thyroid, echo, you name it I had it done, hormone testing, etc. I am just trying to find an answer because they are making me so uncomfortable! Thank you!

    Gina

  21. Hi Dr. John,

    Is there a link between not enough sleep, or poor quality sleep and an increase in PVCs? Also, I have been getting up during the night, and having a hard time falling back asleep also feeling PVCs…would this be something to be concerned about? I am trying to get into my cardiologist office sooner because of this. Thanks for the information!

    Gina

  22. Dr. John,

    Is there a link between pvc’s and sudden cardiac arrest?

    I understand this is a delicate subject, as most people are here for reassurance and relief, not fear.

    I would assume the risk is higher for people with heart disease, genetic abnormalities, or a heavy burden of PVC’s, but I am not a MD, so can you please elaborate.

    Thank you!

    • Yes, there is definitely a link between PVCs and sudden cardiac arrest in people with structural heart disease. Structural heart disease is defined as blockages in the arteries, bad heart valves, heart failure, etc. There is also a link to people with specific genetic abnormalities such as long QT, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Brugada, catecholamine polymorphic ventricular tachycardia, etc.

      The bottom line is that if your heart is otherwise totally healthy then your risk of anything bad happening is exceedingly low.

      Hope this helps!

      John

      • My concern is that the MVP that I have could be causing the PVC’s and could lead to sudden cardiac arrest.

        Which is why you urge people to get a full work up, which includes genetic testing! Thank you!

        I have been checked by a General Cardiologist and now I am heading to meet with an Electrophysiologist, where I will discuss genetic testing.

  23. Hi John,

    I know my question is a bit different than usual, but i hope you want to answer it here..

    Its about angina pectoris. I have some questions about it..
    I sometimes notice in the slightest activity a painful chest and stomach area..burping.
    Now im known with dysautonomia/POTS and Also costochondritis like pain and even acid reflux. So im often confused which pain i feel 🙂 I experience chest and stomach era pain for 24 hrs a day and for yrs. Had several tests last 2 years, which brought hiatal hernia, reflux and later my dysautonomia/POTS.. to the surface. Often my pain on the chest was told to be possibly costochondritis like as well.
    Back to my problem. I really dont know WHAT i feel anymore. I have a bad exercise condition due to my POTS so i dont do much activity and climbing two stairs can make me feel a bit out of breath.. but like i say..even standing up ..walk to the toilet, and back can bring on chest pain more..and burping..
    When i take my pulse, i sometimes notice it isnt even high ..at least for me being a POTS patient.. say 100-110 at that moment..
    i have episodes when just SITTING let alone STANDING can give me a HR of 120-140 easily..and then less pain on chest..

    here is where my confusion comes in and my questions will be about

    1) in Angina pectoris is it fair to say that the higher the heart rate the more oxygen the heart needs..so the higher the HR the bigger the chance of angina pectoris?

    2) Simply put..whe i walk to the tolet or whatever for few seconds.. my HR isnt even high, i can feel more pain on chest stomach era than while sitting or standing with higher heart rate.. Would a higher heart rate sitting or standing say 130-140 hr…trigger angina faster then walking to the toile or in the house with HR of 110?
    Is it more logical that acid reflux or costochondritis is more an option because of the lower HR yet more muscle activity on the chest?

    Hope you can shed some light..

    • Hi Richard,

      Chest pain is incredibly difficult to diagnose the exact cause. While chest pain could represent a life-threatening cardiac emergency it also could just represent acid reflux or a pulled muscle.

      To make the diagnosis, your doctor will need to take a very detailed history. Also, testing will need to be done. However, even with extensive testing, it is still nearly impossible to be 100% sure about the cause of chest pain. Thus, if you are experiencing chest pain your doctor needs to know immediately.

      Hope this helps!

      John

  24. How long after quitting antibiotics will the pvcs stop? It’s been a week straight with 4 to 5 pvcs every other minute. I’ve been on antibiotics almost a month. My last dose is today.

    • While antibiotics are not typically linked to PVCs (the trigger was likely the infection), it is possible that in some cases antibiotics are the cause–especially the antibiotics which cause QT interval prolongation. Unfortunately, there is no way to predict when PVCs will stop…

  25. I have recently been diagnosed with PVC’s after an ER visit in early September when I experienced 4-5 hours of 12-15 times a minute where I could fully detect a sensation of “skipping a beat” in my heart rhythm, which became VERY disconcerting. In the past I had experienced and occasional (once a month) “skip” from time to time and knew it to be completely normal. I have never been diagnosed with a heart problem, though my doctor stops to look at my chart every year at my annual checkup when she listens to my heart to see if I have a murmur – because she hears a “whoosh” in the pumping.

    Last June my thyroid medication (synthroid) was changed slightly (from 125mcg to 200mcg) to accommodate the TSH and T4 changes in my most recent blood (5.00 value).

    At the ER visit (9/8 – 12 weeks after the increased dose), the value was <0.10.

    Four weeks later (10/13) the value is at .38 value.

    I'm still have noticeable PVC's.

    I am not a heavy caffeine user – I have one cup in the morning. Most of my PVC's occur later in the day or after I eat – but not all. I have noticed a connection with the stress as a trigger, but again, I cannot seem to make a general association with any one thing.

    I am overweight but am regularly active with 2 mile a day walks and hiking on weekends, etc. Activity doesn't seems to trigger or have any negative effect on them. I am very focused on healthy eating and hydration. I do not have any accompanying shortness of breath, chest pain, etc. with them.

    I'm looking for any feedback that may indicate whether it's really associated with the hypothyroid and/or the medication for it or should I be more concerned or be looking for more followup? Right now my doctor is thinking it is the synthroid change and doesn't seem concerned about them.

    Thanks – Darlene

    • I have the same symptoms. I have mitral valve prolapse. The whoosh sound my doctors hear is my valve. It hasn’t caused any major issues except it can cause PVC’s. I would recommend seeing a cardiologist and getting an echocardiogram. I am on beta blockers. It helps.

      • How exactly does the beta blocker help pvc’s caused by mitral valve prolapse?

        Or I you simply saying it helps in general?

        • Most of the benefit from beta-blockers for PVCs comes from shielding the heart from adrenalin or catecholamines.

          Hope this helps!

          John

    • Hi Darlene,

      It sounds like you and your physician need to do some detective work. Thyroid hormone levels can be easily checked to see if your thyroid hormone supplements are optimized or not. Also, it sounds like you need a cardiac workup to make sure the murmur and PVCs are not something serious.

      Hope this helps!

      John

  26. Thanks Dr. John for your responses! I really appreciate it, and will definitely start looking into yoga for some relief.

    Thank you,
    Gina

    • Hi Jameson,

      The big genetic causes of PVCs are long QT, Brugada, arrhythmogenic right ventricular dysplasia, catecholaminergic polymorphic VT, hypertrophic cardiomyopathy. All of these are life-threatening causes of PVCs. Genetic tests for these are now cheap and can be easily ordered by a cardiologist.

      Hope this helps!

      John

      • Dr. John,

        Thanks for the reply.

        According to my cardiologist, I was born with Inter Atrial Septal Aneurysm, Mitral Valve Prolapse with trace insufficiency, and also Marginal Pulmonary Stenosis. After researching everything, I found some information linking palpitations and ectopics to these types of congenital abnormalities. I have been told that I have a structurally normal heart but at the same time I have to wonder about these congenital defects and there link to the palpitations I experience.

        What say you, good sir?

        Jameson

        • Hi Jameson,

          These conditions can certainly trigger premature beats. My suggestion would be to make sure you are connected with a good congenital cardiologist to sort through these conditions with you.

          Best,

          John

          • Thank you.

            I am already in the process of getting a second opinion on the matter, I will be meeting with an Electrophysilogist, but I will look into finding someone who specializes in congenital defects.

  27. Hi Whitney,

    I’m so glad that you can relate to me and what I am going through. Thanks for your response. What ways are you trying to control your stress? I’m having a rough time, I am overwhelmed with the baby, even though she is now 2, she is quite a handful! My husband is working crazy hours and I am still adjusting to that, and I work full time. I just feel upset most of the time because people do not know how I am feeling with the PVCs. It is crazy how they can affect your life. It is so hard to accept them. I wonder will they ever go away or just happen once in awhile! When you get them, do you have them every day? I have been feeling them every day, I had some good days over the summer when I did not have any but they always come back, and there is no rhyme or reason to them which is frustrating! I’m sure your friend is having them because of stress too, but it is always good to get checked out. I also went to an electrophysiologist, and was checked out and he said it was benign but I still worry because when I feel them I get so scared.

    Thanks for talking, and write when you can! Take care,

    Gina

    • One of my biggest stressors was my job. I recently switched jobs in the hopes that will help! I’m also considering taking lexapro, which is what my doctor prescribed to help with my anxiety. I’m concerned about the side effects and haven’t taken it yet! It’s crazy, but I would never have thought I would have anxiety, but the pvcs can make me think irrationally. I now have the mindset that I will always have them instead of waking up hoping they are gone! I have them pretty much every day and sometimes several a day! I’m trying my best to ignore them, but I can still get nervous after having them! I have noticed I can have some gas/bloating when I have them and am wondering if it’s connected to the vagus nerve. Any luck on your end?

      • Hi Whitney,

        Yes, the vagus nerve or gastrointestinal issues can be a trigger of PVCs. Also, it is always hard to tell if the anxiety is a PVC trigger or the PVCs trigger the anxiety. Regardless, getting professional help along with meditation, yoga, daily physical exercise, healthy diet, etc. can all help with the anxiety.

        I wish you all the best in finding a solution to the PVCs and anxiety.

        Best,

        John

  28. Hi Gina!
    It’s always nice talking to someone who understands what you are going through. He is over 9 months, but I started having them during the first trimester so it has been over a year! I know exactly how you feel and have felt the same. Just recently, I’m trying to not let them have a hold on me like they have. I’m trying to be more active and take my mind off of them. I’m trusting my physician and am concentrating on working on stress and anxiety, which will hopefully help my pvcs. My best friend has actually just started having pvcs and is extremely stressed at this time. She is going to get checked by a cardiologist, but hopefully it’s just stress. I also know this isn’t going to fix itself overnight so I just expect having pvcs so I don’t get as freaked out when I get them! I take 400mg magnesium per day.

    It’s amazing what kind of hold pvcs can have on you and no one understands until they have them as well! I hope you find ways to help manage them!

    Thank you, I hope you have a great weekend too!

  29. Hi Whitney,

    I am sorry to hear of your PVC challenges too…but you do not know how much better I feel hearing that someone else who had a baby is experiencing what I have been for almost 2 yrs! If you don’t mind me asking, how long ago did you have your baby? Just wondering if we are in the same timeframe with things. These things seriously rule my life, I get them so bad I sometimes am afraid to do anything, like exercise or I feel like I can’t enjoy the little things in life. I had to cut even decaf out to see if that makes a difference, and I still get them! How many mg magnesium are you taking, I am taking 500mg per day. I also have an anxiety disorder and I know stress will do such crazy things. I also try to drink over 100 oz of water a day, but I usually still get them, so I just don’t understand. I don’t understand how having a baby can do this to you! Thanks so much for your response, and hope to hear from you soon! Take care, enjoy the weekend…praying for you too:)

    Gina

  30. Dr. John,

    Could you explain how yoga helps in relieving PVCs? I am interested in starting this to use as a stress reliever and anything to help with the awful PVCs. I need relief from these, can’t take it anymore. I get so scared. Thank you for your time, I really appreciate it!

    Gina

    • Yoga helps PVCs by many different mechanisms. First of all, it relieves stress and is great physical activity. Even better is that yoga somehow modulates the autonomic nervous system which can also help PVCs.

      John

  31. Hi Whitney,

    I am also suffering from PVCs after having my baby, but she was born in November 2014 and I am still having the PVCs! My cardiologist did put me on 25 mg extended release of metoprolol (beta blocker), and I do believe this helps, but I still feel them just about every day. I was wondering if you are still having your PVCs and just curious what your doctors recommended? If you are still on this forum, if you could comment, I would appreciate it! I do hope that you are feeling better, I truly know and understand what you are going through…

    Gina

    • Hi Gina!

      I’m sorry to hear about your challenges as well!

      I still have them! Some days are better than others. My cardiologist prescribed magnesium when I was pregnant because I had a deficiency. I take magnesium every day and think it helps a little bit! I also do my best not to worry about them anymore. Although I’m sure you can understand that it’s easier said than done! I’m sure my anxiety and stress about them only make them worse. Stress can do crazy things to your body. Everytime I get one, I’m just trying to ignore them. My GP wanted to try anxiety medication, but I don’t think that will solve anything as I’m mainly just concerned about the palpitations. I’m hoping my doctor refers me to an electrophysiologist for reassurance.

      I’m also thinking about giving yoga a try to see if that helps. Best of luck to you! Praying for you!

      Whitney

      • Also, I tend to get more when I’m dehydrated so I try to drink water throughout the day to stay hydrated. And the biggest help is staying off google and trusting your physician! Hope you are feeling better!

  32. Dr. John,

    I was wondering could PVCs be caused too by heat? I noticed when I get hot or feel warm I experience more PVCs then usual. Also having anxiety does not help, because once I get a PVC, it makes me more anxious and the cycle continues. Wish they would leave forever! But, I am trying to learn to live with them the best that I can.

    Gina

    • Hi Gina,

      Best of luck to you in learning to live with PVCs. Yes, anything that puts a stress on the body or mind can trigger PVCs.

      Best,

      John

  33. I agree with Dr. John based on my history with PVCs. When I was experiencing them, I could lessen their frequency by lying prone, changing my posture and even stretching my arms up over my head. I could take a deep breath and simply hold it to stop them temporarily. It’s crazy, right. That was what got me thinking that there was a Vagal nerve connection which led me eventually consider the GABA connection. I believe that lying prone inhibits the vagus nerve at least somewhat and temporarily…but hey, whatever helps…

  34. Dr. John,

    You answered a question for me a few weeks ago. Thank you. I am working with a cardiologist and right now I’m wearing a monitor for 2 weeks. I have noticed that my PVCs seem to temporarily be relieved by lying on my stomach. Can you explain why this happens and what it might indicate about the cause of my PVCs?

    Thank You,
    Laura

    • Hi Laura,

      Hard to say why laying on your stomach helps. Perhaps laying on your stomach stimulates, or inhibits, firing of the vagus nerve.

      Best,

      John

    • position shifts ? I notice all my PVCs respond on the position im in. i also notice its somehow involved with stomach and esophageal issues. as in reflux, bloating, for instance when im feeling acid reflux a bit right to the centre of my stomach/chest epigastric region.. and i lay on my right side i can trigger many PVCs. If i then just sit up or change position it almost stops. but pvcs in relationship to position body is something i fully recognize. i often think i have issues like “linked angina”. although not many doctors heard of it, or agree on it, i have a huge interaction between my stomach, esophagus and my heart.

      • It could just be my imagination, but I’m happy to have any trick to relieve the PVCs. Right now laying down in any position feels better than standing or sitting.

  35. This is to Margaret. I’m so sorry to hear of your troubles. Sounds like you need to be followed closely by a cardiologist just now. As I was reading your message, my first thought was SVT but then it sounds more complicated than just that. When the SVT starts you can try to head it off with what is called a Vagal maneuver… Bearing down as if you were having a bowel movement or ice water to the face (so I’m told though I’ve never used that approach) can help. I have used Vagal maneuvers on patients who are asymptomatic (not faint or short of breath) except for the tachycardia. But again, it sounds like you have a lot going on there that needs to be diagnosed. I hope your situation can be diagnosed and treated ASAP. It must be driving you bonkers. At any rate, the GABA won’t make it any worse. :0)

    • Hi Dede
      Thank you so much for your thoughts, they are very much appreciated. This rhythm trouble of mine began when I was under a great deal of strain with a civil law suit when, for the first time in my life, I experienced what the British legal system and its odious lawyers laughably call justice. Though that finished in late 2013 (with no financial cost to me), the long drawn-out process was a shock to my system and my body doesn’t seem able to adjust, even though I don’t actually think about it much any more. The body gets into a pattern which seems impossible to break. Stress is the most evil demon! I’ve read Dr Day’s articles on AF and he does seem to think it can be greatly helped by natural lifestyle methods, which is cheering at least. (Thank you, Dr Day, if you’re reading this.) I’m not massively overweight but the weight has crept on since having babies and I am definitely losing it at the moment, eating mainly fruit and things like cucumber with olive, red pepper, artichoke, mushroom and garlic dips, all vegan, all gluten-free, all organic. If you can think of any other tips, please do let me know. My son sent for lots of grounding products and last night I slept on a full grounding sheet and did sleep much better. I’m also continuing with the acupuncture with a Chinese doctor coming to my home. He’s giving loads of massage as well and also Qi Gong and next visit he’s going to bring Chinese herbs with him. Communication is a bit of a problem as he only speaks about four words of English but he seems very genuine. I’m just hoping for the best but feel very despondent and depressed. I’m also taking lots of vits, minerals etc – my son gets them all ready for me every day. He is such a wonderful young man and his devotion to me moves me to tears, especially at the moment. Anyway, I will keep you informed and, once again, thank you so very much for your kind message and advice. Best regards, Margaret.

      • Dede, forgot to say, the Chinese doctor is adamant that my problem lies in my thoracic spine, about T5, and also a bit in my neck. I certainly am aware I have long term problems in those areas. So whether stress has triggered off where there was already a problem remains to be seen. I hope he’s right and that he can help me. Regards again, Margaret.

  36. Dr. John,

    Thank you so much for the wonderful article! It’s the best out there and am so glad I found it! I am so impressed that you respond to every comment. I’m sure everyone greatly appreciated your time and insight.

    I’m at 27 year old female (healthy, good blood pressure, non smoker, drinks on rare occasion)). I have had heart palpitations occasionally for the last couple of years, but they weren’t life altering until I was pregnant with my son, who is now 8 months. Since pregnancy, they have become quite severe. When I was pregnant, the more active I would be, the more palpitations I would get. I used to love running and even ran a half marathon before becoming pregnant. Now I’m too scared and discouraged to run/exercise as it usually increases the palpitations.. Sometimes I get them during exercise and will become light headed while others like tonight, I will get while relaxing. They can be so severe, they stop me in my tracks and feel like a big thud as if my heat is going to stop. I have had a clear echo, blood work, and ekgs. The cardilogist claims it’s just normal pvcs and a blew them off (or at least I felt like he did). The only risk factors I have is my uncle passed away from cardiac arrest in his 40s, but I believe he had a heart defect and my dad had a heart attack when he was 50.

    I have now developed anxiety and am trying to battle through it. However, once I get a symptom, all logic goes out the window and I become flooded with anxiety, like tonight. I have never had anxiety before and long to be back to normal before I had palpitations. I think anyone who has never felt palpitations think we are crazy for stressing about them, but they are quite life altering as you mentioned previously. I fear the cardiologist is not taking me seriously because of my age/health and is missing something. If they were serious, would the ekg, echo, and blood work indicate a bigger issue? At what point do I have to relax and trust the tests or are there more tests that could be done to ensure its nothing serious like a stress test?
    I would greatly appreciate any insight you can provide! Thank you so much!

    • Hi Whitney,

      Sorry to hear about your PVC challenges. Yes, I have seen many patients with PVCs that started during pregnancy.

      Sadly, many general cardiologists are not that interested in managing symptomatic PVCs. I would suggest seeing a PVC specialist (cardiac electrophysiologist). Here is a link to find one near you: Hi Margaret,

      It sounds like you either have an SVT or Afib. Either way, I would recommend seeing an electrophysiologist. SVTs can be easily cured with an ablation procedure. Afib is a bit more challenging to treat this way. Here is a link to find a specialist near you: http://www.hrsonline.org/Find-a-Specialist

      The goal is to find an electrophysiologist (“EP”) that you can trust and can work with you through these challenges.

      Hope this helps!

      John

  37. Dr John, your is the best site I have found so far. I increased my thyroid med mud July and by August was waking 3 and 4 times a night with my heart racing. EKG showed Sinus Tach but Halter showed PVC’s. MD says PVC’s stacking 4 and 5 at a time but heart was otherwise healthy. Ultrasound stress test this week and Cardio Appt on Oct. 5. I am still scared. I am wondering if the med triggered this can it be untriggered when I reduce the med? I reduced it about 3 weeks ago and I am still woken each night but it is just a fast beat not the pounding. The shortness of breath is reduced and I am not having the sweating and lightheadedness during the day. Can this be reversed and is 4 or 5 stacked a predictor of heart attack or stroke?

    • Hi Nancy,

      Thyroid medication is a powerful stimulant. If you are taking too much, it can trigger all sorts of arrhythmias. Fortunately, thyroid hormone levels can be checked. I would suggest contacting your physician to make sure you are taking the right amount.

      Hope this helps!

      John

  38. Hi there, in the last year i have been suffering from PVC’s, I am 45, run 30k a week, eat fairly well and of course I’ve been googling all about my condition trying to make sense of it all. I have found your article the best (and I’ve read many), and maybe it’s a bit of who I want to believe more, but the last thing I want is to go on medication, I just want to know if my heart isn’t being damaged and it’s just something I have to live with, I can, but getting confirmation of that will help (I have an echo next month) after doing all the other tests. Mine come and go, and just today, I feel that relaxed feeling in my chest of everything beating normally which is SO NICE, as I feel in a constant hyper, anxious state when my heart is fluttering. Anyway, just wanted to say I really got a lot from your article, thank you.

    • Thanks Eve! I would suggest developing a relationship with a PVC specialist (cardiac electrophysiologist or “EP”) so that you can continue to run. Here is a link to one near you: Hi Margaret,

      It sounds like you either have an SVT or Afib. Either way, I would recommend seeing an electrophysiologist. SVTs can be easily cured with an ablation procedure. Afib is a bit more challenging to treat this way. Here is a link to find a specialist near you: http://www.hrsonline.org/Find-a-Specialist

      Hope this helps!

      John

  39. I was just catching up on this site…a lot of good reading. I especially benefit from Margaret’s innovative thinking! Here’s a quick and informative read on yoga etc and the GABA system. NCBI.nlm.nih.gov. You know I love my GABA. I remain PVC free except when I go off of it for more than a few days and hit an especially stressful day at work.

    • Hi Dede
      I haven’t forgotten about you. However, I’ve had a few problems. Had an episode of what I’d presumed were PVCs – felt worse than usual and my son called an ambulance. When it arrived, I told them I felt OK and thanks for coming, but they insisted on putting a monitor on me, found my pulse was 180 and insisted on taking me to the hospital -a daunting experience, to say the least! The ambulance people said there were p-waves on the ECG (EKG in US) and that it looked like SVT. At the hospital the monitor there however also said AF and intermittently also read multifocal PVCs. They wanted to admit me to start their drugs but luckily my ECG then reverted to normal, pulse 83, and I scrambled home asap. Then today I had another episode, pulse this time over 200, got the ambulance again, their ECG said AF – and the hospital monitor also read AF, though this disappeared at times to be replaced by tachycardia with PVCs. Again, they doggedly insisted on their drugs (to the point of saying they’d have me removed if I refused their treatment). Really lovely health service we’ve got – more like the KGB! Anyway, my heart reverted to normal before they could start their drugs and I came home. So I’ve had a traumatic time, and feel awful and full of panic, though they did tell me that my heart seemed to cope well with the elevated rate and the ECG looked otherwise good. I’m shedding a good few tears as I’m so overwhelmed with anxiety over it all. I really don’t feel I can cope with these dreadful heartbeat episodes much longer. The funny thing is that my radial pulse no way felt so fast, in fact at times it felt slow, so I was amazed and horrified at the rates they recorded. I had a long acupuncture session from a Chinese doctor yesterday and wonder if this was a sequel. I don’t know what to do next, I don’t drink, don’t smoke, have excluded caffeine, always eat organic, don’t eat much sugar, take a variety of supplements including Carolyn Dean’s pico ionic magnesium and drink lots of water bottled in glass. I’m at my wits’ end. Anyway, glad you seem to be getting along fine and just thought I’d kerp you updated. All the best, Margaret.

  40. Hi John,

    I have POTS/Dysautonomia and therefor often high heart rate , pain chest, especially when standing straight. Im deconditioned due to the effect and symptoms of my POTS. I somehow learning to live with these symptoms but the skipped beats,mostly PVC’s always make me doubt myself.due to the pain they cause.I ve had numerous ekg’s had an heart echo in rest last year which was fine , so the general consensus is “no worries”. these skipped beats stayed with me for 9 months and 10 weeks ago they suddenly decreased dramaticaly..which was a blessing, cause my skipped beats HURT like hell. i get pain on chest when i have a lot of them..which is explained as just muscle ache, and not due to angina or oxygen problems..cause , cardiologist say, EKG is fine. and troponine fine when i was brought into ER 2 weeks ago. 2 weeks ago , so after 2 months of a few pvcs, they came back strong, sometimes also the feeling of irregular heartrhytm which the cardiologist dont believe what is the problem.
    they think : skipped beats possibly a few close to one another.

    Weird is that my hospital which is a big one in my country doesnt know anything about POTS, so they dont know if there is any co-relation or know what to do.
    they just tell me : you’re heart is fine.
    i also asked about PRilosec/omeprazole and the effects on the vessels and heart cause i m a long year user of that medicine. -> answer? dont know anything about that.

    Now i have had many pvcs when i wasnt taking omeprazole this year. and the last 8 weeks i took them every day and low and behold , it was during the period my pvcs where way less. Now i still take them , but they are back. so i honestly dont know if there is any relationship cause and effect.
    But due to everything i keep having questions which my cardiologist just cant or wont answer. My GP : same thing. just the dont worry.

    I hope you can help me with my questions so i at least know what to do :

    1) Is having 1000-1500 pvcs a day a burden for your heart? this is the largest amount i have noticed. most days when flairing up they are around 500/800 during the day. even in POTS Dyautonomia?

    2) Now is my heart structurally ok, at least thats what they found a year ago, and my cardiologist dont see any reason in making a new one yet. now , taking into account it is still ok, how do i know if my pvcs arent related to slipped arteries? taking into account the omeprazole study about side effect bloodvessels and heart. ?

    3) having dysautonomia POTS and with not much knowledge available about this illness, at least not in the hospital i visit ..it took 8 years to get diagnosed. and they didnt find it, it was diagnosed because i wrote to one hospital in my country who was specializing more in POTS and dysautonomia. I got a referal eventually and what i was thinking all along was true. no anxiety. Illness ! but having this i hardly know what to do and trust. WHEN is it just POTS, which is a hell by itself ;)WHEN is there something more sinister going on with my heart? its tough to live by. in a way this isnt a question, but i frankly really dont know anymore. I can feel the urge to call or go to the ER few times a week due to my sensations. Lately i just try to relax and wait. either i die or it lessens to acceptable pain and heart sensations attitude

    4) I have had numerous ekg;s, and my qt is a bit long, between 420-440 but that is no problem they say, an inverted t wave in lead 3, but otherwise NO abnormalties. yes the fast heart beat varying a lot in seconds yet sinus rhytm..all due to POTS. so they say, no indication of ishemic problems. dont worry ! they used to say high heart rate was due to anxiety like issues, now they know its due to POTS, so now its due to my POTS they say. It all feels too easy. i often feel they dont know , so i dont feel very certain about my health issues.
    having had the many ekgs and testing of troponine in my blood when at the ER , the doubt and fear of still having a vascular/angina , or problem with oxygen is not very likely?

    5) What to do with my omeprazole? take it? or cut it? how do you see the danger for vascular issues and heart and stroke dangers ? and how hard is this evidence. i mean how big is the chance even if its true..lets say i have a 1% chance of cardiovascular problem/incident to how much does taking omeprazole now possibly increases that chance. it says with 16 % in studies.. but is that 16% on that 1 % ..so maybe 1-2 % or 17% in total..which is a enormous difference!

    I know these questions are difficult, but it is so hard to find some consensus and guidance on some of my problems i face..!
    Thx for all you do !

  41. I am 49 years old and have been suffering with PVC’s and PAC’s for 7 years. In the last year, they have gotten much worse and last much longer, days on end. My doctor prescribed Metoprolol 25 mg which didn’t touch the PVC’s, so now I am taking 50 mg and I am STILL having them. I have been to the ER twice and they tell me there is nothing they can do to make them stop and to follow up with my cardiologist, which I do. I am getting very depressed, gaining weight, & withdrawing from social activities. I used to walk my dog after work every day but often times I am dizzy and exhausted from having these palpitations all day long. I had a holter monitor, stress test and a cardiac ultrasound a few years ago which were normal. I am having another holter monitor in 2 days. I cannot nor do I want to live my life like this. I have a treadmill, a trampoline, and walking shoes are of which are collecting dust. I also have anxiety and sleep apnea for which I wear a c-pap. I will do anything to make them stop. I am beyond frustrated.

    • Hi Theresa,

      So sorry to hear about your PVC/PAC challenges. This will likely require working closely with a cardiac electrophysiologist, therapist for anxiety issues, sleep medicine physician, and aggressive healthy lifestyle changes to find relief. Don’t give up. Relief is definitely possible.

      Best,

      John

  42. Hi Dr. John, I received the results to my 24 hr holter monitor and it showed 45 PVCs during the 24 hr time frame. I have been to the cardiologist and a very well known electrophysiologist and they both said that they are completely benign and I have nothing to worry about. However, I still feel each and every one. They also said 45 is a very small number and I have been taking 25 mg metoprolol extended release in addition to 500 mg magnesium. I think it helps but it doesn’t take them completely away. My question is why do the PVCs go away for a couple of weeks (2 at the most for me), then come back with a vengeance? Its hard to believe these are normal things for the heart to do! Thanks for advice in advance!

    Gina

    • Hi Gina,

      So sorry to hear that you feel each and every one of these PVCs! PVCs, as well as PVC symptoms, can wax and wane over time.

      Many people can identify a trigger for them, many cannot. If you can identify a trigger then you could avoid or minimize that trigger.

      Hope this helps!

      John

  43. Dear Dr John,

    I have been diagnosed 2 years ago with an inappropriate sinus tachychardia.(85-95 beats/min at rest and more than 100 at minimal activity). I am not taking any medication for it.
    I have PVCs for one month now (3200/24H) some of them being bigeminies.They are less frequent when i wake up in the morning an appear after minimal to moderate activity. My blood work-up and my cardiac echo are normal. I have no hypertension, no diabetes, I don’t drink coffee or eat chocolate. When I take 2.5mg 0f bisopropol fumarate (Concor cor) the PVCs diminish considerably
    2 questions:
    1- Is there a relation between the dysautonomia and the PVCs?
    2- Could I take the B-blocker occasionally when I am very bothered by the PVCs and the tachychardia so I could avoid the continous treatment?

    Thank you so much Dr John. You are such a compassionate doctor.

    Marie
    2-

    • Hi Marie,

      Sorry to hears about the IST and PVCs. To answer your questions.

      1. Yes, dysautonomia and PVCs can coexist.
      2. While I can’t comment specifically about your situation, I often prescribe beta-blockers to be used as needed for my patients with symptomatic PVCs.

      Hope this helps!

      John

  44. Who is / are the world leading expert(s) in arrhythmia in high performance athletes?

    My 22 year old was a professional cyclist. Sudden onset PVCs led to v-tach; two ablation surgeries later the v-tach persisted (always triggered by a large PVC), and an ICD was implanted. Recurring PVCs continue to trigger v-tach at zero exertion levels. Sotalol (120mg x2 per day) is not stopping the arrhythmia. Quality of life is lost and fear is present. Who can help stop (reduce) the PVCs and how?

    • Hi Derek,

      Sorry to hear about these challenges. It sounds like you are looking for a world’s expert in ablating these PVCs. While it is hard to say who is the best, the following people are all well respected as some of the top people in the field.

      Andrea Natale (Texas), Frank Marchlinski and Dave Callans at the University of Pennsylvania, Vivek Reddy at Mt. Sinai in NYC, William Stevenson at Brigham and Women’s Hospital in Boston, Kalyanam Shivkumar at UCLA, or Jared Bunch or Pete Weiss at my center in Salt Lake City.

      If you are in Europe, I would recommend Michel Haissaguerre in Bordeaux, France.

      Hope this helps!

      John

  45. Hi Dr J
    The link you gave seems to refer to possible effects of cardiac remodelling after a myocardial infarction which would not be relevant to the many ectopy sufferers who have not had a heart attack. However, I looked at some of Dr Shivkumar’s other work which confirms a prominent role of the autonomic nervous system in patients with arrhythmia issues. I’m not sure I’m any further enlightened or reassured and, reading about the poor patient who developed an anxiety state after getting repeated shocks from his implanted defibrillator, I could feel my own heart threatening a pvc episode. I am unsure how Dr Shivkumar’s work demonstrates a primary role of the heart in stimulating the brain to produce anxiety although empirically of course we would all acknowledge a most intimate link between the two organs, mediated almost certainly by the ANS. Sorry to sound so ignorant, perhaps I just haven’t understood enough. Would you be kind enough (time permitting) to perhaps quote a relevant line or two from Dr Shivkumar’s work to enlighten me?

    Very many thanks.

    • Hi Margaret,

      Dr. Shivkumar’s manuscript shows that abnormally functioning cardiac cells send information back to the brain via the autonomic nervous system. This past weekend I shared a ride with Dr. Shivkumar to a conference we were both speaking at. During this ride, he shared the findings of this manuscript with me.

      While this manuscript occurred in cardiac cells damaged by a myocardial infarction, I asked him if the same situation could occur with PVCs. He then responded, “absolutely.” In fact, he is convinced that the anxiety many people with PVCs suffer from may be through this exact same pathway.

      Hope this helps!

      John

      • Hi
        Thank you for that. The presumption then would seem to be that the cardiac cells involved in pvcs behave in the same way (that is, send out the same type of neural signals) as the highly damaged cells of infarction. I note that Dr Shivkumar’s paper specifically states that these signals emanate from the areas of infarct rather than just randomly from hearts that have suffered MIs. This then sounds quite ominous. Has Dr Shivkumar specifically tested the neural signals in hearts which are doing a pvc performance act? It may be, for unknown reasons, that these signals ARE similar, that is, utilising the same pathway/s as each other, but surely this cannot be more than a guess at this point? On another point, has it been considered that ectopic beats may have the intention of being a normalising or balancing influence on the autonomic nervous system? After all, we see that nature tends always towards homoeostasis – admittedly, not always successfully – and maybe the ANS uses the heart to try to achieve this when things are out of balance. After all, what better organ for a good shake-up than the heart which has the capacity to tremble, jump, dance, twitch etc as well as frighten the life out of poor sufferers? The history of pvc treatment in modern medicine seems to show that it is better to leave “benign” pvcs alone than to treat them so it seems at least a credible possibility (? probability) that they have a beneficial intent. I am sure that this hypothesis cannot be a novel one. On the other hand, maybe I am speaking complete rubbish and am just seeking to blunt my anxieties about my own ectopics!

