ASD? Increase in Palps!

I am 33 and was diagnosed with ASD PFO at age 29 via echo, had a Cath following a Transesophageal echocardiogram that couldn't be completed because of difficulties sedating me enough but there was a shunt seen on that short test, I guess I gagged and tried to pull it out of my mouth.  The Cath listed the ASD however it was said there was no significant shunt.  It was dropped at that point.  Have had two echos since Cath was performed most recent 2 years ago and a Stress Echo last year. The ASD was not brought up again until my last Cardio visit last week.  Doc wants a repeat echo to see how the shunt is.  

During the last month I have had a significant increase in PVC's.  Often they come in bursts meaning I feel a series of them for about 10 seconds.  I felt like a burb, then another then another no idea if they were consecutive or if they were spaced with normal beats.  I get occassional couplets and they feel like burbburb real close together, I sensed this was different than that. It scared me.  I had several of those episodes in one day, and now I am having several single ones a day.  Cardio said the echo will tell me if they are serious now or not.  I am worried. Why are some PVC's felt different pain, etc?

Is it possible an ASD/PFO would show on echo and a Transesophageal echo and not on a cath?  I did seek a second opinion and there was none noted on a echo done by the second opinion.  I just am confused because it should have been repaired back then if it is there.  Is there any other conditions that would show like that on a echo?

[CCF-M.D.-RCJ]

skippintime,

Firstly, how do you know that you are now having PVCs?  Have these been formally diagnosed by EKG, or just by your symptoms?  These need to be formally diagnosed to ensure that you are not having afib or NSVT.

It is unusual for PVCs to cause a new pain syndrome, although it can happen.  For this reason, I think you need to ensure that these new sensations are indeed PVCs.

PFO/ASDs can certainly show on a TTE or TEE and not on cath.  Also, a repeat TTE may not show the ASD, but be assured it was there if seen on TEE.  A second opinion should be allowed to see the original TEE, or repeat a TEE, as this test is really the gold standard.

The decision to undergo surgical repair is a complex decision, and rests on more than the echo and cath.

Hope that helps.

[skippintime]

The PVC's have been diagnosed by several holters and event recordings.  Documented couplets on those tests.  After I wrote the message to you this morning I checked my echo and cath reports.  Since 1997 I have had 4 normal echos and 1 TEE and 1 cath, It was the second echo that was abnormal which intiated the TEE and cath.  Doctor's description stated there was color flow aliasing around the fossa ovalis membrane but no definite evidence of intracardiac shunt as assessed by this technique.  The TEE was very brief and said there was a left to right shunting at the intra-atrial level, consistent with a membrane defect. By the way all heart measurements are on the upper limits of normal.

I am not sure why I have to have another echo.  I don't know if I should persue a second opinion again.  I know I have risks of stroke and I was told to take a baby asprin which I have since 2000, also take 75 mg of Toprol.  My echo is scheduled for this week.  Should I have another TEE, like I said there was a problem with sedation on the first and I guess I gagged tried to pull out the scope, vomited so the test was abandoned and he got limited pictures.  Will that happen again?

I apperciate you taking the time to answer the questions again if your would.  I guess I have never been sure if I truly have a ASD, because of the conflicting reports.  But if it is damaging my heart I probably should have it fixed.

[CCF-M.D.-RCJ]

Skippintime,

It's hard for me to comment on whether or not you need another TEE without having seen the first one.  If the pictures were incomplete, then it might make you feel better, or at least give you the total information, to have a repeat TEE.

We only have 1-2 patients per year who we cannot adequately sedate for a TEE.  This is out of thousands.  It would be extrememly unusual for you to not be able to undergo a successful, safe TEE.

Hope that helps.