Heart & Cardiology/PVC beta blocker


QUESTION: Dear doctor

I'm sure you remember me. I posted my trouble with what the doctors assumed to be pvcs, ectopic beats. My cardiologist has refused to give me a beta blocker stating that they did not pick up anything on the holster monitor. As mentioned I suffer from panic disorder which was under control until recent when they cropped up. I've explained to my cardiologist that the pvcs come on during an attack mostly ,as you know with a panic attack your heart is already racing and with me my heartbeat becomes irregular it begins to pause and skip continuously my mind then tell me I'm in v tach and the whole thing spirals out of control.

I'm currently on Paxil cr and xanor for my attacks

I need to know if it is safe without the aid of a beta blocker to go out there get a panic attack and even if i get runs of irregular beats I need not worry? I need to face it, I need to understand that my heart won't stop. I read somewhere that 3 pvcs in a row is v tach this is why I worry, I worry what if the panic attack initiates a fatal rhythm. All my cardiac tests came back negative because at rest my pvcs are infrequent they come up during exercise at times and during panic attack always. Please explain to me if adrenaline released during a panic and anxiety is the cause of this and why the heart acts this way because my doc feels I don't need a beta blocker but I know it will help me even for a short while

I do have asthma mostly caused by allergies so I am limited when it comes to beta blockers but am told that their are betablockers also for people with asthma that are selective? I do lead an active lifestyle so I am trying my best to overcome my panic without meds I have been off training physically for a week with my panic and hope to resume next week

I want to get on with my life but pvcs mostly are holing me back especially pvcs during a panic attack what are your thoughts based on the above how old you address thus?

ANSWER: Your PVCs will not harm you if you have ever had a normal echocardiogram.  No fatal rhythm or any other catastrophe.  Adrenaline is released during panic and exercise, and makes PVCs more frequent.  Beta blockers are a bit risky for someone with asthma.

Please write back if this note doesn’t answer all your questions.

David Richardson

---------- FOLLOW-UP ----------

QUESTION: Thank you doctor, so even if I get a panic attack and they come in runs these pvcs when I mean runs like skip skip skip skip with tachycardia I should not go to the ER I should remain calm and let it pass?As I've said I've read that 3 pvcs in a row is v tach so that's what alarmed me is this true? I'm working on getting over panic but I am struggling because of pvcs, my doctor has assured me the worst that can come of a panic attack with pvcs is I could faint is he correct? I guess all I need is reassurance. My cardiologist told me to get some inderal(propanolol) should I get unwanted pvcs I should pop a tablet but I'm not sure because I am an asthmatic is their any other beta blockers I could use that I could mention to my GP?

Atenolol and metoprolol are both selective beta blockers thought to avoid constricting the airways.  But beta blockers are not very effective reducing PVCs.  Flecainide is more effective in reducing PVCs and has no effect on longs ad is safe fore someone with  normal echo of heart.

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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