Can I stop taking medications for my irregular heartbeat and PVCs if I feel better?

Doctor's Answers 4

Tambocor and Sotalol are commonly prescribed medications that help to control irregular heart rhythm, also known as "Atrial Fibrillation". They act by keeping your heart in the normal heart rhythm. While Tambocor is sometimes used as a "Pill-in-the-pocket" treatment for irregular heart rhythm, Sotalol acts best when taken at a regular interval.

The sensation/palpitations that you may be feeling may be a result of the irregular heart beat or the PVCs (also known as "extra heart beats"). You should probably resume the medication regularly since the symptoms recurred after you stopped the medication.

It is always advisable to consult your doctor if you plan to stop any medication. Your cardiologist will also be able to clarify your concerns about any potential side effects, and to offer alternative treatments if you experience any. If your symptoms are well-controlled, your doctor may also progressively reduce the dosage of your medication. Reducing intake of caffeine, alcohol and cigarette smoking can also help alleviate the symptoms of palpitation.

There are a few questions you should address, in addition to whether you should be taking the medication.

From your description, I assume you have seen a cardiologist and had a proper assessment. If you haven't done so, you should do it soon.

1) what is the cause of the PVC?

For most cases, the cause is unknown, or almost impossible to trace any more. In small number, there may be an important cause that needs to be addressed.

2) is the PVC dangerous type? What are the issues?

This involves detailed assessment and risk stratification. Generally speaking, it would involve echocardiogram, 24 hour holter, treadmill ECG, and in some cases cardiac MRI and CT coronary angiogram.

Majority of PVCc are not dangerous, but some could be. They may result in heart failure and even cardiac arrest. In addition, some patients may have symptoms (eg. palpitation, shortness of breath, dizziness). Some patients have no symptoms despite frequent PVC.

3) natural history of the condition.

Some would improve on its own but many won't. There may be precipitating factors that you have identified so far (some are mentioned by Dr Lim Choon Pin) and you should avoid them.

4) treatment options.

Treatment is directed at underlying condition and (potential) issues they are causing.

a) treat underlying condition if there is one (majority do not have one)

b) if no symptom AND the PVC is not the dangerous type, then no treatment is necessary. However, patient will need monitoring with repeat echocardiogram and Holter in the future.

c) if symptom is minor AND the PVC is not the dangerous type, may or not may need medication (depends on individual). Medicine has potential side effect and only works in 50%. How bad is the symptom is a subjective thing for individual patient to decide.

d) if symptom is troublesome (affecting one's life) OR PVC is the dangerous type, then the patient would need treatment. This could be medication - 50% effective and only controls and doesn't cure - with further monitoring/assessment. Alternative treatment is ablation (key hole procedure through groin) which is curative in around 85% of cases. However, ablation is invasive and carry some risks. So, it is usually reserved for highly symptomatic patient or dangerous type of PVC.

If you have further issues, you should consider consulting a cardiologist experienced in treating your condition.

The best thing to do is, complete the course of your medication, exactly as the cardiologist who saw you has prescribed, and has advised.

If you have decided not to take the medications because of a concern of side effects, then this is something that you should bring up to your doctor too. Most importantly, your doctor needs to know that you've stopped, or wish to stop taking the medication.

Sotalol belongs to a class of medication known as beta-blockers, and it works by blocking adrenaline. They are able to lessen the palpitations and thudding associated with the irregular heartbeats.

Using beta-blockers do not cause any harm.

Should I take Sotalol as and when I feel like the symptoms are there?

Beta-blockers are indeed occasionally prescribed for as-needed use - ie, say for bad days when your PVCs are acting up. However, this is something that you need to discuss with your doctor, so that you know how to use it correctly.

General information about PVCs

To reassure you, PVCs are relatively common. In fact, one in 20 people will have at least one PVC during an ECG test.

Nearly all patients with PVCs do NOT have any increased risks of heart disease. Lastly, they also tend to go away by themselves :)

Exercise, good sleep, and cutting back on caffeine and alcohol can also frequently help to reduce the occurence of PVCs.

The best thing to do is, complete the course of your medication, exactly as the cardiologist who saw you has prescribed, and has advised.

If you have decided not to take the medications because of a concern of side effects, then this is something that you should bring up to your doctor too. Most importantly, your doctor needs to know that you've stopped, or wish to stop taking the medication.

Sotalol belongs to a class of medication known as beta-blockers, and it works by blocking adrenaline. They are able to lessen the palpitations and thudding associated with the irregular heartbeats.

Using beta-blockers do not cause any harm.

Should I take Sotalol as and when I feel like the symptoms are there?

Beta-blockers are indeed occasionally prescribed for as-needed use - ie, say for bad days when your PVCs are acting up. However, this is something that you need to discuss with your doctor, so that you know how to use it correctly.

General information about PVCs

To reassure you, PVCs are relatively common. In fact, one in 20 people will have at least one PVC during an ECG test.

Nearly all patients with PVCs do NOT have any increased risks of heart disease. Lastly, they also tend to go away by themselves :)

Exercise, good sleep, and cutting back on caffeine and alcohol can also frequently help to reduce the occurence of PVCs.

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