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Having trouble sleeping due to worry. Done with nuclear stress test and Echo. Should I be concerned?

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General & Family Physician
Practicing since : 2012
Answered : 3194 Questions
Had a nuclear stress test and Echo done yesterday because of Pvcs. Doctor said the stress test was normal, don't know about the echo. I have had trouble sleeping over past week mostly due to worrying and now sometimes when I try to sleep it feels like I am going to stop breathing. Should I be concerned or am I just over thinking this? I guess I would hope they would say something if it required immediate medical attention but not sure. Thanks.
Posted Wed, 27 Nov 2013 in Hypertension and Heart Disease
Answered by Dr. Shafi Ullah Khan 1 hour later
Brief Answer: All facts point to good outcome, Seems innocuous:) Detailed Answer: hello XXXXX Premature ventricular contraction (PVC) is caused by an ectopic cardiac pacemaker located in the ventricle.The clinical significance of PVCs depends on their frequency(minimum 6 in one strip of 2 mins), complexity( Assciated with any morbities and cardiac disease history), and hemodynamic response ( shocks, hypertesnions, low blood pressures, some infection histories like endocarditis etc). If the above etiologies are ruled out PVCs are then just innocuous and should not be worried about. Here are some innocuous reasons for PVCs -Electrolyte imbalances( increased or decreased potassium levels) secondary to some illness like vomiting diarrhoea or renal troubles. - exercise, -isoproterenol - the recovery phase of exercise, -hormonal changes in female patients (pregnancy, menses, menopause) -male sex has more predispositions -advanced age( beyond 50 and 60. so you are safe) - African American race, -hypertension -underlying ischemic heart disease -a bundle-branch block on 12-lead ECG -hypomagnesemia(Low Magnesium Levels) -hypokalemia(low potassium) Remember PVCs in young, healthy patients without underlying structural heart disease are usually not associated with any increased rate of mortality. PVCs in older patients, in particular those with underlying heart disease, are associated with an increased risk of adverse cardiac events, particularly sustained ventricular dysrhythmias and sudden death. In patients who have had a MI, the risk of malignant ventricular arrhythmias and sudden death is related to the complexity and frequency of the PVCs. Patients with PVCs in Lown classes 3-5 are at greatest risk Frequent PVCs may be associated with increased risk of stroke in patients who do not have hypertension and diabetes If you are out of any serious comorbidities which i am sure you will be as age of 34 is too young to have some serious issue. Just take precautionary measures lose weight excercise use omega 3 fatty acids fruits vegetables use regular sleep patterns Modification of lifestyle AHA assesment of your cardiac score. All precautionary measures of healthy life to be on the safer road. I advise some investigation to be done to rule out underlying cause. -serum electrolytes ( for hypokalemia/ low potassium) -Proarrhythmic drugs screen like theophyllin, digoxin etc -Do ECG or Signal-averaged ECG or 24 Hours Holter Monitoring for lown criteria for counting the PVCS in an hour.The higher the grade, the more serious the ectopy. Grade 0 = No premature beats Grade 1 = Occasional (< 30/h) Grade 2 = Frequent (>30/h) Grade 3 = Multiform Grade 4 = Repetitive (A = Couplets, B = Salvos of = or > 3) Grade 5 = R-on-T pattern -Echocardiography ( to rule out valvular lesions or ejection problems) -Excercise stress test Mean while take some beta blockers for symptoms like Metoprolol (Lopressor) Esmolol (Brevibloc) Propranolol (Inderal) Some calcium Chaneel blockers like Verapamil (Calan, Covera, Verelan) some electrolytes like Magnesium sulfate Consult near by caardiologist for Antiarrhythmics and if the PVCs are complex which i am sure they are not and resistant to medication consider catheter ablative therapy. Your young age with no previous morbidities and any complication and normal test results all point to the fact that you are safe and out of trouble and had a PVC just from some innocuous cause which will resolve soon and by itself. I hope i was of some help.If you have any more queries for me please feel free to ask , i would be glad to answer them.Other wise kindly close the discussion and rate the answer as per your experience. I wish you a very good luck.Take some special care of yourself. Regards Dr Khan
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Follow-up: Having trouble sleeping due to worry. Done with nuclear stress test and Echo. Should I be concerned? 1 hour later
I guess my greatest concern right now is sleeping. I seem to only be getting about 5 hours and I wake up in the early hours and can't return to sleep. I do drink water up until bedtime and sometimes need to get up to use the bathroom during the night. Is it okay to take a sleep aid or any other suggestions? Thank you for your help.
Answered by Dr. Shafi Ullah Khan 8 hours later
Brief Answer: Natural ways are better Detailed Answer: Hello again, Sleep aids can be taken but its better to not get dependent upon them. Use regular routines for your life, do exercise, make a proper bed time, when your circadian rhythms will synchronize you wont need any sleep aids. You can temporarily use 0.5 mg aplrazolam for short term basis but you need to modify lifestyle. Sleep is a trigger in its own ways for PVCS. You need to take good care of your self. Sleep for at least 8 hours a day. Do some yoga exercises, make bedtime book reading a habit it helps in sleeping.Stop using caffeine and carbonated beverages after afternoons. No smoking. Put out the stress upon you if you have any.And you will see how your body copes up with it. You are fine. You just need to take some extra care of yourself. If you have any more query please feel free to ask. Other wise closing discussion an rating answer per your experience will be my humble request to you. Regards, XXXXXXX
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