Expert: David Richardson - 7/1/2009

Question
I am a 35 yr old female, 5'7", 133lbs, and my normal BP is anywhere between 107/70 - 95/60.  I am currently on Propranolol 10mg about 4 times a day.

In 2008 I was having strange sensations that were misdiagnosed as anxiety or panic attacks. Granted I admit I was having anxiety but I realized there was an underlying problem. I was put on xanax 1 to 2mg daily. Once I felt this was not the problem I stopped taking the xanax in December 2008. I have been okay on the anxiety situation, I do get it at times but usually when my frustration levels reach an all time high due to the pvc's. But not enough to warrant xanax use.  Ever since then the PVC's have been out of control and are becoming unbearable. I am at my breaking point! The quality of my life is going downhill quickly.

I was diagnosed with the PVC's in March of 2009. I was told they are benign but they literally occur from the time I wake up until I go to bed. And that is another problem, I rarely sleep because it takes me hours to fall asleep due to the pvc's and often times when I get to sleep I wake due to the startling sensation it causes.

I have thyroid disorder but I was told my pvc's are not linked to my thyroid. It has been in normal range for quite some time now and I have never had to be on meds for it. Right now it is at a 3.27.  I have cut caffeine, chocolate, I do not drink alcohol, or smoke. Basically anything that makes PVC's worse I do not partake in.

They first put me on atenolol but it caused my BP to drop to around 80/50 and my heart rate was 40bpm. So now I am on propranolol and it just doesn't work. Maybe for 30mins to an hour but barely. I got back in my old bottle of xanax just to see and it actually did cut the pvc's almost completely. They are 0.5 mg. I do realize this isn't a drug I should be on regularly but is there anything else that would work that well without the additive quality. I get so angry and upset that nothing is working, I am starting question is the xanax addiction worth it if its going to make me live at least a semi-normal quality of life? (this is my frustration speaking I realize).

Also something I notice is everytime I eat no matter what it is, my pvc's get about 10 times worse and stay that way for up to 3 to 5 hours after eating. Its getting to the point I wish I didn't have to eat. I dread what is to come while digesting the food. I am going to see a gastroenterologist in 2 weeks. I am not sure if I have more than one problem. They have been looking into the fact that I could have dysautonomia/POTS sydrome because someone in my family has it and I am starting to follow in their path it seems. Although they never had PVC's like this.

I just feel the doctors act as if its something I just need to "suck up" and deal with. And I have for 7 months and they seem to be getting worse. I just don't know how I can keep living a functionally normal life like this. I find myself being frustrated to the point of tears on a daily basis because I feel I am being tossed to the wayside and nobody really gets it.

Any ideas of what other meds I could take to help with the constant PVC's?

Thank you for any advice, I truly appreciate it.

Answer
Dear Ashley,

Ask about flecainide, which is safe for someone with a normal EKG and echocardiogram and is more effective than beta blockers like atenolol in reducing PVCs.  GI trouble si unlikely.  PVCs occur in perfectly healthy hearts.  Dysautonomia sounds unlikely.

Please let me know what you find out, and of course write back if this note doesn't answer all your questions.

David richardson