Increasing PVCs after coronary artery bypass surgery

2 years ago my husband had quad CABG. (No heart attack). During a colonoscopy 3 years ago they noticed PVCc on his ECG, he wasn't even aware of them. However, in the last year they have increased noticably, he says they "wear him out". He is on a beta blocker and Lisinopril and Pravastin. He has never had high blood pressure or any kidney disease). He has changed to a healthy diet and more exercise. We are wondering if the CAD is causing them, or perhaps the Lisinopril or statin? He is normal weight, doesn't smoke or drink. He would like to try to go off statin for 6 months to see if he feels better. Thank you so much.  

Hi Mary,

It is unlikely his meds have anything to do with the PVCs. The Beta Blockers reduces their frequency but not eliminate them. However, any time a change occurs it should be checked with a re-evaluation. That may include blood tests, an EKG, Holter monitor and/or a cardiac (stress) echo if indicated. PVCs sometimes are a marker for underlying heart disease, and previous negative tests  don't exclude future problems.

You can check here whether you are at risk. If your heart function is otherwise normal, most often PVCs  are completely benign. If necessary, Beta Blockers can be used to decrease the number of PVCs to a more tolerable level.

My advice: ask his doctors for a stress echocardiogram to make sure his bypasses are working and there is no evidence of recurrent heart disease.

Hope this helps,

Dr T


Thank you for answering. After CABG, how often should stress tests be done? He had an echo last week (first of any testing since his bypass). His doctor did not order a stress test. With diet and exercise changes he has made, is it essential that he stay on statins, and could he try stopping for 6 months to evaluate effects? There have been studies that statins reduce effectiveness of exercise to the heart. Thank you.

Hi Mary,

CABG is not a cure for coronary artery disease: the atherosclerosis disease that caused the blockages is still present. If successful, the operation will restore the blood flow to the heart back to normal, but that is all (even if essential). The same applies to stents. That said, a CABG is often extremely successful. I have a neighbor whom I operated in 1988, who is still doing great all these years later! The same is usually not true about stenting.

Diet, exercise (heart healthy living in general) and drugs such as Statins  may help prevent progression of disease, but don't believe the stories about regression of the blockages. Even if true, to be effective it would take another lifetime for it to happen.

An echocardiogram only shows the heart function at the time of the study. If not done as part of a stress test, there will be no information about it during exercise: it may be perfectly normal, or show areas that don't work well. Therefore I'd recommend a stress test at one or two year intervals after bypass surgery.

I have mixed feelings about the continued use of statins if his cholesterol is now normal. The potential of a protective effect needs to be weighed against the potential complications.

Statins are commonly used to treat  high cholesterol and minimize the major risk factors for cardiovascular disease and in particular, the risk of developing coronary artery disease. Studies have shown there is no clear evidence of any significant harm caused by statin prescription, but - particularly at higher doses - they are sometimes associated with side effects that include

Hope this helps,

Dr T

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