Too many off-track beats could cause symptoms, damage or heart disease

DEAR DR. ROACH » I am a 77-yearold 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?

— R.D.

DEAR READER » 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.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.