PVCs

[NotNortney]

I have PVCs up to 18 per minute as shown on Holter monitor and resting
ECG. I also had Cardiolyte stress test and echo cardiogram. The PVCs
went away when I got started on the stress test, I only seem to have
them at rest. The echo shows possible left ventricular dysfunction
and mild tricuspid insufficiency which the Internist and Cardiologist
said were not a problem and might be related to B P not controlled
properly. The final interpretation of the Stress test: Probably
negative Bruce protocol treadmill exercise test for ischemia. The
probability of high grade coronary artery disease at this time is low.
The resting ECG showed the PVCs but nothing else as far as what the
doctors told me.

Blood chemistry is all good with the exception of PSA which is being
dealt with by a Urologist.

Age 60, male, 200lbs, 5'10".

Medications
Prinzide 20/12.5
Lipitor 10
Toprol-XL 50

I have seen Family Practitioner, Internist and Cardiologist. They say
the PVCs are not a problem since they are asymtomatic. The only
problem they see I need fixed is better control of B P which is a
little high. During the stress test the B P initally was 150/86 and
maximum was 160/80.

I was prescribed Toprol XL 25 then 50 as a possible fix for the PVCs
and it did not help, may have made it worse. At least it seems worse
to me.

I have copies of the test reports if any questions on them.

Any thoughts or insight will be appreciated. Do I have a problem? I
am still concerned. Kind of scary to me to listen to my heart and
hear a lot of missing beats. Originally I heard every 3rd or 4th beat
missing. This morning I heard every other beat missing at times.

Thank You very much for any help.

Roy

[Dr. Andrew B. Chung, MD/PhD]

NotNortney wrote:

> I have PVCs up to 18 per minute as shown on Holter monitor and resting
> ECG. I also had Cardiolyte stress test and echo cardiogram. The PVCs
> went away when I got started on the stress test, I only seem to have
> them at rest. The echo shows possible left ventricular dysfunction
> and mild tricuspid insufficiency which the Internist and Cardiologist
> said were not a problem and might be related to B P not controlled
> properly. The final interpretation of the Stress test: Probably
> negative Bruce protocol treadmill exercise test for ischemia. The
> probability of high grade coronary artery disease at this time is low.
> The resting ECG showed the PVCs but nothing else as far as what the
> doctors told me.
>
> Blood chemistry is all good with the exception of PSA which is being
> dealt with by a Urologist.
>
> Age 60, male, 200lbs, 5'10".
>

Your ideal body weight might be 150 lbs (BMI=20). Therefore you may be
obese.

>
> Medications
> Prinzide 20/12.5
> Lipitor 10
> Toprol-XL 50
>
> I have seen Family Practitioner, Internist and Cardiologist. They say
> the PVCs are not a problem since they are asymtomatic. The only
> problem they see I need fixed is better control of B P which is a
> little high. During the stress test the B P initally was 150/86 and
> maximum was 160/80.
>
> I was prescribed Toprol XL 25 then 50 as a possible fix for the PVCs
> and it did not help, may have made it worse. At least it seems worse
> to me.
>
> I have copies of the test reports if any questions on them.
>
> Any thoughts or insight will be appreciated. Do I have a problem?

You might have MetS (metabolic syndrome) which has been discussed here at
SMC extensively (use Google).


> I
> am still concerned. Kind of scary to me to listen to my heart and
> hear a lot of missing beats. Originally I heard every 3rd or 4th beat
> missing. This morning I heard every other beat missing at times.
>
> Thank You very much for any help.
>
> Roy

Consider asking your doctor about checking a magnesium level (you are on a
diuretic). This being low may be causing some of the PVCs.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

[NotNortney]

On Mon, 24 Nov 2003 13:48:46 -0500, "Dr. Andrew B. Chung, MD/PhD"
<andrew@heartmdphd.com> wrote:

>NotNortney wrote:
>
>> Age 60, male, 200lbs, 5'10".
>>
>
>Your ideal body weight might be 150 lbs (BMI=20). Therefore you may be
>obese.
You are probably right. My weight was less than 130lbs until I
started gaining weight 30 years ago. None of the three doctors I saw
for this mentioned weight.

>>
>> Any thoughts or insight will be appreciated. Do I have a problem?
>
>You might have MetS (metabolic syndrome) which has been discussed here at
>SMC extensively (use Google).

