Premature Ventricular Contractions or Coronary Spasms

I am 44 female, don't smoke, no BP, no diabetes, no cholesterol.  I have always had pvc's but they were once in a while. Since the beginning of 2013 I have them more frequently and sometimes the heartbeat is so painful, it's like a knife stabbing me from inside.  The pain radiates to the neck and jaw.  I just recently had a mibi stress test.  Since my pvc's happen at rest 98%of the time, I didn't have any on the treadmill.  The pictures of the heart showed no abnormality.  I know that I should be relieved, but I am not.  I can't seem to get a clear answer to what exactly causes them.  I drink one coffee a day, no soda.  I do use an asthma medication though.  My twin brother died at the age of 22 of a heart attack with no underlying heart problem.  I have also read on coronary spasms which have a similar profile to pvc's, they happen mostly at rest, are very painful, pain can be felt in the neck and jaw, but they can't be detected on a mibi stress test if you don't have on during the test.  Do coronary spasms show on an ecg?  My next train of thought would be to ask m doctor for a holter.  What are your thoughts on this?  Without a test, is there a way to differentiate between pvc's and coronary spasms?  And are painful pvc's normal?  Thank you, any help would be appreciated. Regards,Jennifer
Hi Jennifer,
PVCs and coronary spasms (also called Prinzmetal’s angina) are two very different things. Your stress test has shown you have enough blood supply to your heart while exercising, an important step to determine whether you have coronary artery disease and whether the PVCs are dangerous. Many patients with Prinzmetal’s angina have coronary artery disease and smoke, a major risk factor for spasms, but not an issue in your case.
However, this test is incomplete if you were asymptomatic at the time. Indeed a Holter/event monitor would allow you to record episodes of chest pain/PVCs and correllate them with EKG changes. 
Symptoms of Prinzmetal’s angina:
  • Located under the chest bone
  • Described as squeezing, constricting, tightness, pressure, or crushing, which is usually severe and may radiate to the neck, jaw, shoulder, or arm
  • Often occurs at rest May occur at the same time each day, usually between 12:00 midnight and 8:00 AM
  • Lasts from 5 to 30 minutes
  • Relieved by nitroglycerin (NTG)
  • Can cause fainting or loss of consciousness 

You may want to ask your doctor for nitroglycerin to take during an epiosode of chest pain. If you are are weraing a recorder, it would demonstrate EKG changes caused by spasms and their disappearance with NTG. If your PVCs are recently more frequent, they could be assocaited with early menopause

For menopausal women who are experiencing irregular heartbeats caused by changes in estrogen production, the treatment is often a combination of lifestyle changes and natural remedies. The decreased estrogen production also puts women at an increased risk for coronary artery disease, particularly if associated with other cardiac risk factors such as a high cholesterol, smoking, hypertension, diabetes,  metabolic syndrome and/or obesity, cardiac risks that can be calculated.

Hope this helps,

Dr T


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