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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Are frequent PACs a serious cause for concern while experiencing anxiety, mild breathlessness and lightheadedness?

Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 6802 Questions

Posted on Tue, 13 Aug 2019 in Heart Rate and Rhythm Disorders
Question: Im a 24 year old female. I had symptoms of anxiety, mild breathlessness and lightheadedness. After a 24 hour holter monitor it was revealed that i had “70” pvcs but i had “720” Pacs! Im concerned about the number of pacs! No significant pauses found.! I feel these pacs i believe at rest when my heart rate is lower, it feels like some of them pound harder than normal. I fear of developing something dangerous or sudden death.
Answered by Dr. Ilir Sharka 37 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:

Regarding your concern, I would like to reassure you that there is nothing dangerous, based on your Holter report.

The good news is that there is no presence of complex cardiac arrhythmia and conductance abnormalities.

Regarding PACs, I would explain that they are not dangerous or life-threatening findings.

Besides giving you the unpleasant feeling of pounding heart, they could not lead to sudden cardiac death.

Overall the most important issue when judging about the significance of arrhythmic events, is the presence of an arrhythmogenic cardiac substrate.

In simple words, this means that if your heart is concluded to be structurally normal by means of cardiac ultrasound, then it may be concluded that no potential arrhythmogenic focus is present.

So, you shouldn't worry about this Holter report.

I would just recommend discussing with your doctor on the cardiac ultrasound, if it is available. If you have not performed a cardiac ultrasound yet, I would recommend performing it.

In addition, I would recommend performing also some blood lab tests:

- complete blood count for anemia
- thyroid hormone levels for thyroid gland dysfunction
- blood electrolytes for any possible imbalance.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 17 minutes later
Thank you so much!! Your reassurance has helped me alot!!

So is it normal to be aware and feel heartbeats upon low heart rate or at rest? And what number of PACs are usually a concern? Is there a certain amount that causes a concern?

In regards to ultrasound, I have had a echo in 2014, would i need a repeat? My blood tests are all normal!

Also, my only rhythm they can find is occasionally sinus tachycardia and sinus arythmia.

Back in 2014 I suffered from fast heart rate and POTS. Changes of hr with posture. I believe i no longer have it because now my heart rate is fairly low all the time. When i stand it increases by a lot but drops pretty fast! Is this normal? Is it normal my hr is now lower aftet suffering from pots?

Again thank you so much, ive been suffering for days with constant worrying about the PACs and feeling my heart. You have really helped
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

I would explain that heartbeats feeling not always defines the presence of an important number of ectopic beats. It may be more pronounced in individuals with low extrasystoles number.

Such a low frequency of PACs (around 1 PAC in two minutes) has no clinical significance and is not considered dangerous.

You should just relax and don't worry about it!

In order to properly judge on this ectopic activity it is necessary to investigate for different potential causes as mentioned above at the beginning of our thread.

A point to consider is also heart rate trends during the day-night period. A pronounced sinus bradycardia may be associated with activation of subsidiary secondary pacemaker focuses.

So a full review of the Holter report is also necessary.

Sometimes a silent sinus node dysfunction may be present in the settings of persistent sinus bradycardia.

Nevertheless, as far as there is no other rhythm abnormality these alternative conclusions are not supported.

Previous POTS doesn't seem to be actually a concern as your heart rate response to body posture is well modulated.

In conclusion, I would add that PACs may be well generated also by excessive anxiety.

Coming to this point, I would recommend you to calm down, take some rest and avoid potential stimulants like nicotine, alcoholic or caffeinated drinks.

Wishing you a pleasant weekend!


Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 2 days later
thank you so much, your reassurance has really helped

im not sure what im feeling are the PACS or not but basically right after a jog when i sit down my heart rate slows down but very forcibly, once it trys to slow down i feel some forceful beats not sure if its just pauses or my heart trying to slow down, but they feel a little hard..eventually its goes to a normal sinus rhythm. This makes me very scared to jog or workout.

Also in a 24 year old female have you seen numbers like 730 before? without any problem? How about young adults with thousands? i dont have a problem with PVCS just the PACS, since they are way more in number
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Yes, I have seen this number of PACs in many young patients.

It does not indicate any serious medical disorder.

Anxiety and physical activity can trigger them too, by activating the sympathetic nervous system and leading to increased circulating levels of adrenaline and noradrenaline.

But, nothing bad is going to happen, especially if you have a normal heart structure and function resulting from the cardiac ultrasound.

From the other hand, it is quite normal to have a decrease heart rate when resting, because the sympathetic nervous system is deactivated and the parasympathetic nervous system gets activated. It is quite a normal physiological reaction of our body and does not indicate any serious medical disorder.

But, if you are feeling a lot of palpitations or lightheadedness when standing up, compared to sitting position, I would recommend performing a Head Up Tilt test to investigate for orthostatic intolerance (including POTS or orthostatic hypotension) which may mimic this clinical situation.

Hope you will find this answer helpful!

Wishing all the best,

D. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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