Heart :: PVCs And PACs Upon Exertion

Just looking for some advice on next steps here. I'm 46 (male) and have had intermittent PVC / PAC for probably 10 years. They have always been infrequent and pretty mild truthfully. Once in a while if I'm stressed, have had too much to drink, or had a big meal close to bed, I'll have a more prolonged and severe episode, usually when trying to sleep. Many of you have probably been in the same situation - rolling around in bed to try and get into a position where you can't feel the pounding and fluttering as much.

Anyways, I'm reasonably fit, not overweight, and have no other conditions (AFAIK). I usually have one cup of Half-Caf coffee in the morning and that's it. I don't drink soft drinks or have a lot of sugar or anything. I HAVE had panic attacks in the past, but have learned to control them pretty well, just through breathing exercises and getting myself to relax. Exercise had always helped too, though I'm not on a "regular" exercise program.

My father had a bad case of Afib, which was solved by an ablation. My identical twin brother has had Afib episodes as well, with a couple being severe enough that he needed to be "shocked" back into rhythm. There is some history of heart disease in my family with 3 grandparents dying (eventually) from stroke, and the other had a moderate heart attack in his 60s (but lived to 93).

From a lifestyle perspective, in my younger years up until probably 35 I was reasonably active but ate a pretty poor diet - tons of dairy, red meat, etc. Typical bad American diet. Despite this diet, I was never really overweight much (blessed with a fast metabolism), and my cholesterol readouts have always been borderline, though in recent years they've improved as I've improved my diet.

3 weeks ago I started to notice PVC and PAC whenever I would exert myself - we're talking walking up 1 flight of stairs, walking quickly to rush to a meeting, taking the dog for a walk. Yesterday a pretty strong one came on while I was carrying something heavy for a home depot return. I had a strong one while carrying it (but just one), then another small one a few minutes after I had put it down. Likewise, I usually will get one or two AFTER I have reached the top of the stairs and starting walking a little bit. I've noticed they seem to be worse if I've recently eaten a meal.

I went to see my PCP who did a resting EKG that was normal, normal BP, resting pulse 65-70 or so. You can predict the response - you're fine and they're benign. Cutout caffeine, exercise more, relax, etc. He did offer up additional tests if I wanted and so I did a 24 hour holter monitor, thyroid blood test, and stress test (just ekg and bp, no echo or thalidomide). The holter showed occasional PVC and PAC. The day I had the stress test was a "good" day - I didn't feel any PVC or PAC while I was on the treadmill (of course!) but the cardiologist did say he saw a few.

Even though I know that what the docs are telling is very likely to be true, my problem now is that I just don't FEEL right. I had gotten used to the occasional PVC and PAC and they were never a problem, even if I had 1 or two DURING exercise. Now they seem to be brought on by exertion and I just can't help but think about the cause being some underlying coronary artery condition, even though my PCP and the cardiologist tell me they're benign. Even though these seem to be brought on by exertion, my fitness level is BETTER than it's been in a while and when I do "power through" the PVC and PAC that I get when I commence exercise, I actually feel pretty good - 30 minutes on the treadmill at fast walk / incline and I'm not even breathing that hard. 6 weeks ago I hiked for 2 days at 11,000 feet, mostly going up and while it was hard, I did it and felt pretty good. I had a few PVC and PAC during that trip, but not many. It's only been the last 3 weeks or so when they happen consistently upon exertion.

I've read online that PVC/PAC CAN be brought on by exercise but I've also read that PVC/PAC with exercise can be a sign of an underlying heart condition such as coronary artery disease. At this point every time I walk up the stairs I'm afraid of what might happen and I'm afraid to do any real exercise. I would really like to have another test done to check for any sign of blockages and so on but I'm not sure what to do since the docs are telling me I'm fine and I should just live with it. I'm just concerned because of family history, lifestyle, and the fact that these come on when I exert myself (it also doesn't help my state of mind that 1 friend and 1 colleague at work are of similar age and had heart attacks recently). Anyone out there experience anything similar?