Arhythmia

[M-Galagher]

  I am a 42 year old male who has been athletically active since childhood.
  Last year I passed out while sprinting for a ball.  I was subsequently taken to the hospital where I had a series of VTAC runs that night. I was dianosed with idiopatatic cardiomyopathy. An MRI indicated slight enlargement of the right ventrical. My ejection fraction was 37%.  The EP study could not reproduce the VTAC.  Currently I have been taking 200 mg of Cordarone w/15 mg of zestril because of high blood pressure. After 12 months my only episode of VTAC was in the hospital after the administration of Sotalol which dropped my resting heart rate from 50 to 38.  The frequency of PVCs has been significantly reduced. I have a few questions
  1. How is it that I could have been so athletically active and not have presented any symtoms until last year if this problem was congenital?
  2. I have had several stress tests and have been monitored during low to moderate exercise with no apparent irregularity (below 110 bpm).   I would like to step up the exertion level but I have  no confidence that the VTAC will not reoccur therefore I have abstained from all sports.  Is there a way to determine what level of exertion would trigger the VTAC, or is it entirely random?
  3.  The Cordarone I am taking seems to be working but is very hard on my system.  I am looking forward to finding an alternative to control my ahrythmia.  My Doctor says that ablation is not an option and that the Sotalol had a severe adverse effect on me.  Are there any other new alternatives?  

[CCF CARDIO MD APS]

_
Dear M.Gallagher,
As for how "it" could be congenital, I am sure that your cardiomyopathy was not
congenital and that is why it is termed "idiopathic" (this is the weaking of
your heart muscle that has resulted in a reduced ejection fraction.)
As for the arrythmia (VT), this can be simply from your cardiomyopathy and less
likely, it could be congenital.  
The abnormal heart rhythms (arrythmias) are in general not predicable, and certainly
not completely understood by scientist and physician, hence I would conclude that there
occurence is random (more so in VT than the other arrythmias like SVT.)
Exercise, daily, aerobic for 40 minutes to an hour is good and very important for patients
with cardiomyopathy, thus it would be a shame that fear of the VT would prevent you from this
form of therapy, especially if you are not experiencing any VT on your regular stress tests at
the doctors office.  
Cordarone is simply the safest drug available today for those patients with the combination
of cardiomyopathy and VT.  There is something called an internal defibrillator which shocks
your heart from the inside if it detects any VT, however most patients that get the defibrillator
also are on an antiarrythmic.  This would be one point to discuss with the elecrophysiologist cardiologist
or cardiologist that you see.  Another very important point that you need to discuss with your cardiologist
is the fact that you are not on zestril for high blood pressure, rather you are on this medicine because it
is one of only a few drugs PROVEN to decrease mortality (rate of death) in those with cardiomyopathy.  A recent
study showed that patients really should be on the larger doses, not the smaller ones (you are not on the highest dose),
in order to get the full effect of decrease in mortality.  Of course, since zestril does lower blood pressure, some
patients can not tolerate the higher doses as it leaves them with too low a blood pressure (which means dizziness and fatigue.)
Good Luck.
I hope you find this information useful.  Information provided in the heart forum is for general medical informational purposes only.  Only your physician can provide specific diagnosis and therapies.  
Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your problem.