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Suggest treatment for anxiety, acid reflux, benign pacs and few PVCs

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Posted on Tue, 19 May 2015
Question: I have had all cardiac tests and all came back with a structurally normal heart. My cardiologist says I suffer from benign pacs and very few pvcs. My 48 hour Holter recorded 450 Pacs and 15 pvcs over the 48 hours. This was 2 months ago. He says they are due to my anxiety and acid reflux and not heart related. I don't totally understand what it means that they are not heart related because the symptoms come from the heart. Lately I have had some more stress due to having to move out of my house and I've noticed an increase in the ethnic beats especially today. Is this safe or normal? My cardiologist says not to worry as my heart is healthy. I have been doing cbt therapy and psycho therapy for a month now and my anxiety has been better and no panic attacks for almost 4 months which is good. I still get anxiety but under control, not to the point of panicking. Am I worried for no reason?
doctor
Answered by Dr. Sukhvinder Singh (4 hours later)
Brief Answer:
please see details.

Detailed Answer:
Dear Mr XXXXXXX
1. Let me explain you why and how these PVC and PAC originate. Actually we have an electricity generator in our heart (SA node) which generate current in heart and it spreads through the whole heart. The muscles of heart contract only in response to this current. If this current from SA nodes stops, practically the heart will stop. However, the God the given ability to generate current to almost all other parts of heart (muscles and conducting tissue). However to maintain supremacy of SA node and to maintain on orderly spread of current (and thus contraction of heart muscle), God has given maximum rate and shortest cycle duration to SA node. Hence it fires next beat before any other tissue can produce electrical current of its own. The ability to fire and its rate are influenced by our autonomic nervous system (sympathetic and parasympathetic). This system is something which mediates our bodily or physical responses to our mental status. Beside the electrical abilities are heart are influenced by physical stretch, medicines and electrolytes.
Whatever VPC and APC we see, they are normally due to two mechanisms. One is if SA node goes to slow and the lower tissues get a chance to fire. Second is that they fire early or prematurely or within the cycle length of SA node (that why premature atrial or ventricular complex). This early firing can occur in response to physical stretch, emotional changes, medicines, electrolyte changes or anything which changes balance between sympathetic and parasympathetic system.
2. Now, you will understand, that why I told you in my last answer, that it is common in normal population and practically impossible to tell that what is the cause for each and every premature beat.
3. Practically if they are not associated with structural heart disease, as in your case, and if they do not initiate serious rhythm disorder we ignore them. Only and only if they are truly causing some symptom in a patient, we try to suppress them.
4. If we can find out some definite precipitant we avoid it. It is not possible to know a precipitant in most cases.
Hope this gives you some insight into the issue.
Feel free to discuss more.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh (7 hours later)
Hi doctor thank you very much for answering my questions. I appreciate the detailed response. So does this mean as long as there is no heart disease or structural problem it doesn't matter how many etopic beats someone has? Are they always benign? One doctor once said to me that they are only worrisome if the exceed 15% of your total beats and then an ablation may be necessary. However my cardiologist says mine do not originate from the heart they have a different etiology.
doctor
Answered by Dr. Sukhvinder Singh (6 minutes later)
Brief Answer:
please see details

Detailed Answer:
Dear Sir
1. In absence of structural heart disease and absence of serious rhythm disorder, VPCs and APCs are considered benign irrespective of their number per day. Ablation is not done for APCs or VPCs alone.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh (2 hours later)
Doctor thank you for your reply I have one last question before I close the discussion. I read that the vagus nerve can slow down your heart rate. I do get some acid reflux or Gerd and I have slight bradycardia as I mentioned to you last time. Sometimes I'll get episodes where I Bend down and get up or just even sitting still and I'll have pressure coming up to my throat from my stomach. It feels like a lump in throat from food coming up but not acidic. I'll check my pulse and it will be very slow but hard for 5 to 7 beats. Can Gerd or acid reflux be causing this to happen? It is quite scary and I know exactly when it's happening cause I get the lump in throat.

The doctor says my heart is healthy so something must be causing this slow beats with pressure
doctor
Answered by Dr. Sukhvinder Singh (9 minutes later)
Brief Answer:
please see details.

