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Suggest Treatment For Persistent Premature Ventricular Contractions
Question: Hi,
I'm hyperthyroid and taking 40mg propranalol 3 times a day to control the tachycardia, however I am still getting PVCs...
My GP won't do anything unless they continue or get worse. Is there anything I can do
I'm hyperthyroid and taking 40mg propranalol 3 times a day to control the tachycardia, however I am still getting PVCs...
My GP won't do anything unless they continue or get worse. Is there anything I can do
Brief Answer:
Treat the cause and not the symptom
Detailed Answer:
Hello Mam, you are very justified in expressing your concern. I went through the history and the ecg image's you sent. The reason for your palpitations is what we call atrial premature beats which come in isolation and short runs. Now these are benign complex and before I start about how I will help you resolve the symptoms, you can be reassured that even them coming poses no extra risk to your health except symptoms.
Now mostly the reason of these extra beats is hyperthyroidism. So when you take propranolol, you are treating the symptoms and not the cause. If your thyroid hormone level are properly maintained these beats will subside.
So start on tab neomarcazole or other drug as per your reports of thyroid status under observation of your doctor and as soon as it comes under control the palpitations will go. Taking propranolol till than is justified, which can be tapered down accordingly.
If I am sent the thyroid report which contains
S. Tsh, free t3, free t4 may help me guide better.
Another option is to shift to cardiac specific beta blocker like metoprolol than propranolol if other symptoms of hyperthyroidism like tremors, starting are not significant.
Hoping that will help
Regards
Treat the cause and not the symptom
Detailed Answer:
Hello Mam, you are very justified in expressing your concern. I went through the history and the ecg image's you sent. The reason for your palpitations is what we call atrial premature beats which come in isolation and short runs. Now these are benign complex and before I start about how I will help you resolve the symptoms, you can be reassured that even them coming poses no extra risk to your health except symptoms.
Now mostly the reason of these extra beats is hyperthyroidism. So when you take propranolol, you are treating the symptoms and not the cause. If your thyroid hormone level are properly maintained these beats will subside.
So start on tab neomarcazole or other drug as per your reports of thyroid status under observation of your doctor and as soon as it comes under control the palpitations will go. Taking propranolol till than is justified, which can be tapered down accordingly.
If I am sent the thyroid report which contains
S. Tsh, free t3, free t4 may help me guide better.
Another option is to shift to cardiac specific beta blocker like metoprolol than propranolol if other symptoms of hyperthyroidism like tremors, starting are not significant.
Hoping that will help
Regards
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi
Thank you so much for your reply. At the moment the thyroid isnt being treated as they believe it is post partum thyroiditis and are monitoring it to see if it starts to resolve by itself, at the moment all other levels are low end of normal only my tsh is really low at the moment, i have more bloods being done in two weeks to see how it is going. I was worried in case it was VT or something alongside the thyroid
Thank you so much for your reply. At the moment the thyroid isnt being treated as they believe it is post partum thyroiditis and are monitoring it to see if it starts to resolve by itself, at the moment all other levels are low end of normal only my tsh is really low at the moment, i have more bloods being done in two weeks to see how it is going. I was worried in case it was VT or something alongside the thyroid
Brief Answer:
Ecg shows atrial fibrillation and not VT
Detailed Answer:
Happy to know I could help. Resolving your concern s further
1) your doctor s are right as most post partum thyroiditis do resolve on itself and many times monitoring is all that is required, however some do progress hypothyroid state on long run, and monitoring should continue even after this episode resolves
2) the added ecg you showed me though broad complex are irregular are by all probability are atrial fibrillation and not VT.
3) continue propranolol as previously and you may uptitrate the dose if tolerated till complete resolution. As I described if apart from heart the other systemic symptoms of hyperthyroidism are nit prominent, metoprolol is slightly better. However, in pure hyperthyroidism, propranolol is the best choice
4)next time do free t3/freet4. To know exact free hormones for action.
5) if atrial fibrillation are common accurate, in spite of propranolol, do discuss temporary need for anticoagulation with your doctor
Regards
Ecg shows atrial fibrillation and not VT
Detailed Answer:
Happy to know I could help. Resolving your concern s further
1) your doctor s are right as most post partum thyroiditis do resolve on itself and many times monitoring is all that is required, however some do progress hypothyroid state on long run, and monitoring should continue even after this episode resolves
2) the added ecg you showed me though broad complex are irregular are by all probability are atrial fibrillation and not VT.
3) continue propranolol as previously and you may uptitrate the dose if tolerated till complete resolution. As I described if apart from heart the other systemic symptoms of hyperthyroidism are nit prominent, metoprolol is slightly better. However, in pure hyperthyroidism, propranolol is the best choice
4)next time do free t3/freet4. To know exact free hormones for action.
5) if atrial fibrillation are common accurate, in spite of propranolol, do discuss temporary need for anticoagulation with your doctor
Regards
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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