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PVC or VT...Here we go again.
Let's cut right to it. 45 y/o male with previous posts here. I was on a stressful phone call today, and all of the sudden, I get a big run of PVCs. I have had a 9 beat bout of monomorphic VTach caught on an event monitor 3 years ago. It was deemed benign but I investigated it anyhow which lead to a nuclear stress and an angioplasty and 2 stents(LAD and Left Circumflux). Both were 80% blocked. No pain, no dizziness, no lost breath though. However, I was told that may or may not solve my PVC issues.
Today's episode seemed worse than that and lasted for about 5-6 seconds before it subsided. I have a new cardiologist at Northwestern in Chicago as my old one moved to Florida. I saw him for the first time 3 months ago. I relayed my fears about PVCs and VTach. My PVCs come and go, and may subside for months. VTach is a rare event for me..and that is just me assuming it is VTach because I know what it feels like. They have been worse over the past few months.
I am starting to think that stress and maybe higher blood pressure causes a "fullness" that can set these off as well. My new cardiologist says that he won't order any new tests or monitors at this time. That was 3 months ago. He also stated that in a structurally normal heart, that what is going on with me is benign. If I have heart disease, can I have a structurally normal heart?? He says yes to that question. Is that true in your opinion? Can another blockage cause the irregular beats?
I don't know what to do anymore. I have had many monitors, testing, and everything comes back to the same conclusion. I am told that I don't qualify for further intervention from an Electrophysiologist. Am I doomed to live like this for the rest of my life in fear of just dropping dead at any moment? Sorry to be so dramatic, but I am at wits end.
Today's episode seemed worse than that and lasted for about 5-6 seconds before it subsided. I have a new cardiologist at Northwestern in Chicago as my old one moved to Florida. I saw him for the first time 3 months ago. I relayed my fears about PVCs and VTach. My PVCs come and go, and may subside for months. VTach is a rare event for me..and that is just me assuming it is VTach because I know what it feels like. They have been worse over the past few months.
I am starting to think that stress and maybe higher blood pressure causes a "fullness" that can set these off as well. My new cardiologist says that he won't order any new tests or monitors at this time. That was 3 months ago. He also stated that in a structurally normal heart, that what is going on with me is benign. If I have heart disease, can I have a structurally normal heart?? He says yes to that question. Is that true in your opinion? Can another blockage cause the irregular beats?
I don't know what to do anymore. I have had many monitors, testing, and everything comes back to the same conclusion. I am told that I don't qualify for further intervention from an Electrophysiologist. Am I doomed to live like this for the rest of my life in fear of just dropping dead at any moment? Sorry to be so dramatic, but I am at wits end.
Hi Michael3763,
This is a difficult question to answer without seeing you, examining you, and having your data in front of me. That being said, I'll give you some thoughts. "Nonsustained ventricular tachycardia" or NSVT, which appears to be what you are intermittently experiencing, is (as you said) a run of PVCs that lasts less than 30 seconds.
There has been a lot of research on this topic. It is really unclear what the significance of NSVT is in those who have heart disease (as you do) but a structurally normal heart. I'm also assuming your EKGs have not revealed anything. When your cardiologist refers to a "structurally normal heart", he is referring to a heart without valve problems or weakening of the pumping function of the heart muscle. It does not refer to blockages of the blood vessels feeding your heart. Based on what you are telling me, your echocardiograms have been normal so you have a "structurally normal heart".
For those who have a weakened heart muscle below a certain point, we do consider an EP study to see if an ICD (defibrillator) is indicated. You do not fit this category. We will also sometimes do a procedure to get rid of the PVCs. This is only when you are having very frequent PVCs and it is causing weakening of your heart muscle (very rare occurrence). I don't think you fit this description either. We do sometimes do MRIs to see if anything was missed on echocardiogram that could be better seen on MRI. You could discuss this with your cardiologist, although I'm not sure this would be indicated for you.
As for blockages causing this, you really should be having symptoms of chest pain, shortness of breath, or other concerning symptoms for me to say that your NSVT is related to blockages. In fact, as your doctors told you before, I'm not sure the stents were going to make your PVCs and NSVT go away. Remember that many normal, young adults get PVCs. While it can be uncomfortable, it's not necessarily dangerous. Given your heart disease, however, it is prudent for you to continue to regularly follow with a cardiologist.
What I would focus on is stress reduction. You are right that this may trigger some of your irregular heart rhythms. Given you do have heart disease, talk to your cardiologist about how to modify your diet and get more exercise (if you are not already doing so). If you recently had stents placed, you should qualify for cardiac rehabilitation. This is a multidisciplinary program with trained cardiac staff that can help you safely get in shape.
I know how frustrating and worrisome this can be, but I think your cardiologist is trying to prevent you from going through unnecessary procedures and testing. None of the procedures we do are without their own risk.