Detailed Answer:
Dear Sir
1. As I detailed you earlier also, that there has to be a temporal (time based) relationship between symptoms of GERD and PVCs. If it is so that you always get PVCs and GERD symptoms together, yes possibly GERD precipitates PVC in that scenario. However, as I detailed in first answer of this discussion, it is very difficult to ascertain exact cause of VPCs in every case.
2. Yes, stimulation of vagus slows down heart rate.
3. Cause of lump in throat is not likely to be cardiac as your stress ECHO is normal. It is not likely to be GERD as it occur because of a very small duration. Transient regurgitation of food without acid is well known in some individuals especially because of eating large amount of food, taking too much fluids with meals, not chewing food properly and in those with hiatus hernia. At times it is not possible to get any plausible mechanism for the symptoms which lasts for few seconds except that these are individual sensations.
sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh (3 minutes later)
Ok so does that mean the slowing down of the heart rate and these sensations are not dangerous?
doctor
Answered by Dr. Sukhvinder Singh (4 minutes later)
Brief Answer:
please see details.

Detailed Answer:
Dear Sir
1. Physiological transient slowing of heart rate in response to stimulation of vagus is not harmful.
2. These sensations, since transient (lasting for few seconds) and without any other symptoms appear to be benign historically. However a physical examination performed by your physician should also be normal.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh (5 minutes later)
Doctor thank you for explaining I told my cardiologist about this but he said he has done every test. 2 Echocardiogram, 2 stress tests, 2 48 hour Holter and blood work along with several ecg. Nothing abnormal has come up. Is this true that I am safe as long as I've had all these tests. The most recent were 2 months ago
doctor
Answered by Dr. Sukhvinder Singh (3 minutes later)
Brief Answer:
please see details.

Detailed Answer:
Dear Sir
1. No test or investigation guarantees that a cardiac event will not occur in future. It is not possible for medical sciences to assure that a future cardiac event will not occur. They only tell us the current status. As per your history and investigations your PACs and PVCs seems to be benign.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh (1 minute later)
Thank you for your time doctor
doctor
Answered by Dr. Sukhvinder Singh (0 minute later)
Brief Answer:
You are welcome.

Detailed Answer:
You are welcome XXXXXXX
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Sukhvinder Singh

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Practicing since :1998

Answered : 1306 Questions

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Suggest treatment for anxiety, acid reflux, benign pacs and few PVCs

Brief Answer: please see details. Detailed Answer: Dear Mr XXXXXXX 1. Let me explain you why and how these PVC and PAC originate. Actually we have an electricity generator in our heart (SA node) which generate current in heart and it spreads through the whole heart. The muscles of heart contract only in response to this current. If this current from SA nodes stops, practically the heart will stop. However, the God the given ability to generate current to almost all other parts of heart (muscles and conducting tissue). However to maintain supremacy of SA node and to maintain on orderly spread of current (and thus contraction of heart muscle), God has given maximum rate and shortest cycle duration to SA node. Hence it fires next beat before any other tissue can produce electrical current of its own. The ability to fire and its rate are influenced by our autonomic nervous system (sympathetic and parasympathetic). This system is something which mediates our bodily or physical responses to our mental status. Beside the electrical abilities are heart are influenced by physical stretch, medicines and electrolytes. Whatever VPC and APC we see, they are normally due to two mechanisms. One is if SA node goes to slow and the lower tissues get a chance to fire. Second is that they fire early or prematurely or within the cycle length of SA node (that why premature atrial or ventricular complex). This early firing can occur in response to physical stretch, emotional changes, medicines, electrolyte changes or anything which changes balance between sympathetic and parasympathetic system. 2. Now, you will understand, that why I told you in my last answer, that it is common in normal population and practically impossible to tell that what is the cause for each and every premature beat. 3. Practically if they are not associated with structural heart disease, as in your case, and if they do not initiate serious rhythm disorder we ignore them. Only and only if they are truly causing some symptom in a patient, we try to suppress them. 4. If we can find out some definite precipitant we avoid it. It is not possible to know a precipitant in most cases. Hope this gives you some insight into the issue. Feel free to discuss more. Sincerely Sukhvinder