        • Hi Margaret,

          Great thoughts. There is so much that we really don’t understand about the autonomic nervous system and PVCs.

          Dr. Shivkumar is certainly on the forefront of how the autonomic nervous system interacts with the heart and with PVCs. In fact, he even has a group of scientists working under him at UCLA to figure this out.

          In my many personal discussions, with Dr. Shivkumar he has repeatedly told me that although we don’t understand all of the specifics, he is absolutely convinced that yoga, meditation, etc. are all extremely beneficial for people suffering from these conditions. Somehow, yoga/meditation reprograms these damaged cardiac cells in what signals they send to the autonomic nervous system.

          Hope this helps!

          John

  46. Dear readers of this blog,

    There is some fascinating research being done by my good friend, Dr. Shivkumar, at UCLA on the cardiac nerves. His recent studies show that PVCs may activate the cardiac nerves which then send signals back to the brain. Thus, PVCs could theoretically cause anxiety by activation of these cardiac nerve pathways back to the brain.

    Here is the link to some of his work: http://onlinelibrary.wiley.com/doi/10.1113/JP271165/abstract

    These findings could help to explain why some people, who have never suffered from anxiety before, suddenly became anxious at the same time their PVCs symptoms first appeared. Let me know what you think.

    Thanks for reading!

    John

  47. Hello,

    I am a 37-year old female with PVCs. I am a former collegiate level track&field athlete (sprints and jumps) and I am in good physical condition and eat a balanced diet. I have had PVCs for about 8 years. Initially, I would only feel a skipped beat here and there. During my last trimester of pregnancy, it got worse. The stress of being a new mom and sleepless nights definitely worsened my symptoms. I would almost say that being awoken by a child’s cry at night caused my body to develop a new reflex. Now, if I am awoken at night for any reason, I start getting PVCs? I had ECHO done and my heart is healthy. My Holter registered about 4,000 PVC/day (I know I have worse days than that). I don’t mind feeling the extra beat here and there but when I have an episode I can have every second or third beat off for hours on and off and for days. I have weeks and months when I am fine and then I have a few weeks when it gets bad. I tried Metoprolol and even with that, I have weeks and months that are good but when I have an episode, Metoprolol did not seem to have helped. I tried Flecanaid which seemed to eliminate all of PVCs but I stopped taking that after about a month.
    I have noticed that I get episodes right before my period. Is that possible?
    I understand and completely agree with all of your lifestyle suggestions. I have 2 questions. When I have an episode, what can I do? And can PVCs cause any damage or structural problems to my heart in the long run. In other words, what are predictions? Thank you for the wonderful article.

    • Hi Lilian,

      Thanks for reading and commenting!

      Yes, you are absolutely correct. Lifestyle and the hormonal changes from menstrual cycles can certainly trigger PVCs.

      I agree that taking flecainide everyday, even though it worked well for you, is not ideal. However, I do have some patients who just occasionally have very symptomatic PVCs that also respond well to flecainide.

      In these patients, I will sometimes prescribe the flecainide “pill in the pocket approach.” In other words, they only take a flecainide when the symptoms are unbearable. This way they are only occasionally exposed to the side effects of this medication.

      Hope this helps!

      John

  48. Hello,

    I am a 41 year old female with PVCs. I am wondering if there is a connection between thyroid problems and PVCs. Similarly, I’d like to know if there is a connection between hormone imbalances and PVCs.

    Thank you,
    Laura

    • Hi Laura,

      Yes, there is definitely a link between thyroid imbalances and PVCs. Most commonly this is with hyperthyroidism (overactive thyroid). Thyroid hormone acts as a stimulant which can trigger PVCs. In some cases I have seen an increase in PVCs with hypothyroidism (low thyroid) but this is much less common.

      If you suspect a thyroid imbalance, check with your doctor about getting tested with a simple blood test.

      Hope this helps!

      John

      • Thank you! I can’t get in to see my primary doctor until next week and no luck getting an appointment with the cardiologist. So today I went for acupuncture and I feel much better. I will definitely follow up with the doctor about the thyroid test.

  49. Hi Dr. John I get pacs when I walk and it’s very upsetting. I also suffer from anxiety. I get them here and there during the day and last week I had a bout all day night with them. I had two echos ef65% normal heart stress test shoes pacs isolated. Dr wants me to take metoprolol but I do t think I need it. Also wants me to try buspar what do you think of buspar???

    • Hi Barbara,

      Some thoughts:

      1. PACs are not life threatening at all. Thus, you are trading the PAC symptoms for metoprolol symptoms. There are some reports that PACs may increase the future risk of atrial fibrillation. However, most people with PACs never develop atrial fibrillation.

      2. Anything that helps with the anxiety may also help with PACs. Once again, you are trading PAC symptoms for buspar side effects.

      Some other things to try might be yoga, meditation, or Tai Chi. All of these mindfulness techniques help with PACs without the medication side effects…

      Hope this helps!

      John

  50. Hi Dr john
    This is dr manoj MD anaesthesia
    I’m experiencing missed beats n palpitations along with that.
    ECG shows occasional vpcs .I’m dealt pilling up anxiety,
    I’m 41 yrs ,no associated co morbidities,no smoking ,alcohol,caffeine,,
    What do I do …
    I have booked an 2d echo too..
    Pls guide

  51. I am very glad to have found your post. Would like to know if you have any thoughts or suggestions. I am 50 years old, have had PVEB’s in the past 10 years (was told that they wouldn’t kill me). I was recently notified of a toxic exposure while in the military. I have developed many health sensitivities including skin hypersensitivities, lesions, and eye lesions. I am currently having a major episode, triggered when I stand up, bend over, or make sudden moves. I am aware of every heartbeat and am jealous of people who can’t feel them. My pulse rate and blood pressure are normal. Do you think all of this could be related to my VOC and solvent endused hypersensitivity?

    • Hi Sharon,

      Certainly anything is possible, however, this is something that has not been well described in the medical literature.

      Hope this helps!

      John

    • I too experienced PVCs with upper body movements. May be you can discuss with your doctor a table tilt test. I did this test years ago and it was negative. It is usually for people that get really dizzy when they stand up suddenly.

  52. I am a long time sufferer of PVCs and of the unfortunate few that feel every eternal pause and bang. Recently, I was sick with a really bad cold that started in my sinuses then turned into bronchitis. I took z-pak which worked well for my cough for 5 days then lo and behold, my PVCs went through the roof on day 2. I have read quite a bit about the FDA study on z-pak and people with prolonged QT intervals, but I have a feeling that z-pak is the culprit here. I do not have a prolonged QT interval, but have always shown an IRBBB on my EKG and I was told it’s quite common and not to worry about it. Could be possible that z-pak also has an effect on the electric conduction of the ventricles?
    Since 2007, I averaged may be 10 PVCs a day at the most. The last few days, I have been having 10-20 an hour and they are very strong. One skipped beat actually felt like someone turned off the lights for a split second. Today I scheduled an appointment with my cardiologist to see what is going on with me. Since 2007, I have seen multiple doctors and cardiologists assuring me that my heart is healthy. Since then, I had a stress echo (2007), stress test (2016), x-rays (every year), numerous EKGs, even a calcium score test (2016) and not once did a cardiologist suggest anything other than a healthy heart. Back in 2008, I was given Propranolol for a month and it did not help at all; as a matter of fact, when I was on Propranolol, I had a very short incident of arrhythmia where my heart went completely out of rhythm for a few seconds and I almost fainted.
    I find this discussion to be very interesting and have taken notes so I can try some of the remedies mentioned. I would like to share some of my experiences which some people here will sure find interesting:
    – I think the traditional way of thinking when it comes to new or existing healthy patients with PVCs is somehow flawed. Many doctors seem to want to treat PVCs in healthy people as an anxiety or anxiety management problem and this is when I have to disagree after many years of dealing with this illness. PVCs are the culprit causing the anxiety, not the other way around. I was prescribed light depression meds and even Xanax; which did absolutely nothing other than making me synthetically numb and drugged out. They never actually reduced or eliminated my PVCs. We lack on PVC research and especially why the Ventricles decide to fire randomly at will.
    – 99% of my PVCs happen at rest or at the very onset of exercise and even the onset of sex! Once the heart rate goes up, they are gone until I rest afterwards and they came back again.
    – This is a funny one: I noticed that PVCs can be triggered during really fast acceleration or turns in a vehicle. I have discovered this many years ago by accident when I had a sports car and when I told my cardiologist that I can trigger PVCs by simply peeling off from a traffic light, he laughed at me. It still happens to me nowadays, but I don’t have a fast car anymore!
    – Posture and upper body movements do trigger PVCs. I swear I can make them happen sometimes by simply moving a certain way.
    – Too much acid or gas in the stomach goes hand in hand with PVCs.
    – Many of the PVCs I feel the most happen as soon as I wake up and before I go to sleep and when I turn from side to side on the bed. Any meal that is rich in simple carbs like pasta will make them happen.
    – Stimulants such as alcohol, caffeine, nicotine, dark chocolate, simple carbs and sugar do make them more frequent, but not by much. The stimulants do indeed make them more forceful perhaps because they make the pause longer.
    – I am betting that most of PVC sufferers out there are surprising their doctors to the extensive knowledge they possess about their condition. I wonder if this is because that area of cardiology is a dark science so-to-speak. We all desperately want to find the cause and cure to this dreaded condition!
    – It is very frustrating that even the most qualified cardiologist that I have seen so far cannot explain the exact underlying cause in my case. One cardiologist suggested a Flecainide test, because I come from a middle eastern background, but I refused since it sounded dangerous.

    I am really glad this webpage exists and congratulate Dr. Day for being compassionate and making himself available.

  53. Hi Dr. John,
    Since october 2015, I have been experiencing PVCs, especially at night, at rest or they wake me up during the night. I also feel them during day time, when feeling more stressed, example: at work. I have passed 2 EKG and Holter, which showed 0.4% heart beat PVC, and was told I had benign PVC. However, I still feel the PVCs almost everyday, and more at night or after eating heavy meal. Should I see a cardiologist again? Thank you!!!

  54. Hi Dr. John,

    Thanks for this great post. I am 35 years old and have been dealing with light to moderate PVCs for several years. I have put a plan into effect that has basically eliminated them for me, and I was curious if you have ever considered poor posture to be linked to PVCs?

    Thanks again!

    • Hi How
      Could you possibly expand on the method you have used to control your pvcs? Breath training? exercising? I’d really love to know as back problems and postural change seem to affect me too- in a big way.
      Kind regards.

    • Great question. While there hasn’t been much mention about posture in the medical literature, anecdotally I have had many patients report this to me. Mechanical strain to the heart, can certainly trigger arrhythmias.

      Hope this helps!

      John

  55. Dear Dr. John. I’m a 40 year old female who have PVCs often. They started about three years ago.I see a cardiologist for them. My problem with mine are that I don’t have a fast heartbeat.. It has always been in the 50’s,and may occasionally beat in the 40’s. I have had several test done, a couple of echo’s, nuclear stress test, been but on two different type beta blockers (which I don’t like cause I do have a slow heart rate) and now lastly they have me on Norpace…which I ready don’t like. I don’t drink caffeine nor do J take any kind of stimulants.. I’m active I don’t have high blood pressure. So this is a puzzling to me. Now my cardiologist says that I have a healthy heart. But for these are to just pop up out of no where a d to be like they are and for me to be on these two different kinds of medicine and nothing is helping is just confusing to me…I’m trying to get my cardiologist to send me to a heart rhythm doctor but he really never agreed with me. So my question is shod I see another cardiologist?? Your advice will be greatly appreciated. Thank you Kemesha.

      • Dear Dr. John, Thanks for replying back..I go see my cardiologist August 16, don’t really want to wait that long but I have to I guess..I’m going to mentioned seeing a heart rhythm doctor, hopefully he will agree.I will let you know how that goes…and thanks for the link to find one….Again Thank You.

  56. Dear Dr. John

    Earlier this year I had a couple of days of hours of continuous PVC’s and the second day i ended up in the ER. After blood work and chest x-ray I was released. Went to see my doctor and he referred me to a cardiologist. At this point I was feeling the PVC’s throughout the day and it was crippling. I had and EKG, echocardiogram, Holter and stress test on a thread mill. Cardiologist said my heart looked healthy and that I had nothing to worry about. Eventually the PVC’s went away. I would feel one very sporadically but now I’m starting to feel them again. They seem to be gradually coming back.
    I don’t smoke. I have a drink of alcohol here and there. I could do more exercise.
    My question to you is considering that I went months barely feeling PVC’s, now that I’m starting to feel them more, should I consider going back to see my cardiologist?

    What’s the difference between PVC’s and PAC’s? Could one be potentially more dangerous than the other?

    Thank you for what you do for all of us.

    Rick

    • Hi Rick,

      Great questions. I have found that most of my patients cannot tell the difference between PACs and PVCs. Both feel like skipped or dropped beats.

      Fortunately, for most people, PACs and PVCs are not life threatening.

      If you are having new or worsening symptoms, it is time to connect with your cardiologist again.

      Best,

      John

  57. Hi Dr. John
    I have PVC very often throught the day. In a 24hr homer monitor, I had on that day as much as 20,000 extra beats. I also have CAD. I have one stent in the right artery and my doctor has told me I also need one or two in the left artery around my heart. I had a procedure last week for placing the stent in the left side, but it was not successful because the moderate-sever blockage was at a place where stent could not have been placed. My doctor said, if he had placed one, my heart muscle could have crushed the stent over time.
    The effect of pvc for me is the worst in the morning after I wake up and have my breakfast. The effect of pvc for me is like feeling fatigue tired dizziness lightheaded and they are the worst in the morning. I have quit all caffeine drinks/food, no smoking at all, take magnesium and electrolyte tablets in my water. I drink plenty of water every day. I also take Lipitor 20mg, and 81mg aspirin every day.
    Normally, until sometimes ago, the effects would go away by noon time. However, recently my pvc is extended throughout the day and feel awful most of the time. I hear my heart beats all the time, feel pounding in my chest, and mostly my mind is occupied with what is happening to me.
    Is there any remedy for me without using dangerous medicines and without a bypass surgery for addressing the blockage in my heart artery. My doctor thinks the most lowest art of my heart is not getting good blood supply.
    Thank you

    • Hi Sayed,

      So sorry to hear about your PVC challenges. With the coronary artery disease, your PVCs cannot be ignored.

      Increasing the blood flow to your heart may help with the PVCs. It would probably be best to at least meet with the cardiac surgeon as soon as possible to learn more about your options.

      In the meantime, some fascinating work by the UCSF cardiologist, Dr. Dean Ornish, has shown that eating mostly vegetables, avoiding unhealthy foods, daily exercise, managing unhealthy levels of stress, getting enough sleep at night, strong social connections, etc. can reverse coronary artery disease. However, with the blockages in your heart, you would definitely need your cardiologists permission to exercise.

      Hope this helps!

      John

      • Thank you again. I find your web site very useful.
        My cardiologist said I have Mycordial Bridge over my left left descending artery, and as a result they can not place a stent in the same artery and the diagonal artery.

        I met the referred surgen next day, he said the solution is to bypass LDA using an open heart surgery or use robotics surgery. My LDA has signs of CAD and there is some blockage. However, I do not feel any angina and no shortness of breath, even when when exercising.

        I have read that MB may be fixed with an unroofing surgery, then they could place the stents easily, I presume.
        Please give me some feed back. Should I be looking at how sever is the MB?
        I would like to get an independent second opinion, could you suggest someone in Southern California.
        I thank you for your feedback.
        Sayed.

        • Hi Sayed,

          Definitely not an easy answer hear…A second opinion would be helpful. Unfortunately, I don’t know anyone in the Southern California area who works with these challenges.

          John

          • Thank you. I am going to have a robotic bypass surgery soon. This should clear my arteries and the mycordial bridge issues. I hope the PVC issue go away after the surgery, or be reduced. I am 56 years old,and feel strong and very athletic. If my heart has only an issue of PVC, I could be more sure of my heart, and less anexity every time I have PVC. I am now more afraid of heart failure due to CAD and the mycordial bridge than PVC. I ride bike 75 miles and swim 3000 yards a week. I never have chest pain or shortness of breath. I do not know how I have got the CAD after being so athletic most of my life. I presume it is more genetic than anything else. BUT I must say I have smoked cigarettes for many years on average of a few stickes a day, but was never a drinker for much alcohol, very moderate and in the past 5 years I have stopped drinking completely because it was triggering my psoriasis every time I had a drink. My psoriasis became very uncontrolled so I stopped completely. Is that true that some people never feel chest pain or shortness of breath while having CAD? I think I am in that category and one of my doctors (pulmonary) said sometimes it is not good to not have any feedback in terms pain or shortness of breath becaus e they give a clue to seek medical help. For these many reasons I am going to have the bypass surgery and worry about the PVC afterward. What do you think? I thank you for your reply.

          • Hi Sayed,

            You are correct, many people have “silent ischemia.” This where coronary blood flow is compromised but yet people have no symptoms at all.

            It is impossible to predict whether or not the surgery will increase or decrease the PVCs…

            Surgery is a big deal with many potential complications. Robotic bypass surgery is a very technically challenging surgery so you want to make sure your surgeon has had a lot of experience with excellent outcomes.

            Whether or not you should do the surgery is a question that is impossible for me to answer. Hopefully, you have had several very competent physicians weigh in on this.

            I wish you all the best. Let me know how things go.

            John

      • Thank you. My next appointment with my cardiologist is tomorrow. It is an important appointment after the last failed attempt two weeks ago to place a stent in my heart left side artery. I hope to be in touch with you again here.
        Thanks

        • Hi
          I went through a CAT scan of my heart last week. They found that I actually have two mycordial bridge over LAD, one closer to to the top and another toward the end of LAD. My surgen discussed that with me and he is more inclined to do traditional open heart surgery than robotics surgery. He is well known and a leading surgen in robotics heart surgery in Southern California. The robotic surgery will not allow access to the second mycordial bridge, and he wants to do unroofing of the second mycordial bridge and bypass the one at the top. He also want to bypass the diagonal artery because I have some blockage. I have one stent already in my right artery for the past 4 years and it is still intact and no sign of being marginalized.
          I have a follow up appointment with my cardiologist tomorrow to discuss further. My surgery date is set for September 21st. Today I was thinking a lot about whether I should go through with the surgery. I do not have any discomfort or shortness of breath. I have started taking 12.5 mg of Metoprolol ER every night and I feel far fewer PVC and when I have them I do not feel them as much as before I started taking Metoprolol. So I am thinking may be surgery is not needed but at the same time I do not want to delay treating my MB for later in life when I am older. I am 56 years old now and feel strong and ride bike for 100 miles a week and swim a lot. Feel very healthy otherwise. However, I have lost a lot of confidence in myself that I could commit myself to doing different things like traveling because the risk of sudden death. I should mention that they have identified 70-80 percent blockage at the opening of the top MB location.
          I think I will go through the surgery just need to built in myself enough motivating factors to go through with it.
          Thank you for your thoughts. I will keep you posted.

          • Hi
            I had heart bypass surgery two weeks ago. A double bypass over the first diagnal and mid LAD. I have been recovering since and slowly I am getting stamina for walking around and doing minor work like showering and puting on my cloths. For my PVC, I still have them and they come in a different pattern than before, but I still have them.
            Should I be concerned now that my artery blockages have been corrected?
            Thanks

          • Hi Sayed,

            Glad to hear that you seem to be recovering well from your surgery. Yes, surgery can change PVC symptoms. Whether or not your new PVC symptoms are concerning or not is something only your cardiologist can answer.

            Best,

            John

          • Hi Sayed,

            A tough case…keep working with your physicians. If you don’t feel comfortable with the recommendations you could always seek yet another opinion…

            Best,

            John

  58. I have pvc’s, wore the holter monitor for 24 hrs. Doctor’s office just called to put me 25mg of lepressor 2x aday, along with 500 mg of magnesium 2x aday, follow up in 3 months. I’m already on 20 mg lisinopril and my blood pressure is fine. I always read on RX’S now b4 I take them. Lepressor or any other beta blocker has me AFRAID to take for my pvc’s.

  59. OH! MY GOD! I have been on Verapamil 240 mg pm and 120 Am since 2001 from sinus tachycardia and migraines….
    I am having PVCs or PACS and when you said calcium channel blockers cause Cardiac Arrest and Death that really got my heart skipping beats..
    WHY! DO DOCTORS PUT YOU ON MEDICATION KNOWING THEY CAN KILL YOU??????

    • Hi John,

      With everything in life there are always risks and benefits that have to be considered. Medications, including calcium channel blockers, are no exception.

      Whenever your physician wants to prescribe a medication, make sure you always discuss the risks, benefits, and alternatives to the medication. In many cases, there are lifestyle changes or natural alternatives.

      Calcium channel blockers can be helpful for people suffering from arrhythmias. Of course, these medications, like any medication or supplement, definitely have side effects. However, in my experience, I have never seen a case or heard of a case of cardiac arrest or death from calcium channel blockers.

      Hope this helps!

      John

  60. Hoping to see a post by Margaret and especially hoping that she has had some relief. :0). A friend and former coworker nurse has reported that the GABA and Taurine has significantly helped her with her PACs and PVCs. I had asked her to post here and hopefully she will. She is taking 750mg of GABA at night and a small dose, 50mg, each morning. The Taurine is 100mg each morning. As I reported in an earlier post, I am taking 500mg GABA and 100mg Taurine every morning and have great results. Again, I am only relaying information. This is not a recommendation from my friend, Dr. Day or myself.ni am merely sharing my stories. I am hopeful that this information might one day help others. Dr. Brahmbatt (sorry if I have misspelled the name), a cardiologist at the medical center where I work, does EP studies.He is going to trial the GABA in at least one patient, a young woman diagnosed with benign PVCs. I will be very curious to see if it helps her. I don’t want to give the impression that I think this recipe will work for everyone with PVCs. As Dr. John has made clear, there are many reasons for this condition and not all of them are benign. I am just so grateful and happy to have found relief (for a continuous 6 months now…YAY!!!) that I feel compelled to share my experience in the hope that I can help someone else. Must be the nurse in me…

    • Hi Dede,
      Just a short postscript to my last post: I forgot to say that, because my ectopics come in periodic bursts, gradually tailing off over several hours before disappearing, the only way I’ll know if the GABA’s helping is if these episodes either stop coming completely or come less often. I don’t currently get many ectopics inbetween episodes. So it’s really just a matter of time as I build up the dose to see what happens and clearly I’m not yet on a big enough dose. But I will persevere.

    • Hi Dede,
      I’ve tried the GABA – the first 200mg made me very sleepy so I’m increasing slowly. I thought it was supposed not to pass the BBB!!! I think it did calm my heart somewhat but I’m frightened to go up too quickly on the dose due to the dreadful anxiety these ectopics have installed in me. As you know, it’s a very very vicious circle indeed. In fact, these days I’m actually frightened to do anything much! I know you started on a much higher dose – and that’s probably what’s needed. However, I will persevere and I promise I’ll keep you up to date. Strangely enough, just a few days ago, it entered my mind that you’d be wondering about my progress – then, low and behold, I logged on and saw your latest post. I’ll be intrigued to see how Dr Brahmbatt’s patient gets on. You must feel wonderful to have been free of pvcs for several months. I so envy you. I wish I could lead a normal life again. The awful heat we’ve had in London over the past couple of weeks hasn’t helped as I can’t take hot weather. Anyway, hopefully I will soon be able report a bit more movement re my ectopics – should I even be saying that or am I tempting fate? These things are certainly enough to drive one right round the bend. Best wishes, Margaret.

  61. Hi Dr. Day

    1 1/2 years ago I was diagnosed with Bradycardia and got a mirca pacemaker. Since then I’ve experienced pvc’s that from time to time send me to the ER. I was put on Metoprolol and while it sometimes helps, it sometimes makes them worse IMO. My blood pressure is already very low and the beta blocker leaves me lifeless. As a result, I have gained 60 lbs. On top of all that, I was going through menopause at the time and felt hormones played another role. I’ve recently started swimming, eating better because I do notice large meals or heavy meals play a part. I’ve been prescribed xanax for days when the pvc’s dont seem to let up. And yes, there is tons of stress in my life as I have a special needs daughter. My question is do you think weight loss and exercise is will benefit more vs the ablation? It’s been suggested in my case but to be honest, I’m terrified already. I’ve had all the stress tests and so on and everything comes back fine. I’m thinking of just sticking to getting healthy and waiting it out.

    • Hi Tammy,

      Sorry to hear about your challenges. Beta blockers don’t work for everyone and weight gain is a common side effect.

      If it is OK with your cardiologist, you could certainly try “lifestyle medicine” first (weight loss, stress management, restorative sleep, healthy eating, etc.). If lifestyle medicine doesn’t help with the PVCs then you could always consider the ablation.

      Hope this helps!

      John

  62. As of Thursday, July 21, I have PVCs 100% of the time. I am slender and fit, go for walks, and do strength exercises 6 mornings per week. I eat a healthful and balanced diet. I have been an anxiety sufferer my entire life. The “newest” stress that seems to have started the PVCs is the discovery of needing a tooth to be repaired. Due to the PVCs, I ended up in the ER instead of the dentist’s office. Along with a lot of bloodwork, I was also given a chest x-ray and a CAT scan. Both came back normal, however my blood pressure is high and my blood work showed abnormalities (my “normal” is to have low iron and low MPV). I was discharged from the ER, with instructions to make an appointment with a cardiologist and find ways to ease my tension. I would like to know if it is possible to get my heart rhythm to return to normal.

    • Hi Lisa,

      It is definitely possible to find relief from the PVC symptoms and to decrease your PVC burden. Finding ways to help with anxiety is the first step for many people. However, it is also important to remember that because everyone has PVCs from time to time, you will never be able to make them completely go away.

      Hope this helps!

      John

      • Oops..I said that I experience PVCs 100% of the time. I saw the cardiologist today, and she told me that if I had PVCs 100% of the time, I would be dead! LOL Today’s EKG showed that I have both PVCs and PACs, so I am wearing a monitor for the next 48 hours to see what percentage of my heartbeats are “funky”.

  63. Hi Dr. John I love reading your articles. I suffer from panic/anxiety disorder I was on meds and I had Palpatations but only when I was stressed I would get them. I’m off meds now and I get them a little more often. I get the skipped beats and once in awhile like a flutter of beats with no normal beat for about 15 seconds then goes back to normal. Palpataions are very scary for me. I did notice sometimes during the cycle I get them more. I had 2 echos multiple ekgs 32 day holter monitors with rare or occasional pvcs mostly junctional rhythm and sinus tachycardia. I have had to episodes in my life on the medicine where I would get a bunch of PVcs in our row and my heart would race last about 15 minutes and It would just stop and go back into normal rhythm so now every time I feel like I get a palpitation I’m scared to death I take 250 mg of magnesium once in a while . Is that good for my heart?

    • Hi Barbara,

      Sorry to hear you also battle with PVCs. As most Americans are magnesium deficient, supplementing with magnesium for most people is safe. As long as your kidneys are functioning normally, and you are following the dosage indications on the bottle, it is unlikely that you would ever get into trouble from taking too much magnesium.

      Hope this helps!

      John

  64. Dear Dr. John. I had a heart attack 2 years ago which cause some muscle damage and my EF is now about 42%. I had a stress test recently which showed normal heart activity up to about 115bpm. At a higher pulse than this I was getting regular PVC’s including triplets which continued during the recovery period. My doctor advises me to keep my pulse to about 110bpm during exercise. On using a treadmill today I reached a pulse rate of between 115 and 120 simply walking at a reasonable rate on a flat surface. Does this mean that I should no longer do any jogging? I have always kept very fit and since my heart attack have been jogging regularly without always feeling good when I’d finished! What do you think? Thank you
    Richard

    • Hi Richard,

      While it is impossible for me to comment on your particular case without reviewing all your records or examining you, in general, moderate levels of exercise improves outcomes in almost all cardiac patients.

      Of course, there are always rare exceptions where cardiac patients may have restrictions on how much they can exercise. If you are not comfortable with the advice of your physician, you could consider a second opinion from another cardiologist in your town.

      Hope this helps!

      John

  65. Hi Dr John,

    Good news for me, yet also a bit puzzled. I have had between 200-1000 pvcs for say almost 10 months non stop. last saturday i noticed somewhere during the day i didnt feel one for hours. From that moment on i now only feel 10-50 every day.. sometimes even 5-20.. Its a great feeling 🙂 BUT i didnt change anything..so i do not understand WHY? I mean..if i knew what triggered this drastic decrease i would gladly continue that “something” 🙂

    questions

    1) the fact it did decrease suddenly and now for almost a week.. is that a good thing also regarding the cause? I mean this would happen more in BENIGN PVCs?

    Thanking you and crossed finger
    Richard

    • Hi Richard,

      Fortunately, your PVC burden has decreased! This was likely due to a change in your “autonomic tone” or how the autonomic nervous system interacts with the heart.

      However, this change does not indicate whether the PVCs are benign or not. This is something that can only be determined by ruling out all of the potentially dangerous causes of PVCs with the appropriate testing.

      Best,

      John

    • Hi Christian,

      PVCs have not been linked to Afib. However, a number of studies have shown that PACs may be a precursor to Afib. I have written a number of articles about Afib if you want to learn more. Here is the link: http://drjohnday.com/cure-afib/

      Hope this helps!

      John

    • I had a HM showing 30,000 PAC’s happening mostly at night despite Bystolic 10mg qd. Moderate mitral regurg and HBP (controlled). Bystolic increased 10 15 MG qd and PAC’s almost disappeared for 3 months….now they are back….not sure what to do next.

      • Hi Linda,

        Sorry to hear about all the PACs. Certainly, the mitral regurgitation or high blood pressure/history of high blood pressure may be playing a role. For PACs, generally these are caused by anything putting a strain on the atria, fibrosis or previous scarring of the atria, or autonomic influence. I would suggest working closely with your cardiologist/electrophysiologist in identifying the cause and treatment.

        Hope this helps!

        John

    • Hi Dede,

      Thanks for sharing. Yes, activation of the GABA receptor does block lower esophageal sphincter relaxation and acid reflux in this study. There is also a nice review article which summarizes the data in this area: http://www.ncbi.nlm.nih.gov/pubmed/19303900

      Unfortunately, these authors don’t tie this back to PVC syndromes. However, for some people acid reflux can be a PVC trigger so for these people anything that reduces acid reflux could possibly help.

      Likewise, activation of the GABA reception also has blocking effects to the parasympathetic nervous system. Thus, for those with vagal mediated PVCs, GABA activation could potentially help. Unfortunately, to the best of my knowledge, this has never been studied.

      There is a nice review of the cardiac effects of GABA stimulation in this article. Please note, that this article is another animal study so the results may not directly apply to humans.

      Of course, my disclaimer to all this is that anyone wishing to explore GABA stimulation for PVCs through supplements or other means should discuss this with their physician as it has never been studied before…

      Hope this helps!

      John

      • Dr. John,
        So glad you had a chance to take a look at the article. I know you’re a super busy fellow and appreciate your time. Based on my own experience, I think there is much to be studied and discovered in this area. Wish someone was interested enough to put a study together. Maybe one day…
        Thank you again for your valuable time and feedback. Happy 4th. And please thank your wife for her delightful recipes.
        Dede

  66. Thx Dr. John.
    The article is at NCBI.nlm.nih.gov/pmc/articles/PMC2275437
    The first 4 letters were lower case on the actual page. Hope this gets you there. I’ll be interested to see if you think there is a connection to some benign PVC conditions.

  67. I wanted to ask Dr. John, if you have a free moment (yeah, right) to read a quick article… We have had some talk on your site about the Vagal nerve as it relates to people’s epigastric issues concurrently with the PVCs. I read an article recently from the British Journal of Pharmacology. It is entitled “The Role of GABAa Receptors in Control of….” It talks a little bit about esophageal/gastric issues that perhaps many of us have experienced. I just thought it might be of interest.

  68. I also take magnesium and taurine. I think they both are helpful (or at least don’t make it any worse), but it was the GABA that made the real difference. Like Margaret, I had taken the Mg for several months with no effect on the frequency of PVCs. It was when I started the GABA that they resolved. I also take the taurine and think it is also effective in combination with the GABA. BTW, I have read that tachycardia and palpitations are symptomatic of GABA deficiency. I read this on line and would be curious if anyone (Dr. John especially) has any knowledge of this.

    • Hi Dede
      I ordered some GABA online because, as I told you before, we can’t buy it in the UK. The product I ordered turned out to be from a Japanese company, made in Canada, ordered from a company in Jersey (Channel Islands), and the postmark on the packet was Gibraltar! Make what you will of that!! Anyway, it’s only just arrived and I really hope it works. It would be wonderful. It doesn’t surprise me when you link GABA deficiency to tachycardia because my ectopic episodes start with a fast rate with missed beats, then slowing down gradually to a normal or even a seemingly slow rate, before gradually disappearing. I’ve been so anxious and depressed this past year wondering when the next episode is coming.
      Anyway, hope you’re well and I’ll keep you in the loop.
      All best.

  69. Stopped my PVCs with magnesium (as mentioned above) and taurine. Also, Carolyn Dean has a book on Amazon about stopping A fib with magnesium called, “Atrial Fibrillation: Remineralize your heart”.

    • Hi Lorraine
      I have that book but Mg has not worked for me. How much did you start with? Also how much taurine did you need for it to work? Finally, could you tell me how long you’ve been pvc free?
      Best wishes.

  70. Hi Dr John !

    I’m sorry to bother you again about the same issue.
    I’m a bit puzzled. I notice my PVCs and possibly PACs keep being very persistent
    I have them for 5 months now on a daily basis. never seem to really settle down. I keep having the idea i have vagus induced PVCs.. cause i have them with bending over, yawning, eating, drinking moving upper chest, deep breathing. Also i keep having the idea there is that co-relation with my GI issues. -> gassy ,bloated, burping, acid.

    anyway. I have around 200-500 of these skipped beats every day. now i know thats hardly 1% of all beats..more 0.2%-0.5%. ..yet i sometimes feel a few in a row. a year ago, before this flared up i had a normal resting echo. holter ok..pvcs and pacs on it..and gastroscopy was ok in november.

