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Heart Disease (Expert Forum)
VTACH
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VTACH
by wmac, Nov 09, 2004 12:00AM
I have posted here several times in the past and just wanted to know your opinion on this as well. First off I have pacs, pvcs,aivr, racing heart(which we have never captured) and nonsustained vtach. I have also had all the test tilt table, ecg, stress test, several echos, single average ekg, mri checking for arvd. All has been normal. I have a bit of mvp with trace of reguritation, my EF 70%. Now knowing all of this in your opinion due you think that if I did go into sustained vtach would my heart be able to handle this? My nsvt runs have been that we know of a three beat run, a five and ten beat run as well. Heart rate up to 155 bpm. How much of a risk for SCD am I? If my racing heart episode feel different than the nonsustained vtach do you think im having a sustained run (they last about 2min) or something different.I now have implanted loop recorder my cardio who is a ep doc and another ep doc in Utah want to know what the racing heart is before treating for the vtach.Also do you believe that mvp can be the cause for the vtach? What meds would you think would work best for me. The meds make me nervous, whenever I do have vtach runs its at rest and Im afraid the meds will make it worse due to the fact they slower the heart and b/p my b/p is normally around 92/62. What is your opinion on this issue I have read so many conflicting things.
Thank you so much for your time.
WMAC
Thank you so much for your time.
WMAC
Doctor's Answer
by CCF-M.D.-MJM, Nov 09, 2004 12:00AM
Hi WMAC,
Tough questions, some without good answers.
1. do you think that if I did go into sustained vtach would my heart be able to handle this?
My first answer, is don't worry about things you don't have. There is no evidence you have sustained VT yet. It is easy for me to say don't worry about it, much more difficult to do. My canned response and one a use for my self is that there are too many things that do happen to worry about then to spend time worrying about the what if's.
To answer your question: the answer depends on the rate of VT. You would certainly drop your blood pressure. If your VT was at 120, you would tolerate it much better than 200.
Wait for the results of the implanted loop recorder. Hopefully this will help put your mind at ease.
How much of a risk for SCD am I?
Your risk of sudden cardiac death is very low--probably that of the normal population for someone your age and medical problems (if there are any you didn't mention). You have normal heart function. Based on the information you presented, you should feel reassured.
Also do you believe that mvp can be the cause for the vtach?
There is some data to suggest that patients with VT have a higher incidence of MVP. Definitive studies are yet to be done.
What meds would you think would work best for me?
I understand your concerns about low'ish blood pressure, but I would still use a beta blocker.
I hope this helps and thanks for posting.
Tough questions, some without good answers.
1. do you think that if I did go into sustained vtach would my heart be able to handle this?
My first answer, is don't worry about things you don't have. There is no evidence you have sustained VT yet. It is easy for me to say don't worry about it, much more difficult to do. My canned response and one a use for my self is that there are too many things that do happen to worry about then to spend time worrying about the what if's.
To answer your question: the answer depends on the rate of VT. You would certainly drop your blood pressure. If your VT was at 120, you would tolerate it much better than 200.
Wait for the results of the implanted loop recorder. Hopefully this will help put your mind at ease.
How much of a risk for SCD am I?
Your risk of sudden cardiac death is very low--probably that of the normal population for someone your age and medical problems (if there are any you didn't mention). You have normal heart function. Based on the information you presented, you should feel reassured.
Also do you believe that mvp can be the cause for the vtach?
There is some data to suggest that patients with VT have a higher incidence of MVP. Definitive studies are yet to be done.
What meds would you think would work best for me?
I understand your concerns about low'ish blood pressure, but I would still use a beta blocker.
I hope this helps and thanks for posting.
Great questions and great answers. Alot should be relieved concerning these annoying arrhythmias. Hope you are reassured!
Take care.
WMAC
(eg http://circ.ahajournals.org/cgi/content/full/101/16/1960) and considering my age and ablation on my ventrical last april, I am a little leery ...
Very interesting to see that you are using implantable recorder. I trust you are getting some good medical attention. That is quite critical to your success.
please let me know about yours.
Thanks wmac
In answwer to your question, I have some short runs of VT (10+ beats), and SVT or atrial tachy as well ( 10 beats or so???, seemingly easily terminated by adjusting my position). The SVT /atrial tachy is much more frequent and annoying than the VT (except for a little vertigo I get with VT), but much better than what I had with the WPW (5 minute runs of SVT from time to time). Uncomfortable, yes, but not a threat to life, as a sustained run of VT "could" be, in the somewhat unlikely case that this ten beat rythmn does become malignant.
I definitely understand your concern, frustration, and eagerness to have the problem solved. It may be re-assuring to know that you are getting some excellent medical attention, that you are closing on the problem, and hence with perserverance will be moving past this difficulty soon.
HANG IN THERE...
your's truly, WPW.
wmac
As far as I know at this point I also have SVT and NSVT. On the EKG, what I am calling SVT is a narrow complex signal and is definitely SVT. I am calling our separate observations of a wide QRS complex "NSVT" because 2 out of three doctors agree with high certainty that the 10 beat wide QRS complex is VT. One of the 2 is a nationally known Penn State doctor (the other is a respected EP right here in Indianapolis), and both of those guys were very convincing in the sense that their credentials were verifiable, and had other traits that gave me reason to believe they knew what they were talking about and were trustworthy.
The third doc, an EP every bit as qualified as the others, and not very far from you at all, took me off of Beta Blocker so that we could monitor all my arryhthmias with "worst case" exercise. This doc is quite a bit more highly suspicious that the wide QRS might be SVT with abberation (this has something to do with how the waveform changes when heart rate is so fast that block occurs), and wasn't prepared to give me such bad news quite as quickly.
Anyway, these "NSVT" runs thankfully (they give me some vertigo a moment after onset) are pretty far and few, as far as I know. As far as I have been able to determine, two cases were recorded on monitor; but several events happened while not being recorded and I have no way of knowing really whether they were SVT or VT. I am guessing that most but not all of those were SVT.
Sorry, as I said, its complicated. I hope that all of this is of help in some way though ...
your's truly, WPW.
PLEASE ALSO LET ME KNOW WHAT THEY DO FOR YOU, ALSO SO NOW WHAT TWO SAY ONE THING AND ONE SAYS ANOTHER, SO WHICH DO YOU GO WITH?DO YOU GO FOR AN EP STUDY OR WHAT? DO THEY SAY ITS LIFE THREATING OR NOT, OR DO THEY JUST SAY DONT WORRY ABOUT IT?
WMAC
Anyway, everything should be OK. All three docs agree that VT is unsafe, and all three agree that having a small amount of it is not as bad as having sustained runs. They also agree on treatment approaches. All I need to do now is decide on the best option for dealing with all issues.
Later...