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Heart Disease (Expert Forum)
Arrhythmia and sudden death...
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Arrhythmia and sudden death...
by Deb__0__0, Dec 19, 1998 12:00AM
Our governor of Florida, Governor Lawton Chiles, died last week slumped over near his exercise back. At first they said he had had a heart attack. Following the autopsy, it was reported that instead of a heart attack, he had died as a result of an arrhythmia. For many of us in this area, including several people that I know who have been told that our arrhythmias are benign, this report was disturbing. In my case, I found it disturbing because I have had so many different opinions. Many years ago, when I went to a walk in clinic complaining of severe fatigue and insisting they test me for low thyroid because I felt so crummy, before I knew what was happening they were sparred into action, putting all this equipment on me, telling me not to worry I would feel better after the lidocaine drip stabilized my heart rhythm...I didn't even know I had an arrhythmia. Although they wanted to send me to intensive care in the cardiac unit immediately, I refused because I had an infant and a baby...I did go to a
cardiologist. At that time it was found I had pericarditis, and severe hypothyroidism, as well as frequent PVCs with no defined cause. I was put on various beta blockers which controlled the PVCs and some tachycardia, however, I have a tendency to low blood pressure and I also have asthma, and had to keep changing beta blockers when side effects became pronounced.
Later I was found to have mild mitral valve prolapse. The beta blockers were stopped as it was felt the side effects were more dangerous than the extra beats. Then we moved and a new cardiologist did an exercise stress test, which had to be stopped early due to frequent triplets and runs of PVCs, according to him. He said this put me at severe risk of sudden death and I would have to start the beta blockers again, and try to control the asthma with other drugs. He said I would need to control the arrhythmia for a lifetime, because of the triplets and runs which appeared during the exercise stress test. He said not to treat would be foolish, since if a bad episode happened away from specialized equipment, I would probably die.
I remained on treatment for several years, then moved again. The new doctors did echos and EKGs and pronounced that my PVCs were benign, and there was no reason to treat them. Because I had mild regurgitation, they said the only treatment I needed was premed for dental work. I asked about exercise test, they said being a young woman, age 38 at the time, having low blood pressure, great cholesteral levels there was absolutely NO reason to do any more testing, and I could just go and enjoy my life, exercise, do anything I wanted, and just ignore the palpitations....advice that I took and was glad to finally feel that I didn't have to be scared. After I wasn't scared anymore, I quit noticing the extra beats most of the time. However, I have always had a high resting heart rate, between 90 - 110 beats per minute, and when I exercise I approach maximal heart rate. Very seldom do I notice the extra beats, but every once in a while I have a very bad day when the extra beats become frequent, the pauses in the
pulse appear to be quite long, and I feel extremely exhausted. If I take my pulse, the rhythm on those days will be VERY erratic...it doesn't happen very often though. Again, I have ignored it because the doctors assured me there was no problem. However, during those periods, I would have to rest...I also discovered accidentally that taking my pulse in the neck would sometimes clear up the rhythm enough for me to get going again. The last time I went to the cardiologist was just a few months ago, and they assured me there was no danger.
However, in the wake of Governor Chiles' sudden death, my concern has resurfaced. The cardiologist around here refuses to do the exercise test, and I find myself worrying. They told me doing an exercise test was irrevelant, because even if there were PVCs on the test, standard practice is now NOT to treat them, so it made no sense. Rather, they told me to lose weight because that would be a better way to lessen my chance of having a bad event...I am overweight (63 inches and 180 pounds) and have tried hard to lose weight, I have cut out many of the bad foods I was eating and have exercised at least some daily, despite how tired I get when my pulse rate gets to 160 or higher with simple exercise like swimming or shooting baskets...I just want to get better. I also have a history of autoimmune illness with a high ANA, but no real diagnosis. I take a lot of medicines for the connective tissue disease, the hypothyroidism, and the asthma....including daily prednisone and plaquenil.
I want to be relieved of the fear that this news story has put in me. I just can't get out of my mind what that other cardiologist said to me...I have tried to locate him, but we moved and so did he...I can't remember his name and the building he used to be in was shut down...I can't find anybody that remembers him. So I have no way to get a hold of the report from the original test. Even though these doctors have told me not to worry, and I didn't until the governor died, now all of a sudden I can't get this other guy's words about dying out of my mind.
: I want a healthier lifestyle. I want to lose weight and exercise more; I was depressed for many years after a divorce and now that I am pretty much back to my old self emotionally, I want to go back to my old self physically....I used to be very athletic, thin, and even healthy...only the asthma plagued me back then.
How can I be reassured about this problem? I am embarrassed to admit I am scared. I am supposed to go back to the cardiologist for a repeat echo in July....it's a ways off but I can probably control my fear till then. Do you think it would be unreasonable for me to beg him for an exercise test....or if the echo is once again normal and he still feels the PVCs are benign, can that clearly be indicated without the exercise test. Am I putting too much into our governor's death? I do now they reported he had hypertension, and his heart was enlarged due to this disease...would that have been the factor that made his arrhythmia dangerous? I certainly do not have hypertension...by b/p is much more likely to be 95/50 - 110/60, so that is very healthy. (Everybody else in my family has high blood pressure, mother, dead father, brother 2 yrs younger than me, and even my 13 yr old had a period of hypertension which has now resolved. So I guess I lucked out there.