    1) Its not strange that these skipped beats never cease? I mean they are constant every day , also on the same moments of movement , eating , drinking and so on i wrote about ! Is this something that you see more?

    2) I also notice when i move, walking, climb a stair, my heart doesnt skip, yet the moment im done with that, and i sit or lay down.. poof a few clustered skipped beats.
    Is that also very common?

    • Hi Richard,

      Most adults have PVCs every day. 200-500 of these daily would be considered more than the average adult.

      As you well know, there is no good explanation why some people have disabling PVC symptoms but yet 99% of the population never feels them at all. As most people have PVCs every day of their adult lives, it is not surprising that they don’t go away.

      Many PVCs are vagally triggered. Others are triggered with activity (sympathetic triggers). For some, there is no apparent trigger.

      I wish I had more answers but there is so much that medical science doesn’t understand about PVCs.

      Best,

      John

  71. Hello, Dr. John.

    I have frequent PVC’s, and I am aware of this thanks to an implantable loop recorder installed in my left breast.

    As you know, they are bothersome, and in many cases benign. This obviously helps to ease the mind, except when you feel them. It feels like a hiccup, but imagine 200 hiccups a day (or more), except these hiccups are derived from one of the most important organs in the body. This is where the fear factor comes into play for myself, and many others.

    My question is this, do you know of any medications helping with PVC’s, other than antiarrhythmics or beta blockers?

    I ask because, I have been taking 1mg of Lorazepam (Ativan) per day, and it has helped to reduce the PVC’s. This medication releases the GABA hormone, and I have heard of the GABA/Vagus Nerve/PVC connection. I am looking for your thoughts because this could be a breakthrough in these troublesome premature contractions.

    Best regards,
    JW

    • Hi JW,

      Yes, while most PVCs are not life threatening, they can certainly be life altering. You ask an excellent question. Other than beta blockers and antiarrhythmics, another commonly used tradition medication are calcium channel blockers like diltiazem or verapamil. I have found that some people respond well to diltiazem or verapamil.

      Yes, I have seen Ativan and other benzodiazepine medications help some people. The problem is that these medications are highly addictive and have a withdrawal effect similar to alcohol. These medications may help through anxiety reduction or other mechanisms that are not yet well understood when it comes to PVC management (like the GABA receptor).

      Supplements, like magnesium and potassium, can be helpful and should be done under the supervision of a healthcare provider.

      For people with specific triggers, like gastrointestinal triggers (like vagal PVCs), may find relief from treating the gastrointestinal issues.

      Unfortunately, most of the research on PVCs has focussed on the life-threatening forms with relatively little to no research on the autonomic nervous system PVCs.

      Lastly, I cannot over emphasize the importance of healthy living to treat PVCs. Meditation, yoga, time in nature, mindfulness, regular daily exercise, healthy diet/healthy weight, restorative sleep, strong relationships all impact the autonomic nervous system and PVCs in very positive ways that we do not fully understand. I have seen many cases where a strong commitment to a holistic healthy lifestyle has resulted in resolution of PVC symptoms.

      Hope this helps!

      John

      • It absolutely helps! Thank you, Dr. John.

        Of note, I also exercise each day, drink plenty of water, take a magnesium supplement, and play with my daughter as much as I can! 🙂

        You must be a very compassionate person to answer all of the comments on this site. Well done, Sir!

  72. I am a 45 y.o. female who is relatively healthy. I started having PVCs in January. They were fairly consistent for about 3 days and then stopped. I was referred to a cardiologist who completed an EKG and an echo which were normal. I had a thyroidectomy in April for non-malignant nodules. The PVCs started again about 4 weeks post-op and have been consistent since then. I’m wondering if my unstable TSH level could be contributing to the PVCs. 3weeks post-op my TSH was 0.16 so my doctor decreased my Synthroid from 125mcg to 100mcg. 6 weeks post-op, my TSH is 7.7 so my doctor increased Synthroid to 112mcg. The PVCs are driving me crazy. I’m also under a lot of stress currently. Have you seen a correlation between PVCs and thyroid hormones?

    • Hi Tracey,

      So sorry to hear that the PVCs are back. There could be many possible reasons in your case.

      Yes, thyroid hormone abnormalities have been associated with many different arrhythmias, including PVCs. I have also seen PVCs suddenly appear after surgery. In these cases, I suspect that something about the surgery affected their autonomic nervous system.

      Lastly, it is also possible that stress may be contributing as well. On the subject of stress, I just wrote an article about a study that completely challenges the conventional wisdom on stress. You may find it very enlightening: http://drjohnday.com/believing-stress-is-bad/

      Hope this helps!

      John

  73. Hi Dr John,

    I have had a resting echocardiogramm and stress ecg one year ago. hence ..didnt have much skipped beats back then.. a holter half year ago and various EKG’s. Cardiologist told me all was fine, except pvcs..and a high heart rate which now is diagnosed as POTS. I do have a question, cause it keeps occupying my mind about my pvc’s. I already told you about the ‘relaationship’ i feel between my skips and my digestive system. But what i also notice is that often when i move or climb a stair or clean something , i experience not many problems during that short activity. lets say my hr which is always higher due to my pots when standing is somewhere between 120-150 during that activity and then when i lay or sit down after that short moment of movement.. i feel skipped beats.

    1) Could you call this recovery phase PVC’s? or is it too short of activity and too low HR for ‘the recovery phase like in a stress ecg”
    2) Is it true they are not so benign as any other PVC?
    3) Could it be its my vagus nerve that tries to brake my high hr and that is what is causing my skipped beats.. ?

    Could you give some more info about this?

    • Hi Richard,

      So sorry to hear that you are also suffering from POTS. Unfortunately, very little is understood about the autonomic nervous system–and even less on how the autonomic nervous system interacts with the heart.

      As there are few answers, here is an article you might find interesting. You can download this article from the Heart Rhythm Society’s website. This document represents the best current thinking from scientists and clinicians. http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/2015-HRS-Document-on-POTS-IST-VVS

      Hope this helps!

      John

      • Hi dr John,

        Thank you for this article/document !
        Very informative. Do you have any add ons on the skipped beats after movement or do you feel this could be all POTS related? This because i soemtimes wonder of these skipped beats fall under the term recovery phase pvcs?

        • Hi Richard,

          Hard to say on the skipped beats after movement…could just be PVCs or POTS. Most of my POTS patients report more “tachycardia” than palpitations. I personally classify “recovery phase PVCs” as those PVCs that occur after strenuous exercise.

          Hope this helps!

          John

  74. Thank you for the update, Margaret. I guess I always thought the USA was more regulated than just about any other country and am a little surprised that we’re not… At least in this one regard. What you are saying about the body using the vagus nerve and stimulation of the PVCs to shake up our ANS is very interesting and I see you are someone who thinks outside of the box. There is so much more to be researched and discovered when it comes to the human heart and how we can hurt and help it.

  75. thank you for explaining PVC I have them, had all the test, everything looks good but now im having them seems all day for several days this is the second time this has happened lasts for several days then goes away. It makes me scared to do anything physically cause I think i’ll have something happen, not sure if I should be exercising or what. thank you.

    • Hi Shirley,

      I can understand your concern. Many of my patients have the fears. Exercise is so important for long-term health. Talk with your cardiologist to see if it would be safe for you to get back to exercising.

      Hope this helps!

      John

  76. Hi Tangerinka,
    It was quite fast. I noticed a huge reduction in a few days and then the rest of them just sort of dried up in The weeks following. I’d say 90% reduction in the first couple to three days and the rest save the occasional odd beat, (comparable to the frequency before they became an issue), were gone within the next couple of weeks.
    I had tried to come off of the GABA last week and found myself out of town and suddenly in a stressful situation. I was again having PVCs about every third or 4th beat. I ran, not walked, to the health food store and got the 750mg bottle. I took one immediately and another that night. They were gone within hours and have stayed away. I will not leave home without them again.

    • Hi Dede
      I’ve tried to get GABA here in London – not possible, as European Union rules have decided it’s a medicine not a supplement so cannot be bought over the counter. It’s hard to justify this as GABA was on sale in health shops in the UK for years and years, and I never heard of anyone being harmed by it. I would say there’s probably something about GABA that the powers-that-be don’t want us to know (just my opinion of course), and it makes me all the more keen to try it. They’ve done the same here with loads of other supplements, including kava kava, which I’ve never tried but which I understand is freely used in many countries with no ill effects being reported. I believe the Hawaiians swear by it. Anyone I’m sending for some GABA online. It may be that I can get some sent from the Channel Islands where they seem to be a rule unto themselves.

      Dede, have you ever considered that the funny beats may be a way of our bodies giving our autonomic nervous systems a shake-up? The vagus nerve is supposed to be a two way thing, afferent and efferent – to the brain and from the brain – so it stands to reason that the brain may cause the vagus nerve to use our organs, ie, in this case our hearts, to stimulate a sluggish ANS. I say this because I usually feel much better in myself following an episode of many hours of these awful beats. Yes, of course this could just be from a sense of relief when an episode ceases but I’m not convinced that this is the case. I have come across other sufferers online who say the same thing. One said he had had these episodes for over twenty years without ill effect and that for a few days after an attack he feels great, his digestion is fantastic and he can eat anything he fancies. Then, as he works his way up to the next episode, he develops more indigestion etc, and the cycle thus continues. Of course, there could be 101 possible theories to explain this, but why would his digestion improve so much after an attack?
      Anyway, I saw Tangerinka’s post to you re the GABA and just thought I’d update you on where I’m at.
      Best regards. Margaret

  77. Shot question. I often read that you need amongst other tests, like Holter and or stress ECG, an echocardiogram !

    Is a echocardiogram in rest good enough or does it always have to be a stress echo.
    Cause in my country we have no stress echo only stress ecg?

    • Hi Richard,

      While a resting echocardiogram is very helpful, it doesn’t rule out coronary artery disease as the cause of PVCs. This is where the stress component is very helpful.

      The reason why I like a stress echo is that it gives you all the information of a resting echo and evaluates the coronary arteries (all without the need for an IV in your arm or radiation).

      If a stress echo is not available in your country, you could do this with 2 tests, instead of one. For example, you could do a resting echo and then a stress test using a different form of testing. This would accomplish the same thing.

      Hope this helps!

      John

  78. My son has cardiomyopathy. Is there any significant reason to stop my son from drinking decaf tea? We use hardly any sugar at all. A half a cup per gallon. He gets 1-2 cups a day.

    • Hi Ron,

      Unless there are some unusual ingredients in the decaf tea, you are probably OK. Given his history, it would be best to bring in the ingredient list so that your physician/pharmacist can review all ingredients with his medications to make sure there are no interactions.

      Hope this helps!

      John

  79. Hi Dr John,
    I am 55, still perimenopausal. A year ago after coming back from overseas and dealing with jet lag I noticed an irregular pulse.
    Several ECGs (bigemini, trigemini), an echocardiogram (fine), halter monitor and multiple blood tests (thyroid, electrolytes, cardiac enzymes..all fine)later I was diagnosed with bradycardia and PVCs. 8000 PVCs in one day and a heart rate dipping down to 38 at night.
    When I exercise the PVCs disappear. I have lots of energy, eat lots of vegetables, fruits and grains plus nuts. Occasional one cup of coffee. Sleep well at night.I am on no medications. My BMI is 20. Only supplement is B12. Feel overall great.
    Except, when I check my pulse at rest it is now 36 to 38 and irregular. Multiple PVCs in one minute. I don;t feel them otherwise.

    By the way I was a competitive athlete in my younger years and as far as I can remember my pulse hovered between 40 and 50.
    My concern is why am I so low now?

    In my teens I had a lot of dental work done. And I had lots of amalgam fillings. Still have.
    Last year before I discovered my PVCs I had major restoration done of old crowns.
    Could I have been exposed to more mercury?
    Is mercury potentially harmful to my heart?
    How much should I be worried?
    Thank you for offering so generously your advice on this website.
    Carole

    • Hi Carole,

      Great questions.

      People with a significant number of PVCs often note that their pulse is low. This is because most people, blood pressure machines, and non-medical grade heart monitors are unable to detect PVC beats. For these people, if you do an EKG the heart rate is often much higher than the pulse.

      For most cases, a slow heart rate is only concerning when it causes symptoms. Interestingly, when you look at longevity studies in humans, as well as other mammals, it appears that the slower one’s heart rate the longer the survival.

      Mercury is not a known cause of PVCs.

      Whether or not you should worry about PVCs is a question that only your cardiologist can answer after they have evaluated you, put you on a Holter/event monitor, and has looked at your heart with a study like a stress echocardiogram.

      Hope this helps!

      John

      • Thank you. I really appreciate your taking time to answer my question.
        This helps.
        I will check with a cardiologist.

  80. Hi Dr John
    Sorry I forgot to ask, do you think low iodine has a connection with premature beats?

    Margaret

    • Hi Margaret,

      To answer your questions:

      1. Iodine does not directly trigger PVCs. However, if iodine levels are not optimal this could impact thyroid hormone levels. Thyroid hormone can directly affect the heart if it is too high or too low.

      2. Low blood pressure would not be expected to trigger PVCs unless the blood pressure was so low that it compromised blood flow to the heart.

      3. Most people, blood pressure machines, etc. cannot detect the faint pulse from a premature beat. This is why many people with PVCs mistakingly believe their pulse is too “low.”

      Hope this helps!

      John

  81. Hi again, Dr John Day.

    Please could you tell me, do you think premature beats can be caused by low blood pressure? Also, is it common for the wrist pulse to feel faint with premature beats?
    Many thanks, Margaret

  82. I have a high burden of pvcs (>35% in 24 hours)that don’t respond to beta blockers or lifestyle changes, so it seems like an ablation is the next step. Generally, what is the average length and recovery like for an ablation?

    • Hi Courtney,

      With such a high PVC burden it shouldn’t be too hard to map the PVC site(s). Make sure you select a very experienced EP and hospital. Also, be sure to carefully discuss all risks with your EP.

      Most people bounce back pretty quick. For others it may take a week or two until you feel 100% again. I usually instruct my patients to hold off on heavy lifting or exercising for 5 days.

      Hope this helps!

      John

      • Thanks, Dr. John. This was very helpful. From what I’ve read the procedure is a few hours, is that right? I am going to an experienced hospital/EP (NYU) and will definitely carefully discuss the risks/benefits at my next appointment. It’s still a couple of months away, but luckily I do not feel all of the PVCs (otherwise the wait would probably drive me insane).

        Thanks again,

        Courtney

        • Hi Courtney,

          Good luck with your procedure. These procedures generally take anywhere from 2 to 6 hours.

          Best,

          John

  83. Question To the Doctor,

    Can IBS caused PVC’s and rapid pulse over 100? Is beta blockers (1/2 of 25 mg atenolol) prior to bedtime (even if bedtime is morning) the answer? Am sensitive with all medication. Haven’t had very much medicine in my life only vitamins etc. Having a lower than normal blood pressure and pulse readings from atenolol. It did take care of the PVC’s but not in the stomach. (This is only the second time I took atenolol). I have always had normal blood pressure even through this problem the past 2 weeks! It spikes when the pulse races-up to 125,(BP goes to 150/80 or higher.) Happens usually when getting up for work and on feet, subsides later. I am older (60’s female) still working and of course stress in life. Thank You for any advise on this.

    • Hi Donna,

      Fortunately, there are many different beta blockers so a different medication could be tried. PVCs don’t generally give you an elevated heart rate. Work with your physician to document this rapid heart rate on a monitor.

      Hope this helps!

      John

  84. Hi Doctor,

    What’s them recommended daily dosage of magnesium and potassium that should be taken to improve PVC symptoms? And is there an specific type of these supplements that should be taken?

    Also, are PVC’s there same as heart palpitations or rapid heartbeats?

    And lastly why would indigestion or upset stomach cause palpitations or rapid heartbeats?

    Thank you.

    • Hi Dianela,

      Thanks for reading. To answer your questions. PVCs are just premature beats from the lower chambers of the heart (ventricles). Palpitations are the symptoms of an abnormal heart beat. A rapid heartbeat is an elevated heart rate.

      PVCs don’t generally give you an elevated heart rate. Some people experience palpitations with PVCs but most people have no symptoms at all.

      For some people, gastrointestinal issues can trigger PVCs. This is likely through activation of the vagus nerve.

      For legal reasons, the use of any supplements, including dosages, should be under the direction of your physician or healthcare provider.

      Hope this helps!

      John

  85. Hi Dr John,

    Maybe its to state the obvious what im about to ask, if so then sorry 🙂
    I now have 3 months of pvc’s. I have them every single day. in the amount of 250-800 that i seem to notice. the amount varies, but i have them every day.

    questions
    1) It is normal for pvcs to be there for months and months even years every single day?

    2) Im trying magnesium citrate 250 mg, and vitamine d3, i have some deficit there in my blood test. but i still dont feel any relief. Could this take months before working, or if it dont work after months taking those supplements, it probably isnt working ?

    3) There is ,between laymen like we are, always a debate how many pvcs is in fact a lot. In what amount do cardiologist in general rank pvcs? Is 500 every day lot , or in fact for cardiologist not that many? hence day in day out for months and months even years. so not a single episode. for us sufferers every one is one too much, but how do cardiologist see this.

    • Hi Richard,

      Great questions. PVCs often wax and wane over time. Other cases may just be persistent. Everyone is different.

      If magnesium works, the effects usually pretty obvious within a week or two. I have not found vitamin D to be helpful for PVCs.

      Electrophysiologists, or cardiologists who specialize in heart rhythm issues, generally don’t get concerned about PVCs, provided there is no structural heart disease, unless people are having more than about 20,000 PVCs a day.

      Hope this helps!

      John

  86. Hello Dr. John. I am glad you made a disclaimer. I absolutely do not want anyone thinking that Dr. John is recommending what I have reported to have worked for me. This forum has offered some very useful information and tips from our host, but also from the site participants. Regarding the GABA…this is me sharing my experience alone and what has helped me. I do hope that it might some day become a useful tool for people with similar symptoms but, as our host has stated, he is not recommending this supplement nor has it been studied or shown to be an accepted treatment for this condition.

    • Dear Dede, I was soo excited to read your comments! I have tried everything to stop my PVCs with the only result that they have become stronger. My last holter 2 years ago showed some 1200 PACs and PVCs a day, now I guess I am at a few thousands. I always feel a tight chest and a massage could formerly bring some relief. Mine are triggered mainly by overthinking, heavy meals, alcohol (even a small beer), caffeine (even a sip of coffee), but even if I am avoiding all these, they are still there, only a little bit less frequent. They disturb my sleep, my work, my activity. Medications don’t help, so I bought GABA. How fast did you notice that your condition is getting better? I am starting with a dose of 500 mg 2x per day, right today.

  87. Dear Dr John,

    Some things i noticed. Lately when i start moving, like walking around or have to go somewhere with the car and i noticed more activation of skipped beats.
    I can easily feel an increase to say 3-5 skipped beats per minute. then i notice i get a bit uneasy about it, and this is like fuel to prolong the time i have those amount of skipped beats per minute. then after half an hour or an hour they stop being this much all of the sudden and return to say 10-20 skipped beats an hour.
    i know from a previous holter that almost all my skipped beats are pvcs.

    I dont know if this is normal for people who experience pvcs?
    I mean for me walking is exercise cause i have POTS but i never experienced that much skipped beats increase when walking.

    Lately i also notice that when i get more nervous or stressed my heart skips away. it never did this it always just shot up to say 120-140, it now decides to skip around even on this 120-130 bpm.

    can you explain this? Is this something you see often?

    • Hi Richard,

      As you described, PVCs can wax and wane over the day and over time. Exercise may increase or decrease PVCs. Also, stress is a strong PVC trigger.

      A heart rate of 120-140 does not occur with PVCs. I suspect something else is going on. Perhaps sinus tachycardia or a much more serious arrhythmia. Work with your doctor to get this arrhythmia documented.

      Hope this helps!

      John

      • Hi John,
        Maybe i dont understand your response, or my question was not very well written by me, but why cant you have skipped beats/pvcs when having a heart rate of 120-140 while walking or still a heart rate of 110-120 being nervous?

        I read on the net that people even get pvcs while running..and thats no problem

        • Hi Richard,

          Sorry…I wasn’t as clear as I could have been. Typically, when people are having PVCs, the pulse the record is generally low as the premature heart beats generally cannot be felt.

          A heart rate of 100+ at rest indicates something else is going on…sinus tachycardia,, atrial tachycardia, atrial fibrillation, etc. Yes, it is possible to have both PVCs and a tachycardia occurring simultaneously. My point was that PVCs alone wouldn’t be expected to give you a resting heart rate of 100+ beats per minute.

          Hope this helps!

          John

  88. Thank you for the educational information just undestanding what is happening makes me feel better I had all the tests done and my cardiologist told me I was too anxious but he never explain that pvc were benign thank yougod bless you

  89. Dear Dr John,

    I do hope you did get my mail about my POTS/Dysautonomia and ECG? I do have another question about something odd i noticed a couple of times lately. And its about my pulse in wrist. When i have many skipped beats i sometimes change my position -body- and this often works in getting less skipped beats. But while doing that, cause i then feel my wrist if it works i noticed that in some positions i CANT feel my pulse in my left wrist yet i do feel it in my right wrist and sometimes in another postion vice versa.so i feel it in my left and not in my right wrist. if i even move my upper body an inch , i feel them on both again or feel one wrist come back and the other disappear?? Is there any explanation cause i often find this odd?

    • Hi Richard,

      For some people, changing your body position can make premature beats better or worse. This is likely due to a mechanical strain on the heart.

      Some people may have a stronger pulse or blood pressure on one side of their body versus the other side. This can sometimes be due to peripheral arterial disease or PAD. If this is the case, make sure your physician knows so that appropriate testing can take place.

      Hope this helps!

      John

  90. Hello Margaret,
    I am so hopeful that the GABA helps you as it has me. Do start with a large dose… at least 500mg twice daily. Keep in mind that they fed rats 5 Gms (5000mg) at a time and the rats had no ill effects… not that this means we couldn’t have ill effects… but up to one gram (1000mg) daily is widely acceptable. It was interesting reading your post as your digestive and heart issues are so similar to mine. I don’t want to take up this site with all I’ve discovered regarding the Vagus (10th cranial) nerve and how it affects the esophagus and heart… and how GABA affects the parasympathetic nervous system which in turn affects the Vagus nerve. I just am so hopeful that you get relief. Please do let us all know. I will keep checking this forum with anticipation.
    Dede

    • Hi Dede,

      Thanks for sharing. For legal reasons, I need to mention to readers that the FDA has not evaluated this supplement for safety or efficacy. I do not recommend any supplements or treatment plans on this website. You should always discuss any supplements first with your physician as many supplements can have serious or life-threatening side effects.

      John

  91. Hi John,

    I did sent you an email on may 1st. I hope you received it, cause through FB it didnt work 🙂

    Hope to hear from you soon !

    Richard

  92. Hi Margaret,
    Yes, I was having very many and frequent PVCs prior to trying the GABA. I think the Holter showed between 8 and 12 thousand per day, depending on whether I was working or off. I was diagnosed after wearing a Holter, running cardiac labs, having a stress test and of course an interview with my cardiologist. The fact that I had few to none during exercise or whenever my heart rate was elevated was telling that the condition was benign.
    I had tried everything that had been suggested by the cardiologists at work as well as my own cardiologist and nothing worked…her next suggestion was beta blocker but she was hesitant as my systolic BP seldom goes over 100 and my resting pulse is in the high 50s to low 60s…so I went on line and tried everything that was suggested there. I was desperate. The PVCs, although diagnosed as benign, were driving me nuts. My anxiety, which I was supposed to be keeping down, was just getting worse. The sleep, which was important to PVC prevention was herder to get as I would lie quietly feeling the knocking in my chest…a viscous cycle set in. One day my charge nurse mentioned that she was taking GABA for anxiety. I studied it on the Internet and thought it might help with my PVC generated anxiety and with the vagus nerve issues that seemed to be somehow intertwined in the problem. I just knew that the PVCs and upper GI issues were related..i knew that all these issues started after a sustained high stress period in my life. I started with a very high dose…the recommendation I found was no more than one gram per day. I actually went over that initially with 750mg twice a day. The PVCs were alleviated by probably 95% within only a couple of days. After a week I went to 500mg twice a day for about a week…the PVCs stayed gone…I then went down to 750mg once a day and still no PVCs..I then went to 500mg once a day about two weeks later…still no
    PVCs thank goodness. I graduated the dose down gradually every couple of weeks. I stayed at 500mg daily for several weeks. I now am taking 200mg once a day and am so grateful that I still have not relapsed. It has been a miracle for me.
    I got the stronger dosages from Amazon on line. Since then I have shopped the health food store locally. I know it’s the GABA that’s helped. It helped my digestive issues that were associated with the PVCs as well. I did read that GABA does not cross the blood brain barrier but I’m not buying it…and when I asked one of our cardiologists at work about it, she said that there were receptors in the lower brain and throughout the spinal cord that wound pick it up. At 200mg once a day I have experienced a return of some of the esophageal issues so I don’t think I’ll try to try a smaller dose, for fear of the PVCs returning. I hope you’ll try this. If it works for just one other person, I will be so happy to have helped. Believe me, I know how disrupted your life is with this condition. Good luck! And please post whether or not the GABA helps. :O)

    • Hi Dede
      Thanks so much for your speedy reply. I’ll look on Amazon today! My current condition also started during a long period of great stress and, like you, I’ve tried loads of things without success. I have had periods of missed beats over the years which would disappear eventually, but nothing like my current situation. It is interesting that you mention the vagal issue. For years I have had intermittent periods of this awful sensation in my throat/upper chest – not pain, just a sort of pressure – accompanied by loads of mucus, which improves with movement. It has not necessarily been accompanied by the ectopic beats, but certainly is at the moment. When it first started many years ago I went from doctor to doctor – luckily I have private insurance – and also did the rounds of Chinese herbalists, acupuncturists, homoeopaths, Bowen practitioner, reflexologists etc etc. Eventually I accepted it was a losing battle. I was slim when I was young, but gained weight with my two pregnancies, during which I had dreadful heartburn – not surprising since my daughter weighed nearly 12 lbs at birth! (No gestational diabetes, had all the tests, was told she was just a super developed baby, which she was (bless her) – she has just been awarded her PhD in politics from Cambridge University). Anyway, I am digressing, but what I am trying to say is that I have such a lot of wonderful things in my life – both children have done superbly well which is all I ever dreamed of and wanted – yet all I can think about is that I will die from these beats. My son is always ordering things he thinks might help me – Q-links for my mobile to protect me from radio waves, an earthing mat to rest my feet on, Claire Weekes’ audio books; my daughter’s been making me delicious raw meals; I don’t drink, have never smoked anything ever, I drink loads of glass-bottled mineral water and, despite being vegetarian, I even tried omega 3 fish oil (which actually made me feel pretty bad). So far, nothing’s worked. I just live in anticipation of the next bout. It’s the ninth day today since my last big attack. I had an iffy day yesterday with the strong vagal feeling and about ten minutes of bigeminy, then a bit later a missed beat every three to ten beats, but it went back to normal when I moved around. I do have long term back trouble which began with juvenile disc disease as a young teenager but, despite the severe impact this has had on my life, it’s still not as bad as the ectopic beats. I strongly suspect that my vagal problems may be intertwined with my spinal ones. At the moment I’m just lying in bed waiting to see when the dreaded beats will start again. It’s truly a dreadful life with this problem and I am very depressed. I will certainly keep you informed with regard to the GABA and thank you very much for all your input. I am so so pleased that you have achieved relief.
      Best regards, Margaret

  93. I just wanted to post an update. I am now taking only 200mg of the GABA each morning and the PVCs have continued to stay away. I had a hallway consult here at the Med Ctr (I work at Johnson City Medical Center in East TN) a few weeks ago with the cardiologist here who does our EP studies and ablations. He was the first doc I approached after first noticing the arrhythmias. He is the one who laughed in my face when I told him I had just finished building a house. He laughed because he was in the middle of building a house too and said it would probably give him PVCs before he was moved in! (LOL) Anyway, after I told him my story about trialing the GABA, he said that he was going to try his patients with benign PVCs on the GABA before starting them on a beta blocker. He just wanted to see if it might help some of them. I have also spoken to 2 other cardiologists who are curious to see if it might work on their patients with benign PVCs who also experience the esophageal-gastric symptoms. Anyway, I just thought I’d give you an update. I am PVC free (except for the odd one here and there… never more than one a day… It is such a wonderful, free feeling.

    • Hi Dede
      I’m so interested to hear about the GABA. I know you’ve posted about it before. Could I ask, were you having lots and lots of premature beats before you started taking it? The general consensus seems to be that GABA doesn’t cross the blood brain barrier, although I know that’s disputed. Is there a particular form of GABA that you take? I don’t think we can buy it in the shops in the UK any more (probably some EU ruling to keep us all sick) but I will gladly order some online. The anxiety engendered by these damn beats is really getting on top of me so basically I’m willing to try almost anything (barring “eye of newt and toe of frog”!). I’d be really grateful for any further info.
      Best wishes, Margaret

  94. Hello Dr. John
    I about two months ago I started having a vacuum feeling in my esophagus I really did not pay much attention to it until I decide to check my pulse. I have been a firefighter/paramedic the last 18 years on a very busy fire department in a big city and I vast understanding of cardiology. I put myself on a cardiac monitor and there it was I was having PVC’s. I usually will have one per minute very regularly. It seems that I can really feel them when I do not get any sleep. We work 24 hours shifts and sleep is not really a option. As you can guess I tend to drink way to much caffeine to make up for the last sleep. I completely cut off all caffeine and alcohol and about 6 weeks ago. I continued having them and finally broke down and made appointment with a cardiologist. I 41 and in very good shape, and eat minimal junk food. I have been on health kick about eating fish including mostly wild salmon. My 12 lead was normal sinus without catching a PVC at the Dr office. My blood work is very good, total cholesterol of 169, triglycerides are 37. The cardiologist asked the normal family hx questions, and did not seem that concerned. He mentioned beta blockers right away. I asked him what about running other test to see what is going on first. He finally decided to put my on a holter monitor for 24 hours and I am scheduled for a echo. I have researched all about the side effects of beta blockers and I consider this a last resort. I decided to dig deeper into all triggers that might have caused them in the first place. #1 Stress in my career is off the charts, I have started to use stress relieving techniques #2 sleep, I have up my sleep and not replacing hours of sleep with coffee or the evil energy drinks. I am very good about taking a multi vitamin and B12. Three months ago I went into GNC for some new multi vitamins and the store employee asked my age and picked one out and said you need these. GNC mega man prostate and virility multi vitamin. I took these vitamins for three months. I read the label to all of the ingredients, and to my complete surprise it contain yohimbe bark extract 100mg per vitamin, this is used for ED which I do not suffer from. All the research I have done on this product says it is a power stimulant. The bottle has no warning of containing a stimulant. Could this garbage be the trigger for my PVC’s and what is the half life and how long will it take to leave my body for good? Thank you for your website I have gained a lot from it.

    • Hi DW,

      Congratulations on your commitment to living a healthy lifestyle! It looks like you have hit on the 2 areas to work on…stress management and sleep.

      You also bring up a good point about supplements. This is why I am leery about putting any chemicals into your body–prescription meds or supplements. They all can have unintended side effects.

      As you well know, any stimulant can be a trigger for PVCs. It is unclear what really was the trigger for you. We will likely never know for sure. All you can do now is eliminate any further potential PVC triggers. With regards to the supplements, I suspect they have likely cleared your body by now.

      Hope this helps!

      John

  95. Thanks for this website and the information you provide. It has been one of the best resources I have found online. I am writing regarding my wife, who has had PVC’s for probably the last ten years, but they have now gotten much worse.
    She is a 44 year old woman, in excellent health. She is 5’3″ and approximately 116lbs. She has exercised (running, lifting weights, etc) for the last 20 years. Her blood pressure is usually about 60/90 with a resting heart rate around 55. She eats healthy foods (fruits, vegetables, low sodium, etc) and has never had any health issues. She doesn’t take any medications and has never had any surgeries (except C-sections for our three children). She avoids caffeine, and has very little candy or chocolate as well. She has stopped any alcohol consumption (it was very little before). She started taking 250mg of magnesium about two months ago to see if that would help, but it has not.
    About 6-7 years ago, the PVC’s were worse, so she visited a clinic and they did a Holter monitor for 24 hours. We never got the exact results, but they told her it was just PVC’s and she should be fine. Over the years they have come and gone (never fully going away, but decreasing enough they were tolerable). Now, over the last two months, they have become life changing for her. Someone that used to run 6-8 miles per day, now has a hard time walking for a few miles without being out of breath and winded.
    We went to a local heart institute and had a consult with a cardiologist. He listened to our concerns, and acted like it wasn’t a big deal, and then he used his stethoscope and listened to her heart. He was actually shocked at how hard and often the PVC’s were happening even while just sitting in the doctor’s office. He then ordered the Holter monitor, as well as an EKG and a prescription for Atenolol.
    She had the monitor placed the next day, before we started on the Atenolol. The results of the monitor came back at 15% according to the doctor, although we think it was actually higher than that. The EKG results show a very healthy heart, although it showing she now has PVC’s and PAC’s as well.
    The first day that she took the Atenolol (half of a 25mg tablet), within 3-4 hours she was in complete amazement. All of her PVC’s were gone, and she could no longer “feel” her heart beat every time in her chest. She asked over and over “is this how it is for you all the time?”. Her breathing changed, her anxiety level was lowered, she was like a completely different person. She got the best sleep she has had in years that night.
    Now, a few weeks later, she is taking half of a 25mg tablet in the morning, and another half at night before bed… but it is not having much affect any longer. The PVC’s are back (at the same strength as before), and she is back to how things were before. We did our test result consult with the doctor last week, and he wants to wait a month or two before possibly doing another Holter monitor.
    After seeing how quickly she responded to the Atenolol the first day, is it normal for the effectiveness to wear off so quickly? And is there a reason to keep taking the medication if it’s really having no effect now?
    Any other thoughts or ideas? Maybe we need a second opinion?

