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Dr. Andrew Rynne

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Suggest remedy for premature ventricular contractions

Answered by
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Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 910 Questions

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Posted on Fri, 16 Oct 2015 in Hypertension and Heart Disease
Question: Dear Doctor, My father In law was admitted in hospital due to some illness and during the routine ecg the report says minimal abnormality, premature ventricular contraction. Please advice us what the problem is what further diagnosis should be done
doctor
Answered by Dr. Priyank Mody 29 minutes later
Brief Answer:
Mostly it's normal, do upload the ecg and clinical information

Detailed Answer:
Hello XXXXXXX ventricular premature beats in ecg may be a perfectly normal appearance most likely due the stress of admission (greater than 90%) probability due to various changes in electrolytes, infection and various other reasons , it per say doesn't mean that the heart is at fault. However if many occur or its persistent and if you father is hypertensive (most common reason why a vpc will occur) , some medication modification would be good enough, a rarer possibility of heart disease shower ruled out if other changes in ecg and clinical profile points towards it. In isolation vpc should not be regarded as evidence of heart problem.
Do upload the ecg if possible, and other clinical parameters if possible so I can interpret it for you
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Priyank Mody 18 minutes later
Dear Doctor, I had uploaded the ECG report for your necessary review with the profile.Thank you Best regards, xxxxxxx
doctor
Answered by Dr. Priyank Mody 21 hours later
Brief Answer:
Nothing to worry

Detailed Answer:
Hello, XXXXXXX

I did go through the ecg. Nothing to worry in context of the ecg. It s a single ventricular premature beat, and as I say it's very common to have in patients of hypertension due to decrease elasticity of the heart , otherwise the ecg is normal.

Two things I think that should be done

1) do send me the list of anti hypertensive medication and his present blood pressure so I can suggest a medication which will take care of both

2) as your father in law is more than 50 years, so if never done for complete cardiac evaluation a treadmill stress test and 2d echo, is what is suggest. However the same can be done at convenience.

Lastly if you want to be extra sure and if your father in law had episode of palpitations or dizziness ever, a thyroid profile, S. Creatinine and s electrolytes and 24 holter can be considered to complete the list of all reasons for the ecg change

Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Priyank Mody 2 hours later
Hello doctor,
Thank you for the information. It relieved us a lot.
For the hypertensive medications he is taking triolmezest 20 mg and having the last last recorded BP was 137/90 during the hospitalization. Now since he is out of station it is difficult for me to provide you the current BP.

Best regards,
xxxxxxx
doctor
Answered by Dr. Priyank Mody 13 hours later
Brief Answer:
Do go through the detailed answer. Regards

Detailed Answer:
Hello, Thank you for the info.
Now triolmezest contains 3 drugs, olmesartan 20mg, amlodipine 5 mg and hydrochlorthiazide 12.5 mg, so infact he is taking 3 antihypertensive.
Now in ideal practice we refrain from such combination because of 2 reason s
1) all are given at same time and so their effect doesn't last 24 hours, so you have variations in blood pressure which is not good for the body
2) the effectiveness of each drug is reduced, as one will interfere with absorption of others and make titration difficult.
If he not staying with you it's ok. However I would suggest the below regime which is best according to me.
Instead of triolmezest 20,
Plain olmezest H 1-0-0 in morning and Tab concor 5mg at night.
This is the same dosage as before, but I have changed amlodipine to a better drug called bisoprolol, which will take care of the extra beats and protect the heart against any stress.
If triolmezest taken today, the above to be started from tomorrow.
Hopefully we could clear your doubts.
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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