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Pacs Driving Me Nuts


mkoven
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I've been having a lot more skipped beats, which I"m guessing are pacs from results of past event monitors. It feels like I get two close beats togetehr, then a longer then normal pause, then a beat. I could deal, but I get a big adrenaline rush from them. And I'm otherwise not emotionally anxious, but the sensation is triggering a weird rush.

The triggers I can think of are my blasted hormonal fluctuations, maybe electrolytes off from florinef(waiting for results). I also started norvasc about two weeks ago. But they are really distracting/annoying. If my electrolytes come back normal, are my options then to live with them or take a beta-blocker-- contraindicated with all my allergic issues? I've been told to avoid hormones, because of my migraines, but I'm sorely tempted!

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mkoven,

Are your hormones triggered by the estrogen or the estrogen withdrawal? I was put on continuous estrogen because of my migraines; I only got them with my periods. I would have three months on and one week off and a WHOLE LOTTA pain meds! My OB/GYN has me on estrogen now because of low hormone levels (low estradiol, LH, FSH and testosterone) but it is a low continual dose so that I never get the estrogen dip that is low enough to trigger a migraine. I am one of those who needs an "estrogen priming" to get a migraine, so if my estrogen levels don't spike before the dip, I won't get a migraine. So far, so good. Good luck!

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Interesting-- do you take bioidentical or the standard? My neuro tells me beware because I get "complicated migraines" with tia-like symptoms. But I think it's definitely perminopausal hormonal fluctuations behind 90% of my health woes- from pots, to pacs, to allergies, to migraines, to allergies...To think I was a relatively healthy person who never went to the doctor or really needed to go until 7 years ago-- and I get stranger as time goes on. I definitely feel like the pacs are worst right after ovulation and right before my period. and this frequency is new. I'd say I'm getting at least one per minute, when it used to be one a week.

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Interesting-- do you take bioidentical or the standard? My neuro tells me beware because I get "complicated migraines" with tia-like symptoms. But I think it's definitely perminopausal hormonal fluctuations behind 90% of my health woes- from pots, to pacs, to allergies, to migraines, to allergies...To think I was a relatively healthy person who never went to the doctor or really needed to go until 7 years ago-- and I get stranger as time goes on. I definitely feel like the pacs are worst right after ovulation and right before my period. and this frequency is new. I'd say I'm getting at least one per minute, when it used to be one a week.

My OB/GYN used a "sledgehammer" as he called it, to see if it would make a difference first using full strength Estratest. It worked wonderfully :D , except for the unpredictable cycle lengths :( Now he wants to "unbundle" the effects and will have me take the same amount of estrogen and testosterone in two separate entities (pill and cream) then I am supposed to stop one hormone for two weeks and see what happens, then stop the other and re-take the first. Once we know which hormone is helping, we will titrate the dose to the lowest possible dosage to get the desired effect. ALL three of my endos had a big, ugly hissy-fit over this (just warning you!) I am NOT perimenopausal or have PCOS, I am just not making enough LH, FSH and the other hormones to have my ovaries do what they are supposed to do. All three endos agree that I probably have not ovulated in 7 years, but my OB/GYN questions that.

If you went on a monophasic BC pill, it would suppress your ovulation and even out your hormones. (That's what I was on.)

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I tried low-dose monophasics twice and couldn't tolerate them. I don't know if it's the synthetic estrogens? It seems like there isn't as much research on the bioidenticals, but that some people tolerate them better. I'm all for being alternative, but I do want to know if I'm safe--both with migraines and a family history of breast cancer. I know that "natural" doesn't necessarily mean safe. (Many non-dinet people have suggested I take licorice instead of florinef as "safer" because "natural," but at least with florinef I know it's more standardized and studied.)

