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Are too many PACs and PVCs along with sinus arrhythmia a concern?

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Posted on Tue, 1 Oct 2019
Question: Hello, Im a 24 year old female, no smokikng, no drinking, exercise 5 days
a week, and no anxiety/stress. I used to have (in 2014 follwoing a
miscarriage) sinus tachycardia and then POTS. Just recently, I noticed
that I do not believe that I have POTS anymore. When I stand it raises a
lot but its drops VERY fast to what my resting rate is when i lay/sit (60-75 bpm)
with some fast walking it increases, but as soon as i stop i feel it slowing down but very forcibly with hard beats as it slows down almost like pauses ??? eventually goes back into normal sinus rhythm.
Most importantly, just recently, I was experiencing some fatigue and
lighheadedness, and when im at rest, before sleep, or after working out i
feel some forceful beats. not fast, but just forceful. They dont cause any
symptoms just bothersome when they happen, i notice i dont feel them
when im active or running. Basically I had a 24 hour holter monitor which
showed 70 PVCS and 730 PACS! the number of PACS really concerns
me a lot, because ive been searching and i have not found one case
where someone my age has these many PACS. what is the number of
concern, especially at my age. I also have sinus arythnmia and cant tell
if im feeling pauses of my pulse slowing down with breathing in my neck
or pacs. Im constantly stressing myself out now about things like sudden
death and ive heard that there is studies that PACS may soon lead to
Afib. Im 24 and its ruining my life. my doctors are not very concerned, i
just really need a second opinion.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

I would explain that if your heart rate increases more than 30bpm when standing up compared to sitting position, the diagnosis of POTS is very likely.

In such case, a Head Up Tilt test would help to confirm the diagnosis.

Regarding the PACs encountered in your Holter monitoring, you should know that they can be quite normal in persons with a normal heart (resulted by the cardiac ultrasound).

There is no reason to develop Afib.

I would just recommend performing a cardiac ultrasound, in case you haven't performed one yet.

I would also recommend performing some blood lab tests to investigate for possible metabolic causes (like thyroid gland dysfunction, chronic anemia, electrolyte imbalance) which may trigger PACs and your symtomatology.

For this reason, it is important performing the tests below:

- complete blood count
- blood electrolytes
- thyroid hormone levels.

Besides, you should know that anxiety can trigger PACs and all this clinical situation too. For this reason, I would also recommend focus on your anxiety and try to manage it. Yoga and meditation can help in this regard.

Hope you will find this answer helpful!

If you have any other questions, please don't hesitate to ask me again!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (10 hours later)
Have you personally seen people my age (24) have as many as 700 pacs daily? Is there an amount that would cause a concern
doctor
Answered by Dr. Ilir Sharka (15 hours later)
Brief Answer:
Opinion as follows;

Detailed Answer:
Hello again!

I would explain that PACs may cause sometimes considerable disturbance due to unpleasant palpitations feeling, but in general they are not dangerous.

They are quite common in medical daily practice; I am almost daily in contact with patients experiencing cardiac arrhythmia issues in ICCU and PACs are the most frequent among them.

Not rarely PACs are an expression of an extra-cardiac disorder in the absence of an obvious structural cardiac abnormality.

They may also be present during certain cardiomyopathies, but even in such case they don't appear to play a determinant role in clinical course and overall prognosis.

Furthermore, 700 PACs/day are not a large amount and any adverse remodeling effects on the atria is quite unlikely.

In conclusion, I would like to assure that nothing dangerous arise from those PACs and it is advisable to check the above mentioned tests for excluding possible triggering factors.

At the end, an important issue to remember is relaxing yourself body and mind as things would be more easy especially in controlling any arrhythmic phenomena.

Wishing your all the best!

Regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thank you so much, you have really been a great help! I truly do appreciate it!!

I had an echocardiogram in March 2014 that was all clear, would i need another one. I had 350 pacs in 2014 holter monitor now i have 700 pacs...is the 2014 echo enough to show cardiomyopathy or do u think i need another one?
My doc is saying i dont need one but i want a second opinion
doctor
Answered by Dr. Ilir Sharka (24 minutes later)
Brief Answer:
I would explain:

Detailed Answer:
Hi!

350 PACs and even 700 PACs/day could not lead to any structural atrial or cardiac changes.

In this regard we would not expect any new findings from a careful 2014 echocardiogram.

Nevertheless, I would be more in favor of re-evaluating every possible component potentially explaining the interplay of the heart with other organs system.

A new cardiac ultrasound (echo) is an important component when rethinking about a review of potential causes of arrhythmia.

So, though I agree with your doctor that a new echocardiogram would not reveal important changes (newly appearing cardiomyopathy), it would serve as a cornerstone for building the right clinical judgement about extra-cardiac causes of your complaints.

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7689 Questions

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Are too many PACs and PVCs along with sinus arrhythmia a concern?

Brief Answer: I would explain as follows: Detailed Answer: Hello! I would explain that if your heart rate increases more than 30bpm when standing up compared to sitting position, the diagnosis of POTS is very likely. In such case, a Head Up Tilt test would help to confirm the diagnosis. Regarding the PACs encountered in your Holter monitoring, you should know that they can be quite normal in persons with a normal heart (resulted by the cardiac ultrasound). There is no reason to develop Afib. I would just recommend performing a cardiac ultrasound, in case you haven't performed one yet. I would also recommend performing some blood lab tests to investigate for possible metabolic causes (like thyroid gland dysfunction, chronic anemia, electrolyte imbalance) which may trigger PACs and your symtomatology. For this reason, it is important performing the tests below: - complete blood count - blood electrolytes - thyroid hormone levels. Besides, you should know that anxiety can trigger PACs and all this clinical situation too. For this reason, I would also recommend focus on your anxiety and try to manage it. Yoga and meditation can help in this regard. Hope you will find this answer helpful! If you have any other questions, please don't hesitate to ask me again! Wishing all the best, Dr. Iliri