Doctor's Apathy Concerning Benign Arrhythmias

Doctors, oy vey. My recent and continuing bout with ectopics, and in my case, at this time, almost exclusively PVCs, has me frustrated. On the positive side, stress/echo December 2013 was good, Holter monitor after the bout started was good (showed 6000 PVCs, and included swallowing induced examples recorded on the Holter) but getting them horribly when I eat (I must have lost weight, even a half of sandwich will send my heart into a fit, so I eat much less) and when I lay down makes them difficult to tolerate, so I sleep with my upper body upright.

Though I'm heavy now (not Jabba the Hutt stuff, don't take this too far), when PVCs (not swallowing induced PVCs) originally afflicted me I was as thin as a rail and 15 years old, nearly 40 years ago. I've scheduled to see an EP in a month, must be a busy man. He promised to look over my records next week, and the test results, and if he is concerned, will call to discuss, or have his office call to order extended monitoring if need be. At least it's a start.

Looking online I found some interesting material, though not a lot of it, about "Swallowing induced arrhythmias", though the technical term for swallowing is "Deglutition". One article that discusses the topic is linked below. The article discusses angina as well, but I don't think they're making a correlation, but the discussion is intermingled.

bjcardio.co.uk/2009/07/cardiac-manifestations-and-sequelae-of-gastrointestinal-disorders/

My PVCs are not just limited to the swallowing part, but seem to be, at least, part of the time the stomach is involved in digestion.

Treatments vary from Propranolol, to Proton Pump Inhibitors, to Flecanide, to moving the esophagus by surgery, to ablating the Vagus Nerve input at the heart. Contributing factors range widely, from no discernible pathologies (complete heart work-ups and complete GI work-ups, not uncommonly with no pathologies found) to GERD, Hiatial Hernias, stomach issues as well, I'm certain.

Now I had this before, a year or so ago, but at the time it presented as an isolated PVC with each swallow of food, only occurring towards the evening, and no issues with PVCs upon laying down in the evening. Trying to get a broader coverage of possible causes and to secure assurance that these things happen and to discuss strategies in dealing with them, I returned to a GP (PCP) that I left a few years ago, and only when he walked in did I remember why I left, almost from the get-go. He asked me what brought me in, a natural enough question, but when I mentioned the swallowing induced PVCs, brusquely said "you've had this before" with an attitude that I was wasting his time. That elicited a strong response from me, informing him that my previous isolated PVCs on eating were not tantamount to this, and providing details. He can put that in his pipe and smoke it, eh?

He did a physical, he does great physicals, but he didn't help me with my dilemma. Incredibly, the entire visit was a physical and him sitting at the computer, poking away at the keys, telling me that the CDC recommends:

1. An HIV test at least once everyone's life (I've been married for over 35 years)
2. A Hepatitis C test. (See 1. and I don't use drugs).

Also asked (Not sure if he attributed it to the CDC):

3. When I had my last Tetanus vaccination?
4. Was I sexually active?
5. What sex I was sexually active with? He filled that one in, my wife used to work at that office?
6. Do I have Smoke Alarms in the home and how many?
7. Do I have Carbon Monoxide Detectors in the home?
8. Do I have firearms in the home?
9. And more questions still, all entered into a computer, tied by the Internet to the outside world for authorities and hackers to see.

He was able to pull up my Holter results and, I believe, E.R. Test results, that's fascinating, but reassurance wise, nothing was happening there. When I asked for reassurance, he resorted back to speaking for the Holter interpreter (an excellent Cardiologist) and my cardiologist, who I suspect is competent, he's the head of the hospital's Stress Echo department, but I don't know if it's comprised of anyone but him.

Dr. JungRulz would want to know if all is well in the Alimentary Canal, that tube and related structures that extend from your mouth through and out the other side. Dr. JungRulz fears barium swallows or endoscopy until some control can be had over the swallowing and/or Vagal reflex arrhythmia, lest those procedures exacerbate the problem unduly. Of course, Dr. JungRulz is me, who is not a doctor, but a patient tired of doctors that misdiagnosed my seizures for over 15 years, that tried to dismiss my complaints when I unknowingly had Thyroid Cancer, and had I listened to Dr. Thorough Physical above I may have been dead from cancer by this time.

Does anyone else have PVCs, PSVT, SVT, etc., conditions often considered benign, that worry about them, but encounter one apathetic doctor after another that supplies no more reassurance than one would get by reading the darn stuff online? I'd love to be seen by a GP (PCP) that is plagued by PVCs that says "You think your PVCs are bad, here, take my pulse, I'll show you what bad is" all the time smiling and keeping a cordial attitude. The medical community is worried about counseling drug addicts, people with ambiguous sexual feelings, etc. but if you're afraid for your health and life due to a flipping and banging heart, many act like you're a psycho hardly worth the time of day.

Anyone know of a compassionate GP (PCP) in the Pittsburgh Pennsylvania area that's also thorough?

Post Edited (JungRulz) : 5/11/2014 2:59:04 PM (GMT-6)

Hi Palpit,

I remember the discussion.

It's the apathy of the doctors, or their failure to even begin to address my concerns that has me incredulous. If it were a vagally mediated problem, that means that the parasympathetic system is exerting undue influence on the heart (slowing it or trying to). The Sympathetic system's influence on the heart (speeding it up) is partially suppressed by BetaBlockers, and if it is strictly a vagally mediated problem, BetaBlockers would most likely be contraindicated. Yet neither my cardiologist or GP shows the slightest interest in understanding the problem. My cardiologist said to take more Atenolol, and the swallowing induced arrhythmia seems to have gotten worse. Calcium Channel Blockers don't interfere with the parasympathetic or sympathetic systems and may be a better choice for rate control with this problem.

I'm on Prilosec 20 mg bid, something I put myself on, because this same GP has told me in the past to do it. I waited until the Holter test results came back and I spoke with my Cardiologist before beginning to take it, lest there be a rhythm disturbance that Prilosec could effect. Telling my GP of the Prilosec, he told me to take it that way for 6 weeks. Would it really be to much to ask that he initiated the medication lest an ulcer or GERD flare was causing the arrhythmia?

Thank you for the suggestions, a list of symptoms and concerns is better than frantically trying to remember things, assuredly many concerns aren't otherwise addressed in the confusion of the visit to the EP.

Yep, still live here. It's a beautiful city since you can look down at it from Mt. Washington and other areas, many other cities are flat and the only chance to see it is being up in a building or airplane. Who was your old doctor if you don't mind saying? My wife worked as a medical assistent for several practices, Family, Pulmonary, Cardiology. She's familiar with many others due to patients and scheduling requirements. Not a problem if you'd rather not say.

I was pleased with the Doctor at the E.R., she didn't make me feel stupid for coming back, in fact she listened to my concern and said it was reasonable. Honestly, insurance wise, people that are in crisis concerning their arrhythmia should be given the option for event monitoring (rather than the E.R.) and when they had a suspicious rhythm, they could call the center and, most often in people with benign arrhythmias, be reassured. I had PSVT once, elusive, never captured on a Holter, so for 10 days I wore an event monitor. Finally caught the rascal, phoned it in, and the guy at the technical center said, in a bored voice "oh, you had a little PSVT", he wasn't concerned, my doctor wasn't concerned, it helped me to realize that in my case, I had nothing to worry about.