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I tried low-dose monophasics twice and couldn't tolerate them. I don't know if it's the synthetic estrogens? It seems like there isn't as much research on the bioidenticals, but that some people tolerate them better. I'm all for being alternative, but I do want to know if I'm safe--both with migraines and a family history of breast cancer. I know that "natural" doesn't necessarily mean safe. (Many non-dinet people have suggested I take licorice instead of florinef as "safer" because "natural," but at least with florinef I know it's more standardized and studied.)

Mine were NOT the low-dose monophasics, they did not work at all for me. I had A LOT of break-through bleeding and other side-effects with them. I also like "natural," but there is a HUGE misconception about supplements not being drugs. Even willow-bark tea is a drug! I don't know which estrogen they use for the bio-identicals, but I would go through a doctor with that. I know many are against it but I don't know enough about it to know why.

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I think that people with neurological signs during migranes (such as TIA symptoms) are the people who should avoid taking oestrogen due to the increased risk of stroke. For some people using a progestogen only birth-control method helps even out other hormones without increasing the risk of stroke. Sounds like you need to consult a gynae or endo with an interest in this type of problem.

Have you tried any alternatives to beta-blockers to reduce the PACs? I know calcium channel blockers slow the heart rate but I don't know if they would help PACs? Worth asking your doctor. There is another med called Ivabradine that slows the heart but I don't know if it is available in the USA yet? Most people just feel the "thud" of the beat after the PAC so you must be very well "tuned in" to your heart to be able to sense the early beat too (that is the actual PAC, not the thud beat afterwards)

Hope you get some relief soon,

Flop

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Count me in the boat for the choppy heart beats! They have been driving me crazy for the last week! AGAIN.

Isn't it SO strange how you can go months (sometimes years) with hardly a missed beat in the bunch ... and then all of a sudden WHAM they are back again.

Like you described it not so much the Ba-BOOM but it's that rush of ick that seems to follow the episode that is the pits. I've had hot flashes before ... and I can't say it's like that. I don't sweat and it's not over in a couple minutes. For me it is HOT and it feels like all of my muscles are in a holding pattern. Then there is this back/neck/shoulder pain that comes out of no where. Then in about a half hour (or an hour if its a doozy) it all seems to subside.

I suspect in my case it's perimenapause and/or my thyroid acting up. Either way, not much to do. My cardiologist took me off birthcontrol pills last fall so I am literally free falling now into menapause without a parachute. My PCP wants to see how bad things get before we do anything "chemical" to try and mitigate the menapause symptoms. Since I am still having regular periods ... it looks like I'm in this for a longer haul than I had thought.

I do feel for you sweetie, these are NO FUN and a bear to cope with in the moment.

Sending you easy breezy and highly rhythmic thought waves ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ...

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It does feel strange that I"ve had such an increase in pacs--when they were such a rare occurrence. I swear it's multiple times a minute--and yes, it is the icky surge that gets to me. I may check in with my pcp to see if my blood work is back, in case my electrolytes are off--which would be easy enough to fix. I almost wonder if my magnesium fluctuates at different times of my cycle-- when I look up the symptoms of hypomagnesium, it looks just like me! But I already take 800mgs a day. My doc said it's hard to measure and absorb.

The last we checked my hormone levels were normal, but my gyne said that doesn't mean anything, as it's just a snapshot in time. My mother didn't go thru menopause till 50, so, as you say, I may have a long free-fall ahead of me! My periods are still relatively regular, but increasingly miserable-- not the actual period, but all the other associated symptoms of feeling like I"m being crushed/smushed by a truck. I'm all for celebrating "natural" events in theory...

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...I almost wonder if my magnesium fluctuates at different times of my cycle-- when I look up the symptoms of hypomagnesium, it looks just like me! But I already take 800mgs a day. My doc said it's hard to measure and absorb.

...

My cardio suggested Slow-Mag ... I also use to take huge levels of magnesium supplement but this special time released magnesium which is actually quite small in terms of how much is delivered, does seem to help more. (Except for this week of course!)