    • Hi Travis,

      Thanks for sharing. I find that beta-blockers help about 50% of people with PVCs. Usually the results aren’t so dramatic or so short lived. With 15% PVCs, she would also be a candidate for an ablation. Unfortunately, you can’t suddenly stop beta-blockers as there is a withdrawal–they have to be weaned off slowly. There are certainly many other meds which could be tried. If you are not happy with your first cardiologist you could certainly get a second opinion.

      Hope this helps!

      John

      • Thanks for your quick response. The last four days have not been good for my wife. The PVC/PAC’s are now almost every single beat. I can even hear them with a basic stethoscope. It’s almost as if this has become her new heartbeat, as every single beat there is an “extra” small beat before, then a bigger beat, and then a pause.
        We have an appointment scheduled for tomorrow, but I think it’s time we get a second opinion about the issue. Do you see these type of cases, and how far ahead are you currently scheduled, and how do we contact your office?

        • Hi Travis,

          Hopefully your visit went well. As my practice is primarily hospital based, I would suggest that you work with your local physician on getting the PVCs and PACs treated. Hopefully, your wife will soon find relief!

          John

  96. Great information and well appreciated but the little colorful blocks on the side are annoying and cut off many words.

    • Glad you liked the info! I’m sorry the share buttons aren’t formatting properly for you. There is a “hide” button if you hover below the blocks that will make them go away.

      John

  97. Hi Dr Day
    Due to an irregular beat, I have had my heart investigated four times over the past 19 years, the last time about two years ago. Each time I was told it was structurally normal. When I was first investigated, I even had an angiogram which was apparently clear and I was told I just had benign missed beats. These would disappear for years, then reappear with stress. I have never (touch wood) had chest pain or fainted, though do feel a bit weak with them and my anxiety hits the roof. More recently, I have had a very stressful few years and had a resurgence of the irregularity. When the stress resolved I thought I would improve but this hasn’t happened, my thoughts are now on my heart 24/7 and I have become very depressed. I recently went to my GP (general practitioner – I’m in the UK), who told me my heart sounds were completely normal and I had a regular beat when she felt it. I told her that I was having episodes of the “beats” every 7-12 days, lasting several hours each time. She started telling me how great warfarin was. After I left the surgery, I had to take a valium and cannot go back. However many people tell me to go back, I just can’t. The anxiety is just too bad.

    Thus I hope you will forgive me for writing to you. I know you can’t diagnose me online but I’d just like you to tell me if the following pattern fits with pvcs or pacs: the pulse may start a bit fast but doesn’t stay fast, in fact, it can feel quite slow. First, it feels like 4 or 5 regular beats, then a pause, a thump and a flip flop feeling. The pattern changes over a few hours, it can feel quite faint, then gets stronger, sometimes it is clear bigeminy, other times it pauses after various numbers of beats. The number of regular beats increases gradually so that eventually it feels fairly normal, then another pause/flip flop comes. It does not feel chaotic but, due to my anxious state, I keep worrying about this. After several hours, I can often terminate the episode by running around the house, though this is very hard to do as I have quite severe arthritis. A cold shower sometimes does the trick as well. I know my autonomic nervous system is up the creek but, since the heart is under ANS control, knowing this does nothing to alleviate my anxiety.

    Sorry to sound so neurotic but at the moment that is exactly what I am. As I’ve said, I know you cannot diagnose me online, but please could you give your opinion about the pattern I’ve described. I cannot – CANNOT – visit a doctor’s surgery the way I feel at the moment.

    Many thanks and just to say I think it’s great how you answer people’s posts.

    Margaret

    • Hi Margaret,

      Your symptoms sound like they may be consistent with premature beats. The only way to know is to document these beats with an EKG monitor of some sort. This monitor could be through your physician’s office or you can buy your own. The monitor I purchased for myself was through Alivecor. You really do need to work with a caring healthcare provider at this time. If your current provider is causing you too much anxiety then perhaps explore finding a different person.

      Hope this helps!

      John

      • Hi again Dr John

        You stated in a previous reply that people with pvcs often have a falsely low heart rate and that a monitor such as Alivecor could pick up the real rate. Please could you tell me, is it ever possible that premature beats occur along with a SVT, i.e. you could feel a wrist pulse of, say, 70, while the real pulse that the Alivecor picks up is 140? This is a hypothetical question but I’d be very interested to know if this ever occurs.

        With very many thanks for your time.
        Margaret

        • Hi Margaret,

          Yes, it is possible to have premature beats during an episode of SVT. For most people, SVT is going so fast that it is hard to count anything. Yes, EKG monitoring of an SVT would allow you to accurately determine the rate.

          Hope this helps!

          John

          • Hi Dr John

            Many thanks for your reply. I have sought an answer to this question all over the internet without success and am very grateful to you for clarifying this so succinctly.

            Thanks again.
            Margaret

  98. Dear Dr. John:

    I am a 52 year old woman experiencing daily PVC’s and PAC’s that occur for hours at a time. Back in November, I had an ablation for A-fib, but ever since the ablation, I’m suffering with these PVC’s/PAC’s. My doctor took me off the tikasyn to see if perhaps it could be causing these symptoms. But, I’ve been off the tikasyn for three days now and am still having the same issue. Obviously, it wasn’t the tikasyn that was causing this daily occurrence.
    The next direction they want to take is admit me in the hospital to try me on another anti-arrhythmia medication. I don’t trust being on these powerful drugs!
    Anyhow, my question for you is, could having the ablation procedure be the cause for these PVC’s and PAC’s? I never had an issue with them before the surgery… I only experienced occasional skipped beats prior to my periods.
    I’m very scared and thinking maybe something may be going on with my heart that the tests I had prior to the ablation didn’t pick up.
    I look forward to your response… Thank you so much! Judy

    • Hi Judy,

      New PACs/PVCs after an ablation is something people can experience although it has never been described in the medical literature. This could also be due to a heightened awareness or autonomic and/or electrical changes to the heart after an ablation. Antiarrhythmics can help if the symptoms are unbearable.

      Hope this helps!

      John

  99. Dear Dr John,

    Maybe a “strange” question, but i notice taking my pulse when i have my skipped beats, mostly PVCs holter showed a while ago, the following pulse : beat, beat, beat, little beat, beat, beat no pause , just the same rhytm but one of the beats feel like its not complete or less powerful, but you can feel a decent pulse beat when taking my pulse.

    Is this still technically a skipped beat -like a pvc and pac – ?
    Does a pac/pvc need to have a pause in the rhytm to even call it a pvc or pac or skipped beat?
    Some cardiologist wrote on a heart forum, that most skipped beats and PVCs are vagus induced and therefore never ever can harm you, cause they not originating from the heart? although i fully understand the involvement of the vagus , i do fail to see this statement to be true, cause arent it cells in the heart itself that cause the misfiring?

    • Hi Richard,

      PVCs and PACs are determined by EKG not symptoms. Symptoms are often unreliable. The vagus nerve can trigger either the atria to fire prematurely (PAC) or the ventricles to fire prematurely (PVC).

      The only way to definitively answer your question would be to record your EKG while you are having these symptoms. This could be done at your doctor’s office or you could do your own EKG at home. Alivecor has an excellent system for $70 USD that works for the iPhone or Android phones. By recording your EKG while you are having these symptoms, the answer will be readily apparent.

      Hope this helps!

      John

  100. Hello , I’m 37 yrs old and stated feeling pvcs in the last couple years. I have had all the tests twice . Recently my cardiologist started me on a beta blocker which worked ! It significantly reduced my pvcs to almost none at all. However during my cycle (after mentruation) my pvcs always get much worse for a week or more. This unfortunately is happening even on the beta blocker. Is it normal to still get quite a lot of pvcs even on a beta blocker? And any thoughts on the relation to hormones ? Thank you so much

    • Hi Coegema,

      Great questions. I find that only about half of my patients are helped by beta-blockers. Many women report that PVCs may wax and wane over their monthly cycle due to hormone fluctuations.

      Hope this helps!

      John

  101. Had been on Atenolol for 15 yrs. Had palps forever, but several mos ago palps began, and never stopped. Had all the tests which appeared benign Tried Topral XL that wasn’t good. Went back the atenolol 25 mg. No better. Now will begin plain Topral 25 mg. If you are on these beta blockers for a very long time -could that lead into having a Pacemaker? doctor suggested Ablation? I’m a senior.

    • Hi Zelda,

      Beta blockers do slow the heart rate. In very rare cases, if a patient absolutely has to be on a beta blocker and the heart rate is too slow, a pacemaker is sometimes considered. However, this is a very usual situation.

      Ablations can be an excellent option for people with an extremely high burden of PVCs (generally more than 10% of all your beats are PVCs). At experienced centers, age is generally not a consideration as long as the person is in good physical shape.

      Hope this helps!

      John

    • Hi Richard,

      Great question. The senior author on this paper was one of my former mentors at Stanford University. The study population were veterans at the Palo Alto VA. I spent a lot of time working at this VA during my cardiology training at Stanford. I also supervised many of these treadmill tests at this VA.

      This study did not separate out those with absolutely no underlying heart disease versus those with underlying heart disease. This was a relatively sicker VA population which tends to have much more heart disease.

      In this study they noticed that those with more PVCs were more likely to have a bad outcome. This is totally expected. A large percentage of patients with PVCs on a treadmill study at a VA facility will have some degree of underlying heart disease.

      Any risk from PVCs is primarily driven by underlying cardiac disease. If there is absolutely no underlying heart disease then the risk is very low.

      To understand the risk of just PVCs, you would need a study that rigorously rules out coronary disease, valvular heart disease, heart failure, etc. and then follow patients for their long-term risk with PVCs. This study did not due that. Based on my experience at this VA, most of the veterans who had a treadmill study likely had some degree of coronary artery disease.

      Hope this helps!

      John

  102. Hi Dr John

    I’m new to this and have been feeling the sensation in my throat and sometimes it makes me cough. I have been to see doctors at urgent care and today my pcp. They suspect PVC but haven’t been able to catch it. I do have a device that I take a short ecg on my phone it’s called Alivcare. So yesterday I got several I believe and one that I couldn’t recognize but I think it’s a PAC. Well I haven’t had any holter done yet and I’m getting nervous because I feel it through out the day. It’s very worrisome for me. When I have them I only feel it in my throat, but no other noticeable symptoms. I felt my pulse and it felt like a pause in between beats when it happens. Need some advise to help ease my mind and what I should mention until I get an ok for a holter monitor.

    • Hi Christine,

      So sorry that you are experiencing bothersome PVCs. Keep working with your physicians to make sure these are the non-lifethreatening forms of PVCs. I find that a Holter and stress echo are two good tests to start from for my patients with newly diagnosed bothersome PVCs.

      Hope this helps!

      John

  103. Hello again Dr. John,
    I was reading tonight an article in the British Journal of Pharmacology entitled “GABAb receptor-mediated effects on vagal pathways to the lower oesophageal sphincter and heart”. This is good stuff. Especially under the “Introduction”, the second paragraph down discusses how “GABAb inhibits transient relaxations of the lower oesophageal sphincter” in experiments on ferrets (which react like humans in this regard). Transient lower esophageal relaxations are the primary cause of gastro-esophageal acid reflux in humans and ferrets according to the article. It doesn’t get into how this may or may not relate to PVCs but I know, as I’m sure many of your readers know, that the PVCs feel almost like a side effect to the gastro-esophageal issues.

    • hi Dede,

      i was wondering, do you feel your skipped beats on different spots on your chest?
      i can feel them in my stomach then hrs later left chest, then even right sided chest. Im astonished i almost cant find a single person that feels them on different spots.

      • I feel them in different parts as well. I have felt them on my left side, in my throat and in the center of my chest.

  104. Dear Dr John,
    I might have some difficult questions, but i feel they might be interesting , not only for me.

    Could you explain , or is there a possible explanation, why people, like me, can feel their PVCs on different spots on their body? I can feel the skips under right ribcage, on left part chest, on sternum, or almost under my throat/high sternum? these spots can change during the day or over night!

    Also why is it possible, for me at least, to trigger skipped beats when pressing on sore spots on my chest, where i at that moment already experienced my skipped beats?
    Is this nerve involvement? as in because it causes pain the vagus nerve responds?

    raising my arms up can trigger PVCs! is there any explanation? i used to be afraid i have blocked arteries because of this.

    and last question, as a sufferer from PVCs i often wonder : i have had a normal rest echo one year ago. a normal stress ecg. So my heart seems to be ok. The general rule is, when your heart is structuraly healthy, PVCs arent dangerous ,just a nuisance whether you have 50 or say 1000 . So if you have the “all clear” a year ago , how do you know if your heart is still structuraly healthy say in 2 or 4 years? in other words, what is the general consensus about this? time frame PVCs will remain benign because your heart echo was fine x yrs ago?

    • Hi Richard,

      Great questions for which there is little to no research. There is a concept called “referred pain.” This is where pain may be in one part of the body but felt in a completely different part of the body. I suspect that PVC symptoms for many people behave the same way.

      Many of my patients have reported that changes in body position may increase or decrease PVCs. I suspect that this is likely due to mechanical changes to the heart as well as potentially changes to the autonomic tone.

      With regards to when should you be tested again to see if the PVCs are still non-life threatening, this is really a judgement call between the cardiologist and the patient. There are no hard and fast rules here. In my case, I will generally re-test if there has been a change in their clinic condition or after a period of time. This period of time varies from person-to-person and once again, is really a judgement call.

      Hope this helps!

      John

      • Thx dr John!

        I will not try to take too much of your time, but i would like to ask some things regarding your answer.

        The feelin’ in different spots on the chest is a puzzle for me as well, i sometimes think it has to do with gas, gerd and vagal response.

        the bodily positions are indeed weird. the mechanical changes you are talking about, can you explain this a bit more? Bending over for instance is one of them, could something “push” against the heart.. due to hernia diaphragmatica? and what could it be with raising arms? Its not that the heart cant pump the blood up through the arms?

        About the re-testing thing. On the internet i read about a lot of people having pvcs for years. on and off. varying in amounts also. yet most of them dont get retested cause the heart was tested ok and so nothing to worry. Dont matter if there are 100 or 1000+ . Going back too much times for the same problem might give the or some doctors a hypochondriac feeling about you. So im still puzzled when “you as a PVC sufferer” need to feel the need to get retested? Take me for instance , if my echo was fine a year ago, i can with a reasonable certainty go through my pvcs for some more months or years before retesting?

        I know these are tough questions, sorry for that

        • Hi Richard,

          Feeling PVCs in different positions or triggering them by having them by doing certain things is something that varies from individual to individual. Regarding retesting, this is a judgement call between the patient and the physician. There are no guidelines when it comes to retesting.

          Best,

          John

  105. Greetings Dr. John,

    I have written before earlier in the year, and I am updating you right now. After trying magnesium pills which did lower my PVCs from about 26 – 17000 I agreed to go on beta blockers. It has helped quite a bit, and four weeks later and 8 pounds heavier, I was just wondering do people get off beta blockers? Or do they need to stay on them for life? I realized this is something my doctor and I will talk about, but I was just wondering in general what the thought was in the medical community. Thank you for your time

    • Hi Sally,

      Glad to hear the magnesium offered some help. Yes, weight gain with beta blockers is common, especially with women. Beta blockers can be discontinued if you and your doctor agree to do so. If so, beta blockers should be weaned slowly to prevent a rebound effect.

      Hope this helps!

      John

  106. Hi Dr. John,
    You had mentioned “autonomic tone” in an earlier comment. That is very interesting. I was on call in the hospital a couple of weeks back and was taking a short cut through the cath lab on a Saturday night. I ran into one of our cardiologists. She was at the scrub sink so I stopped to say hello. She isn’t MY doctor but she is a really good one and considered by most around here to be one of the best we have. I mentioned my benign PVCs, gave her a brief history of the GI involvement and told her how I had started taking the GABA after reading up on it and that it had worked like magic on my ectopic. She asked me a lot of questions about my symptoms and the conversation became centered around what she called Vagal Tone. She apparently is well aware of the relationship between the heart and the GI symptoms that I and so many sufferers like me have reported. I was not surprised. She is such a super sharp doctor. She said that there was a definitely a link between Vagal Tone, the autonomic nervous system and GABA levels. She said it made sense that the supplement might have worked to resolve the PVCs since, although the literature says the GABA does not cross the blood brain barrier, there are clearly receptors outside of the brain. She said she had not heard of anyone trying the GABA for this application before. She added that she would like me to try to reduce and wean off the supplement as there was no research to show any long term detrimental effects. I will follow her advice but I’m not too concerned. They fed lab rats 5000 mg a day and there were no toxic effects. Still, it is a neuro transmitter and I respect her opinions.
    Last week I read an article that stated that in Japan GABA is actually used as an ingredient in chocolate goodies and caffeine drinks to reduce the effects of the caffeine, which makes sense since GABA is a caffeine blocker.
    I am disappointed that my personal cardiologist wasn’t up to speed on all of this. I know you all must have plenty of conferences, meetings and publications. I wish that a few of you all would do some serious research into how to treat Vagal tone issues as it relates to benign PVCs. Because when you experience them as I have, they may be considered benign medically, but they are truly awful and can rob a person of their quality of life. I liken it to a case of hiccups or a dry chronic cough… Hiccups or a dry cough may be benign, but if you had to wake up with either one, tolerate them constantly all day and try to fall asleep every night with them…. Thank you for taking the time to read this.

    • Hi Dede,

      Once again, thanks for sharing! There is so much we don’t understand about the brain/autonomic nervous system and the heart. Perhaps in time…

      All the best,

      John

  107. 28 year old female, no known serious health issues. I had a period of PVCs lasting several hours one night and it freaked me out so I went to the ER. They did an ECG and the doctor said it’s very common and there’s likely nothing wrong. Since that extended period I’ve only had them in short waves here and there. I followed up with my primary doctor who repeated that info but referred me to a cardiologist just to be sure. The problem is that the cardiologist can’t schedule me in for a month and I’m due to travel internationally for a couple of weeks before then and I just feel extremely stressed and anxious about not having more information before then. Aside from the PVCs, I have been having anxiety issues and also some intermittent chest pains, sometimes sharp pains down my sternum other times dull pains to the right or left of my sternum. Should I try to find another doctor before I leave or just assume I’m part of the 99% for whom it is benign and not worry about it until I get back? Also, I have reflux issues occasionally and I read that ranitidine can interfere with heart rhythms and that scared me so I haven’t taken any since the PVC episode happened. Is there something else I can do to relieve the reflux? I don’t get heartburn exactly but a stinging/swelling sensation in my throat, it sometimes makes me feel like it’s hard to breathe and can trigger a panic attack. Which can then cause more PVCs, so I feel like I’m kind of screwed either way when I get reflux. It’s especially horrible during pregnancy for me and I’m thinking about becoming pregnant soon if everything checks out with my heart. Last time I took 150 mg twice a day every day and I want to have a gameplan ready to try to avoid that next time.

  108. I am not sure what 10,000 steps is….maybe four miles. I cant manage that but do things about 20 min. Three times a day. When under stress rest is the best thing. I keep reading about the vagal nerve so i eat slow small portions. I never knew that.
    Laura

  109. Hello everyone, i ‘ll share with you my experience with PVCs. I am 26 years of age and i have PVCs nearly everyday since i was 21. I have tried many medications. All b-blockers were ineffective against my PVCs except from one, Bisoprol. I started taking Bisoprolol when i was 23 years old in the low dosage of 2.5mg (1/4) daily. Before i had tried anti-depressants and other anxiety-associated meds with failure (Dumyrox,Lexotanil,Cipralex and a year before Ladose, Effexor). My life came almost back to normal PVCs had decreased a lot and for about two years i felt wonderful. When i turned 25, the PVCs came back for good. Bisoprol had no effect, instead i had blood pressure of 10 and average heart rate 50-55 beats per minute. I had all tests done , triplex ,holter monitors , stress echoes , blood tests( thyroeid, etc) and all came normal. I had about 1000 pvcs a day. I know it’s a small number but they caused me a terrifiyng feeling each and every one. I am also an athlete, i play basketball, and many times in the recovery phase i get a lot of them, but i have learned to ignore them. I have also tried magnesium suplemments with failure. I know some things that cause them are, the rising adrenalin in basketball or in panic attacks and stressed moments. The worst thing is when i lay in bed at night. The doctor said that i have about 40-45 beats per minute at sleep and many times i wake up from pvcs or i can’t even sleep. When i am sleepy and in bed , pvcs come with bigeminy, trigeminy episodes and they are pretty annoying. I have changed my medication in verapamil on September ( 120mg daily) and my heart rate came back to normal 65-70 beats per minute, and one holter monitor showed only 35 PVCs one day, and there were days that i felt only a small number of them. But now (still on verapamil) my heart rate is about 55-60 beats per minute and i have these bigeminies and trigeminies at sleep, and i don’t know what to do anymore. Dr John, is there any connection with PVCs and low heart rates ? My physician told me that sometimes PVCs happen in a “window” of beats ( for example when my beats are below 50 bpm or above 120bpm). B blockers will decrease my heart rate and cause more PVCs as in the past. What medication could i try next?

    • I find that beta-blockers are effective in about 50% of the PVC cases I see. Sometimes, a patient may respond differently to one beta-blocker versus another.

      Occasionally, I use verapamil. I find that only about 25% of patients respond to this medication.

      If patients have a lot of PVCs, at least 10,000 per 24 hours we will consider an ablation. Other options include an antiarrhythmic.

      With regards to heart rates, PVCs, and beta-blockers there is a lot of confusion. For non-PVC patients, beta-blockers slow the heart rate. Also , many PVC patients have a falsely low heart rate. This is because many PVC beats can’t be felt. Thus, a patient could have a heart rate of 80 with every other beat a PVC but the pulse will only read 40 (PVC beats are often not felt).

      Thus, in PVC patients, sometimes the “pulse” increases with beta blockers. This is because as beta blockers suppress PVCs the deleted pulse appears faster.

      If you want to know what your real heart rate is, the Alivecor EKG app is a great option. With this app you can actually do your own EKG and see what your real heart rate it.

      Hope this helps!

      John

  110. Dear Dr. Day,
    Thank you again for this forum. I am getting a lot out of the emails on healthy living as well. I found an article today that talked about painful PVCs as Richard says he experiences. Thought I’d pass it along for his sake. coronarychronicle.BlogSpot.com/2013/03/pvcs-and-vagus-nerve.html

  111. Dr. John,
    I hope I am not wearing out my welcome but I wanted to direct Richard to an article on line that addresses PVCs and Vagal tone. It talks about painful PVCs such as he experiences. It is an interesting article and helps to explain the relationship between the GI issues and PVCs. I stopped at the scrub sink in our cath lab today and spoke to one of our cardiologists. I told her about how the GABA had resolved my PVCs. She was able to explain perfectly how this was possible and seemed surprised that I had come to the idea of taking GABA. She said there was nothing wrong with taking it but that I should take as little as needed and to wean off of it as soon as possible.
    I hope the article on the internet helps Richard… https://www.reddit.com/…to_those_who_suffer_from_palpitations_read… if that doesn’t take you to the article, google.com and then type in PVC’s and the Vagus Nerve and look for the article. It appears under 2 topics, the 2nd one is coronarychronicle.BlogSpot.com/2013/03/pvcs-and-vagus-nerve.html
    Best and thank you again Dr. John

  112. hi Dr John,

    sorry for writing to you again. I agree its a vagus nerve digestive issue in my particular case. Could you please think with me about what im about to write.
    I often feel pressure just a bit right of my process xiphoid,like a gassy pressure like feeling which triggers many pvcs with movement and especially eating and drinking. its a dyspeptic trapped gas feeling. i burp like crazy. than after hours it suddenly can all move to theleft, so then the pressure feeling is way more left side of xiphoid process, say ,draw a vertical line from left nipple to below and on left ribcage? SAME gassy pressure,,dispeptic indigestion feeling. and then the pvc are more felt left side sternum and from the position left , stomach area..

    What i want to ask. the fact it moves from right to left,so the same trapped pressing full gas feeling , i almost have to conclude the pressure feeling what brings the pvcs must be either air, or trapped gas? what else could it be that is able to move from position?

    • Hi Richard,

      I am so sorry to hear about all of these digestive challenges you are having. Unfortunately, I really am not able to advise or diagnose your condition through the internet. I would suggest working with a functional medicine physician and a gastroenterologist to help sort out these digestive challenges.

      Best,

      John

      • Dear Dr John,

        Thanking you for your dedication. I will add that i have had a gastroscopy 5 months ago and an echo. both were fine. only a hiatus hernia diaphragmatica. I do have some GERD. Our system works different, we can not visit a specialist ourselves. we need a referal. on the cardiology side i have had my standard ECHOcardiogram, stress ecg and several ecg’s and a holter. for my gp and cardio , and gastro-enterologist , there is nothing sinister going on, yet no one can explain my symptoms. So im in a bit of a void. 🙂 I understand , and respect its impossible to give a diagnosis over the net, also i understand the position your in as a cardiologist. you always have to be careful. So i will make some f my questions more general, although related to what i experience..

        1) Having PVCs , even 200-500 a day, especially after eating and the feelin’ there is gas/reflux relation as a trigger for my PVCs, with all my tests being fine, it should be not a very dangerous problem, yet a very nuisance one?

        2) For a person having these PVCs, and i feel all of them, having those PVCs gives a feelin’ that my heart isnt FINE anymore, yet i understand that when they are vagus induced, its nothing more than a hiccup or misfire and doesnt have a clinical significance?

        3) Often after having many PVCs i have sore packs. so my chest muscles hurt more. is this normal? or easy to explain?

        4) The PVCs just started to act up more for the last 2 months, before that i had more arousal and my heart rate seem to be higher than it is in general for the last 2 months. also i feel more stomach digestive issues. as in gas .. is it , not uncommon, to have an increase because of this?

        5) Being on omeprazole for years and years, and knowing omeprazole is not that great, but having digestive issues like gas and reflux that seem to co-relate with my PVCs, and with no specialist left to visit cause they give me a green bill of health :).. what is the best way to try to diminish the digestive issues cause they seem to trigger my PVCs? i am almost certain of this, cause when my full gassy feeling is under right ribcage , the PVCs start there. and then after hrs the full gassy feelin moves to theleft chest..and then i feel the PVCs there.. and many burping..

        I hope you can answer my questions. I understand the difficulty, but i hope you can shed your light in general on these kind of problems.

        thanking you

        • Hi Richard,

          Let me try to answer your questions.

          1. 200-500 PVCs a day is more than what I typically see but no where near some patients who may have 20,000 to 40,000 PVCs daily. While the total number of PVCs matter, what the heart looks like structurally is probably more important. Fortunately, you report that all of your tests have come back normal. Only your cardiologist, who has personally evaluated you and has carefully reviewed all of your studies, can tell you if your 200-500 daily PVCs is something to worry about or not.
          2. I have found over the years that PVC symptoms do not predict clinical significance. Anecdotally, it seems like the PVC patients that I tend to worry about most, or those with life-threatening conditions, often have minimal or no symptoms at all.
          3. Sore pectoralis muscles with PVCs is not a common symptom but one that I have heard before. Not completely sure on the mechanism of this symptom. It likely has something to do with tensing up your muscles with each PVC multiple times over the day.
          4. PVC symptoms tend to wax and wane over time. This is likely due to changes in autonomic tone. This could also explain the correlation with gastrointestinal symptoms.
          5. Omeprazole, and other proton pump inhibitors, are not great long term medications. They cause many malabsorption problems. For example, vitamin B12, magnesium, calcium, and other micronutrients are not absorbed properly. This micronutrient deficiency, especially with magnesium and calcium, can affect the heart and PVCs. This is a medication that has to be fully discussed with your prescribing doctor to make sure you still need it. Of course, never stop a medication without first discussing it thoroughly with your physician.

          Hope this helps!

          John

  113. Oops, I forgot to mention… I also take 2 tums every night before sleep but I doubt this is very significant in alleviating the PVCs.

  114. Hi Richard. I read your post. Interestingly, you and I have exactly the same symptoms..even down to the sitting slouched aggravating the symptoms. Perhaps that means our conditions are the same. And IF they are, then maybe the treatment that has worked for me, might work for you. It sounds too simple and easy to be true, but it has been like a miracle for me. Even if it doesn’t work, it won’t hurt you any more than taking any other health food store supplement. GABA is a naturally occurring substance in your body. I believe in my case, I don’t make enough. I believe that with the supplement my body’s parasympathetic nervous system is stimulated to a therapudic level and is able to reduce anxiety (which I honestly am unaware that I am having) and somehow influence my vagus nerve in a way that my digestive issues as well as the PVCs are greatly alleviated. I am currently taking GABA 750mg every morning as well as L-theanine (a compound from green tea). Other than this I am taking absolutely NO coffee or tea (this means no decaf as well) and no chocolate. Also no large heavy meals, no hot food or drinks and no extremely cold or iced drinks. I also have abstained from spicy foods. I hope you will try this combination of therapies. If it works for you as well as it has worked for me you will feel so much better. I do still have a few PVCs here and there but I would say less than 5% of what I used to have.

  115. Dear DR John, I Just was tested with a 24 hour Holter and my Doctor said they were benign and mostly PAC’s with a few PAC’s. I posted about a month ago and in that time I have given up all alcohol reduced my coffee intake and started meditating. The changes in the last ten days are very positive to say the least. My question is I some time I get a heart beat with two or three beats that are about 2/3s quicker than the regular beat. They are not the very quick double beat. What are they? Thank You for being here the last four months when I was under a lot of stress. Just following this site really helped me stay on track and stay focused and some what positive. Thank You Bill

    • Hi Bill,

      So glad to hear things are better!

      It is hard to say what the beats are that you are feeling. The only way to know would be to document them. This could be through a Holter or event monitor with your physician or you could document them yourself with a smartphone EKG app like Alivecor (cost of about $70 USD).

      Hope this helps!

      John

  116. Dear Dr John,

    i am more and more convinced my PVCs are related to my stomach or the lower esophagus sphincter of my esophagus. I often notice that after meals, and especially when it gives a full bloated gassy feeling afterwards, my PVCs come up. they even hurt like sharp twinges. I have to burp a lot and sometimes i feel some reflux in my throat..
    I know i have a hiatus diaphragmatica and i have GERD. Last november i had a gastroscopy but besides the hernia diaphr. nothing outof the ordinary was noticed.
    When these PVCs are present, i can also trigger them by bending over, or slouched sitting position etc, But it all starts somewhere around my stomach. Like i wrote earlier, my echo in rest was fine. stress ecg was ok. I dont know about my coronary arteries, but my cardio isnt worried that my PVCs come from blockage due to normal stress ecg.
    What puzzles me is when i keep relating my PVCs to my stomach most doctors say “no way”. but im pretty sure. just yesterday i ate late in the evening, a bit to quick also and poof ..hours of bloating, gass ,burping and many many painful sharp PVCs..
    Is this vagus related? and what would you recommend? I have taken omeprazole for many many years , and i am bit afraid to keep taking them due to latest literature that omeprazole might cause heart issues. but not taking anything isnt working also..

    my gp keeps saying its anxiety but i know its not. its stomach related. What do you advice your patients when they come with these kind of explanations of their PVCs..?

    thanking you

    • Hi Richard,

      It sounds like you may have at least a component of vagally mediated PVCs. You are correct in that there is a growing link of heart risks, as well as malabsorption issues, with omeprazole and the other proton pump inhibitor medications. To find relief it sounds like you need to find ways to minimize the gastrointestinal symptoms. In addition to working with your cardiologist, you may also want to work with a gastroenterologist.

      Hope this helps!

      John

  117. Dr. Day,

    This is a great article and blog, very glad I came across it in my research. I am a 50 y/o male that was recently diagnosed with PVCs. Admittedly a am a pretty anxious person which reared it’s ugly head with the passing of my mother 8 years ago and all the family tension that came with it. It’s all worked out now, but I don’t think I have ever shed the anxiety and now other life issues make me more anxious than I should. Around 2 years ago, I was put on a low dose of Liprinosil for pre hypertension due to family history. A year or so ago, I went in for a routine Colonoscopy. When they brought me into the room for the procedure and hooked me up to all the machines, the nurse who was monitoring casually asked if I was experiencing any chest pain. I was actually quite relaxed, and asked if I should be expecting some. I assume all was well because the procedure went forward and I woke up! I think the assumption was low electrolytes from the test prep were causing the issue. I jus t went on for a routine physical, and the my doctor noticed PVCs on the EKG. She said she would wait for all tests to come back and then we could decide how to move forward. I have already seen the results of blood and urine tests, everything was in normal parameters. I have to admit, my anxiety level is a little high right now. Knowing about this new issue with my health, and the anxiety that goes with it, seems to have a compounding it. Considering all these facts, is it worth convincing my doctor that I want to go through further tests? The majority of my anxiety comes from the fact that I live alone and have no assistance if a medical emergency occurs.

    Glenn

    • Hi Glenn,

      I would at least work with a local cardiologist to make sure these PVCs are the non-life threatening variety. For most of my patients, just knowing that their PVCs are not life threatening, and that everything is OK with their heart, helps with their anxiety–for many, this knowledge makes the PVC symptoms diminish with time.

      Hope this helps!

      John

  118. Hi Laura and Richard.
    I am going to pick up the Ashwaghanda. I am having amazing relief with the GABA. I was taking 500mg morning and again in the evening. I am down to taking 750mg once a day and still only having occasional PVCs. I take “Nighty Night” tea at night. It is a compound containing Passionflower, which was recommended along with the GABA and Ashwaghanda. Richard, I hope you will try the GABA. I now swear by it. I think that absolutely NO caffeine or chocolate has been part of my answer as well. I am VERY careful now about not eating or drinking anything hot or extrememly cold if possible. As long as things are cool to lukewarm my Vagus doesn’t get too reactive. Laura, how does the Ashwaghanda affect you? Do you notice a reduction in the PVCs and if so, how do you think the Ashwaghanda makes that happen?

  119. I use gaba and ashwaghanda at times too….i had been on hydrocodone for years and just read that could have the qt prolongation thing like sefatives do….luckily i do not have it.