I looked up metabolic syndrome on this page

http://www.labtestsonline.org/news/obesity020131.html

and don't meet the criteria to have metabolic syndrome.
I would qualify if not taking Lipitor which brings my triglyceride and
cholesterol levels to normal readings.
>
>Consider asking your doctor about checking a magnesium level (you are on a
>diuretic). This being low may be causing some of the PVCs.
Magnesium level was checked and is ok.

Can the PVCs really be benign at the frequency I have them?

The only thing I have heard that might help is lose 50lbs. May have
to study up on the 2lb diet.

Thank You Dr Chung

[Dr. Andrew B. Chung, MD/PhD]

NotNortney wrote:

> On Mon, 24 Nov 2003 13:48:46 -0500, "Dr. Andrew B. Chung, MD/PhD"
> <andrew@heartmdphd.com> wrote:
>
> >NotNortney wrote:
> >
> >> Age 60, male, 200lbs, 5'10".
> >>
> >
> >Your ideal body weight might be 150 lbs (BMI=20). Therefore you may be
> >obese.
> You are probably right. My weight was less than 130lbs until I
> started gaining weight 30 years ago. None of the three doctors I saw
> for this mentioned weight.
>
> >>
> >> Any thoughts or insight will be appreciated. Do I have a problem?
> >
> >You might have MetS (metabolic syndrome) which has been discussed here at
> >SMC extensively (use Google).
>
> I looked up metabolic syndrome on this page
>
> http://www.labtestsonline.org/news/obesity020131.html
>
> and don't meet the criteria to have metabolic syndrome.
> I would qualify if not taking Lipitor which brings my triglyceride and
> cholesterol levels to normal readings.
>

Then technically you have MetS. Treated hypertriglyceridemia is the same as
untreated for diagnosis purposes.

> >
> >Consider asking your doctor about checking a magnesium level (you are on a
> >diuretic). This being low may be causing some of the PVCs.
> Magnesium level was checked and is ok.
>
> Can the PVCs really be benign at the frequency I have them?
>

If they go away or become less frequent during a Stress EKG test, then the
answer is probably "yes."

>
> The only thing I have heard that might help is lose 50lbs. May have
> to study up on the 2lb diet.
>

It's easy. Most people on it tell me they only wish they had started doing it
sooner.

>
> Thank You Dr Chung

You are welcome.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

[NotNortney]

On Mon, 24 Nov 2003 19:07:17 -0500, "Dr. Andrew B. Chung, MD/PhD"
<andrew@heartmdphd.com> wrote:

>>
>> and don't meet the criteria to have metabolic syndrome.
>> I would qualify if not taking Lipitor which brings my triglyceride and
>> cholesterol levels to normal readings.
>>
>
>Then technically you have MetS. Treated hypertriglyceridemia is the same as
>untreated for diagnosis purposes.
I went back to see my Doctor of Internal Medicine. The one I have
been working with was out for the week so I saw the other one in the
clinic. I pressed him hard for a change in Rx for my hypertension. I
had found the PVCs happening every other beat twice and that was worse
than I had found it ever before. I attributed it to the Toprol-XL,
the only medicine changed since the PVC frequency change. He insisted
the Toprol could not do that and I should continue it but I could cut
in half to 25mg. Since the Prinzide, in my opinion, has never
controlled my hypertension properly I pressed for a change to a
different class of medicine which he agreed to do and switched me to
Benicar HCT 40/12.5. I disagreed with the diuretic part of that
because when diuretic was added with the Prinivil I could not see any
improvement in B P. I told him I did not think I was salt sensitive
and did not need that, He insisted I did wether salt sensitive or not.
Not my understanding but I am taking the Benicar HCT as RX. I did
discontinue the Toprol-XL against his RX. For the one day I have
been on only the Benicar HST my BP has been good...127/77 120/70
107/67 116/77. Will have to wait a while for my body to clear out
the old and adapt to the new medicines to see how it is going to work
out.

I also brought up the metabolic syndrome as a problem I have/might
have. The doctor rejected that possibility immediately by saying you
aren't diabetic so you don't have that although by this website I do.

http://www.labtestsonline.org/news/obesity020131.html

I said I thought if I lost some weight things might improve also, he
thought that might help some but did not seem to put much importance
on that or think it would help much.