...My periods are still relatively regular, but increasingly miserable-- not the actual period, but all the other associated symptoms of feeling like I"m being crushed/smushed by a truck. I'm all for celebrating "natural" events in theory...

I would have held on to my pills until they ripped them from my post-menopausal fists. But my cardiologist insisted. Easy for him to do. I still haven't ruled out other hormonal options ... its just so hard to pin point what is causing what. Like you my blood work snapshots are still coming back "normal". My mother completed menapause in her late 40's though I thought I was good to handle this for only a couple of years. But who knows, it's not like there is any kind of GPS that tells us our ETA! <_<

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Well, I'm getting between 6-10 skipped beats per minute. I called the cardiologist on call who said this is not an emergency. but should be followed up on. She agreed that this is unpleasant and dhould be addressed, esp. as this is new. So I was surprised and a little freaked that they are so often-- and acouple instances where I get two in a row. And I've checked a bunch of times this afternoon, it's consistently this many. Any ideas/suggestions?

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HI mkoven,

I'm curious about the skipped beats and the adrenaline rush. Do you get the feeling like a whole lot of blood is being forced into your head when this happens? My whole POTS experience began a year ago with this same sensation. I would get a skipped beat and then the rush. I have talked to my cardio, internist, and PCF about this, and all of them assure me that I will be fine. I wish they could understand the amazing pressure this causes in my head, and then, I wonder if they would think its fine. I get them all the time now. Sometimes it even gives me a headache. I am new here and just trying to continue to figure this all out. Thanks for your input.

Julie

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That's rough. I'm so sorry your system hasn't settled down for you. Do you sense that it is skipping 10 times a minute all the time (i.e. can you feel them) or do you think it's just when you are checking for them? I know I tend to get more when I am counting them. But I can feel them in my throat even when I don't have my fingers on my pulse points.

Feel reassured that the doc said its not a critical care matter and that you can schedule an appointment with your regular doctor who is treating you. My cardiologist agreed that unless I was having 10,000 a day he wasn't going to treat them at all, and even if it was 10,000 a day it wasn't a matter for me to go to the ER.

Hang in there and let us know how you are doing.

p.s. I know you are knowledgeable about all this, so its safe to assume you are avoiding caffeine, no artificial sweetners, no smoking, no alcohol, as well as some cough meds and other over the counters have stimulants in them as well.

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I feel them all day long-- some more than others, I think the ones with the longest pauses are the ones that I really feel and give me the weirdest rush. The shorter ones I can tune out. I think it may be all day long. I think I really feel about half of them.

I talked to the cardiologist on call at my cardiologist's office and she agreed I needed follow up, and got how annoying this is, but didn't think it was dangerous. I calculated, though that if I'm doing 6/minute, that's over 8000 a day. I don't know what happens during sleep.

Could this be related to my ans issues at all?

The causes I can think of: hormones, some weird reaction to my new drug norvasc (though apparently this shouldn't happen), electrolytes. I've also been switched from klonopin to valium to make it easier to taper off-- but that also seems unlikely. I don't think I"m in benzo withdrawal.

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Klonipin to Valium is the right way to go if you are going to taper. I only did benzos for two months but when I tapered off which probably took another 4-5 weeks I did get lots more heart arrhythmia. It probably took three months off of the benzo before I noticed a reduction in the skipping (then again, I started taking the Slow-Mag at about that same time ... so clearly I have NO idea why they started or stopped.)

There is lots of anecdotal forum posts about norvasc and heart issues (pounding, slow, fast ... some skipping not much) but that's not to say your body isn't going through an adjustment period and it will still settle down. But you may want to mention the coincidence that the heart skipping seemed to come on at the same time you began this calcium channel blocker.

Hand in there. Is your regular cardiologist on call today? Or is it one of those offices that take forever to get an appointment?

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I just talked to my cardiologist. I guess it was an okay conversation. I think the problem with cardiologists, even the most human ones, is that they are (quite reasonably) most concerned with treating what is life-threatening not just qulaity-of-life threatening. She doubts it's the norvasc, but agrees that I'm not a typical responder to meds.