Please help me know what to do? I appreciate your help so very much
---------------------------------------------------------------------------------------------------
Dear Deb
PVCs that are benign (in patients with no underlying heart disease) are not routinely treated with medicines anymore. In the past, patients were put on medications to suppress PVCs, but these medicines did more harm than good. The only reason patients with benign PVCs are put on medicines now is if they need help with their symptoms. The governor’s situation was different; his heart was not structurally normal. People with benign PVCs do not share the same risk of cardiac arrest that older patients with heart disease have.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.
cardiologist. At that time it was found I had pericarditis, and severe hypothyroidism, as well as frequent PVCs with no defined cause. I was put on various beta blockers which controlled the PVCs and some tachycardia, however, I have a tendency to low blood pressure and I also have asthma, and had to keep changing beta blockers when side effects became pronounced.
Later I was found to have mild mitral valve prolapse. The beta blockers were stopped as it was felt the side effects were more dangerous than the extra beats. Then we moved and a new cardiologist did an exercise stress test, which had to be stopped early due to frequent triplets and runs of PVCs, according to him. He said this put me at severe risk of sudden death and I would have to start the beta blockers again, and try to control the asthma with other drugs. He said I would need to control the arrhythmia for a lifetime, because of the triplets and runs which appeared during the exercise stress test. He said not to treat would be foolish, since if a bad episode happened away from specialized equipment, I would probably die.
I remained on treatment for several years, then moved again. The new doctors did echos and EKGs and pronounced that my PVCs were benign, and there was no reason to treat them. Because I had mild regurgitation, they said the only treatment I needed was premed for dental work. I asked about exercise test, they said being a young woman, age 38 at the time, having low blood pressure, great cholesteral levels there was absolutely NO reason to do any more testing, and I could just go and enjoy my life, exercise, do anything I wanted, and just ignore the palpitations....advice that I took and was glad to finally feel that I didn't have to be scared. After I wasn't scared anymore, I quit noticing the extra beats most of the time. However, I have always had a high resting heart rate, between 90 - 110 beats per minute, and when I exercise I approach maximal heart rate. Very seldom do I notice the extra beats, but every once in a while I have a very bad day when the extra beats become frequent, the pauses in the
pulse appear to be quite long, and I feel extremely exhausted. If I take my pulse, the rhythm on those days will be VERY erratic...it doesn't happen very often though. Again, I have ignored it because the doctors assured me there was no problem. However, during those periods, I would have to rest...I also discovered accidentally that taking my pulse in the neck would sometimes clear up the rhythm enough for me to get going again. The last time I went to the cardiologist was just a few months ago, and they assured me there was no danger.
However, in the wake of Governor Chiles' sudden death, my concern has resurfaced. The cardiologist around here refuses to do the exercise test, and I find myself worrying. They told me doing an exercise test was irrevelant, because even if there were PVCs on the test, standard practice is now NOT to treat them, so it made no sense. Rather, they told me to lose weight because that would be a better way to lessen my chance of having a bad event...I am overweight (63 inches and 180 pounds) and have tried hard to lose weight, I have cut out many of the bad foods I was eating and have exercised at least some daily, despite how tired I get when my pulse rate gets to 160 or higher with simple exercise like swimming or shooting baskets...I just want to get better. I also have a history of autoimmune illness with a high ANA, but no real diagnosis. I take a lot of medicines for the connective tissue disease, the hypothyroidism, and the asthma....including daily prednisone and plaquenil.
I want to be relieved of the fear that this news story has put in me. I just can't get out of my mind what that other cardiologist said to me...I have tried to locate him, but we moved and so did he...I can't remember his name and the building he used to be in was shut down...I can't find anybody that remembers him. So I have no way to get a hold of the report from the original test. Even though these doctors have told me not to worry, and I didn't until the governor died, now all of a sudden I can't get this other guy's words about dying out of my mind.
: I want a healthier lifestyle. I want to lose weight and exercise more; I was depressed for many years after a divorce and now that I am pretty much back to my old self emotionally, I want to go back to my old self physically....I used to be very athletic, thin, and even healthy...only the asthma plagued me back then.
How can I be reassured about this problem? I am embarrassed to admit I am scared. I am supposed to go back to the cardiologist for a repeat echo in July....it's a ways off but I can probably control my fear till then. Do you think it would be unreasonable for me to beg him for an exercise test....or if the echo is once again normal and he still feels the PVCs are benign, can that clearly be indicated without the exercise test. Am I putting too much into our governor's death? I do now they reported he had hypertension, and his heart was enlarged due to this disease...would that have been the factor that made his arrhythmia dangerous? I certainly do not have hypertension...by b/p is much more likely to be 95/50 - 110/60, so that is very healthy. (Everybody else in my family has high blood pressure, mother, dead father, brother 2 yrs younger than me, and even my 13 yr old had a period of hypertension which has now resolved. So I guess I lucked out there.
Please help me know what to do? I appreciate your help so very much
---------------------------------------------------------------------------------------------------
Dear Deb
PVCs that are benign (in patients with no underlying heart disease) are not routinely treated with medicines anymore. In the past, patients were put on medications to suppress PVCs, but these medicines did more harm than good. The only reason patients with benign PVCs are put on medicines now is if they need help with their symptoms. The governor’s situation was different; his heart was not structurally normal. People with benign PVCs do not share the same risk of cardiac arrest that older patients with heart disease have.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.