    Laura

  120. Dr. Day,
    One of the best articles I have read. I now need to read the blogs mentioned. Last year was an extremely stressful year and as a result I think anxiety is wreaking havoc with my body and my heart specifically. I do have mild COPD and due to some pain meds knocking my 02 sat. level to 43 I am currently on supplemental 02. Other devastating things happened during the year to cause more stress. I am under the care of a cardiologist who referred me to a cardiac electrophysiologist. I am currently on the Heartrak monitor for a month. After the first week the electrophysiologist said that he saw no Afib or flutter. No arrhythmias.The symptoms hit all of a sudden…light headed, strange chest feeling, sometimes palpations, urgency to urinate, occasional shortness of breath. Then the BP goes way up and it wipes me out. I do know I have pvc’s from seeing the ECG. Three years ago I had an angiogram which showed I had a strong heart and no blockages. I am overweight and working very hard on that. I am just trying to get to figure out what is causing all this, is it my heart(pvc) or just anxiety or both. I will be relieved if in the end there is still no Afib. I do not like taking some of the meds I am currently on and feel like they were given for “just in case”. Can one get off some of these meds….ie. blood thinner, flecainide? I am extremely meds sensitive and the fewer the better. I just want to get back to my old self. So at this point I will work on all your suggestions with all the energy I have. I am an extremely young 72 and have much to do yet.

    • Hi Lynne,

      Thank you so much for your kind comments! Also, I love your desire to turn things around!

      Probably the most important thing for you would be to work with your electrophysiologist to find out what arrhythmias you actually have and what medications are absolutely necessary until you can hopefully reverse things with lifestyle changes.

      Hope this helps!

      John

  121. Dear Sir, I have had severe PVC’s and PAC’s for years. Recently I experienced this every 3-7 beats and my heart began to feel as if it hurt. It was difficult to sleep because it beat so hard. My cardiologist prescribed 400 mg of Magnesium Oxide and it helped immensely! Here is my question: a few weeks later I had a stroke, and then three months later two more. They cannot understand why. Everyone says PVC/AVC’s do not cause strokes. What is your opinion? Thank you, Sandra

    • Hi Sandra,

      So sorry to hear about the strokes. There are observational studies linking PACs and PVCs to stroke. However, these are just observations and don’t, in any way, prove that the premature beats are the cause of stroke.

      In the case of studies liking PACs to stroke, the cause of the stroke is likely atrial fibrillation. People with excessive PACs are more likely to also have atrial fibrillation.

      In the case of studies linking PVCs to strokes, these are generally studies of older people. In the elderly, PVCs usually represent underlying coronary artery disease. Coronary artery disease is a well known cause of stroke.

      Hope this helps!

      John

  122. Thank you Richard! We are NOT dreaming all this business up about posture and belching and PVCs. I have noticed that, even though I do not take any form of caffeine, even herbal teas will set things off if the liquid is too warm or I take it in too fast. I am so grateful to you for your comment. Having this condition has made me feel like a freak at times. It’s good to have someone to identify with. Do you know of any safe measures to take to stimulate the parasympathetic nervous system. I know Yoga does the job to an extent but it alone did not reduce my PVC load. BTW, when I was pregnant I did not experience the PVCs, but the digestive issues felt very similar.

    • Hi Dede,

      I have read many research about this phenomenon, but i still cant put my finger on what is causing what and why. For me its clear , that my stomach , gas, trapped air, and reflux are involved with my PVCs. Then it seemed logic to me that the vagus nerve is a common factor in this. Thats how i found Roemheld syndrome long ago. The problem for me is that i knock on closed doors. Every time i myself address the possibility of vagus involvement and my stomach to my doctors , i get zero response. Thats what makes this so hard for me. NO explanation. I mean if you have to believe its benign it would be nice if the doctors i visit could give me an explanation or show interest in the possible link i describe. vagus, stomach, heart. cardiogastric link. But the easiest way to explain this for my doctors is stress and anxiety. Now i will never dismiss the role of both, its not the cause. So you start wandering the internet and find people like Dr John and some years ago i was in contact with an all expert doctor who sadly stopped. The problem over the internet is that these doctors want to help but they are restricted.So it remains difficult to go into the deep regarding the sensations you or i feel. So the search remains :).. I slowly learn to live with my skipped beats, but the biggest problem is that i get many sharp painful skipped beats. and these skipped beats that feel like spasms/lurches/electrical stabs, lasting a second during the skip, those scare me to death. these skips travel into different spots on my chest. they can develop around my gallbladder, so not close to the heart. stomach pit. so just under sternum as in below. then they can be around and under left nipple. so it MOVES. and it always appears in a spot where i feel most pressure on my chest from air/gas or acid. so when i feel this right under ribcage i feel that spasms right under ribcage. my heart SKIPS at the same time although its far away from the heart!? it doesnt make sense but it happens. And then i belch like crazy. also i cant seem to be able to live UPRIGHT. it sounds strange but its true. standing straight and still causes me many issues. fast heart rate, starting of skipped beats. weird is when i try to walk a little its a bit better. but standing still ?? problems. i have had a stress ecg, an echo , not stress echo but normal, many ecg’s , bloodtests, event holter but got the ALL CLEAR. even there is some question about P.A.T. atrium tach. “you can exercise what you want ” is what they say to me, if i then tell them i cant even take a shower and dry myself or walk for half a mile they look at me if im crazy. but its true. the problem is that its therefor you keep thinking they dont understand whats wrong and there must be something going really bad. cause otherwise they knew i am not able to exercise.
      and you start doubting yourself and the doctors again. at least thats how it works for me. All i want is an explanation. I m looking for WHY? i never had this , and suddenly, many years ago out of nowhere this started! why? it never left a day.. why? you often read. if you have proper testing than its safe. But how do i know this was proper? anyway. thats my story 🙂 and my search for answers :)..

  123. Hello, Dr. John –

    My Dr. has stated that I have occasional Sinus Tachycardia, found after strenuous exercise. Along with the Tachycardia, there are also PAC’s and PVC’s present on my EKG at the same time. Would a beta blocker be an option for trying to reduce these occurrences? Or, should I just learn to live with this as the Dr. has stated this is completely benign. All other tests (stress, echo, etc..) have come back normal.

    Thanks,
    Gregory

    • Hi Gregory,

      If these PACs and PVCs are interfering with your quality of life and a healthy lifestyle, which includes avoiding triggers, is not working, then beta-blockers would be a reasonable next step. There are many different beta blockers and ways to dose them so it may be a trial and error process to see what works best for you.

      Hope this helps!

      John

  124. Hi Dr. John and thank you for your comment. I went on line and researched the PNS (parasympathetic nervous system) a little. I found an article that was looking into the effect of yoga on stress related disorders, namely, PTSD, depression and epilepsy specifically. It discussed the PNS, GABA and innervation of the Vagus nerve. Most people with benign PVCs sooner or later put a connection between eating or drinking and an increase in PVCs. I have also noted that many people talk about an extreme need to belch at times and how this somehow is linked to getting relief from the dysrhythmias. It seems like medical people with PVCs take it a step further and connect the dots to the vagus nerve. I think there is something important here to be discovered and researched. I think perhaps benign PVCs have less to do with an irritable bit of myocardium than with a depressed PNS, low GABA and some issue with how these relate to the vagus nerve. I think the PVCs are a symptom rather than the problem. Maybe the PNS, and it’s effect on the vagus nerve is at the root of benign PVCs. Clearly the condition is effected by stress, digestion and even the body’s posture and position. Maybe it is the vagus nerve rather than the heart, that the body’s position is affecting. Even now, although the GABA has markedly (thank God) alleviated my PVCs, I still know I will experience a few extra resets after eating a meal or drinking a cup of hot tea. However, with the GABA they are FAR less in number and intensity now. it just seems to me that there is something very important to be looked into here. I believe benign PVCs might be lumped in with PTSD, depression and epilepsy in so much as it is affected by PNS, GABA and Vagus nerve depression or stimulation. I have ever never experienced clinical depression, PTSD or epilepsy so I don’t know what they are like. I would love to be apart of a study into the possibility of a new treatment for benign PVCs if anyone is needing human subjects. Thank you again, Dr. John, for your time and attention.

    • hi Dede..
      the effect off the vagus nerve and the digestive system, bodily postions are well documented for years. Roemheld syndrome !
      What i personaly notice , is that many cardiologists. NOT ALL..but many, only look at the organ itself. if the heart is ok, well then their job is done. connecting the dots is not what they do. the same with POTS. in my country, many cardiologists dont know anything about POTS? The same with digestive issues and pvcs. and vagus nerve.. i keep insisting my senstations are intwined with my digestive issues and vagus nerve. But in my country.. they are not interested !

      • Hi Richard
        I was reading your post from early March in which you spoke of Roemheld syndrome and also POTS. You stated that in your country the medics don’t seem to know anything about these issues. Are you in the UK by any chance? If so, I totally agree with you. I tend to feel it’s a waste of petrol even going to a doctor’s surgery or hospital any more. Waste of breath telling them your symptoms! However, some years ago, I had a specialised form of physical therapy by a chap in central London called Dr Paul Sherwood, who wrote various books, including one called The Back and Beyond. I was not suffering from ectopic beats at that time but had various other ANS symptoms. Dr Sherwood believed that lots of these things were caused by upper back problems. I don’t know if he was right or wrong, but he told me that I had over dominant parasympathetic tone and low thyroid (though thyroid tests, such as they are, were normal). I suffered a severe depression around that time (as well as my back problems) and Dr Sherwood told me that he believed that my brain was generating fearful thoughts in order to stimulate my autonomic nervous system back into balance. I have hypermobile joint syndrome (as do many in my family) and this is very often associated with dysautonomia. Certainly, I gave been able to identify with this throughout most of my life. With regard to the addition of these dreadful ectopics, I would go to see Dr Sherwood again but unfortunately he died (in his 90s) a few years ago. So there are doctors, once in a while, who are open-minded about these things but, on the whole, allopathic medicine doesn’t seem interested – at least in the UK anyway. I feel pretty lost and desperate, which is why people like us gravitate to fantastic sites like this one, for information and reassurance (although obviously I realise diagnoses cannot be given online).
        Regards, Margaret

        • Hi Margaret,

          Thank you so much for your kind words! Unfortunately, I am not in the UK.

          Autonomic dysfunction is a cause of many arrhythmias. Unfortunately, we really don’t have great treatment options available at this time. For some people, aerobic exercise, meditation, or yoga can be very effective for arrhythmias caused by autonomic dysfunction.

          There is a lot of exciting research currently going on in this area and hopefully we will have more answers and treatments in the future.

          Hope this helps!

          John

  125. Hello Dr. John,
    You are so amazing to host and support this forum. I really appreciate your kindness and compassion. I had posted a couple of days ago regarding my condition which has been diagnosed by my cardiologist as “benign PVCs”, which, as I have stated, are not benign as they disrupt my life and keep me I’ll at ease daily. The Holter showed that they were not very frequent as long as I was active and my HR was up in the 80s or higher. I am a PACU nurse so my work days are fairly active and frequently stressful. They were always worse at night when I became still and my HR went down…as well I was still enough to notice them more. You have mentioned autonomic nervous system tone.
    As I had posted, the most important steps I’ve taken was to eliminate all caffeine and chocolate and adding the GABA 500mg BID. I also have added vitb6 100mg and l-the anime 100mg each morning. It was written that the GABA doesn’t cross the blood brain barrier and yet my PVCs have nearly stopped since I started this regimen. My Dr. Had wanted to start me on metropolol but my SBP never gets over 100 and she was hesitant.. My resting HR was also 60 or less. I believe with all my heart that the PVCs are linked to an issue with my Vagus nerve and anxiety. When the problem started over a year ago, I stopped one of the cardiologist I know at work and asked him why I never had this before and now I do. He asked what had been going on in my life. I told him I had just constructed a house…that I had decided to be my own contractor. He just laughed and said he was building a house too and said he would probably have PVCs before he was done. He said that it took a sustained level of stress to cause my PVCs and it would take at least as long for them to ease up. It has been over a year and that didn’t really ease off at all. Hence, the visit to a cardiologist and my quest to try anything and everything to help myself. The GABA has made a HUGE improvement. They are no completely gone but are quite infrequent. I was having them about 6 to 10 times per minute…and the reset QRS complexes were very forceful… To now feeling one or two a minute at most. The PVCs are not nearly as noticable as they are more mild now. Can you please explain what the GABA is doing that is helping so much? I know this is not in my head. Numbers don’t lie. I am even sleeping better and feel more comfortable in my skin. Thank you for any light you might shed. And thank you again for all you do. Chronic benign PVCs are only benign if you don’t have them.

    • Hi Dede,

      I could find nothing in the scientific literature on GABA and PVCs, or other arrhythmias. There are some data that GABA may help with anxiety, sleep, and activation of the parasympathetic nervous system. If these findings are true, this could explain your positive experience.

      Hope this helps!

      John

  126. questions about pvc’s and p.a.t as in paroxysmal atrium tachycardia.
    All in a structural normal heart..dont know if all arteries are fine..but passed stress ecg..

    1)Is it strange that i experience positional depending pvc’s.. -> bending forward, leaning forward, reaching with my arms above my head to pick something out a closet.
    working with arms above my head.. putting pressure on my chest..leaning on my side when im in bed..? can you explain this?

    2) Why is it that one day you have 200 pvc’s and a day later 500? doing the same things

    3) why is it that you can exercise sports with pvc’s? no chance for v tach?

    4) i have some incidents of short p.a.t rhytm.. usually around 130-150 bpm..and only a few seconds or minutes.. -> everyone keeps telling me p.a.t is benign..and you can do sports with p.a.t. why is this benign? and wont it cause bloodclots or fatal problems in rythm?

    • Hi Richard,

      Let me try to answer your questions.

      1. For some people PVCs can be mechanical. Different positions may put a strain on the heart that could cause more PVCs. Also, most people feel PVCs more when laying on their left side. When you lay on your left side your heart is closer to the chest wall which tends to amplify the PVC symptoms.
      2. Hard to explain why some days you could have 200 PVCs whereas other days there could be 500. I suspect some of this may be affected by inputs from the brain/nervous system (autonomic tone), subtle changes in your body or hormonal levels that you are not aware of, or even random fluctuation.
      3. If your cardiologist has done the appropriate work up and has told you that your PVCs are benign, then your risk of working out would be extremely low. You can never say “no chance.” Even a 100% totally healthy 18 year old athlete could die suddenly although this would be extremely unlikely. Unfortunately, risk can never be 100% eliminated for anyone.
      4. You are correct, paroxysmal atrial tachycardia is generally a benign condition. Most forms of atrial tachycardia are not associated with strokes. As with PVCs, after the appropriate testing only your cardiologist can tell you if your paroxysmal atrial tachycardia is benign or not.

      Hope this helps!

      John

      • I never liked the idea of intense exercise….slow and steady is my mantra. There is a particular tai chi exercise good for circulation..it sort of mimicks the movement of being on skis.
        Laura

      • Thank you Dr John.

        The fact that my PVCs are more mechanical as in more felt with bodily postions, it doesnt change the fact they are benign in a structural healthy heart.? The heart is just more irritable for these postions?

        I also read in this thread various people that have the feeling their stomach or esophagus Lower esophageal sphincter and hiatus hernia seem te have some influence on their PVCs. Could you elaborate on that? and still this is all no real problem in a structural healthy heart?

        Being a sufferer of PVCs and they do scare me, what kind of activity or exercise you recommend? im in my forties ! bad exercise condition. I need to exercise a little, but the fear of my PVCs keep me inactive !

        • Hi Richard,

          I am not aware of any studies reporting that PVCs from changing body positions are associated with any increased risk. We really don’t fully understand the “vagal effects” (includes gastrointestinal causes of PVCs) on PVCs. Even if the PVCs are triggered from the gastrointestinal system, as long as the heart is structurally normal there is no increased risk.

          As long as your cardiologist has told you that your PVCs are the non-life threatening type, then the best exercise is the one you will do.

          Hope this helps!

          John

  127. I should mention that other things I am doing concurrently are absolutely NO caffeine, and that means no chocolate too…only herbal teas for me, small bland snacks rather than filling up at meals, no very hot or cold anything by mouth and taking small amts of liquids rather than guzzling down a full or even half a glass. I don’t want to take beta blockers, anti arrhythmic a and I don’t think I need an ablation. I have been studied by a cardiologist…labs, stress test, Holter monitor… My diagnosis is Benign PVCs. I think anything that takes my peace of mind is not benign. The GABA along with the diet and conservative measures to reduce daily stress and GI challenges is working well for me. The Reduction in PVCs as well as the peaceful feeling in my chest now has replaced the vicious anxiety cycle with the peace and calm cycle.

  128. I tried everything with only a little success. Then I tried GABA with vit B6 and L-the anime. I take the GABA 500mg morning and night and the vitB and Ltheanine (100mg each) in the morning. I also take Tums in the evening. Wow, what a difference now. Still have them but not at all like I did before. In fact barely noticable! Hope this helps someone.

  129. Dr. Day,

    I am 32 years old. In early January I was diagnosed with PVC’s after feeling skipped beats frequently for hours at a time. I went to ER and after blood work, urine sample, EKG and x-ray the doctor told me that I was having PVC’s. He went on to explain to me what that meant and that I should follow up with my physician. My physician looked at the Labs from the ER and he said that it was nothing to be concerned about. That I could do everything without having to worry about the PVC’s having serious consequences.
    After a week I went back because I was worried. He ordered an echocardiogram. A few days later he said that results came back normal and that by every indication my heart was structuraly healthy.
    I tried to accept it and move past it but still couldn’t. Went back and he referred me to a cardiologist. I went in and the cardiologist had an EKG done. A 24 hour Holter monitor and an stress echo. Again, a few days later went back for the results and he said that the Holter did show some ‘events’ but that said ‘events’ were not dangerous. He said the stress echo came back normal. That he had me on the treadmill for 15 minutes and pushed my heart to 200 beats/minute and didn’t see anything abnormal. Ultimately he said that I have nothing to worry about and that there was no reason to even consider giving me medication.
    In a way, this gave me some peace of mind and even though lately there’s been some days where I hardly feel them, there are some days where I do feel them and quite honestly they freak me out.
    My question to you is the following, should I still worry even after multiple EKG’s, echocardiogram, 24 hour Holter monitor and stress echo plus the blood work and xray from the ER? Or should I seek other tests, if any?

    Note: my cholesterol is at 168 vs 210 a year ago.

    Thank you in advance.

    Ricardo

    • Hi Ricardo,

      Congratulations on getting your cholesterol down!

      Sometimes it is hard to decide when enough testing is enough. This is a personal decision between you and your cardiologist. This is where having a cardiologist that you can trust is very important. Without that level of trust it may be hard to have piece of mind.

      Best,

      John

    • Hi Billie,

      Yes, anxiety is a powerful trigger of PVCs. However, before blaming PVCs on anxiety, it is important to work with your cardiologist to make sure the PVCs are “benign” first.

      Hope this helps!

      John

      • I have had an echo done and it was normal and ekgs that are normal except a short PR interval because of high catechalomines from anxiety and stress.

  130. I did have lifeline screening two years ago. They check your ankles for pad..do a sonogram of carotid arteries and a sonogram by the stomach of the aorta. I also read somewhere that a whooshing sound with stethescope can point to a blocked artery.

  131. Dr. John,

    Can you share your thoughts on using beta blockers, like Propranolol, for PVC’s? I am currently wearing an implantable loop recorder in my chest, and my Dr. has found PVC’s present since it was implanted.

    Thanks,
    Jameson

    • Hi Jameson,

      Sorry to hear your doctor found PVCs. Beta-blockers are a very safe medication for PVCs. Some people struggle with fatigue issues with this medication. In my experience, about half of the patients I start on beta-blockers have a significant decrease in their PVC burden.

      Hope this helps!

      John

  132. Hi Dr. Day,

    I was diagnosed with PVC’s 5 years ago, I’m 60 now. I wore a monitor, did an echo stress test, etc. My cardiologist says it’s nothing that is going to hurt me. I take magnesium which seems to help. I’ve noticed lately sometimes I have a strange sensation in my lower throat when they happen. This usually happens shortly after a meal. Is that something to worry about? I usually just feel a hard beat in my heart.

    • Hi Linda,

      Everyone experiences PVCs differently. Unfortunately, it is impossible for me to say from afar if the throat sensation is something to worry about or not–this is something you will need to check in with your doctors about.

      John

  133. Dr. John,

    I am a 78 year old healthy male. My major problem is hypertension. I have had APC’s my entire adult life. Recently, I have noticed an increase in the pauses in my heartbeat. They run from 3 to 10 per minute. My physician is weaning me off tenormin but I don’t notice a difference yet. My EKG’s do not indicate heart disease and I passed my stress test with flying colors. My physician wants me to begin discussions with a pacemaker doctor. That seems like quite a leap! No doubt anxiety and stress comes into the picture to some extent–I lost my brother and several friends within the past year and at 78 I am thinking more (my wife says too much) about my own mortality. What in your judgment should be the next step for me to take? And is up to 10 pauses a minute a dangerous matter? I am personally inclined to do nothing.

    • Hi Rich,

      Great question. Too often, when people with frequent premature beats check their pulse it is low. The reason is that the premature beats may not be detected with a blood pressure machine or by checking the pulse.

      Before contemplating a pacemaker, I would want to see that the heart rate is actually slow by a monitor. Please continue to work with your doctor to confirm if you really need a pacemaker or not.

      Hope this helps!

      John

  134. Hi, Dr. John! Can you discuss the correlation, if any, between anxiety (anxiety disorder specifically for me), digestive issues, and PVCs? It’s been BAD this week!

    • Hi Liz,

      Anything that gets the adrenalin up, whether it be anxiety or digestive challenges, will cause more PVCs. In fact, when we do procedures to get rid of PVCs, we give and intravenous drip of adrenalin so that we can see where they are coming from.

      Hope this helps!

      John

  135. I had a normal echo except for mvp..doctor wasnt concerned. I do exercise as i can but in a more gentle consistent manner…yoga..miranda whites flexibility routine..stationary bicycle…walking…use stairs in house alot but cannot do stess test as i cannot run or speed walk as ive had two level lumbar fusion. Perhapsdown the road for me an angiogram or calcium scan might be better?
    Laura

    • Hi Laura,

      An angiogram just gives you the “anatomy” of the arteries. It does not answer the question of whether the heart is actually getting enough blood flow. Radiation is involved with this test.

      A calcium scan just tells you if there is calcified plaque. It cannot answer if there is a blockage. It also cannot tell you if the heart is getting all of the blood it needs. Radiation is also involved with this test.

      For people with orthopedic challenges, I may keep the treadmill belt slow but significantly increase the incline to stress the heart.

      Alternatively, there are “chemical” stress tests. Some of these tests are with radiation and some can be done without any radiation.

      Hope this helps!

      John

      • Is a pet scan or mri useful to see arteries….although with back implant do not know if mri can be done.
        Laura

        • Hi Laura,

          Both the cardiac MRI and PET scans can identify if there are areas of the heart that are not getting enough blood flow. A stress echo is another stress test. However, none of these tests allow you to actually see a blockage in an artery.

          To actually see a blockage of an artery you need either a CT angiogram of the heart or a coronary angiogram.

          Hope this helps!

          John

          • Hi Laura,

            Yes, I am very familiar with the Aivecor ECG app. I even bought one for myself a year ago…

            It works very well for many of my patients. This is especially true for those who know how to read an ECG. However, for some patients it only intensifies their anxiety.

            Best,

            John

          • Thank you…didnt understand the difference of these tests…ive only had an echo cardiogram and an event monitor for a week..nothing came up. I got an app on my phone..heart core that takes a recording of your heart for up to five minutes like an ekg and also pulse. My bp is 114/75 which isnt bad for 60 yrs. You can also email the readings from the app to your doctor.

  136. hi John,

    I wrote to you, see january 30, .. ive been to my cardiologist yesterday and he still feels there is no real heart issue. He concludes that because my echo in rest march 2015 was fine, and at the same time i had a stress ecg while cycling. those were fine he said. The fact i have pvc’s is not a problem, and the racing heart when just standing or moving slightly.. up to 140/150 ? advice cardiologist -> try not to focus on it.?? I asked if my skipped beats could be related to gass,acid reflux, indigestion?
    But it seems he dismisses it, or cant believe that is what causing it.
    But i really feel its related. nervus vagus..irritation.
    I asked if POTS was a possibility, but it almost felt he didnt took that one serious.

    He doesnt see any risks nor does he feel betablockers will benefit me.

    So back to square one.!! What is wrong with me? and why is it so difficult to relate my stomach issues with my heart.. ? cause i know they are related.
    I have had a esophagus and stomach gastroscopy/endoscopy, and they found hiatus diaphragmatica..but that was all.

    questions..

    1) how do i know, although i have 100’s of pvc’s a day that i will be alright?
    2) Why wont having skipped beats cause a problem when doing some exercise?
    3) I really can feel my skipped beats, right side chest, under sternum, left on chest and even below right under ribcage.. where my heart isnt even postioned?? and trust me, its my heart skipping then.. how is this possible?
    4) i sometimes fear small pulmonary embolisms.. but my cardio says thats nearly impossible cause my symptoms doesnt match that.. but i dont know what to trust anymore..

    Hope you can shed some light
    Richie

    • Hi Richie,

      Yes, PVCs can be frustrating. I’ll try to answer your questions as best as I can:

      1. Of the thousands and thousand of monitors I have looked at, 100 PVCs in a day really is not that many. It is important to remember that everyone has PVCs from time to time. I wish I could tell you that you will be alright but this is impossible for me to do from afar–only your cardiologist can tell you if it is alright or not.
      2. If the heart is normal (normal echo, normal stress test, etc.) then PVCs are felt to be a benign thing. This is something that only your cardiologist after reviewing your test results, examining you, etc. can tell you.
      3. Everyone feels PVCs differently. Hard to say much about palpitation symptoms.
      4. A pulmonary embolus could cause PVCs but a blood clot to the lungs is likely to have other symptoms like shortness of breath, chest pain, etc. If you don’t trust your cardiologist you could always get a second opinion from a different cardiologist.

      Hope this helps!

      John

  137. Hi DR Day, I logged on last month and since then Have seen my doctor, He said that my PVC’s were benign. No limits on exercise.Yesterday I was under stress and the PVC’s Returned. I am having runs of 7 or so with a skip and then another run of three or more and then I will go a minuet or more with nothing. Last night after I calmed down I went 5 minuets without a PVC. When the Adrenalin kicks in is when it gets bad. My question is are the long runs common? Bill

    • Hi Bill,

      Yes, PVCs can often be consecutive or in “runs.” PVC runs are somewhat more concerning than just isolated PVCs. Make sure your physician is aware of these runs of PVCs.

      Best,

      John

      • Thank You! I did the cold shower and they went back to 2 to 3 in 300 beats, And yes I have called my Doctor. Thank you again! This site has helped me more than you will ever know. I also believe that stress is like an onion,each layer is easier to peel than the last, and you have to stop the stress to address the problem. Bill

  138. After menopause i changed my diet significantly. After learning to refine it…now second nature. As follows…farina…oatmeal…veggie burgers..salmon…makerel…herring…tuna….walnuts…use jarred beets for salads..marinated garlic..any fruits or veggies. I luv jarred artichokes. I HOPE I HAVENT MADE ANYONE GAG..BUT THAT IS WHAT I BELIEVE NEEDS TO BE DONE. Oh do use rye bread.

  139. I am 45 y/o/f who has had pvc’s since I was about 27. I WONDER IF PVC’S COULD BE HORMONAL. WHEN I WAS 37, I STARTED GOING THROUGH PERI MENOPUASE. IRREGULAR PERIODS, NOT ABLE TO SLEEP, HOT FLASHES, ETC… I KEPT RECORDS OF MY PVC’S THEN BECAUSE THEY INCREASED DURING THIS TIME. I WOULD HAVE THEM FOR HOURS, AND IT WAS A;WAYS THE WEEK BEFORE OR AFTER MY PERIOD. USUALLY THE WEEK BEFORE. I STARTED EXERCISING And lost about 20lbs, and I still had them, but not near as much. I went through menopause at 43. I have not had a period in 22 months, and I have had blood work done that says I have been through menopause. 2-3 WEEKS AGO, MY BREASTS STARTED GETTING SORE AS THEY USED TO WHEN I WAS HAVING PERIODS. LAST WEEK, I WAS IN THE KITCHEN FIXING MY BREAKFAST, AND I STARTED FEELING PVC’S. THEY FELT LIKE THEY WERE HAPPENING EVERY OTHER BEAT. I HAD FOUR EPISODES DURING THE DAY OF THIS. IT WAOULD LAST FOR 10 SECONDS OR SO, AND I FELT LIKE AT THE MOST I HAD ABOUT 10 OF THEM DURING ONE EPISODE. USUALLY IT WAS ABOUT 5. THEN, THE NEXT DAY I STARTED HAVING SPOTTING TO SMALL AMOUNT OF BLEEDING. THE SPOTTING HAS BEEN GOING ON NOW FOR 5 DAYS. I HAVE ALSO HAD WHAT I CALL A PERIOD HEADACHE LIKE I USED TO GET AT TIMES WITH MY PERIODS. COULD THESE PVC’S BE CAUSED BY MY HORMONES? IT SCARED ME BECAUSE IT FELT LIKE RUNS OF BIGEMINY. I AM ASYMTOMATIC THOUGH OTHER THAN IT TAKES MY BREATH AND MAKES MY STOMACH FEEL FUNNY. IT JUST SCARES ME DUE TO I WAS A PARAMEDIC FOR YEARS AND A NURSE NOW, AND I KNOW THAT THEY CAN LEAD TO DANGEROUS RHYTHMS. I KNOW I NEED TO EXERCISE, BUT I AM SCARD TO NOW BECAUSE AFRAID I MAY HAVE THEM, ALTHOUGH I USUALLY DO NOT WHILE EXERCISING. I JUST WANT TO KNOW IF THEY CAN BE CAUSED BY HORMONE CHANGES.

  140. I vaguely remember a test for particle size cholesterol….is it a blood test anyone can get. Are the particles suppose to be large or small?

    • Hi Laura,

      Yes, your doctor can order tests to evaluate your cholesterol particle sizes. There is some debate in the medical literature as to whether this provides additional prognostic information or not over the simple cholesterol test. If you are one who likes more data then talk with your physician about these more advanced cholesterol tests.

      Hope this helps!

      John

  141. Dear Dr. Day, I am A now 48 y.o. Woman who began having symptoms of heart stuff in my late 20’s. I was dismissed mostly by cardiologists because of my age, and eventually that heart stuff came FULL FRONTAL to almost killing me. I have the following conditions as of today. 1) Coranary artery disease- Heart attack in 2012, 100% blockage of the right coranary artery, (& 40% in the left noone told me about till 3 years later.)
    2)Carorotid Artery Stenosis- 2011 had Right carotid endarterectomy.(“discovered when i bagan having eye strokes” see #3)
    3)Amourosis Fujax- eye strokes, was thought to be caused by rt. carotid artery (90%) blockage.,
    post endarterecctomy, did not resolve the condition.
    4)PFO- discovered by a Migraine specialist i was seeing, bubble echo confirmed, later TEE performed.
    5)Atrial Fibrulation- Made aware of this during 2012 Heart Attack.
    6)PVC arrythmias- Disturbing and too frequent.
    7)Early Advanced onset Atherosclerosis- as noted by CAD, CAS, and eventually.. diagnosed w/Peripheral vascular Disease.
    8)PAC arrhythmia’s discovered & occurring with PVC’s on recent 48 hr Holtor monitor.
    9)Rt. Bundle Branch Block noted on last ECG
    10) recurring TIA’s (approx. a dozen post myocardial infarction)

    11) Question of Vascular dementia and referred to neurologist for eval.

    Ok.. thats the brief summary. Now for my question. WITH ALL THAT IN MIND, my dr. has suggested nothing to me other than statin drugs, blood thinners, and quitting smoking.

    Im Not a pretty picture, i dont fit nicely in a protocol.. my cholesterol is low but particulates lg., My heart rate is very low 30-40 bpm range, as is my blood pressure 110/70 avg and lower.. I FEEL IM BEING ASKED TO SURVIVE ANOTHER EPISODE BEFORE ANYTHING IS DONE, & I FEEL SO FRUSTRATED!

    When My ecg showed the bundle branch block, he said SURELY NOT. (where have i heard that before?)

    SHOULD I BE LOOKING FOR ANOTHER PHYSICIAN?

    I live 3 Hours from SLC Utah, and the u of utah comes up a lot with people where i live, seems they get care there we dont have in this small town in S. central Idaho.

    Thank you for your thoughts,
    Dawn.

    Oh yeah.. P.S. I took oral EDTA FOR 9 months prior to the heart attack and just after the carotid endarterectomy. I brought my cholesterol down from 221 to 60. That is why later they checked to see if my particulate size was the issue rather than the number.

    • Hi Dawn,

      So sorry to hear about your cardiovascular challenges. Keep working on giving up the smoking as that alone could explain most of the challenges you now face.

      Given the challenges you have faced, most physicians would recommend statins until all of your risk factors can be eliminated through diet and lifestyle. This may take some time. Please be understanding with your physicians as they have probably not seen many patients who are able to make the hard life-long lifestyle changes that are necessary to prevent and reverse cardiovascular disease.

      You definitely need a local physician that you can trust. In addition, a preventive cardiologist would likely be of benefit. There are cardiologists who specialize in preventative medicine at the University of Utah Hospital, LDS Hospital, and Intermountain Medical Center.

      Hope this helps!

      John

      • In my mind lifestyle change is a no brainer especially if it reverses artery disease…the most inexpensive easy solution. Menopause is challenging…why have a bad diet make it worse…and forget about smoking….that can cause clots all by itself
        Laura

  142. Dear Dr Day, im in my 40’s, male, bp 135/90. I have many weird heart/chest sensations.
    I get very painful, almost an electric sharp spasm when i have my pvc’s. So they hurt a lot. Its not a hard thump.. but a very painful electrical feeling ..spasm like. I notice them more when i have a full indigestion gassy feeling in my stomach, when i bend over forward, stretching, laughing, with thoracal pressure…leaning on my arms on the table, putting weight on my chest. I also notice that i feel those skipped beats on different places. So i can feel those painful more to the RIGHT !! of the xiphoid process , but also mid sternum, i also can feel more painless skipped beats all the way to the right pector, and also all the way above left nipple… often i feel them there laying on any of those sides, or when the chest is hurting already on any of those sides.. the pain does feel like muscle pain …cause deep chest breathing or moving stretching can reproduce. i have had MANY MANY ecg;s and just last march i had a normal stress ecg and normal echocardiogram in rest. My holter , got an event recorder noticed pvc’s at the moment of the spasms, and possibly some P.A.T. i do have some copies here but cant post them. These problems are bothering me for years now and mostly every day. questions:

    1) Why can you feel skipped beats on so many different places on the chest? and why do they” move” ?
    2) On my ecg, every time i feel this very painful electric sharp skipped spasm..i see some pvc activity , but often a strange tall r wave..very tall. my gp says artefact..but i dont get it cause its about the same time i have these spasm?
    3) How dangerous are these pvc’s..when they hurt so bad, and some P.A.T? Do i have restrictions? cause im a bit scared to exercise.. even walking or household proving to be a problem cause movement, bending, lifting, causes these spasms.
    4) i VE Been to ER and ambulance has come to my house a few occassions, but no one seem to be too worried.. although they sometimes mention an inverted t wave in lead 3, but no cardiologist ever worry about that one. Still i feel really bad. often chest pain.. so how do i know when now when to call that something is wrong? i mean..they cant find anything?
    5) I do feel it has a lot to do with my stomach, vagus nerve, esophagus. cause i do have a hiatus diaphragmatica. and im on omeprazole for more than 10 years. even drinking water can trigger skipped beats.!! ? can you explain?