She wants me to take two grams of magnesium today (instead of my usual 800mgs) to see if it helps with the skipped beats but said she wasn't really worried. Great-- glad to hear it's not dangerous, but it's really unpleasant. Not sure she appreciated that there's a threshold to how much unpleasantness I can tolerate! So I'll try the increased magnesium-- hope that's not so much that it drops my bp. I'm going to call my pcp to see if he has the blood work back, in case my electrolytes are off. I asked her if I could be getting more skipped beats because of hormones, and she said yes. from increased exercise/post-exertional fatigue--yes, but she doesn't want me to cut back. But she seemed totally unphased... a good thing? But I guess I wanted more concern...

So we're not stopping the norvasc-- which is fine. I really do want to give it a fair trial to see if it helps my night-time chest pain amd migraines. and if it's an unlikely culprit, then I don't want to blame it.

And my guess is that the main reason she works with me is because she thinks I do have prinzmetal angina-- the one heart-related condition that could really hurt me. and the rest is mostly distraction to her. Dysautonomia seems like it's sort of an orphan problem. It is rarely life-threatening, more often life-disabling, so less interesting to most cardiologists????

So with my pcp, I guess we can look for other causes of the increased skipped beats. I do drink one cup of coffee in the morning, but that's my only caffeine/stimulant. Don't think I can quit cold turkey without provoking a migraine, but I can start weaning.

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I did a quick google search for the words Norvasc and Heart Skipping and there was just a smattering of stuff out there on various bulletin boards ... nothing substantial.

However drugs.com lists "fast or irregular heartbeat" as one of the possible side effects.

http://www.drugs.com/sfx/norvasc-side-effects.html

Best source is your doctor though.

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Chiming in here late. I have been so plagued with pac's the last few months, it really is making me nuts. I waited a week and finally went to the ER, where they brought in the pace maker tech and she upped the rate of my pacer, which helps over ride them, so I don't feel them so much.

The thing is, all they could say was, well it's not life threatening you know. They actually said I wasn't having arrythmias. SO WHAT! I said, it makes me feel like crap. Fix it. Then the tech comes in and says I'm having them continuously. of course she still went out afterwards and told them I was a nut job and asked if anyone had bothered to give me ativan yet. My cardio said the same thing and i said I didn't care if it wasn't lethal, that doesn't automatically mean it can't make you feel like crap. He had to agree to that. pac's don't perfuse well, so if you are having them constantly, how can they NOT make you feel awful?

I asked him if I went into the ER with a heart attack, but wasn't dead, would they just give me an ativan and send me home, since I wasn't dead? . You actually now have to be dead before you are taken seriously? He just shrugged. Good grief. Sorry about the rant, but I really get tired of hearing, well it's not lethal, so why are you bothering us.

Whether or not it's hormonal...I'm 54 and past menopause and haven't changed meds for years, so I don't blame it on that. I hope you get to feeling better soon. morgan

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She wants me to take two grams of magnesium today (instead of my usual 800mgs) to see if it helps with the skipped beats but said she wasn't really worried.

The "good thing" about magnesium is the body will flush out any excess it can't use (i.e. you get loose stools -- which is usually the sign you've taken too much and you can back down a bit the next day until your bowels are back to normal.)

Good to hear the news from your cardiologist was good.

I do know how hard these are to cope with ... as my husband says for me they are "deal breakers". When I am having a run of them (like in the last week) I don't go out at all. Pitty, I haven't learned to handle them better. But I am trying.

Hope the magnesium does the trick!

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Good grief. Sorry about the rant, but I really get tired of hearing, well it's not lethal, so why are you bothering us.

Exactly. How about we follow them around on rounds for a day tapping them on the shoulder every minute. Then occasionally hitting them really hard to knock them off balance a few times each hour. How long before they get that "living with it" isn't as easy as it sounds!

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