Early heartbeats can be a problem
DEAR DR. ROACH: I am a 77year-old retired internal medicine physician. Last year I started to have asymptomatic PVCs. I also have prediabetes and mild high blood pressure. I am on 100 milligrams of Lopressor twice daily. I had a negative stress test.
My cardiologist wants to reduce the frequency of the PVCs to less than 10%. Is there any good scientific rationale to this approach?
ANSWER: Premature ventricular contractions — PVCs — are early heartbeats. An average person might have 500 of them daily. You are having a great deal more than average: more than 10% of your beats. If you have 100,000 heartbeats daily, that’s more than 10,000 PVCs. Too many PVCs may cause symptoms in some people, but it can also cause damage to the heart, leading to heart failure in a few people. That kind of heart damage is more common in people with longer “runs” of PVCs, which you apparently don’t have.
While there are medications to stop them, it’s not clear that doing so is a good idea. Old trials, using medication to stop PVCs around the time of a heart attack, showed that people were MORE likely to get dangerous rhythm disturbances if treated.
I reviewed the newer data and discussed with a colleague in electrophysiology, Dr. Gregg Shander. He, like other experts in the field, will not treat people who have no symptoms and no abnormalities in the structure or function of the heart by echocardiogram, but he would recommend a follow-up echo in six months to be sure there has been no deterioration in heart function.
The beta blocker (metoprolol) you are on for high blood pressure is also one common treatment for PVCs. I don’t know of any reason to treat you further. Ask your cardiologist to explain the rationale.
DEAR DR. ROACH: I’m 21 years old, and I have had trouble getting and maintaining erections since 2017. I don’t smoke or drink alcohol. What might be the possible cause?
ANSWER: Erectile dysfunction is a common problem in older men, but it’s very uncommon in teenagers and young adults.
There are four major systems involved in erectile function. The heart and blood vessels need to be adequate, and while this is frequently a problem for older men with blockages, it would be rare but not impossible for a man your age. The nerves to the penis need to be intact, and nerve damage from trauma could occasionally cause this problem. You would have known about a nerve problem after the trauma began. Although it’s rare, I have had dedicated bicyclists note decreased erections after spending all day on the bike.
The hormones of the body need to be in balance. Low testosterone is a big issue and you should be checked, but high estrogens and prolactin also can cause ED. Your doctor should consider testing all of these hormone levels.
I’m glad you don’t smoke, but heavy cannabis use can lower testosterone enough to cause ED. Finally, the brain is called the primary sex organ in humans for good reason: Psychological or relationship issues can cause difficulty with erections.
Most 21-year-olds are transitioning to an adult medicine doctor, but any general doctor should be able to evaluate what’s going on.
Email ToYourGoodHealth@ med.cornell.edu