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Being treated for anxiety, HYPERTENSION with PVC in EKG.

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I have been treated for anxiety (cipralex) and mild hypertension (cozaar) for years. Age 38, male, overweight (about 280 lbs, 6'2"). Recently (over 4 months) I have been having PVCs.
My family doctor argues that they are benign, related to anxiety, and has had me to a cardiologist for an EKG and a listen to my heart. No PVC showed up on the EKG.

When I have these symptoms, it is a pause followed by a strong beat, and then immediately afterwards I get a bit of dizziness (but not always) and a feeling like an adrenaline rush or hot flash throughout my body (usually). I have tried to put up with these over the last months. They happen usually a few times per day at the most and I don't really notice them as much when I am busy, usually only when I am driving or working or falling asleep.

Recently, in the last two days, I have found a huge increase in the PVC at night time and in the morning, when I am falling asleep and waking up. They decrease after being up for a bit in the morning. They come often a few beats apart so they are really noticeable. I find that if I focus on them they get worse, and they are causing me a lot of worry. I went to the ER and
they did two EKG with only one PVC showing up but this is after I had been awake for a while.

My doctor did not do any further tests (ECG, holter, stress).

The two trips to emerg having yielded only one PVC had them sending me home with a shrug ?

I would like to know if I have any structural heart disease or if these are truly benign.

My questions:

1. Are the hot flashes typical of PVC ?
2. Should the increase in PVC at bed time and in the morning upon waking signify anything ?
3. Am I at risk of VT ? Should I go to ER and insist that they do more evaluation now even though the PVC incidence is very low in the daytime (more than 10-20 minutes from waking).

Thankyou.

 

 


Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Hello

Thank you for your query at DoctorSpring.com
The symptoms that you describe can very well occur with vpcs. Whether you are at increased risk of vt that needs some tests. A normal echo study will render these vpcs as benign. Do you have family history of vt and sudden death? Do these vpcs cause giddiness or dizziness or blackouts?
Kindly reply as a follow up,

Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

Hello
Thanks for the reply. I have never passed out but sometimes the bigger ones make me a bit lightheaded. I also notice sometimes after exercise I get them.
I do not have an EKG from my doctor handy but I caught two of them this morning when I got into work after a brisk walk and I am attaching the pdf of the EKG (sorry for the resolution. I work in a biology department and we had a cheapo one sitting around) here. I am rarely symptomatic during the day, perhaps one or two per day that I notice, it is really only in the morning waking up and after some activities that I notice them alot.
Thanks for any additional information, I will ask about the echocardiogram tomorrow during my checkup.


Expert:  Dr. Vivek Mahajan replied 3 Days.

Hello,

The ecg shows a rhythm like vpcs. Due to the resolution and calibration details not being available it is difficult to comment anything else. Nevertheless it seems to be a vpc. So there are mild symptoms associated. If the echo is normal you may start beta blockers for symptom relief. Also a hokter examination for 24 hours ecg will help to rule out any self terminating vt that may be occurring and causing these symptoms though it is unlikely.

Regards
Dr Vivek Mahajan


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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