Hope this helps!
CCFHeartMD20
This is a difficult question to answer without seeing you, examining you, and having your data in front of me. That being said, I'll give you some thoughts. "Nonsustained ventricular tachycardia" or NSVT, which appears to be what you are intermittently experiencing, is (as you said) a run of PVCs that lasts less than 30 seconds.
There has been a lot of research on this topic. It is really unclear what the significance of NSVT is in those who have heart disease (as you do) but a structurally normal heart. I'm also assuming your EKGs have not revealed anything. When your cardiologist refers to a "structurally normal heart", he is referring to a heart without valve problems or weakening of the pumping function of the heart muscle. It does not refer to blockages of the blood vessels feeding your heart. Based on what you are telling me, your echocardiograms have been normal so you have a "structurally normal heart".
For those who have a weakened heart muscle below a certain point, we do consider an EP study to see if an ICD (defibrillator) is indicated. You do not fit this category. We will also sometimes do a procedure to get rid of the PVCs. This is only when you are having very frequent PVCs and it is causing weakening of your heart muscle (very rare occurrence). I don't think you fit this description either. We do sometimes do MRIs to see if anything was missed on echocardiogram that could be better seen on MRI. You could discuss this with your cardiologist, although I'm not sure this would be indicated for you.
As for blockages causing this, you really should be having symptoms of chest pain, shortness of breath, or other concerning symptoms for me to say that your NSVT is related to blockages. In fact, as your doctors told you before, I'm not sure the stents were going to make your PVCs and NSVT go away. Remember that many normal, young adults get PVCs. While it can be uncomfortable, it's not necessarily dangerous. Given your heart disease, however, it is prudent for you to continue to regularly follow with a cardiologist.
What I would focus on is stress reduction. You are right that this may trigger some of your irregular heart rhythms. Given you do have heart disease, talk to your cardiologist about how to modify your diet and get more exercise (if you are not already doing so). If you recently had stents placed, you should qualify for cardiac rehabilitation. This is a multidisciplinary program with trained cardiac staff that can help you safely get in shape.
I know how frustrating and worrisome this can be, but I think your cardiologist is trying to prevent you from going through unnecessary procedures and testing. None of the procedures we do are without their own risk.
Hope this helps!
CCFHeartMD20
Hi Michael3763,
Glad to help. Again, I'm not sure an MRI is indicated for you, but you can discuss this with your cardiologist. As to the question of repetitive monomorphic VT, I would agree that it seems that your NSVT/PVC episodes are really too infrequent to make that diagnosis.
A lot of the diagnoses similar to repetitive monomorphic VT are seen in young people with structurally normal hearts. They often present after being severely symptomatic (passing out, etc) and/or having much longer/more frequent episodes than you seem to be having.
You could consider asking your cardiologist to refer you to an electrophysiology specialist just to further discuss these issues. They can look at your previous Holter monitors and the morphology of your PVCs/NSVT and give some recommendations. May give you some reassurance.
-CCFHeartMD20
Glad to help. Again, I'm not sure an MRI is indicated for you, but you can discuss this with your cardiologist. As to the question of repetitive monomorphic VT, I would agree that it seems that your NSVT/PVC episodes are really too infrequent to make that diagnosis.
A lot of the diagnoses similar to repetitive monomorphic VT are seen in young people with structurally normal hearts. They often present after being severely symptomatic (passing out, etc) and/or having much longer/more frequent episodes than you seem to be having.
You could consider asking your cardiologist to refer you to an electrophysiology specialist just to further discuss these issues. They can look at your previous Holter monitors and the morphology of your PVCs/NSVT and give some recommendations. May give you some reassurance.
-CCFHeartMD20
Thanks for the reply. I will follow up with my cardiologist to discuss MRI and other options. My last echo (stress) was about a year ago, and indeed, did not show any structural damage. My EF was very good. Over 60% I think. The report did show some mild concentric left ventricular hypertrophy, which I understand is common and is caused by long term elevated blood pressure. I currently have the bp under control.
I'm not sure if you can answer again, and I don't want to self-diagnose, but could it be possible that I have repetitive monomorphic ventricular tachycardia. I'm not sure how repetitive my VT actually is however, since I can basically count the troubling episodes of this in my life at under 15.
In any event, it all leads back to the same thing that you mention and that I have known all along. Diet, exercise and stress management.
I'm not sure if you can answer again, and I don't want to self-diagnose, but could it be possible that I have repetitive monomorphic ventricular tachycardia. I'm not sure how repetitive my VT actually is however, since I can basically count the troubling episodes of this in my life at under 15.
In any event, it all leads back to the same thing that you mention and that I have known all along. Diet, exercise and stress management.
That title should read:
PVC AND VT...Here we go again.
Sorry
PVC AND VT...Here we go again.
Sorry
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