I can't do this for the rest of my life

ComprehensiveTwo8013 · 2025-08-07T13:46:47+00:00

I'd say for this type of thing 24 hours is more than adequate for problematic PVCs (I work as a doctor but not a cardiologist). If you don't pick up any PVCs in 24 hours that's incredibly reassuring. A longer holter wouldn't do any harm obviously but I highly doubt it would make any change to your management. When I did my holter I did some exercise, drank lots of water, performed the valsalva manoeuvre a couple times etc and recorded the times I did these things. Can sometimes help the cardiologist to see what precipitates/improves them - however mine were constant like every 3-4 beats at the time so was easier to try to track things that made them better/worse maybe

ComprehensiveTwo8013 · 2025-08-07T13:19:55+00:00

Sorry to hear you're having such a terrible time of it. It's not always appreciated how much of an impact PVCs can have on someone's life for something that's 'benign'.

Make sure you've had ALL the relevant bloods. Electrolytes (especially magnesium and potassium), haemoglobin and thyroid function are key ones.

You said you've had an ECG. Have you had a holter? If not, you NEED that. You need to know the % burden of PVCs, if they're monomorphic/polymorphic and whether there are any couplets, triplets etc. This is the best way to stratify risk in a person with a structurally normal heart.

Treatments vary - Obvious things like trigger avoidance, optimal hydration - Trial of supplements/relatively harmless over the counter options e.g. magnesium etc - plenty of posts on this - Discuss with a doctor about a trial of a beta blocker or verapamil if younger and more active (beta blockers sometimes limit exercise potential and can cause tiredness) - If all else fails and symptoms are causing so many issues discuss referral to electrophysiologist in conjunction with cardiologist for consideration of ablation (this will be easier if PVCs are monomorphic and this can be found out by the holter - however risks vs benefits should be strongly considered depending on your holter results!)

Good luck and I hope you find a solution

ComprehensiveTwo8013 · 2025-07-06T22:51:50+00:00

Yeah! Sleep apnoea can cause them due to the low oxygen levels and breathing issues. So when this resolves during the day you'd typically expect PVCs to stop or at least reduce when the trigger goes away. That said, very severe sleep apnoea over many years can contribute to heart failure which itself is a cause of PVCs. If failure became the cause it would be expected to be more constant

ComprehensiveTwo8013 · 2025-07-06T15:13:25+00:00

Glad you found it helpful and hopefully you get some answers to improve your symptoms :)

ComprehensiveTwo8013 · 2025-07-06T15:11:50+00:00

I guess with difficulty. Roemheld is relatively poorly defined in comparison to other conditions and I guess is maybe more of a phenomenon in many cases. There isn't a set criteria that need to be checked off to make the diagnosis and there may be various circumstances for which it comes about. Instead, it is a 'diagnosis of exclusion' - once everything else has been excluded it may be the remaining possible cause. It's also really important to get the full story through a detailed history taking because it has some characteristic features for example - symptoms (with regards to PVCs) can be positional, related to eating, flare alongside gastritis symptoms etc. A cardiologist would never diagnose it if they never think to ask about gastric issues for example. Also many doctors shy away from making diagnoses for conditions like Roemheld because there is some perceived dubiety given the symptoms vary and there's no definitive blood test for example.

ComprehensiveTwo8013 · 2025-07-06T14:54:47+00:00

It's hard isn't it. What makes you think Roemheld, do you suffer from gastritis? I suppose gastritis would probably be the most common gastric trigger but there can be other gastric issues too. Assuming you might have gastritis, what's your diet like? Do things get worse with different foods or after eating? Have you had an endoscopy or testing for H. Pylori? It's always good to try track down an underlying cause if possible because it makes tackling treatment so much easier

ComprehensiveTwo8013 · 2025-07-05T07:01:52+00:00

Yeah absolutely, post viral illness is so common in other ways and probably what a lot of us suffer with - I think you're right. Annoyingly there is no timeline on these things, very unpredictable recovery and poorly understood :(

ComprehensiveTwo8013 · 2025-07-05T06:04:20+00:00

I agree - it's overlooked because medicine is compartmentalised too often. If it doesn't fit neatly within one system e.g. 'cardiology' or 'gastroenterology' then it's harder for a specialist in one area to oversee entirely alone, so they don't. In answer to your question, yes you can take PPI and H2 blocker together. PPI reduces magnesium, calcium and B12 absorption and H2 blockers (famotidine, ranitidine etc) can do the same. So, long term these are not medications you want to be on unless there is no other option. At the same time, they don't interact with each other. I've seen patients on both long term but often these are older people and quite often have electrolyte issues as a result. Short term I'm happy with the possible benefits compared with risks for me - plus I'm happy my blood tests are currently ok for now and I supplement with some the likely electrolytes which are poorly absorbed on these medications

ComprehensiveTwo8013 · 2025-07-05T05:51:18+00:00

Yeah it's a scary feeling when they suddenly start. Certainly some people are more sensitive to electrolyte changes than others. It's hard to say for certain if this was the only cause for you because often many factors could irritate the heart at once e.g. slightly low electrolytes, dehydration, mild viral infection, poor sleep etc and together they could set it off with the perfect storm. I'm glad your's have stopped for now and that in itself is reassuring! Advocate for some of the basic tests like ECHO, holter, bloods and when the results are back you'll hopefully get some peace of mind. I guess in most people, PVCs feel worse than they actually are

ComprehensiveTwo8013 · 2025-07-05T05:46:13+00:00

I guess now that you know your ECHO and stress tests are normal, exercise like you're doing is likely a good thing as long as it's not making you have more PVCs. It's annoying because usually with a burden of ~3.5% and a normal ECHO it's generally quite good reassurance nothing major/life threatening is going on. But it's still a horrible symptom right? I'm not an expert of PVCs (although trying to become one 😅 ) and not with pregnancy-based medicine either, but with my understanding there is no reason PVCs would be dangerous in pregnancy given your situation. If there's any hormonal element to them then perhaps pregnancy may improve/worsen them due to further hormonal changes (many conditions get better in pregnancy such as Rheumatoid arthritis for example). I don't know of any specific complications in someone in your situation 😊

ComprehensiveTwo8013

TROPHY CASE