    Thx for all your time

    • Hi Richie,

      PVC symptoms are tough to explain. Of the rare 1% of the population that can feel their PVCs, everyone seems to feel them differently. Unfortunately, without looking at your EKG it is impossible for me to make any comments.

      Speak with your cardiologist to find out if your PVCs are dangerous or not. For people with benign PVCs there are no limits on physical activity.

      If you read through the posts you will see that many other people seem to have their PVCs triggered by stimulation of the vagus nerve (eating, etc.). Not a good explanation for this as there are limited studies on this relationship.

      Hope this helps!

      John

      • Hi John,

        thanking you ! Ive been brought into coronary heart unit, cause again there were some strange symptoms a gp couldnt explain. ive been there for hours. they noticed i have these painful electrical spasms skipped beats.. and they told me those were pvc’s…why they hurt??? maybe chestmuscles..cause i always have pain around xiphoid process..but they couldnt explain. Furthermore i had some weird things. My heart rate was 140 just standing next to the hospital bed..and the cardio was surprised.. i had pvc;s than also..
        they couldnt explain it again..i was on the ecg monitor..normal sinusrhytm..
        maybe POTS or IST they told me. because my echo in march 2015 was fine..and i passed the stress ecg at that very same moment..the cardiologist wasnt concerned.. he told me , he feels my symptoms are a nuisance but not dangerous. they also told me..being inactive as i am..this very inactive life i lead..could worsen my sensations..especially if its IST or POTS.. still i am always scared that my heart cant take the exercise.. due to the many weird sensations.

        i sometimes are still scared that my pvc’s occur due to vasospasm or clogging..or..something like that..?
        I sometimes feel a few pvc in a row..not many..but 2 or 3..is that a problem?
        the nuisance its they hurt and because my chest always hurts..it intensifies the pain after those painful pvc’s..and that burping !!? i burp like crazy..after it

        im willing to mail you my ecg;s..if you want too..
        any advice would help..!

        • Hi Richie,

          So sorry to hear you have been in the hospital. It is nearly impossible for me to identify what is going on remotely. Also, not every symptom can be explained.

          Postural orthostatic tachycardia syndrome (POTS) or inappropriate sinus tachycardia (IST) can both be difficult to treat as the problem isn’t really the heart but rather the autonomic nervous system. For these conditions, regular aerobic exercise and mindfulness techniques, such as meditation or yoga, can be extremely beneficial.

          In the big picture, the key is to find a good local cardiologist or cardiac electrophysiologist that you can trust and to work with this person in managing your symptoms.

          Hope this helps!

          John

  143. Greetings Dr. Day,
    I’m a fit 40 year old male in what I consider to be good athletic shape. I regularly road cycle (6000 miles last year) and run. I compete in local bike and running races. A heart rate monitor is a daily part of my riding/running. This all started about 11 days ago. Now, I’ve always had the occasional PVC while resting up after a hard ride. I’d have a few then they’d just go away. 11 days ago, after an 8 mile training run in cold weather (25 degrees F), I started getting PVC’s on and off for pretty much the entire afternoon and evening. The next morning, still experiencing them, I drove myself to the ER and EKG, BP, chest x-ray, blood work… all came back fine. I’m on zero meds whatsoever and have 1/2 cups of regular coffee in the morning, no soda or energy drinks. I have 1-2 glasses of red wine per night. I must also admit I suffer from anxiety. A week after my fist ER visit, I had a single sharp pain shoot through what I felt to be my heart area. The pain shot from left to right (this was the only time this ever happened). Later that night, fatigue set in and I felt very tired. While all this was happening, I was still experiencing the PVC’s very frequently. Oddly, and opposite most descriptions, they seemed to worsen with movement and become less frequent with rest. I woke up a few hours later and decided to get myself checked out again given these new symptoms. Again, everything came back all clear. They even kept me for the day in the cardiac wing and monitored me for a full 12 hours. They did notice PVC’s but not many (as I was at rest most of the time). They put me through a stress test which I aced. My guess is that since I’m an athlete, I wasn’t really put under much stress. They sent me home stating everything was great and mentioned the possibility of my anxiety contributing to my situation. I’m currently waiting on a call to schedule a 2D echo ultrasound of my heart. Basically, I’m left worrying if I’m indeed suffering from a medical condition or it is indeed anxiety. They prescribed me xanax short term until I can consult with my family Dr. but I’m very reluctant to take it as I prefer to right myself the natural way if I can. What has me worried is that I now have this onset of fatigue and the PVC’s increase WITH increased movement and activity, not like I had them before… at rest. As a test, I ran my normal 5 mile loop yesterday and it didn’t go well. For the first 20 minutes or so, my heart rate was erratic and I had a very tough time getting up to my normal aerobic zone. Once there, I became winded very easily and found it hard to maintain the pace I’ve come to expect over years of running/riding. Also, I feel like a general “soreness” around my heart area post-run. I can’t even classify this as a pain, just a sort of soreness. I’ve never fainted or felt any major dizzy spells. Basically, I’m at a loss. Any helpful advice would be greatly appreciated!!

    • You most likely have thyroid disease. Hyperthyroidism like me,most likely. Find a naturopath who specializes in thyroid issues.Please!

      • Thanks, that actually hadn’t occured to me. During my last hospital visit, which was this past Tursday, they ran two tests called ‘TSH Without Reflex’ and ‘T4’ I looked these up and they both have to do with thyroid. The first one: (TSH) test is often the test of choice for evaluating thyroid function and/or symptoms of a thyroid disorder, including hyperthyroidism or hypothyroidism, came back in the norm. In fact, my value was on the low side. Same for the T4 test as well. Hopefully, these values rule out any kind of thyroid disorder. Unless there’s something else to test for things like that? Again, thanks for the reply!

        • Hi Jeremy,

          So sorry to hear about what is happening. A few thoughts:

          1. Yes, thyroid conditions may cause PVCs. This is generally with an overactive thyroid as PVCs tend to occur in the setting of any stimulants (this also includes adrenalin release from anxiety).

          2. A great point by another reader. Too often people are diagnosed with symptomatic PVCs when in reality the PVCs may not even be the problem. This is something that I see everyday in my practice. Because PVCs are so obvious when you go to the ER, people tend to focus in on what is obvious (the PVCs on the monitor) rather than trying to identify other causes of the patient’s symptoms.

          3. Sounds like you need to find a good cardiologist to help determine if your symptoms are coming from the PVCs or not. Also, your cardiologist can help you to quickly determine if the PVCs are dangerous or not. For most of my patients, once they have gone through the appropriate testing and find out that the PVCs are benign, the symptoms often do not bother them anymore.

          Hope this helps!

          John

          • Thanks! I actually worked with a cardiologist during my hospital visit and although we didn’t speak much, he checked me out, reviewed my labs/results and gave me the all-clear for discharge. I talked to him about the PVCs during our visit. I’m following the channels to rule out if the PVCs are dangerous. Next step is my 2D Echo which is coming up in 3 days. I also plan to ask my family Dr. to refer me to a good cardiologist in order to further determine if my symptoms are coming from the PVCs if need be, or if they are indeed dangerous. So far, 2 sets of blood work, 2 chest x-rays, a cardiologist visit followed by a stress test show completely crystal clear! I’m intrigued by your point #2. Armed with my labs/results, I’ll be sure to ask my Dr. if there could be other things to look into. Thanks again for your help!!

  144. Interested in shawns post about sedatives. I thought stimulants were the culprit not sedatives. I never used valium but once for a breast biopsy and i have used hydrocodone in past. the only things ive used for anxiety was l tyrosine and gaba. The hydrocodone was for lumbar 2level fusion.

  145. Dr. Day, I am 41 year old male in good shape, have a slight Pectus excavatum in my left rib cage, eat a good balanced diet. However I have been dealing with premature beats for the past 5 months or so. I tend to get them later in the day and especially after a large meal at dinner time. I am also recently off of a benzo stint (about .5 to 1mg a day)that started late 6/2015 and ended with a taper in late 11/2015. I have read conflicting reports that benzo’s like xanax and klonopin can cause PVC/PAC’s. It seems as though these PVC’s arose while I was on this medication, and now are more frequent that I am about 2 months off. I have heard that withdrawal from benzo’s, both tolerance withdrawal and post-use withdrawal can trigger and/or exacerbate premature beats. Ironically I got on the benzos because of chest pain and shortness of breath that numerous cardiac tests found nothing. Cardiac CT, echo, stress test, holter monitor, blood work all came back normal, but all these test were done in June and July when I wasn’t having premature beats. These started to arise after the tests in August. While I dont have the chest pains or shortness of breath anymore, I now am left with these premature beats that drive me crazy, and leave me lightheaded with every “thud”. So, is there a benzo use and withdrawal correlation? Can eating bring them on? Should I request another round of tests for potential changes that the benzo use caused my heart? Should I wait some time for my body to adjust to being off the benzo’s? Thanks in advance for your time!

    • Hi Shawn,

      Thanks for sharing. In general, anything that puts stress on the body can trigger PVCs. Stimulants are a stress. Likewise, withdrawing from highly addictive medications, like benzodiazepines, is also a stress.

      If you read through all of the comments on this article you will see that many people suffer from vagal PVCs. For these people, significant stimulation of the vagus nerve, like with a big meal, triggers PVCs.

      As far as another round of testing goes, only your cardiologist can answer this one. Please check with your doctor to see if more testing is indicated or not.

      Best,

      John

    • Hi Laura,

      Great question. Carnosine was discovered in 1900 but until recently little was written about it. Recent small studies have suggested a benefit as an anti-aging compound. Also, recent small studies have suggested a benefit in controlling lipids, blood pressure, and heart failure.

      There really is not much about carnosine and arrhythmia management. Also, not all studies have been beneficial. For example, this most recent study shows that too much carnosine in your muscles is associated with obesity, diabetes, and bad cholesterol numbers.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595442/

      Thus, it is hard for me to say at this point if carnosine is beneficial, harmful, or neutral when it comes to the heart. Stay tuned on the carnosine story. Some very interesting data and there is still much that we do not know…

      John

  146. Dr. Day,

    Thanks for the great article. When I am having episodes, I like to find articles that soothe my worried mind.

    I am hoping you can explain why I feel each and every thud, yet some people never feel any at all? What causes the “thud” vs. no symptom at all?

    • Hi Sharon,

      After a PVC there is typically a pause or delay before the next heart beat. During this period of time, the heart may “overfill” with blood. Thus, the normal heart beat after the PVC may feel like a “thud” due to the extra blood being ejected from the heart.

      You are correct. Most people never feel PVCs. PVCs are something that everyone has from time to time.

      Why some people feel PVCs and others do not is not something that is well understood. The same thing is true with pain. Why do some people have a high pain tolerance and yet others experience excruciating pain with even the slightest bump or touch?

      It is well known that certain meditation or yoga masters can raise or lower their heart rates. This is likely because they can tap into their autonomic nervous system. Perhaps people who feel PVCs have trained their brains unconsciously to detect every misfire. I have had patients who, through mindfulness techniques, have trained their brains to not feel PVCs.

      Best,

      John

  147. Hi Dr Day,

    Like many I’ve had PVC’s since I was about 14 and never thought much of them.I was looked at in my teens and was diagnosed with PVC’s, and I moved on .My PVC’s seem to have gotten worse over the years , and I was going to say more forceful , but when I think back they’ve always felt the same. The feeling I get is more of a squeezing feeling and then a forceful push at the end.

    The trouble I’m having is every so often I get a really bad bout of PVC’s that seem to turn into something else. Like most PVC’s you can feel them coming but I get pain, and what feels like very fast short burst PVC’s with shortness of breath, I get cold and clammy, and feel exhausted after. These bouts last anywhere from 1 minute to about 5 min. Now as you could imagine I go to the ER just to make sure, most times the Dr’s tell me those trace markers that tell of damage are slightly raised, not a lot about 4.0 out of 2.0 they tell me.

    Any other time they do blood tests those markers are normal. The most recent ER visit I was admitted to the hospital for 4 days of testing, stress tests , Imaging tests, EKG’s..etc. The attending Dr that did the stress test seen me have one of those attacks , looks at the readings and exclaims “that’s not good”. The nurses told me they felt I was cold and clammy and sweaty, but every test comes out saying heart is normal. I did see a electrocardiologist that visit as well who said the stress test was normal?

    I was curious if you had any ideas on where to turn from here as I am exhausted trying to figure out what this is when these attacks happen. I was on Coreg for a while, works well but hated the side effects. Do you have any recommendations on Beta Blockers that are similar that might work better with my body?

    Thank you for any information, and thanks for taking time out of your busy schedule to answer these. Much appreciated.

    • Hi Kevin,

      For some there is no reason for bouts of PVCs. Others may have triggers.

      Sounds like you need to find a good cardiologist that you can trust and will be willing to work with you.

      With regards to beta-blockers, it often is a trial and error process. Some people do react differently to different beta-blockers.

      Hope this helps!

      John

  148. What is edta in some vitamin supplements?

    How does depression affect heart? I Have at times used gaba or kava..always afraid of meds.

    • I took oral edta for my cholesterol and brought it down from 221 to 60 in 9 months, but i had a major heart attack anyways because i had 100% blockage in my right coronary artery caused from advanced early onset athlerosclerosis. EDTA is great for lowering cholesterol, finding a pure source and deciding whether to have I.V. infusions prior to taking an oral maintenence is the issue id be more concerned about. EDTA was created to pull heavy metals from the body after WWII and used by germans who had worked in the ammunitions building and subsequently suffered from lead poisoning and others. It has been generating some interest by some and is gaining a reputation for being a good chelator for plaques as well, but like vitamins or anything else not regulated by Big pharma or FDA, there is no money in it for them and therefore little incentive to study it. All i can tell you is that it worked for me in bringing down my cholesterol signifigantly, it did not solve all my issues though. Id say if cholesterol is your only issue then definately get on it, because that i know it does work for! You have to take a very high amount of minerals while you are on it due to the fact that it will leech certain positive ion minerals out of the body.. like zinc, calcium,magnesium and others. Not supplementing these while taking Oral EDTA will cause terrible muscle cramps and lead to mineral deficiencies and potentially the host of illnesses that go along woth that. As with traditional medicine, a healthy diet and lifestyle will go a long ways towards attaining the desired goal. I Hope that Helps you, knowing someone else took it and had success with it. Again… EDTA needs to be a pure formula, not just a small minute preservative you get in a vitamin. It comes in a powder form and ive even seen some packaged as capsules, there are also dr.s who do i.v. infusions.

    • Hi Laura,

      EDTA is felt by some to be an antioxidant that helps to prevent plaque build up in the heart. Unfortunately, data is lacking for this supplement.

      Depression is a strong risk factor for coronary artery disease.

      John

  149. Hello Dr,

    A few months ago I started feeling this “skipping beat” in my chest. At the time I didn’t think much of it because it was random and only happened a few times a week. This changed a couple weeks ago when I had that same feeling for several hours at a time one evening. After about three hours of this feeling, it slowly decreased until it stopped. The next day it happened again. It started and it was continuous. I told my wife about it and she quickly suggested I go to the ER which I did. There they did an EKG which showed an abnormal heart beat. Because of this they also did some blood work and an x-ray. Ultimately the doctor said it was PVC’s. He assured me that in most cases PVC’s are benign but that I should follow up with my physician.

    My physician went over the blood work and the EKG and proceeded to explain to me what PVC’s were using the EKG. He went ahead and ordered an echocardiogram to check for any valve issues. Today I went back for the results and he said that everything checked out just fine, no valve issues and that my heart looked to be healthy.

    He asked me how often I get the PVC’s and I told them that there’s days when I only feel a few of them and other days where it’s a lot more. Nothing like continuous hours but that it still made me feel very uneasy every time I felt it.

    He suggested beta blockers to help but I told him I rather stay away from pills as much as possible and would consider taking them only if I didn’t see any improvement or if the discomfort wouldn’t go away.

    I asked him if it would be a good idea to see a cardiologist about it but he responded that because of the echo, blood work, the fact that I don’t smoke, only drink alcohol occasionally and do not consume a lot of caffeine and the lack of heart problems within the family history that he didn’t think it was necessary.

    In a way that has helped but it is amazing how feeling PVC’s can make it difficult to function. I find myself trying not to over exert myself. Once I start feeling them I can’t seem to focus on what I’m doing good because my focus seems to be in my heart beats.

    Anyways, after reading your article (which is great, by the way) and after reading a lot of the posts left here by many people I think that maybe I should see a cardiologist just to rule out everything and anything that might be much more than just a pvc.

    My question to you is, should I check in with my physician about seeing a cardiologist and have him refer me to one? Or should I seek out a cardiologist on my own since my physician said he didn’t think it was necessary?

    Thanks again for the great article. For Taking some time to respond to everyone who has left a post.

    Ricardo

    • Hi Ricardo,

      Seeing a cardiologist can’t hurt. Especially if it gives you piece of mind. There may be subtle aspects to your case where a cardiologist could provide insight.

      Some cardiologists require a referral and some do not. When possible it is generally best to keep all of your doctors “in the loop.”

      Hope this helps!

      John

      • Dr. Day,

        Thank you for taking the time to reply to my post.

        I will be seeing my doctor about referring me to a cardiologist. I believe it to be for the best. I will benefit from it and as you suggested, my doctor will be in the loop.

        Again, thank you.

        Ricardo

    • Ricardo,
      Based on my experience with the PVCs leading me down the path to a stress test which ended up being abnormal and stress tests which for certain people and/or people who reach a certain age are a good idea ….a second opinion from a cardiologist is your choice. If your insurance allows it and some insurance companies allow you to see cardiologist without being referred too and it would make you feel better I say find a good cardiologist and perhaps they can take this worry away for you or investigate further into it.
      I never smoked, drank, I ate healthy and was perfect weight for height. I never had high blood pressure or cholesterol and I have exercised since being an athlete in college. The only risk factors I had were family history. Heart disease for some can have no symptoms and for some can have many causative factors. I was quite honestly mind blown by the
      ultimate outcome of the PVCs and the journey they sent me on. I’m still on the journey because stenting in no way stopped PVCs. I don’t feel my PVCs. But they show up on EKGs and whenever I’m hooked up such as in cardiac rehab.
      Let’s just put it this way…seeing a cardiologist can’t hurt.

      • Hello,

        Thank you for taking the time to read my post and thank you for your feedback.

        You mentioned something that has been on my mind… Just because the risk factors aren’t there doesn’t mean it can’t happen. I try to tell myself that with what the doctor said I should feel better but another part of me wants to know that there’s really nothing wrong with my heart.

        With your reply and Dr. Day’s I am going to talk to my doctor about seeing a cardiologist. I now believe it to be the best course of action… To rule out any other things that the tests already done could have missed and like Dr. Day says, for peace of mind.

        Again, thank you for taking the time to reply.

        Ricardo

  150. Hello. I get what feels like an extra heart beat or a flip-flop feeling in my chest/throat. Sometimes it goes on for awhile. When I feel my pulse, there is a pause before the next heartbeats. Lately it has been happening when I wait too long to eat. If I end up having a late breakfast they will end up happening before and after I eat late. Are low blood sugar levels (or blood sugar problems) known to trigger these?

    • Any form of stress (physical, mental, trauma, illness, abnormal blood sugars, etc.) on the body can trigger PVCs in some people. It is great if you can identify a trigger as you can take steps to minimize or avoid those triggers.

      John

      • Thanks for your response. I never thought of abnormal blood sugar levels as stress before. Thanks for the information!

  151. My PVCs actually saved my life because they were discovered by a doctor pre examining me for a colonoscopy. He sent me back to my internist. A cardiac doc did 2 stress tests one regular and then one echo stress test. These were abnormal. Cardiac doc wanted to do CCTA and insurance denied. My other doctors were pushing me to get a cath test. The cardiac doc was not pushing for cath. Finally one of my doctors insisted I get a cath and called the cardiac Doctor and in the cath they discovered 95 percent blockage of the LAD Artery which was major.
    They stented the artery and collagen plugged the groin. The cardiac doc released me immediately and said all was well.
    Other docs have been monitoring me with EKGs and those PVCs are rampant.
    Needless to say I went to a new cardiologist and he is going to get to the bottom of these PVCs and monitor groin because collagen plug should have been absorbed by now.
    Sometimes I feel PVCs but in beginning I never felt them and the gastro doc is the one who discovered them.
    From the stress tests to the actual stenting I had no symptoms and was walking around with death possible at any time with that blockage.
    But the PVCs remain.

  152. I was never heavy but i do not eat red meat….many veggies…soy…polenta…beans..wheni started this during menopause lostfour inches on waist. At this time of life important to be proactive. I am not sure if diet helps mvp but should improve arteries and circulation.

    • Hi Laura,

      Congratulations on being proactive with your health! Not much data on MVP and diet. However, your healthy lifestyle will definitely help not only the cardiovascular system but most of the other organ systems in your body.

      John

  153. I’ve had these horrible things for over a year I’m 21 year old female. I cut out all caffeine and don’t drink or smoke ect… My palps range from one or 2 a day to 30 or 40 a day when I feel them I panicked I’ve been for 2 ecg and they were normal I get them mainly when I lie down or squat but can all suddenly get them when I’m just sitting down calmly it’s odd tho it’s almost like I know just before I have one. I’m worried my heart will just stop.

    • Hi Kayleigh,

      So sorry to hear you suffer from palpitations. Sounds like it is time to connect with a cardiologist. The first step is to see if the palpitations are even coming from the heart. At least 50% of the patients I see for palpitations have symptoms that are not even coming from the heart. Based on what you see from your workup your cardiologist can then guide you on the best treatment approach.

      Hope this helps!

      John

    • Hi Margaret,

      Lexapro can lengthen the QT interval on the EKG. If the QT interval gets too long it can cause a life-threatening form of PVCs (long QT). People who develop palpitations from antidepressants should speak with their physicians immediately. An EKG could quickly determine if the QT interval is dangerously long or not.

      Hope this helps!

      John

      • Thank you for your prompt reply. Are there any antidepressants that won’t contribute to heart problems. Thanks.

        • All of the antidepressants I am aware of can, to some degree, lengthen the QT interval on an EKG. As with everything in medicine, people need to discuss the risks versus benefits of any treatment with their physician. It is important to remember that depression is also very dangerous to the heart.

          To be safe, people with known long QT syndrome should not be taking these drugs except in rare cases. For people without the long QT syndrome, an EKG before starting an antidepressant and then a follow up EKG at peak drug levels on the antidepressant, which is typically 2 to 3 hours after taking the drug, can be helpful in identifying risk. Ongoing periodic EKGs can also be helpful to help identify risk.

          If the QT intervals lengthens significantly with the antidepressant then it isn’t safe for that person.

          John

          Hope this helps!

          John

  154. Thank you about explaining angiograms.

    Does anything like niacinamide or anything else help to dilate blood vessels?

    • Hi Laura,

      I am not aware of any studies showing that niacin helps to dilate blood vessels. There are data that adopting aggressive healthy lifestyle changes can help to reverse coronary artery disease and dilate blood vessels.

      John

  155. I have had benign pvcs for over a year now. I have had stres echo, bloodwork, holter, event monitor. I do struggle with anxiety and am now on effexor fir that. It has helped tremendously with the anxiety and the palps. I’ve been on for 3 months. However, for some unexplained reason, last week my anxiety spiked out of the blue when I was grocery shopping. Then a few days later my palps got bad again and have been that way for days. I take 12.5 mg of metoporol but it has never helped. I tried 25 mg but my pulse goes below 50 bpm so my dr cut down. Basically, it doesn’t help at all. Do beta blockers not always work for pvcs? Will a different brand help?

    • Hi Doreen,

      So sorry to hear the anxiety and PVCs are back. Beta blockers don’t work for everyone. In my practice I find that about 50% of patients find relief with beta blockers. Sometimes one beta blocker works better than another…

      Hope this helps!

      John

  156. Dr. Day,

    Thank you so much for this info. I am 49 and in June was diagnosed with AVNRT after a heart racing event that I needed to go to the ER to slow my heart rate down. I already suffer from high anxiety, so after my diagnosis I decided to have the ablation procedure to correct the AVNRT. Since then I have had no racing incidents, but my PVCs have increased.

    My ECHO was fine and my cardiologist has increased my beta blocker Metoprolol to 50 MG. If a beta blocker is going to work how long does it take to kick in?

    I also take Wellbutrin, Prozac and Xanax (as needed). My doctor has reassured me that my condition is benign, but when they occur and seem to hang around for the afternoon or evening it really feels like something’s wrong. I have not had a Holter monitor to see what my percentage is…since there is no evidence of abnormalities does it even matter treatment wise what my percentage is?

    Also, do you think my ablation for AVNRT is related to my increase in PVCs?

    Working hard to ignore it 🙂

    Thank you

    • Hi Christie,

      Anecdotally I have seen cases where PVCs have worsened after an ablation although this is not well described in the medical literature. In general, most beta blocker responders start to feel some benefit within a few days.

      Holters can be helpful in determining the PVC burden. When the PVC burden is greater than 20% of all heart beats then these people need to be followed periodically with echocardiograms to make sure they don’t develop heart failure.

      John

  157. Hello, I am 22 years old female with pvcs, I’ve been on metoprolol (75mg) for almost 2 years, my doctor says they will go away, and over the next 5 years will wean me off the medicine, honestly I’m tired of taking meds everyday, I dont exercise like I should, they did the stress test (hr up to 178) the PVCs were not as bad. Recently I’ve been feeling some titeness, a little bit of chest pain and flutters, should I stay on the medicine or ask my doctor to take me off of it?

    • Hi Amanda,

      It sounds to me like it is time to get in contact with your cardiologist right away. Could be many things going on.

      John

  158. John, I’m an Anesthetist 57 y/o in good shape. have degenerative disc desease however and I was placed on 75 mg effexor 2 years ago for pain. I am now getting off of it slowly to avoid withdrawls. down to 18mg/day. Have started experiencing some pvcs late morning to early afternoon. I don’t experience it when I workout at the gym. Think it may have something to do with the anxiety feeling getting off effexor or the reduced seritonin levels?

    • Hi Eric,

      Hard to pinpoint the cause. Both the anxiety and serotonin withdrawals could be contributing to the PVCs. Alternatively, it could be a completely different mechanism. Continue to work with your cardiologist to pinpoint the cause.

      Hope this helps!

      John

  159. I remember a doctor suggested pycnogenol for a neighbor.

    Can you see arteries with echocardiogram or only vascular sonography?
    thank you

    • Hi Laura,

      Unfortunately, you cannot see the arteries with echocardiography. To see how much of a blockage in an artery one might have you really need an angiogram or a CT angiogram.

      Hope this helps!

      John

  160. When is vascular sonography used. Can you see arteries with regular echo.

    Also like to mention my supplements include fish oil…coq10…bvitamins..lcarnitine…ashwaganda..rhodiola….gaba. i sort of rotate things. Also mag esium and calcium. My blood calcium level isnt too high. Sometimes baby aspirin and tylenol.

    • Hi Laura,

      Of the supplements you listed, fish oil has been shown in some studies to help with arrhythmias but not all. Electrolytes have also been shown to be helpful for arrhythmias. Not much data on the other supplements.

      John

  161. All the posts are helpful. My first episode was in my thirties for a month with a strrssful job. At 40 after spine surgery again. Now i am 60 echo showed mvp and i do better with gentle exercise…bicycle or yoga. Stair climbing if done too long can initiate a few skips.
    The worst episode was in my thirties.
    Laura

    • Hi Laura,

      An interesting account of PVCs over time. This is often what I see as well. PVCs may wax and wane over time. Sometimes, bothersome PVCs earlier in life aren’t so bothersome over time.

      John

  162. Thank you Dr. Day for taking time out of your busy day to answer our questions!
    Regarding PVCs, I’ve had them in the past, went to my cardiologist and after an EKG and an Echo, heart problems were ruled out, and the PVCs stopped.
    In the last few days, I’ve had them seemingly triggered by gas from an irritable bowel, after meals with flatulance and abdominal bloating.
    Is it possible for an irritable bowel to trigger PVCs?
    Thank you for your help!

  163. I have had PVCs for four years after I had a severe neurotoxic reaction to Cipro that destroyed my autonomic nervous system. I have about 15% PVCs daily. I take no stimulants whatesoever, take magnesium, eat high nutrient diet, but they still come on strong. The weird thing is, for sometimes a month at a time, they almost disappear. I cannot, for the life of me, figure out a pattern as to why. My only option at this point is an ablation. I want to have another child, so I’ve been putting that off. I’m afraid they might get worse in pregnancy, however. Any tips on the brand of magnesium that might work well?

    • I highly reccomend one called Calm. Its a powder you take at night in water and it helps you sleep like a baby and wake refreshed. If you cant tolerate a stevia sweetner though i reccomend the plain flavor or its generic equivalent you can buy from vitacost.com called natural tranquility. These are
      non GMO which is a plus when you consider they have all but ruined most of the vitamin supply now to. Best of luck to you with the ablation and your future family 🙂

    • Hi Sarah,

      With regards to magnesium, there is no one specific type that works for everyone. It is generally a trial and error process to see which form works best for you. Here is a great explanation from the National Institute of Health below. Hope this helps! https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/

      John

      Magnesium supplements are available in a variety of forms, including magnesium oxide, citrate, and chloride [2,3]. The Supplement Facts panel on a dietary supplement label declares the amount of elemental magnesium in the product, not the weight of the entire magnesium-containing compound.

      Absorption of magnesium from different kinds of magnesium supplements varies. Forms of magnesium that dissolve well in liquid are more completely absorbed in the gut than less soluble forms [2,11]. Small studies have found that magnesium in the aspartate, citrate, lactate, and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate [11-15]. One study found that very high doses of zinc from supplements (142 mg/day) can interfere with magnesium absorption and disrupt the magnesium balance in the body [16].

  164. Hi DR Day, My question is, are the beats that pause and then beat PVC’s or PAC’s. I have both. I will get one to three quick beats in a row and some times they pause and then beat. My cardiologist said they were benign after an EKG. Thank You

    • Hi Bill,

      Yes, you are describing some of the classic symptoms of premature beats (PACs or PVCs). Whether or not PVCs are benign is something that only your cardiologist can tell you after the appropriate tests. Fortunately, your cardiologist told you that your premature beats are benign.

      Best,

      John

        • Bill… P.A.C.s are in the upper chambers, P.V.C.s are in the lower chambers. Depending on how sensitive you are to these arrythmias you may denote their whereabouts or you may not.

        • It is nearly impossible for most people to tell the difference based on symptoms alone. It is easy though with an EKG…

          John

          • John.. P.A.C.s are in the upper chambers, P.V.C.s are in the lower chambers. Depending on how sensitive you are to these arrythmias you may denote their whereabouts or you may not.

  165. The information out there is ambiguous on high frequency PVCS but again mine do not bug me except for the fact I have them. I was wondering if I can take any neutral supplements to aid in these PVCS

    • Hi Curt,

      Yes, there are few studies on PVC burden and the risk of cardiomyopathy/heart failure. In general, most people agree on the 20% burden level for when the risk goes up.

      Electrolyte supplements can be helpful for people suffering from PVCs (especially magnesium). For other supplements there are limited data and most reports are just anecdotal.

      Hope this helps!

      John

      • Is there anything else I could do to decrease frequency of PVCS – I will do anything not to have an ablation

        • So sorry to hear about your challenges with PVCs! To minimize the key to PVC symptoms it is important to live as healthy as possible and practice mindfulness techniques to minimize the effect of stress (yoga, meditation, etc.). Electrolyte supplementation or medications can also help. Good luck! John

  166. The main trigger for my pcvs is lung congestion/tightness due to what has recently been diagnosed as asthma: as the phlegm builds up in the lungs, the pcvs kick in. I’ve recently been taking a cortico-steroid inhaler (Asmanax) which has reduced my pcvs considerably.

  167. I have 1/4 of my heart beats are PVCS and feel fine. Had a work up and nuclear stress and echo came back negative- blood work as well. I really do not want an ablation and currently on a beta blocker. Do people live with these high frequent PVCS – I believe that this is my normal heart rate as long as I can remember. My anxiety is kicking in and that is not helping things

    • Hi Curt,

      I have many patients with very high burdens of PVCs (more than 20% of their total beats) that also do not want an ablation. Many of these high PVC burden patients are on beta-blockers, some are not. For these patients, I periodically do an echo to make sure the PVCs don’t cause any injury to the heart. As long as the PVCs are not bothering them or their heart function (we have also ruled out other heart problems like artery blockages), I am fine with leaving things alone.

      Hope this helps!

      John

  168. Dr Day, isn’t there some recent evidence to suggest that PVC’s may be risky (in terms of heart failure and maybe even stroke) at much lower levels of frequency than we have traditionally thought?

    • Hi Pat,

      This is certainly a moving field. While there may be some data suggesting lower PVC burdens may also pose a heart failure risk, the generally accepted PVC burden at which heart failure is a risk is 20% of total beats. Of course, nothing in medicine is “black and white” and there is no absolute level at which something is safe or a risk.

      Hope this helps!

      John

      • Thanks, John. I know the 20-24% is the traditional figure for cardiomyopathy. I think the new data I heard about is from a population-based study using participants in some sort of ongoing CV health study, with follow-up of a decade or more.

        Appreciate your fine blog here!

