How to manage premature ventricular contractions?

Question

Hi doctor,

I have a history of benign PVCs. Lately, I have been experiencing pauses between my heartbeats that I can feel in my stomach, ranging from two to 12 beats per minute. I also have gas and burping. How many pauses per minute are considered dangerous, and could this indicate a cardiac issue? When it happens, I place my fingers on my pulse and can feel the pauses between beats. Sometimes, the pattern is one beat, a pause, two beats, another pause, two more beats, and then another pause, followed by a regular rhythm for a minute or two. My anxiety is heightened because of this, and I need to understand what is happening. I am 73 years old, work 40 hours a week, and go to the gym five days a week.

Please advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

These pauses are due to PVCs (premature ventricular contractions). Immediately after a PVC, which is an extra beat, there is a temporary pause until the next normal beat resumes. Most of the time, these are benign and not dangerous. However, considering your age, it is important to rule out ischemia as a potential cause. Since you mentioned these as benign, I assume you have already been evaluated with echocardiography, ECG (electrocardiogram), cardiac stress tests, etc.

Factors that can increase PVCs include smoking, excessive alcohol intake, elevated thyroid hormone levels, and caffeine. I recommend that you get your thyroid profile tested to rule out hyperthyroidism, and an ECG to confirm your heart’s status. If not already done, a cardiac stress test, such as a treadmill test or stress thallium test, can also be performed.

Regarding your current symptoms, they appear to be related to acidity and gastritis, which can worsen PVCs by altering the vagal tone. Overall, the likelihood of serious issues is low, but further evaluation is necessary. For treatment, beta-blockers like Metoprolol 25 mg once a day may be prescribed, with a gradual increase as needed, so please consult your physician for a prescription. For managing gastritis, I suggest the following:

Avoid fatty, oily, and spicy foods.
Take a walk after meals instead of resting.
Eat multiple small meals rather than heavy ones.
Maintain regular sleep habits and manage stress.
Consume plenty of green leafy vegetables and fruits.
Elevate your head with pillows during rest and sleep.

I also recommend trying Pantoprazole and Domperidone 40 mg three times a day for two weeks, along with a prokinetic agent to help propel the acid forward. If you do not find adequate relief, consider adding Sucralfate and Oxetacaine syrup, two teaspoons three times a day for a week.

I hope this information is helpful. Feel free to reach out if you have any other questions.