This doctor spent a lot of time trying to convince me I should not be
concerned with or even listen to my heartbeat to hear the PVCs as it
just causes me to worry over them and they are not a problem. Well,
it started as missing one out of every 3 or 4 beats and went to every
other beat missing...I have to wonder...one more dropped beat and I am
dead but he assures me that is not going to happen.


>> >Consider asking your doctor about checking a magnesium level (you are on a
>> >diuretic). This being low may be causing some of the PVCs.
>> Magnesium level was checked and is ok.
Magnesium was checked again and is ok.


>> The only thing I have heard that might help is lose 50lbs. May have
>> to study up on the 2lb diet.
>>
>
>It's easy. Most people on it tell me they only wish they had started doing it
>sooner.
I have started the 2lbs diet.
>>

Thank You Doctor Chung

[Dr. Andrew B. Chung, MD/PhD]

NotNortney <junktogo@juno.com> wrote in message news:<5hsbsv4ho4pgemqul5meplpiia2ufonvnt@4ax.com>...
> On Mon, 24 Nov 2003 19:07:17 -0500, "Dr. Andrew B. Chung, MD/PhD"
> <andrew@heartmdphd.com> wrote:
>
> >>
> >> and don't meet the criteria to have metabolic syndrome.
> >> I would qualify if not taking Lipitor which brings my triglyceride and
> >> cholesterol levels to normal readings.
> >>
> >
> >Then technically you have MetS. Treated hypertriglyceridemia is the same as
> >untreated for diagnosis purposes.
> I went back to see my Doctor of Internal Medicine. The one I have
> been working with was out for the week so I saw the other one in the
> clinic. I pressed him hard for a change in Rx for my hypertension. I
> had found the PVCs happening every other beat twice and that was worse
> than I had found it ever before. I attributed it to the Toprol-XL,
> the only medicine changed since the PVC frequency change. He insisted
> the Toprol could not do that and I should continue it but I could cut
> in half to 25mg. Since the Prinzide, in my opinion, has never
> controlled my hypertension properly I pressed for a change to a
> different class of medicine which he agreed to do and switched me to
> Benicar HCT 40/12.5. I disagreed with the diuretic part of that
> because when diuretic was added with the Prinivil I could not see any
> improvement in B P. I told him I did not think I was salt sensitive
> and did not need that, He insisted I did wether salt sensitive or not.
> Not my understanding but I am taking the Benicar HCT as RX. I did
> discontinue the Toprol-XL against his RX. For the one day I have
> been on only the Benicar HST my BP has been good...127/77 120/70
> 107/67 116/77. Will have to wait a while for my body to clear out
> the old and adapt to the new medicines to see how it is going to work
> out.

The Toprol XL needs to be weaned off. You need a doctor's supervision
for that.

> I also brought up the metabolic syndrome as a problem I have/might
> have. The doctor rejected that possibility immediately by saying you
> aren't diabetic so you don't have that

The doctor is in error.

> although by this website I do.
>
> http://www.labtestsonline.org/news/obesity020131.html
>
> I said I thought if I lost some weight things might improve also, he
> thought that might help some but did not seem to put much importance
> on that or think it would help much.

The reluctance to diagnose and treat obesity is pervasive.

> This doctor spent a lot of time trying to convince me I should not be
> concerned with or even listen to my heartbeat to hear the PVCs as it
> just causes me to worry over them and they are not a problem. Well,
> it started as missing one out of every 3 or 4 beats and went to every
> other beat missing...I have to wonder...one more dropped beat and I am
> dead but he assures me that is not going to happen.

He is correct.

>
> >> >Consider asking your doctor about checking a magnesium level (you are on a
> >> >diuretic). This being low may be causing some of the PVCs.
> >> Magnesium level was checked and is ok.
> Magnesium was checked again and is ok.
>
Ok.
>
> >> The only thing I have heard that might help is lose 50lbs. May have
> >> to study up on the 2lb diet.
> >>
> >
> >It's easy. Most people on it tell me they only wish they had started doing it
> >sooner.
> I have started the 2lbs diet.

Good. Now you need a doctor to supervise you on this and the weaning
off of Toprol XL.

> >>
>
> Thank You Doctor Chung

You are welcome.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com