  169. Dr.John,
    I am 68, I am 5’4″at 115 lbs. I’ve had stress test & CT angio with 0 plaque. I have a pacemaker for type 2 heart block, RBBB & LBBB. I pace 7% atril & 5% vent. I take 25 mg Toporol XL for PAC/PVCs. My pacemaker does not help my PAC/PVC symptoms. In the last year I have jumped from 66 PAC’s per day to 1100 a day. These occur when I eat or drink or when I walk. I have walked 2 miles a day for 20 years, but now I wonder if I should keep walking? There are a few days I can walk without any PAC’s or PVC’s. Most times it is constant PAC’s. Thank you Pam

    • Hi Pam,

      Always best to check with your cardiologist to make sure the PVCs aren’t serious. If the PVCs are benign then walking is a great way to keep active.

      John

  170. Happy New Year Dr. John,
    After wearing a holter twice in a month and finding a high number of pvcs, my cardiologist wants to put me on metoprolol succ.er, 12.5 mgs.
    I have two questions. First, are beta blockers for pvcs for life? Last, I have mild environmental asthma (perfumes, pollution, cold air, etc.) This is on my medical record. Should I be concerned about the asthma after all the times I gave read that people with asthma shouldn’t take beta blockers…
    Thanks,
    Sally

    • Hi Sally,

      Great questions. Beta blockers may be used for life if you have the dangerous kind of PVCs or if they are controlling symptoms. Regarding asthma and beta-blockers, there are 2 types of beta-blockers. These are the cardiac selective and the non cardiac selective beta-blockers.

      In other words, some beta-blockers work primarily on the heart (i.e., metoprolol) and others affect the entire body (i.e. carvedilol). For people suffering from asthma, they should only be tried on the cardiac selective beta-blockers. Here is a good article on Medscape if you want to read more: http://www.medscape.com/viewarticle/464040_4.

      Hope this helps!

      John

      • Thanks for your info. It was very helpful. I do have mitro valve prolapse and this round of pvcs were at about 16,000… does that qualify as dangerous?

        Thanks again…
        Sally

        • Hi Sally,

          Many people have very mild forms of mitral valve prolapse which is of minimal significance. However, others may have have severe mitral regurgitation along with their mitral valve prolapse. If the mitral valve prolapse is significant it could cause mechanical stretching and PVCs.
          Only your cardiologist can tell you if your mitral valve prolapse and your PVCs are serious or not.

          Hope this helps!

          John

  171. Hi Dr Ray
    I am healthy, 47 years old and have recently begun feeling these skipped beats. I have a long history of anxiety, and I probably drink too much coffee. When I was 30, I had a severe panic attack that led me to the Dr, where I had stress test, ekg, etc, all normal. My question is this: could a serious heart problem have developed over the last 17 years that would be an underlying cause of PVC’s? I know it’s impossible for you to make a diagnosis, but would love your opinion. Thanks

    • Hi John,

      Impossible to say. I would suggest getting in to see a cardiologist to at least run a Holter monitor and a stress echo.

      Hope this helps!

      John

  172. Mine started in 1993. Got better when time but being a police officer for 20+years I think stress is my mine trigger. When they first started I had a panic attack and then noticed the pvcs. Ekg, echo, holter , blood test for thyroid. You name it. All came back normal.

    I have a severe anxiety disorder and when I have them it causes more anxiety so it is a catch 22. I can go to the er or doctors office and they will subside. This is crazy and makes me think I am crazy. They have come back over the last several years. Currently taking benzo to the panic disorder this does relieve the edge to where I am no freaking out

  173. Dr. John: Thank you for posting this information and opening up a forum for people share what their going through. I just recently found out my ❤ heart experiences PVC’s. Aroundmy cycle I get a string of them. My cardiologist our me on 25mg of Metoprolol and as need basis. He wants me to start with half and hopes that all I need, which I’m hoping and praying for as well.

  174. I have been suffering from PACs for many years, and recently the symptoms have become unbearable. I’ve had a full work-up (treadmill stress test, resting echo, 48-hour holter). The stress test and echo were normal, and my holter monitor showed 19% PAC load. I don’t smoke or drink, and I have one cup of coffee in the morning (I tried eliminating that for a while, and nothing got better with my PACs, so I went back to it).

    I have seen a cardiac electrophysiologist, and he said to simply not worry about anything. My major concern is that after exercise (moderate exercise — light jog for 30-40 min), the pain becomes unbearable. I’ve ended up in the ER a couple of times, and they haven’t found anything concerning. Even after being in the ER with severe pain, the cardiologist told me to not worry and go about my life. I’ve essentially stopped exercising now because the pain is so severe — each time I try to go back and do a light workout, the terrible pain comes back. Yet the cardiologist shrugs and says, “well, we can do an angiogram? Or some other test? Tell me what test you want and I’ll order it”. I feel like he’s patronizing me and ignoring the fact that my life is significantly impacted.

    Is all of this pain really normal, especially when associated with exercise? It can go on for hours after exercise — days, or weeks in the worst case (with no exercise in the weeks following the event, though the pain continues).

    • Hi Darren,

      Pain with exercise is definitely not normal. The biggest question that comes to my mind is what is causing this chest pain?

      To determine whether or not it is coming from your PACs would be rather simple. Just monitor your rhythm during exercise and see if the pain correlates with PACs. If the pain is coming from the PACs, then these could be suppressed with medications to see if it eliminates the pain.

      If the pain is coming from something else then you would go on a completely different pathway.

      It sounds like you need to work with a physician or physicians who will help you to identify the cause of the pain.

      Hope this helps!

      John

  175. I have both PVC’s and PAC’s. Holter monitor showed about 4,000 per day extra beats. Since discovering triggers, caffeine, alcohol, artificial sweeteners, msg they have improved. I am confirmed in the beginnings of menopause and believe hormones play a role too since they get worse around hormonal times. I have had to step down from the job and position I love due to side effects of these but since they have become less as long as I don’t touch the triggers. I have low blood pressure normally so was not prescribed beta blockers. Cardiologist did put me on low dose of Flecainide but I did not like the side effects so no longer take. Strangely, when this began a couple of years ago my gall bladder also stopped functioning and I am a healthy weight female that did not eat poorly and have always exercised moderately. I had my gall bladder removed due to 9% function. I wonder if there is any relationship or just coincidence that they were happening simultaneously?

    • Hi Tracy,

      A tough question…

      It is certainly possible that the hormonal changes of menopause may be causing these symptoms or it may be more than one thing going on. No way for me to try to sort this one out over the internet. Continue to work with your physicians and hopefully you can find answers to these symptoms.

      John

  176. Dr. Day, you suggested I document my HR jumping up as high as 170 in the night. I wore a monitor and did have a minor attack where it again woke me up racing, this time was 148 on the monitor and was sinus tach. Would you consider this adequate documentation of what has been happening? My anxiety symptoms have been intense lately, my biggest fear being my heart, esp the way it’s been racing in the night (and PVCs). Can I stop worrying about this now? Can a “healthy” 49 yo heart take this? And do you attribute it to anxiety? Have you heard of this before? Thank you for your opinion.

    • Hi Rhonda,

      Yes, there is a condition called “inappropriate sinus tachycardia.” I have many patients in my practice who suffer from this type of an arrhythmia. This is on my list of future topics to blog on–

      An inappropriate sinus tachycardia translated means, the normal heart beat (sinus) that is too fast (tachycardia) for the wrong reason (inappropriate). For example, exercise would be an appropriate sinus tachycardia but if you are just sitting it could be an inappropriate sinus tachycardia.

      This diagnosis is a diagnosis of exclusion. In other words, all other arrhythmias have been ruled out.

      There are many causes of a sinus tachycardia such as dehydration, fever, anxiety, thyroid or other hormonal problems, etc. The condition, inappropriate sinus tachycardia, is caused by a problem with the autonomic nervous system. The autonomic nervous system controls the body functions like temperature, digestion, heart rate, etc.

      My suggestion would be for you to work with a cardiac electrophysiologist (cardiologist who specializes in arrhythmias) to see if this is indeed your diagnosis. If so, I have found that the 2 things that help with this condition are regular daily aerobic exercise (bike, swim, run, etc.) and daily mindfulness exercises to reprogram the autonomic nervous system (meditation, yoga, Tai Chi, etc.).

      The best medication for an inappropriate sinus tachycardia is Corlanor (ivradabine). Beta blockers, calcium channel blockers, or digoxin may also work for some people.

      Sorry about the long answer. Hope this helps!

      John

      • Thank you very much for that explanation. I wonder if mine is “inappropriate” or adrenaline induced in the night due to an overstimulated nervous system. Either way, is it considered safe? Can I just lie there and let it happen? Will it probably go back to normal rhythm? I think I panic when it happens. It will help if I believe it won’t hurt me and that it will stop racing. The longest it has raced so far is 30 mins and usually comes with lots of PVCs.

        • Hi Rhonda,

          Great questions. Only your cardiologist can answer these questions.

          Certainly an adrenalin-like state brought on by either anxiety or other medical conditions could trigger sinus tachycardia and PVCs. If your physician suspects an adrenalin-like state due to a medical condition they can test for this. If your diagnosis really is an inappropriate sinus tachycardia then this is a benign condition. However, this diagnosis can only be made by your cardiologist after ruling everything else out.

          Hope this helps!

          John

  177. Already on anti-arythmics and beta blockers and had an ablation. still get pvc/pac strong enough to wake me up nightly. and quite often pulse drops into the 50s when this is happening. sometimes pulse drops into the high 40s. Already did away with all stimulants and potassium level is fine, any ideas?

    • Hi Bill,

      Congratulations on your efforts to live as healthy as possible. For people suffering from PVCs the key is to live as healthy as you possibly can in all areas of your life (weight, sleep, stress, healthy diet, physical activity, etc.) and to also work with a physician who specializes in PVCs (a cardiac electrophysiologist).

      When it comes to lifestyle changes, only you can answer if there is anything more you can do in the weight, sleep, stress, healthy diet, or physical activity categories. Work with your cardiologist as there may be other treatment options you can look at as well. Most people can find relief.

      Hope this helps!

      John

    • low pulse cannot be written off to physical condition I am overweight and 64 yrs old. Try to get to the gym 3 days a week, 20min walking, weight training, and the 12 min biking. improvement in physical condition does not have any effect on condition

  178. With my pvcs, sometimes it happens when I wake up after a nights sleep. I am just laying there trying to wake up and it seems to happen. Also I seem to have bradiacardia. That seems to trigger it sometimes or at least I think it does. It sure is irritating sometimes. Makes you worry too much. Oh well, I’ve had this for over 20 years now. I am now 62. Still it gets on ones nerve a lot. Anyway, just thought I would jot these things down, maybe in a way it will calm my nerves. I also try to stay away from caffeine, sugar, too much exercise. One thing that seems to help when I do get some pvcs is read your bible. It can’t hurt. God bless.

  179. Thank you! You even answered on Christmas Day! What a committed doctor you are! My cardiologist doesn’t think my increased exhaustion with more frequent ectopics is enough to warrant more testing since everything was normal one year ago. I would like a 2nd opinion– do you agree? Can anxiety in fact cause episodic PVCs like this? I’ve also been waking many nights with heart racing, and one time it hit 170bpm! He thinks that is stress related too. I’m trying not to worry and to get stress under control, but how do I not worry about these heart symptoms!

    • Hi Rhonda,

      Only your cardiologist can answer whether more testing is indicated or not. A heart rate of 170 at rest should at least be documented with a monitor if it has not already been documented. Anxiety can definitely cause symptoms like you are experiencing but you must rule out all dangerous causes of arrhythmias before blaming anxiety.

      Hope this helps!

      John

      • As a patient on this side of the scenario… ive found they usually try to prove the anxiety 1st and the dangerous conditions as the latter. Are you of a differnt breed of dr.s? Cause if so, that is very encouraging!

        Not to sound condascending, hopefully you are not offended, sometimes on this side it seems cardiologists are paid only to push pills and manage conditions rather that diagnose and treat or cure them.

  180. Are they strongly associated with anxiety? I’ve been symptomatic for several weeks with stress/anxiety, I’ve been experiencing fatigue and nervous stomach… my PVCs have become more frequent but also episodic, like if I exert much at all, I get them, sometimes every 2 or 3 beats for several minutes, then they start spacing out over the next 20-30 mins as I sit down and try to relax. My cardiologist is not concerned (normal work up one year ago) but you mentioned that if they get worse with exercise, or in my case exerting or doing normal chores, they might be serious? Or could my anxiety be causing episodes like these?

    • Hi Rhonda,

      You ask some difficult questions–questions that only your cardiologist can fully answer.

      Stress or anxiety seems to be the number one issue my PVC patients struggle with. I have found over the years, based on taking care of thousands of patients with symptomatic PVCs, that if the stress/anxiety can be be controlled then the PVC symptoms generally go away or at least significantly improve. However, you never want to blame PVCs on stress/anxiety until all serious causes of PVCs have been ruled out by your cardiologist.

      Hope this helps!

      John

  181. I’ve been suffering from both pac’s and pvc’s for the past few years, It started once or twice a day to a few times a day now on and off all day long, I’m 35 Years old in excellent health and can’t get no answer to this situation..

    • Hi Nathan,

      I completely understand where you are coming from. While it is impossible for me to help you find specific answers for your case via the internet, I would recommend visiting with a cardiac electrophysiologist (a cardiologist who specializes in heart rhythm issues) in your home area. Here is a link to find a physician near you to help you in your quest to find answers: http://www.hrsonline.org/Find-a-Specialist

      Hope this helps!

      John

  182. I am a 19 year old female living with PVCs that I can feel every single day. I have gotten most every test done, including ekg, heart monitor, ultrasound, and chest X-ray. Everything is apparently normal and I have no heart disease yet I still am uncomfortable every day, anxious about when these things will get better! I also do have a history of anxiety but I now only feel worried about PVCS and if they are going to hurt me. I also get chest pain and feel drowsy when these occur. I work out every day to try and help it and give me a peace of mind that I am healthy but they still never seem to go away. I take magnesium every day to help but nothing seems to work… Help!

    • Hi Jadie,

      So sorry to hear about your PVC struggle. For most people who struggle with PVCs, relief generally comes only after you have met with a PVC specialists (a cardiac electrophysiologist which is a cardiologist who specializes in arrhythmias) to know there is absolutely nothing wrong and by practicing daily mindfulness through meditation, yoga, nature walks, etc.

      Here is a link to find a cardiac electrophysiologist near you: http://www.hrsonline.org/Find-a-Specialist

      Hope this helps!

      John

  183. I find this page the best on the net concerning information about pvc’s. Betablockers didn’t help for me (inderal 10-40mg). Am on low dosage of verapamil now, doesn’t help either. Bad days give me 10k of pvc’s/24h.They keep me up at night and turn me into an insomniac, which worsens them of course… Sleep ,diet, being well mentally and vitamines help more than meds for me

  184. To all who have been plagued with this popular condition, it can be a real problem. in my case it started at 15,(i remember the very first one like when Kennedy was shot) i’m 71 now and just a few minutes ago while watching tv they kicked in again as they have all my life. fear and anxiety made me feel cold. although i believe that god is so good and i’m totally in his will, still it shakes me. so, please give yourself a break and start listening to these great doctors on the net and learn as much as you can about it, try a support group. didn’t have anything to turn to in 1960, and too afraid to go to a doctor. Whenever i had to see a doctor my blood pressure would be like 180/70, like when i went to my draft physical. the doctor knew i was psychological mess and looked the other way, I was only 22. but good ol’ pvc kept me out of the draft (vietnam 1967) I think the doc at the draft physical thought i had been eating soap or something and made me wait 30 minutes and several tries. made him disgusted but truly i couldn’t help it. I was totally humiliated. But i got through it, finished college, had a fun job in advertising for 29 years, raised a family, own a small comfortable home. and now thanks to the current political mess and economy, am working at favorite job, a art director for a small town newspaper learning higher levels of computer design in small town Centre AL. The only other health problem i have had all my life was a mild case of colon cancer, and i laughed out loud as i write this, (cancer) was nothing as compared to the awful fear of pvc’s, which i read is a ok problem? I have never talked to a doctor about a fix, with no real explanation except it is just normal, don’t worry. sure. so i told myself if i’m going to die of this it would been a long time ago. i stay active with a creative project and good books at night to help sleep to come. Also I have 2 rabbits and a cat which is a good thing. Never told friends either although the stress of this phantom problem caused several bad depressions, just kept working through that too. Take God at his word, please, and we can take everything the evil in this world can give if we believe He knows what is best. As you get older life gets easier if you grow in his spirit. I’m sure from what i have read over the years since the net, i had a anxiety condition that cause me to not be able to shake something off that bothered me about health issues, there were others. It’s just the way god made me and as they say he makes no mistakes. Hope this helps you. email me and I would love to tell you other details about pain and acceptance, it’s the only way to go.

    • Thank you so much for your words. I’ve been plagued by this for years…I feel like no one understands. I’m just the one with the funky heartbeat. Try and convience someone, your yourself, you’re healthy when your heart does beat so funky…It is good to know you’ve lived many years with this and haven’t died lol
      And yes, God is what gets me through it every day. There is nothing more annoying and if I could ask for one miracle it would be to stop this forever so I can eliminate 98% of my stress level.
      Again, thank you for your words.

  185. I have PVC’s. They were found when I had a hernia surgery. The Rhythem Cardiologist wanted to put me on Amiodarone which has life-threatening problems to the Lungs and Liver. I refused that drug. Then, he thru a different Cardiologist prescribed Verapamil which also has bad side effects but not as bad. I have found out from Dr. Stephen Sinatra, a cardiologist, on his website, to take L-Carnitine, D-Ribose and especially CoQ10 and Magnesium Chloride. What is your Medical opinion to just take the vitamins?

    • Hi Cecil,

      Magnesium can be helpful for many people who suffer from PVCs. CoQ10 is helpful for people who take statin cholesterol lowering medications.

      I am not aware of any studies showing benefit of L-Carnitine or D-Ribose for PVCs. Of course, if you choose to take supplements please make sure your physician is aware of this as supplements may cause side effects or interact with other medications.

      Hope this helps!

      John

  186. Hi John,
    I left a message before here, but want to write again. My PVCs are getting worse – more frequent, worsened by activity and I feel breathless on exertion with them. Also, I am having them approx 7 x a minute. I hate, hate, hate them!
    I saw my gp again recently about them and was asked to come back in 3 months.

    What is the hidden magic that means they stop as soon as a doctor has their finger on my pulse? This has happened 3 times now and makes me infuriated.

    Also, I didn’t actually realise they sap my energy levels until I had a good day yesterday (no special reason, I just woke up and noticed they were pretty absent) and managed to get up our workplace building’s 3 flights of stairs without feeling like the lights were dimming and gasping for breath once at the top. It was like the old days and then I realised how these things are negatively affecting my energy levels. I sweat sometimes with them as well.

    My gp doesn’t seem to be worried about them. I am! They are with me day and night. They seem to activate even more when I move. I have no idea what to do to stop them. I’ve tried carotid massage and I have even asked a friend (who describes similar symptoms and whose gp has given her medication for her symps) for a few of her propranolol tablets and I find the symptoms are relieved by 10mg. I know I shouldn’t do this, but I am at my wits end.

    Right now, as I type, my pulse is 87 and I am having irregularly dispersed PVCs – sometimes every 2nd beat, sometimes every 7th or 9th. There’s no strict pattern to them.

    I have autoimmune hypothyroid, which is treated with levothyroxine 100mcg daily. Blood test last week showed all to be in range. Our consultant at work (psychiatrist) suggested I should ask my gp about ‘sick thyroid’. But tbh, what’s the point when they aren’t interested in my arrhythmia?

    I am literally at my wits end with these. I have just turned 47, am wondering if maybe perimenopause is upon me and is adding to these. Again, I have to guess and wonder, as my gp just says that I ‘probably’ am perimenopausal, without any tests. (the same gp who denied I could possibly have arthritis in my spine, despite my difficulties with mobility and family history of it, without even looking up from his desk – on 5 separate appointments spanning 10 months – it turned out to be osteoarthritis of my spine when on a 6th vist to the surgery, a young locum agreed to get me xrayed). I have now lost faith in my gp and am in the process of changing my surgery.

    I’m not usually a worrywart, but this has me worrying each night if I’m going to wake up in the morning and who will look after my 6 year old son if I die.

    I am right in the middle of the healthy BMI range (21.3), better-than-average fitness, active and a mental health professional. I have two cups of tea a day, no coffee, I don’t smoke (occasional, maybe 2 a week if I go out).

    Sorry to waffle on, but these are beginning to sap my spirit.

    • Hi Becky,

      So sorry to hear about your struggles. Arrhythmias can come and go–it is unusual to be having them in the doctor’s office. This is why we use Holters, event monitors, or even the smartphone EKG apps like Alivecor to document arrhythmias.

      If your GP is not listening to you it sounds like it is time to be seen by a cardiologist or, even better, a cardiac electrophysiologist which is a cardiologist who specializes in arrhythmias. They can at least tell you if you have the serious or benign PVCs.

      Here is a link to find a cardiac electrophysiologist near you for a second opinion: http://www.hrsonline.org/Find-a-Specialist

      Hope this helps!

      John

  187. Is it possible that one Beta Blocker works better to treat PVC’s than another? I was taking Bisoprolol before my valve surgery and it stopped them cold. After surgery I was switched to Metropolol and they have returned. About 3 -4 every minute sometimes less.

    • Hi Bill,

      Great question. It is certainly possible that PVCs react differently to these different beta-blockers. This is something that has not been reported in the medical literature, however I have seen in my practice that it does seem to be the case for some people.

      Hope this helps!

      John

  188. I have been suffering pvc 3 years with bigeminy trigeminy couplets etc been through many stress test and echo all within normal … Pvcs are tooo much but since they don’t fit cardiologist criteria they ignore me… But I get severe pain burning for days and cardiologist say not to worry… Please advise as when they do my holter it doesn’t catch all the action and so they ignore.. Have used concor it keep my bp very low plus its not helpful either

    Your guidance is appreciated

    • Hi Vikas,

      Only your cardiologist can tell you if your PVCs are worrisome or not. If the Holter is not catching all of your symptoms, have your physician order a one month event monitor so that you can record all of your symptoms for a month. Also, if you feel your cardiologist is not paying attention to your symptoms it may be worth getting a second opinion or a consultation with a cardiac electrophysiologist (a cardiologist who has done advanced training in arrhythmias).

      Hope this helps!

      John

  189. very nice articles and i have pvcs since 30 years and see that reading of your article are very very useful and it is exact tips.

    • Hard to say. Even in younger people I like to get a Holter monitor to quantify the PVC burden and do a stress echocardiogram to make sure the heart is otherwise healthy. Talk with your doctor about being evaluated.

      Hope this helps!

      John

  190. It seems that every few weeks or months i get pvc beats like crazy. Holter monitor shows them as well. Everything that i read shows that pvcs with a structurally normal heart is ok. In my case i have congenital pulmonary stenosis. The stenosis has remained the same for the past few years, but the pvcs and pacs have increased huge plus i am getting them in runs now… Are they still harmless is my case?

    • Hi Pat,

      Thanks for reading!

      Congenital pulmonary valve stenosis represents a form of structural heart disease. This obstruction put a strain on the right side of the heart which could explain both the PACs and PVCs. Also, if it has been corrected surgically, the surgery may have created additional issues.

      I would recommend being seen by both a cardiac electrophysiologist as well as an adult congenital heart disease specialist as there are unique aspects to your PVCs.

      Hope this helps!

      John

      • Thank you. No it has not been fixed. The degree of stenosis remains unchanged from 5 years ago (when they started to monitor it). Yearly echo shows no other problems. However i did have an ablation 20 years ago for svt. Could old scar tissue be causing pvc/pacs now that i am getting older??? They went from occasionally about 5-6 years ago to very often and very scary for me!
        I dont even know what a cardiac electrophysiologist is yet….i need to read up on them.
        Thank you.

  191. I HAVE BEEN DEALING WITH THIS PVC’S NIGHTMARE FOR MANY MANY YEARS, I’VE TRIED EVERYTHING, VITAMINS, MEDITATION, EXERCISE, MED’S, NOTHING WORKS IT’S A NIGHTMARE.IF ANYONE KNOWS A GREAT DOCTOR IN LOS ANGLES , LET ME KNOW CAUSE I SURE CAN’T FIND ONE WHO EVEN CARES.REGARDS DENIEL. 11-3-15.

  192. Hello dr john, i was recently diagnose with pvc, well it started at the degining of these year, it started usually when am running on treadmills i usually feel like a flutter or shock through my heart, by that tym i didnt take it seriously coz it didnt bother me, but recently it started to come when am even lying down before sleeping, so i have been to the ER 3times and admitted 3 times, they did holter 2 times, echo and stress test came out to be normal, the doctor assure me that they re harmless, did a blood test everything came out normal, but honestly when ever i feel that flutter sansation, i feel really bad, no matter how much i try to cope with it, it really scare me, its like my heart is going to stop or blow, or thinking maybe am gonna develop a heart disease in the future, i finally did a MRI, waiting for result, doctor put me on beta blocker low dose of 1.5 mg per day, honestly those pvc are affecting me physically and mentally, as am almost completing my university, am not concentrating anymore, so plss your comment is highly needed plss

    • Hi Abdull,

      So sorry to hear these PVCs are so bothersome to you. For people suffering from PVCs it would be best for you to meet with a cardiac electrophysiologist near you. Here is a link to a directory from the Heart Rhythm Society to find a local electrophysiologist.

      http://www.hrsonline.org/Find-a-Specialist

      Together, you can discuss the various treatment options available.

      Hope this helps!

      John

      • Hello dr john, thanks i finally saw an electrophysiscs, unfortunately my MRI test came back with a rare conginental heart disease called LV non compaction as you knw it, so the pvcs are symptoms i guess, the doc told me there is nothng they can do, as they cannot correct it surgically or with medicine, no cure he said, i look it up at d internet, heart failure, is d end result, so know am just waiting for d tym i guess, anyway thanks for hooking me up with dat elecrophysis site, its been a great help

        • So sorry to hear about this diagnosis…I have many patients in my practice with this condition. I have observed that those with the healthiest lifestyles often show no disease progression. Work closely with your cardiac electrophysiologist and keep living as healthy as possible!

          Best,

          John

  193. Hello Dr.john.i talked to you about my 5 year olddaughter few days back about 24% pvc’s in 48 hour Holter. We had meeting with cardiologist and he said her echo is normal and these beats are coming from most favorable area of the heart (close to the junction).he said if it’s originated from very bottom of the heart it will be danger .so we are lucky that it’s originated from middle of the heart. Cardiologist asked us family history and symptoms. We have nobody in both side have heart problem and she has no symptoms. Cardiologist suggested to visit after 1 year for stress test when she will grow up.my question is , is this common in children if they have PvC in favorable area and it will go away with age ? Is there more danger in in future? Thank you doctor

    • This is somewhat uncommon to have so many PVCs in such a young person. Hard to say what the future will hold. Hopefully, this will improve or resolve with time. Most major cities have a pediatric cardiac electrophysiologist (a pediatric cardiologist with additional subspecialty training in arrhythmias) that may be worthwhile consulting with regarding potential long term risks.

      John

  194. Dr. John, I had a physical, including an EKG and blood work. My numbers were perfect and EKG was great. Blood pressure is controlled with 25mg of Atenelol after a BP reading of 140/90 5 years ago. I suffer from anxiety and have tried a number of meds over the past summer. The starting and stopping of these different meds caused all sorts of strange side effects. I started 12.5mg of Paxil CR and a week or so after starting this med after tapering off Lexapro, PVCs started. I feel a flutter in my throat and the PVC every 15-20 minutes. Is this possibly due to my body chemistry being out of whack from the different SSRI drugs? Also, the PVCs started the day after my physical where I received a flu shot. PVCs have been happening for 12 days now.

    • Hi Mark,

      Yes, there can be strange side effects with any medication. Many patients have reported being able to feel their PVC symptoms in their throat. I am not aware of any connection between flu shots and PVCs. Keep working with your physician until everything is under control.

      Best,

      John

  195. Hello Dr. Jay, I am a 40 year old female diagnosed with pvs, followed by a left bundle branch block and trigeminy beats especially when stressed. All my test can back inconclusive and a heart Cath. was scheduled. Long story short I ended up in the emergency room due to an episode of hot flashes in the back of my neck and neck pain. I also had and cold flashes which radiated from my chest and palpitations with chest pain. I felt extremely weak afterwards. I ended getting my heart Cath done early with the results of no occlusions, no signs of a previous heart attack but they did find my ejection fraction rate was 50% on my left side. I was sent home and was asked to come back in a couple weeks to talk about meds for my weakness. I am still having episodes of the hot/cold flashes and palpitations (and no it’s not perimenopause)and now I am dealing with panic attacks also. What can I do to strengthen my left side? And can I live a normal long life with these types of conditions? I have three children all under 12 and I am deathly scared something will happen to me. Please help, you advice would be very much appreciated!!

    • Did they put you on betablockers to help with the PVC’s. I was started on 50 MG of Metroprolol and had severe panic attacks, feelings like I may faint, and numb feet. The doctor has since then changed my medication.

      • Hi Mel,

        Yes, beta blockers are often used as a first line drug to treat symptomatic PVCs. While many people tolerate these medications, many do not.

        John

    • Hi Shannon,

      Sorry to hear about your symptoms. Fortunately there are no blockages or prior heart attacks.

      The two most important things you can do right now is to live as healthy as possible in all aspects of your life and continue to work with your physicians.

      All the best,

      John

  196. Would welcome your opinion. As I mentioned in a different post , I was going back to see my cardiologist basically for reassurance even though I had the tests recently that say my heart was in good shape and nothing to worry about. I guess I let these things scare me too much. In any case he said if I wanted to, that he would put a reveal loop recorder on me, if that would give me peace of mind knowing that the recorder reports to their computers on a daily basis. I know you don’t know me pesonally and I’m not asking you for medical advice over the internet. What do you think though of these devices, and would a patient benefit with the knowledge of being monitored or is that going too far…. Just your opinion of this..

    • Hi Kevin,

      The implantable loop recorder technology has dramatically improved over the last couple of years. These devices work extremely well and they are much smaller. Battery life is a respectable 3 years. The major drawback is that this is a foreign body placed in your chest.

      I have never heard of this form of invasive monitoring being used to monitor benign PVCs. If there was a high risk feature to your PVCs, then this strategy could be considered. However, if there is a high risk feature to your PVCs, then many other tests should be considered as well like MRI, EP testing, genetic testing, etc.

      At the end of the day, this is a decision that only you and your cardiologist can make.

      Hope this helps!

      John

      • Thanks I appreciate it…. I kind of felt like if it were high risk he would have said from the other tests… plus I felt as if this was more to make me feel secure. I thought it might be a little over the top. I think he was trying to figure out a way to capture my confidence in the fact that they wouldn’t hurt me. I’m going to think about it about, but I appreciate the information.

  197. Two years ago, after my 12hrs shift, I started having skipped beats. I went to the ER, Which showed PVC’S. Once my adrinelin ruch was over, they slowed down. I f/u w my PCC, did a 24hr holter monitor that only showed 24 monophasic PVC’s, a stress echo, which was normal. I continue to have PVC’S everyday, maybe 2-4000, but that a gues. I understand that they are benign and I do not want to take medication, but I really hate them. They make me feel anxious! :/. My PCP states that I do not need to see a cardiologist and I only need another stress eCho or holter monitor if I have new sx’s. Do you agree??

    • Hi Rosalinda,

      For people suffering from the symptoms of PVCs, I would definitely recommend seeing a cardiac electrophysiologist which is a cardiologist who specializes in heart rhythm abnormalities. To find one near your home, you can check the medical society’s directory at http://www.HRSonline.org.

      Hope this helps!

      John

  198. Hi,
    A few years ago I began having what felt like “extra beats”. In the middle of my heart beat, I would feel a pound in my chest. I saw a cardiologist and had a full work up, and it was said to be pvcs. They were happening frequently, so I was put on a beta blocker. I also completely eliminated caffeine from my diet and was sure to take better care of myself. More recently, I’ve been having them more frequently. They don’t make me SOB, but they make me take a deep breath in, almost as if it took my breath away. I also get a heaviness in my chest. I am not under any more stress or had any changes in my life. Do you think this could be harmful? I know I should probably refer back to my cardiologist.

    • Hi Lauren,

      So difficult to say if your PVCs are worrisome or not. That is something only your cardiologist can answer. Sorry…

      John

  199. I was recently told by my doctor that I have anxiety after having a out of the blue panic attack! She ordered all the testing and blood work and everything was fine my ekg said normal sinus rythm with sinus tachycardia and sinus arythmia and then I was on a 24 holter monitor and it said normal sinus rythm with periods of sinus arythmia and sinus tachycardia and occasional pvc! I am 24 and have always been healthy but I’m scared there is something wrong with my heart the doctors keep telling me I’m fine

    • Im beginning to think with ALLLLLLLLLL the people and ESPECIALLY THE YOUNGER ONES WHO ARE IN FIT CONDITION, that there is something more sinister at fault for all this, Like GMO’s in our food, and intentional and non intentional Aerosols and chemicals in the environment. How else do you explain the explosion of heart related issues that were never an issue like they are today?

      Ever notice the Gluten free crowd seems to be growing exponentially too? In all my life i have NEVER known there to be more than maybe a handful of people who suffer from celiac disease or gluten intolerance, that was ALWAYS A RARE CONDITION, until today. I do NOT believe people are wheat sensitive to the degree we are seeing this Gluten free Revolution, I DO BELIEVE people are unable to digest the GENETICALLY MODIFIED wheat that is now the new normal today.

      There is a push/pull for more money, not more research. Most dr.s today do not give a diagnosis let alone try to run one down, they push pills with far greater risks than benefits and manage symptoms not treat disease.

      This is a precursor to getting people to get so fed up they will gladly lend themselves to genetic manipulation, which has CREATED MOST OF THESE PROBLEMS TO BEGIN WITH.

      WHAT A WORLD!

      I wonder whatever happened to the hypocratic oath our Dr.s used to have to take and what they teach them to replace their conscience that enables them to watch all this suffering without ever raising an issue over the cause of these things?

      In just 48 years ive seen the total system flipped on its now UGLY UGLY HEAD!

      God have mercy on us all, not many physicians out there will risk their tenor, reputations, or whatever financial prosperity they can still make in this day and age to save 1 of us let alone a generation or more of us.

      Its just SAD!

