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Heart Disease (Expert Forum)
PACs, PVCs and CAD
Answered by
Cleveland - OH
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
PACs, PVCs and CAD
by Duplix, Jan 04, 2007 12:00AM
Thank you for taking my question. I have been reading that PACs and PVCs are benign in the setting of a structurely sound heart. I have CAD and a 5 graft CABG but have had no heart attacks or heart damage. Does that mean that the PACs and PVCs that I have are benign? In other words, is someone who has CAD and no heart damage considered to have a structurely sound heart?
Thanks again.
Thanks again.
Doctor's Answer
by Cleveland Clinic, Jan 04, 2007 12:00AM
, Jan 04, 2007 12:00AM
duplix,
thanks for the post.
By definition, the presence of coronary disease means you do not have a normal heart and ncreases your overall risk of a cardiac event even without PACs and PVCs. What you have to realize is what the actual risk is from though and guide your therapy and focus in those directions.
In the absence of blockages that are leading to rhythm issues or any significant previous heart damage, your main risk of having a major cardiac complication comes from the risk of having progression of your coronary disease, such as with the rupture of a atherosclerotic plaque. Thus therapies designed specifically to prevent progression of your disease and decrease your overall risk of a myocardial infarction will have a significant impact on that risk.
In certain subsets of patients with a prior history of coronary disease, such as those with a low ejection fraction, or very frequent ventricular ectopy the risk of sudden cardiac death is markedly increased and those specific patients may benefit from cardiac electrical therapy such as implantable defibrillators.
I know it's hard not to focus on the extra beats, but I can't stress enough the importance of taking care of your overall health. An interesting study was performed in patients several years ago that tries to suppress PVCs in patients with CAD. Interestingly, by using arrhythmic medications, researchers were able to suppress the extra beats. However, the main side effect of the medications was to increase the risk of sudden cardiac death. Thus, the cure was worse than the disease.
Hope this helps.
good luck
thanks for the post.
By definition, the presence of coronary disease means you do not have a normal heart and ncreases your overall risk of a cardiac event even without PACs and PVCs. What you have to realize is what the actual risk is from though and guide your therapy and focus in those directions.
In the absence of blockages that are leading to rhythm issues or any significant previous heart damage, your main risk of having a major cardiac complication comes from the risk of having progression of your coronary disease, such as with the rupture of a atherosclerotic plaque. Thus therapies designed specifically to prevent progression of your disease and decrease your overall risk of a myocardial infarction will have a significant impact on that risk.
In certain subsets of patients with a prior history of coronary disease, such as those with a low ejection fraction, or very frequent ventricular ectopy the risk of sudden cardiac death is markedly increased and those specific patients may benefit from cardiac electrical therapy such as implantable defibrillators.
I know it's hard not to focus on the extra beats, but I can't stress enough the importance of taking care of your overall health. An interesting study was performed in patients several years ago that tries to suppress PVCs in patients with CAD. Interestingly, by using arrhythmic medications, researchers were able to suppress the extra beats. However, the main side effect of the medications was to increase the risk of sudden cardiac death. Thus, the cure was worse than the disease.
Hope this helps.
good luck
My docs do tell me not to worry too much about PVCs or PACs, but do tell me to take note of any changes and to get checked out. I've leared to pretty much ignore them, but if I get some whacky ones, they do raise my eyebrow.
Netscape crashed on me. I lost everything. Hope all is well
Jodie
Hi Al,
Just wanted to say hi and hope your feeling well. Happy New Year to you and everyone too! Best wishes (:
Doc bjk had a great post...those of us with heart disease get another opinion on PVCs/PACs. I've had some nasty runs caught on event monitors. During a couple caths I had some really ugly kicks that the cardios took a look at...I had few nasty beats in a row, and the doc just looks over and says "you ok buddy"....lol.
I do have some concern of what lurks, but if we dig enough we'll find something. My CAD seemingly is in check and hasn't progressed. I keep the 50% in my RCA and 30% in my LAD in the back of my mind...moreso the LAD and it has a tunneled section.
My CAD is diffuse--it's everywheres so we have to keep an eye out and control all risk factors. What I've found pretty interesting is the role of small vessel or microvascular disease and angina. I'm on an intensive treatment with diabetes meds and my angina has greatly reduced.
I won't get another cath for a while. Like the doc says, take care of yourself and take your meds.
Take care 8 ^)
I'm glad to hear things are going well for you (: That's good news. What kind of nasty beats did you have in a row? PVC's? I had a little run of them when exercising this past fall (they felt huge) and the doctor said no big deal. I just don't get why exercise tends to bring mine out. Weird. Oh, why can't the heart beat perfectly 24/7?? Or in your case, have clean and wide open arteries (:
My brother-in-law is diabetic also and lately hasn't been taking good care of himself. He's on metformin and says it works well. How interesting that the diabetes meds have helped with your angina. Any idea why? Geez, you have a lot going on (: Well, have a great New Year and take care (: Best wishes to you and your dad too!
momto3girls
Hope you are doing well...Those are some very good questions that you have--why cant the heart (insert problem here)? The heart is an interesting machine that throws out alot of complex problems. We ask questions out of curiosity of what our hearts are doing.
I've had a few ventricular ectopics recorded, as well as bigemy. Lots of PVCs and PACs. I don't know what the guys caught during the caths, but the last one caught some very strong PVCs. My RCA spasmed during one cath--not sure if that was a cath/operator induced event, or something that's been going on. With medication, the coronary spasm has been dormant, which is good!
I'd love to figure out whether it's my aorta or superior vena cava that throbs with each beat (kinda annoying). One doc said during a cath, "gee your heart pumps hard."
----
There is quite a strong connection with diabetes/insulin resistance and heart disease. It all falls in step with cholesterol, hypertension, and all those neat chemicals that constrict or dilate our vessels. Endothelial dysfunction and coupled with a problem in how the cells use insulin has an influence on how the heart's muscle uses oxygen...this stuff gets pretty complex.
Good cardios are up on how insulin restistance plays a role in small vessel disease. Along with the cardiac meds, the diabetes stuff (Actos, Metformin, Januvia) seems to making a big difference. I haven't taken a sublingual n