      No.. your not crazy, your at the mercy of people without answers many times, who want you to just go back to sleep. Beware those pushing psych drugs, they can further complicate your condition, and are not a cure for anything either, ask anyone who has ever had to withdraw from them, ask the attorneys who fight lawsuits after lawsuits because of them… the benefits of todays drugs have to far outweigh the risks, or its just the beginning of a life of questionable conditions you wont wanna live with.

    • Hi Ann,

      I am so sorry to hear you are suffering from PVCs and anxiety. Yes, they can be quite scary. Keep in touch with your physician to make sure your PVCs are the benign type.

      Best,

      John

  200. Hi,
    I have had unusual heart beats since my teens. I only realised that’s what they were when I was over-prescribed levothyroxine and my heartbeats became pronounced and irregular for hours at a time.
    I have worn a 24hr holter a few months ago and was diagnosed with ectopics. On the day I wore the holter, my heart behaved itself for most of the day, typically, and didn’t reveal that it misfires much more often most days.
    I was diagnosed by my gp with a ‘benign murmur’ (a mid-beat sucking sound?) when I was in my 20s.
    I’m now mid 40s and these irregular beats are becoming more frequent. Should I be worried, or should I just accept that what the cardiologist who read my holter result said and that I can forget about them?
    They are rather unnerving, to say the least. It feels like a bird fluttering its wings in my upper chest, or in my throat. I am aware of them a lot of the time.
    Exercise doesn’t seem to make them worse – which I hope is a good sign.

    • Hi Becky,

      Thanks for your comments. First of all, a murmur is just blood making noise as it goes through the heart. It may mean absolutely nothing or it could be the sign of heart valve problems. This is why I like stress echo studies for my patients as it can assess blood flow to the heart, chamber sizes, heart muscle function, and also rule out any significant heart valve issues.

      Yes, thyroid hormone is a stimulant and if you get too much thyroid hormone it can cause many different arrhythmias.

      For my patients who have “perfect days” when they wear a 24 hour Holter monitor, I generally will prescribe a 30 day monitor to make sure we are not missing anything.

      Hope this helps!

      John

  201. Hello Doctor.
    I spent a full day in emergency last week because I thought I was having a heart attack. I have had heart flutters on and off over the past few years. Although I felt them they were minimal, a little scary but didn’t’ last. Last week these flutters started in the late afternoon and did not stop. They were continuous and seemed to take my breath away and made me cough on and off. I went to the hospital after 16 hours of them not stopping. I was hooked up to the monitors and had blood work. I was told I had PVC’s and I am waiting for an appointment for a stress test. I was prescribed Metoprolol, 25 mg daily. I am scared! They just go on and on and on. I can’t concentrate on anything, I feel tired, I keep taking deep breathes, my head aches slightly all the time. The doc in emerg says they are nothing to worry about but that isn’t possible. I drink 1 cup of coffee a day. I do not smoke or do any drugs. I drink red wine, one glass with dinner on the odd week day evening and maybe 3 or 4 glasses on Friday’s after curling. I do exercise and try to eat healthy and I am maybe I could lose 10 pounds but am not extremely overweight. Today I woke up with them and they have not stopped at all. It has been 15 hours. I need to make them stop

    • Hi Karen,

      I am so sorry to hear you are suffering from PVCs. Everyone has PVCs and fortunately most are benign. Keep your appointment for the stress test and your cardiologist. Most people find relief in time. Living as healthy as possible, in all areas of your life, can also help with the symptoms.

      John

  202. Hi Doc. When I was in my early 20’s I learned I had WPW. Had 3 EP studies and had a successful ablation 5 yrs ago. The ablation site was near my av node. Now at night occasionally, I get wenkebach. My EP doc says its from the scar tissue from the ablation site. If that s true I wonder why it doesn’t happen all the time and only at night? Any comments on that? I also suffer from pvc’s, probably a few hundred a day. I am on 1.5 25 mg Atenolol pills a day. I just read articles on magnesium and potassium supplementation, along with CoQ10 which say may help. I know I don’t get as much naturally of those electrolytes as I should. A bannana is only about 10% of your dailey dose that s alot of bannanas to get 100%. Is there much of a difference between vitamin grade potassium and magnesium than pharmacutical grade? I am taking 400 mg vitamin grade mag. I also read taking mag at night is better? Any comments on that. Thanks for all your insight. Your article and seeing all these posts makes me feel better.

    • Hi Brian,

      It is possible the Wenckebach is from your previous ablation or just as likely from your atenolol. At night the parasympathetic nervous system dominates so we see more of a “vagal effect” or heart rate slowing at night.

      Yes, most people in the U.S. are magnesium deficient. I recommend more “greens,” nuts, and seeds to all of my patients to help with magnesium deficiency.

      Whenever possible it is always best to get your micronutrients from real food rather than a pill. Supplements should only be supplements or things that your body is deficient in and you cannot get it any other way.

      One possible benefit of magnesium at night is that it is relaxing and may promote sleep. However, when it comes to magnesium from food sources this should be eaten throughout the day to get enough of this key mineral.

      John

  203. Have you heard about the study by Dr. Frederick Dewey, Stanford Med School, published in the Archives of Internal Medicine January 28, 2008?
    That study indicates that it is worse to have PVCs after exercise than during. Do you agree with that? I am currently wearing a 48 hour Holter monitor and find that most of my PVCs are after running up the stairs or running to catch a train. Am wondering what my cardiologist will make of that. He is an electrophysiologist and I have had a stress echo about 3 years ago and a nuclear stress test about 6 years ago. Am told that my heart is sound, but these PVCs and now that study trouble me.
    Is my testing too long ago to be currently accurate?

    • Hi Halina,

      Great question. There have been a number of these studies looking at the risk of PVCs in relationship to exercise. Studies have looked at PVCs before exercise, during exercise, and during the recovery period.

      The important thing to remember is that these are just observational studies and don’t prove causation. However, as there have been a number of these studies published there are some emerging trends. PVCs during exercise may, according to these studies, be more problematic. Next in line would be PVCs during recovery. PVCs at rest seem to be the safest.

      I suspect that the reason this plays out this way in these observational studies is that there are probably some people with PVCs caused by ischemia (lack of blood flow to the heart) that is not picked up on stress testing. If stress tests were 100% accurate these studies may not play out the same way.

      What should you do? I would suggest working closely with your cardiologist. Once again, these are just observational studies with many limitations that may or may not apply to you.

      Hope this helps!

      John

  204. Had them for years, but went 7 years with none. now their back but normally 20 or so a day….. I notice more about a half hour after eating any meal…. I wonder what eating has to do with them. They still manage to scare me… take 25mg Atenolol daily and run 3.5 miles every other day. Age 57….. Wish they would just go away again all together. Just recently had echo, nuclear stress test and holter monitor…. Cardiologist said keep on running .. All my blood tests are normal as well… again just wondering why meals would trigger, even though my diet is pretty bland.
    Thanks

    • Eating activates the vagal or parasympathetic nervous system. This, in turn, can trigger PVCs. I have heard of PVCs triggered from eating from many patients. Hope this helps to explain some of what you have been experiencing!

      John

      • Thanks for your answer… Yet again, Right after Lunch today I had about 4 or 5 that scared me …. I am going back to my cardiologist Thursday… To try and discuss this. I mentioned I take 25 mg of Atenolol.. been taking that amount for along time. During this week my pulse was at 53 most mornings until after I ate lunch. He did not seem too concerned when I called him about this change , because we had just run all these test. But I see him again Thursday, I think you Doctors are great to put up with the worrying types like me, even though you have have told us we are fine. It’s just hard to accept sometimes when your heart is fluttering. It’s hard to believe that it isn’t going to hurt you even though you have been told by a Doctor who is far more educated on the subject then I’ll ever be.

  205. I had a cardiac ablation for SVT in 1999 when I was 24, then again after I had my first baby in 2008. I did a chemical stress test and wore a halter when I began experiencing pvc’s a year and a half ago. My cardiologist stated I don’t have much to worry about unless they get worse. I feel them everyday especially in the afternoon. When should I start to “worry”. I don’t like this feeling everyday. I have a strong cardisc history with my dad (quadruple bypass at 35, AAA in 2012 at 75, multiple balloon angioplasties with the most recent being in the widow maker a year ago-99% occlusion). My younger brother has a valve issue as well. Should I be worried? Should I get a second opinion from a different cardiologist? Thanks for any guidance you have.

    • Hi Amy,

      Tough questions. Only your cardiologist can answer when should be concerned with PVCs. Second opinions never hurt if that is the direction you want to go. Good luck!

      John

  206. My husband, 76 y/o went for a clearance for minor surgery and the EKG resulted with PVC’s. This is the first time it happens. Eight months ago he had a perfect EKG and the Eco performed resulted that his mild to moderate Aortic Insufficiency diagnosed 2 years ago had changed to moderate to severe AI with an Ejection Fraction of 65%, normal chambers dimensions & contractility normal, no effusion, no pulmonary hypertension but with significant eccentric aortic regurgitation. Now tests will be performed to gather more info. Patient was taking Cipro for UTI at the moment of the PVC’s. Patient has never had any symtoms except some tiredness. He walks 2 miles twice a week; very “hyper” and under considerable stress. Could you give me your opinion on this case please? Could this valve problem cause the PVC’s? What would be your assesment and reccomendations? Thanks!

    • Hi Dianne,

      Cardiac valve issues can definitely cause PVCs. He needs to see a cardiologist for evaluation and treatment.

      Best,

      John

  207. I get pvc’s and I have to try and reliaze there not bad. I’m 34 years old female I get anxiety attack since I was 17 I took Lexapro got off of that tried Zoloft I’ve noticed the palpitations were bad in the beginning I am and medicine but they went away only to come back when I was extremely stressed now today I was clean the bathroom bending over leaning over I felt my heart racing and lo and behold here came the palpitations very uncomfortable feeling took half a Xanax now I start to feel better I just wish I did Not get them. Doctors gave me my toper all to take but I refused to take it because of the side effects I get palpitations but not all the time they just come when they feel like it I just feel like then my whole day is shot and I dwell on them and I try really hard not to . Your information on the site is very good though so I thank you for that

  208. Hello,

    I’m 18 and I’ve had heart palpitations for two years and a few months. About a year and a half ago, I saw a pediatric cardiologist, and he put me in a halter (with no stress test) and diagnosed me with benign PVCs, and said that they would go away on their own in a few months, but they haven’t. Might this be a reason to see a cardiologist again? I understand if you can’t respond, as I’m sure you’re very busy, but anyone’s feedback would be greatly appreciated.

    Have a good day!

    Best,
    Maddy

  209. Hi
    I was having over 20,000 pvc’s a day and had a successful ablation last October 2014 . However , just 2 days ago I went under General anesthetic for IVF treatment and had a very bad reaction . Heart went from 36 -140 in a matter of seconds as I came around . A lot of very worried people when I woke . Anyway since then my pvc’s are back with a vengeance . Once again I feel them all day long . I’m 38 year old female

  210. I had an ablation almost 2 years ago for debilitating PVCs and have been great. A few months ago, the PVCs started again but not so frequent that it was a problem. But today, I woke up with PVCs every 3 or 4 beats again. I tried to go to work but when they are that often, they are exhausting so I just came back home. It seems like others I know who have had this procedure never have problems again. Is it common for it to recur? Also, I read you list of drugs that can cause problems and I’ve been on both Cipro and Flagyl for the past 3 weeks for diverticulitis. Could those drugs be the culprit? I have a call into my cardiologist. All I know is I’m so depressed now, thinking that this could be coming back.

    • Hi Cindy,

      I am sorry to hear the PVCs are back. PVCs can certainly return after a previously successful ablation. The PVCs could be from the same site or possibly a new site. Hard to say if your current illness/medications played a role. Glad to hear you have a call into your cardiologist.

      Hope this helps,

      John

  211. Have you or anyone else been able to discover the link between menstrual cycle, age and all day episodes of PVCs? They are making my life very difficult and I often need to rearrange my work schedule because I am uncomfortable driving when they get this bad. I am going back to the cardiologist on 01/06/16 for the 3rd time–mainly to appease my mother but I am feeling quite frustrated. Thank you for anything you can offer and for this blog–it is very helpful.

    • Hi Melissa,

      Yes, hormonally induced PVCs can be quite bothersome. Some women are affected by them and others are not. Every person seems to have a different trigger.

      John

  212. I was tested that I had 35400 PVCs from a 24-hr holter monitor and they were bigeminy, I was on a trip at the time, so I thought the busy schedule and hot weather triggered the problem since I didn’t have that before. A few days after I came back to the states, I had to go to ER because I had chest pain, shortness of breath and dizziness. I had chest X-Ray, EKG, and other lab tests, seemed everything was in normal range other than the PVCs. I went to see an EP after that, was prescribed verapamil 180mg for a month, but it didn’t work well because I still had palpations constantly. When I saw the EP last time, he increased verapamil to 240mg, and suggested me to have an ablation procedure. I’ve been taking 240 verapamil over two weeks now, for some reason I’ve been having non-stop palpations everyday since, and feeling getting worse with the higher dosage. I guess ablation might be the only choise for me now, but wondering why the doctor did not give me any other tests before he wants me to have ablation, his diagnosis was all based on the test results from the ones I brought back and ER. Do I need to see another doctor? Maybe a cardiologist instead of EP? Thanks for your time!

    • Hi Joy,

      For severe cases of PVC’s I always recommend an evaluation by a cardiac electrophysiologist. If you have questions, make sure you ask your doctor every question. You should only consider procedures after all of your questions have been answered.

      Hope this helps!

      John

  213. I am also suffering from bigeminy PVC and mainly depressed, these PVC disappear on ETT. I also have many other anxiety symptoms. i have normal thyroid tests and ETT. please advise me if some more investigations are required. thanks.

    • Hi Salman,

      Great question. Additional testing really depends on other clinical factors. When you meet with your physician please share all of your symptoms, family history, any supplements you may be taking, etc. Based on a review of your case, as well as any other unique factors in your life, your cardiologist can help to determine whether further testing is warranted or not.

      Best,

      John

  214. Hello,
    I was just seen by a cardiologist and he’s saying that mine are caused from being in severe pain from spinal injuries. Have you ever heard of this being a cause for PVC and bigeminey?
    Thank you

    • Hi Jai,

      Pain causes adrenalin release and this, in turn, can trigger PVCs. Yes, I commonly see arrhythmias get worse if people are in a lot of pain.

      John

  215. Hi Dr Day. I am 5 days out of ICU for a rapid heart rate with tons of runs and pairs of PVCs in a 24 hour period. I had ultrasounds, echocardiogram, stress tests, chest xrays while in the hospital for 4 days. I am a marathon runner, 44 years old female and have never had any issues in the past with my heart and when I went into the ER they thought I was in A-fib but turns out its just my irregular regular heartbeat they tell me. The doctor put me on theophylline 400mg per day to try to increase my heart rate as they think this is what caused me to appear to be in a-fib and why I’m having so many PVCs. Problem is I still find I have no energy and the shortness of breath and heavy left arm is still hanging around. I can’t even run for 15 minutes without being exhausted. I am going to do the holter next monday and have a follow up with my cardiologist at the end of November. Is there anything else this could be and is the medication making me feel worse?

    • Hi Lisa,

      So sorry to hear you were in the ICU. It is difficult to say what else me going on from an internet post without looking at all of your test results, reading your chart, examining you, etc. It could be one of many different things. Keep working with your physicians to find answers and relief.

      John

  216. Hi Dr John,

    How long should exercise-induced PVCs last? I ran a half-marathon race on 25Oct, and shortly after finishing, i started getting PVCs. The PVCs have lasted since then, though they have decreased in number from probably over 200/day to about 50/day after cutting out a lot of caffeine. I had trained for the race for a few months, racking up over 100 miles per month, and I ran the race faster than any long training run. I didn’t get the PVCs very often during training (couple times per week), so I’m thinking that the hard race is the cause, but I’m not sure if I should be concerned that they are persisting. I’ve only run 5 miles since the race, and I don’t get PVCs while running, and they seem to be fewer on the days that I run. Could the vagus nerve have something to do with it? Loved the article, thanks!

    • Hi Mat,

      Glad to hear you enjoyed the article. Exercise induced PVCs generally resolve once the recovery period is over. Yes, it is possible the vagus nerve is playing a role.

      John

  217. I have had PVC’s in the past due to too much caffeine or stress and it usually lasts a day at most. I didn’t know what they were and didn’t worry too much about them because they were short term and infrequent. This time around I am on my 4th day straight with the strong contractions. I was so nervous I went to the ER and everything checked out fine. This is where I learned they were PVC’s. I realize I don’t have to worry (hopefully), but wonder if everyone is experiencing these daily and all day? Or is it intermittent? How long should they last as I am used to them occurring in short term, infrequent stints.

    • Hi Robin,

      As you can see from all of the comments, everyone’s experience is different. In general they wax and wane over time. They can be all of the day or just part of the day. Sometimes they go away for periods of time. Many can learn to ignore them once the serious causes of PVCs have been ruled out.

      John

  218. hi john,

    i have been having pvc or pacs for a couple years now. i never felt them until one day during a workout.

    since then i have had an echocardiogram, a 24hr holter monitor and a 48hr holter monitor, and followed by a stress test lasting 12 minutes.

    i do not fear them at rest but i really fear them during exercise.
    more recently they have begun in runs, or what feels like runs shortly after i stop exercising, within 60 seconds of stopping. it doesnt occur every session but on my more intense session – skipping or running. what does this sound like in a ‘ non diagnosis ‘ point of view?

    thank you

    • Hi Liam,

      It is impossible to diagnose these over the internet. You will need to speak with your doctor about scheduling a monitor to determine what these abnormal heart beats are that you are experiencing.

      Hope this helps!

      John

      • thanks you for the reply john

        i have it in mind to request a longer holter monitor from my E.P to see if we can catch this in action. the stress test caught nothing of this nature nor did the 48hr holter in which i exercised with.

        hmm, strange though that this ‘ abnormal rhythm ‘ doesnt happen every time.

  219. I was diagnosed with Myocarditis and once it went away, it was determined that the scar tissue left behind is what caused the PVC’s to start. I have been dealing with this for over a year. I have had 2 ablations now, both were unsuccessful. By unsuccessful, I mean that “on the table” it appeared that they were gone, but after the first one, the PVC’S came back within a week at 21%. After the second, which was 3 weeks ago, the PVC’S came back within 4 hours after the surgery. I do not know the % yet. I just finished wearing a 10-day monitor and I am waiting for the results. I walk 3-5 miles a day, I do have some weight to lose (10 pounds) and I don’t sleep well. What, in your experience, do you see patients like me facing as a future treatment? On the bright side, I am so happy to find this article and not feel alone. I am also really interested in the magnesium and potassium suggestions. (rambling my thoughts here, sorry).

    • I forgot to add that all of the plumbing is in the clear. I have had stress tests, Echo’s, MRI of the heart, etc.

      • Glad to hear there are no plumbing issues. Myocarditis can leave behind fibrosis (scarring) which can be a source of PVCs.

        Ablations can be tricky as the most important part of the whole procedure is to get the PVCs to happen. Often sedation will silence PVCs and we have had to do many of these procedures with the patient completely awake to make sure the PVCs don’t go to sleep when the patient is asleep.

        I wish you the best in getting this under control!

        John

  220. My 5 year old daughter diagnosed with high ventricular ectopic beats .
    Her result as follow
    Ventricular beats in 48 hours
    Total 56000
    Single 5630
    Pairs 678
    Total runs 9328
    Beats in runs 63000

    What means of total runs and beats in runs?? Her echo is normal and no symptoms. She got typhoid and hepetise a vaccine month ago.this result is after vaccination .please advice me

    • “Beats in runs” means that these are consecutive PVCs. For example, a “4 beat run” would represent 4 consecutive PVCs in a row. In general, PVCs in consecutive runs carry more risk than isolated PVCs.

      Glad to hear the echo is normal. Her PVC burden is high and I would definitely recommend connecting with your cardiologist soon.

      Hope this helps!

      John

      • Thank you very much John for your quick reply .I am already in contact with cardiologist . One another question is, vaccination effects PVC’s? She recently got typhoid and hepetise A vaccine same day before all tests.

        • Certainly anything is possible–vaccines causing PVCs is not something that has been described in the medical literature. I have not seen any cases in my experience. John

  221. Relax. I have suffered with PVCs for 6 years and have now developed anxiety. But I am damn determined to beat this and have come to the conclusion that pvcs are no different that a hiccup. Annoying but doing you no harm. So my best advice is slow breathe relax and ignore them. Worry wont stop them so enjoy life and know that you WILL NOT DIE. Far worse things can happen to you.

  222. I am a 32 year old female and I have had PVCs since I was in my mid 20’s. I’ve had several stress echo tests(all 100% normal) and worn the heart monitor several times. My PVCs are extremely noticeable during ovulation, my menstral cycle and extreme stress. I suffere from anxiety/panic disorders. My cardiologist suggested therapy, more exercise and no caffeine. I am 100% gluten free due to my celiacs, so I eat very healthy. I do not consume caffeine. My PVCs are noticeable more so at night or as the day progresses. I do not get enough sleep due to insomnia triggered from my celiacs. I get freaked out to take a Zpac from my dr if I have sinus issues bc it has made my heart feel “fluttery”. Honestly, you make a very valid point to reduce stress. My anxiety is what triggers my PVCs the most!! I’m more hormonal when I notice my PVCs and I am under stress. So, I stopped seeing my therapist after a month due to insurance not covering it and I’ve noticed my PVC’s get worse. Thank you for this article!! I needed to read this!! I am going to do my best to whip this anxiety so I can stop the PVCs from being bothersome to me. It helps to know other people feel the same thing I do. I beat my anxiety once before and my PVCs were something of the past…somehow the anxiety has crept back up but I’m determined to beat it again so I can feel “normal” ?

  223. Dr. John, thank you for all of your input, this article was very helpful. I’ve had what I assume to be PVCs (though never seen on an ECG and I haven’t had a holster monitor) for years, since I was 15 (I’m a 24 year old female). I’m an athlete, I trained as a sprinter for many years in high school and university and played intense sports (basketball, soccer etc.). I still run ~5 kms per day and weight train 5-6 days per week. I’m healthy otherwise and have no history of medical issues of any kind. I’ve had ECGs and blood work, all normal. Doctors have always told me I was healthy and not to worry. I do suffer from anxiety/panic and one particularly troubling incident of PVCs happened during bad turbulence while I was on a plane (I’m terrified to fly as it is) and had a panic attack. My heart rate felt very irregular and it felt as though I was having PVCs ever 3-4 beats. I know that I was hyperventilating as my fingers and hands/ lips were tingly and my heart was racing. I don’t often have PVCs when exercising (if it ever happens, rarely, it’s at the very beginning when I begin to run and as my heart rate increases they subside) they typically only happen while at rest. I sometimes feel them when laying on my back at night while I’m trying to sleep. They seem to worsen with stress and with mensus. Although doctors have told me I’m perfectly healthy, that sporadic irregular pattern I had during that panic attack really worried me and I started to wonder if they had missed something. That was the only time I felt them as more than just the occasional palpitation. Is this something I should be concerned about?
    Thank you,
    Cindy

    • Hi Cindy,

      Thanks for sharing your experiences. Only your physician can tell you if there is something else you should be concerned with or not. Fortunately, for most people this is a benign thing once they have gone through the appropriate cardiac work up. Hope this helps! John

  224. Thank you for this post – I really needed to find this at this moment in time. Believe it or not I’m a cardiac nurse who needed reassurance that PVCs weren’t going to kill me. I now completely understand why my patients with symptomatic PVCs are so anxious. A tremendously stressful event put me over the top and has set off panic attacks with all the usual suspects – shortness of breath, jitteriness, jumpy, crying at the drop of a hat (very embarrassing as I can’t hide this from anyone), anxiety, PVCs every 5-10 beats, can’t sleep, nauseous all the time. This is happening several times a day for the past several weeks and has taken its toll. This site has given me a “recipe” to follow so that I can get this under control and get back to being myself and not a “scaredy cat”.
    Thank you for this.

    • Hi Stacy,

      Thanks for sharing. You are correct in that many people ultimately find relief from their PVCs once they can manage or eliminate stress and anxiety. Each person has a different path to take to find relief. I wish you all of the best in your quest to get this under control.

      John

  225. I just finished reading this article about PVC’s and THANK YOU! I am a 63 yr old woman in good health. I walk daily approximately 3-4 miles, kayak whenever I can, and generally try to live a good, healthy lifestyle with an occasional glass of wine. I have been bothered with PVC’s for over 30 years, and they have become more frequent over the past few years. I have been diagnosed with benign RVOT by 2 physicians. An ablation was suggested, which we did attempt. However, both times PVC’s disappeared. Follow up Holter Monitor showed frequent PVC’s, enough so that cardiologist wants to repeat ablation attempt (although he once again assured me these are benign). They at times keep me awake most of the night, which I am fairly certain, makes them worse the following day. I try my best to ignore, but as anyone who suffers from every third or fourth beat being off rhythm knows, ignoring can be difficult. I have had medications prescribed over the years, and have tried some – to little avail. Some just had too many side affects. I have tried many of the other recommendations in this article, but do know that I do not always get enough sleep, and I do like my occasional glass of wine (which will be hard to give up!). Your article has assured me that I am not the only one out there with this condition. I do go to the gym, but am going to go in search of a yoga class. Also am going to attempt to reduce my stress level, and start making more time for me. I work from home, and was sitting here today miserable with PVC’s until I decided to click on this site … Shutting down the computer now and going for a walk on this beautiful afternoon. Work can wait! Just wanted to say thank you for having this information available. Chris

    • Hi Chris,

      Thank you so much for your kind words! So glad to hear this article helped you today. I agree, going on a walk on a beautiful afternoon is one of the best things you can do for your heart!

      John

    • Hi Gary,

      Unfortunately, nitro doesn’t seem to help with PVCs. The one exception might be in the person with inadequate blood flow to the heart (ischemia) where nitro could theoretically help. I should point out that everyone suffering from PVCs should at least undergo a cardiac work up to rule out ischemia as a potential cause of PVCs (stress test).

      Hope this helps!

      John

  226. Hi, I’m wondering does an ultrasound rule out structural problems with the heart? I’m 27 & have experienced pvc’s for many years now – 4 years ago I had 2 heart ultrasounds, a holster monitor & many ECGs the cardiologist just said they were a none event. The last month or so I’ve noticed an increase but for some reason during both my pregnancies I noticed a decrease. Is there a reason for the increase?

    • Hi Amanda,

      An ultrasound of the heart, or echo, can rule out most structural problems with the heart but not all. For example, a cardiac MRI can see some things that an echo cannot. With regards to PVCs, they generally wax and wane over time so there may be some periods when they are worse or better.

      John

      • Thanks for replying – I’m really struggling with PVCs tonight & had a visit to hospital today – they told me I was fine but this time I had accompanying chest pain. Is this normal? I also experienced a very long one tonight which felt like quivers in the heart & lasted maybe 20seconds… Could this be dangerous?

        • Hi Amanda,

          Hard to say–PVCs can cause chest pain for many patients. However, chest pain can also be a sign that there is something else wrong as well–possibly even dangerous.

          John

  227. Dear Dr. Day,
    What is your understanding about the relationship between the Vagus nerve and PVCs? I find that sometimes when I bend over, take a deep breath, reach for something, turn my neck, or cough, this will stimulate a PVC. Is this at all related to the Vagus nerve? Thank you.

    • Hi Halina,

      An excellent question. You should always let your physician know that you are supplementing with magnesium as toxicities may occur. This is especially true in people with compromised kidney function.

      When I prescribe magnesium to my patients I use the pharmaceutical grade and never go over 400 mg twice daily of magnesium oxide. I also don’t prescribe magnesium if there are kidney issues or other potential interactions for that particular patient.

      Hope this helps!

      John

      • I have peri pelvic cysts in my kidneys which I have been told are begnign. When I take extra magnesium the pvcs ease up. When I worry about the toxicity and stop the mag, the pvcs go crazy. Any change in position in bed can trigger hours of them. My electrophysogist says my heart is sound although the testing was 7 years ago. Am loosing lots of sleep and am developing anxiety. Is there some way to monitor the magnesium effects?

        • Fortunately, as long as people have healthy kidneys, the risk of magnesium toxicity is extremely low. Magnesium can be monitored with a blood test. However, this blood test only monitors the “circulating magnesium” rather than tissue levels. With regards to arrhythmias, there have been many studies done showing that serum levels of magnesium are a reasonably good predictor of arrhythmias. If you are worried about your magnesium levels talk to your doctor and ask for a simple magnesium test with your next blood work. Hope this helps! John

  228. Dr John,

    I usually have my PVC/PAC’s under control, utilizing the methods you have shared, but I have recently discovered a new activity that triggers an episode*. (Episode*= lasting 1 hour or more, with frequent premature beats)

    The trigger is, playing hockey, a fast sport with quick bursts of large energy followed by sitting on the bench waiting for your next shift. Stop and go kind of stuff for the heart. Sometimes the episode occurs while on the ice, but last night it occurred after we finished and I was in a cool down mode. The contractions continued for 2 hours afterwards, it was hard to bear.

    The occasional premature beat no longer bothers me, thanks to your article on the subject. However, these episodes lasting anywhere from an hour to more than 3 hours, has me concerned.

    What can I do to eliminate these episodes* after exercising vigorously?

    Thank You!

    • This is a tough question to answer as everyone has different triggers. For some exercise triggers PVCs and for other the recovery phase after a work out triggers PVCs. I can’t recommend treatment options through the internet–this would be something to discuss with your cardiologist.

      John

  229. Hi. This has been very helpful. I have had PVCs for a few years now but just started noticing them getting worse when I lay on my left side. This just started on Saturday and it is really difficult for me to ignore it. I am on a low dose of Metropolo to control them but just recently started getting worse when I lay on my left side. I am diabetic and for the most part have controlled my sugars. I have already had a stress test with echo about a year ago. What could be causing the increase when laying on my left side?
    Thank you in advance

    • Hi Claudia,

      It is common for my patients to report worsening palpitations when laying on their left side. While this could be mechanical stretching it could also be that when you lay on your left side the heart is in closer contact with the chest wall so it may magnify the symptoms. In contrast, when you lay on your right side the heart is in the center of your chest and people often don’t feel these PVCs.

      John

  230. Greetings, thank you for the helpful post!
    I have been experiencing PVCs daily for about 2 years. I am a 18 year old male and have always been able to exercise without getting short of breath, and have played soccer. Yet for these past 2 years, I can only exercise for about 2 minutes without getting very short of breath. And then I start getting PVCs during exercise.
    My cardiologist told me that they are benign and would go away, but that was two years ago! Anyways, I have had symptoms every day since then, and basically, I really want to know if it is appropriate for me to contact my cardiologist and ask for treatment options? I have already eliminated my anxiety, eliminated caffeine, altered my diet and have been taking magnesium and potassium supplements…NONE OF THESE HAVE WORKED TO EASE MY SYMPTOMS.
    Thank you 🙂

    • Yes, it is time to reconnect with your cardiologist. I would even suggest connecting with an electrophysiologist to discuss all treatment options.

      Best,

      John

        • Sorry…I should have said a “cardiac electrophysiologist.” A cardiac electrophysiologist is a cardiologist who has done an extra 1-2 years of training to specialize in arrhythmias or heart rhythm disorders.

          John

  231. I have very high PVC, over 360000 PVC in 24 hour holter monitor. Fortunately I do no have any symptoms. Can I just take magnesium to cut down the PVC? Thanks !

    • Hi Virginia,

      Magnesium often helps with PVCs. However, this is something you should discuss with your physician first before trying.

      Hope this helps!

      John

  232. Greetings, thanks for the post.

    I just scheduled an appointment with my GP, but the date we set is about five days out. For the past two and a half days I’ve been dealing with a constant stream of “Bigeminy” beats. For hours today my heart has been going thud-thud….pause….thud-thud….pause….and so on. For hours. I haven’t passed out and I haven’t felt any chest pain. It’s just the constant THUD sensation in my chest every second, every minute, every hour. It started after getting sick (I just got over the stomach flu) and it has been very unnerving. It should be noted I *do* have a diagnosed anxiety disorder, and I have gotten PVCs in the past (but nothing like this). Often they just went away on their own after a day or two.

    Years ago I went to the ER when I had a similar bout. They hooked me up to all the machinery there, gave me a blood test, and discharged me with paperwork on anxiety disorders. The doctor told me what I was experience was okay, that I was healthy, and that I shouldn’t stress so much.

    So, my question is whether what I’m experiencing is severe enough to maybe try getting a doctor’s appointment sooner, or maybe heading to the ER. Those close to me are, understandably, not too concerned since I have a real anxiety disorder and I’ve been hypochondriacal in the past; but the symptoms are exactly as I presented them here and it seem strange to have such a persistent string of these things over such a long period of time.

    • Hi Ben,

      I am so sorry to hear that you are suffering from PVCs and anxiety. This can make PVCs especially challenging to deal with. Unfortunately, it is completely impossible for me to know if your symptoms are worrisome or not through these web comments. Please work with your physicians to find answers. If you feel it is an emergency then you need to go to the nearest emergency room. Hope this helps!

      John

  233. Hello,

    I’m a 27 year old male. I struggle since 2 years with ectopic beats. After medical tests i know they are benign. 2 years ago i had about 1000 ectopics /day. They have slowly decreased in frequency, at this point i haven’t felt them in about 4 months.

    According my doctor most ectopics cure themselves in about 5 years. Or at least, the ones we feel. Can you back this up? What’s your experience in this? Is it possible that my ectopics just cured themselves?
    ( i know “cure” isn’t a correct word, as everyone has ectopics. But there’s a difference in feeling them, and not feeling them at all)

    I have another question that i struggle with for some time now. Do i have any risk of A-fib? What’s the relation between benign ectopic beats and Artrial fibrillation?

    Thanks a lot!

    • Hi Manuel,

      Thanks for your comments. You are correct, while PVCs never go away (as everyone has them), the frequency or the awareness of them can dramatically decrease over time. This is just my clinical experience as I have not seen any studies on this.

      Also, there are some very limited data suggesting that those people who have a high burden of PVCs may also be at increased risk of atrial fibrillation. If this link is true it would make sense as often the same triggers for PVCs may be the same triggers for atrial fibrillation (high levels of perceived stress, sleep deprivation, high blood pressure, obesity, etc.).

      John