Benign PVCS? with a twist in MRI

43yr F. PVCS since college(1st time felt them) Come and go through the years.In 2000 had Afib(ABOUT 3 Hrs),went to hosptial, blood test showed low K.Eliminated all caffine. Never smoked+Never drugs. No Afib ever again.Kept insisting about these PVCS,so my DR refered to CArdio.
RESULTS:
BLOOD-all normal
ECG-Borderline-Diffuse T-wave Abnormailites
30DAY EVT-PVCS and PACS/few Sinus Tach
ECHO-All Normal-All within limits except trace regurg in mitral+tricuspid
STRESS ECHO-Impression:"Very good excercise tolerance,PVCS from RVOT, NO chest Pain, Baseline abnormal ECG, w/ST changes becoming significant in recovery. Probably a false +. NO echocardiographic evidence of myocardial ischemia to the level of excecise achieved"
SAECG-NEG
T-WAVE ALTERNANS- Neg
My cardio(by his admission)is anal about "getting all info possible with all the tools out there", so included MRI.
MRI-Impression-Small dyskinetic portion of the right inferior wall.All other normal
NO family history of heart disease or SCD.Grndprnts died very old. Dad(67) and has had some PVCS on ECG's but otherwise asymptomatic and healthy

My cardio says this is benign PVCS. He says he MRI(Which causes me great anxiety) finding doesn't change prognosis(excellent)since I've never had a heart attack am not overweight.As far as he is concerned,many people with PVCs may probably have the same MRI findings but aren't screened with MRI."Maybe born with it,maybe a virus"

**ECHO June05-No chg.-normal+w/in limits

?-Does this sound like just benign PVC's and no worry ? Have you seen similar case?

Thx very much

[Cleveland Clinic]

girl,

You may be the result of too many test and finding something slighly abnormal. The main worry I would have with your MRI and right ventricualr findings is whether the 2 are related as there are some diseases of the right ventricle that can be associated with arrythmias.

Cardiac MRI is best interpreted in tertiary referral centers.  I would seek an electrophysiology opinion in that setting.

good luck

[stlcard1521]

hypokalemia (low blood potassium) can cause PVCs because it regulates cell membrane potentials. see what the doc says though when he posts. im guessing the low K wasnt clinically significant though, or your cardiologist probably would have said something.


if your cardiologist said that the MRI finding doesnt mean anything, just trust him. the tests are so good they can detect every little tiny unimportant defect, and its unusual for them not to find a defect. i was in the same boat, my cardiologist told me my valves were leaking and i freaked out bc my great grandpa had leaky valves and all kinds of problems, but then i talked to the cardiologist about that the next time and he said it is very minor and insignificant and more people have that trace leakage than dont. probably the same thing with your MRI. i wish they just wouldnt tell you stuff like that and give you something to be anxious over. see what the says here though when he posts.

cutting caffeine/alcohol and beta blockers dont seem to help me either. regular excercise has greatly reduced my PVCs though if they are bothering you.

[Momto3]

Sorry for hijacking the thread.  I just HAD to respond to 4paws post.  I also had pvcs in the high numbers (22,000/24 hours) which led to dilated cardiomyopathy.  Like you, when then were in such high frequency, they were sorta "normal" for me....weird.  Anyway, EPS also provoked VT for me and irritable foci were successfully ablated.  Hope you have an equally successful RFA if you end up on the path.

Other than me, I think you are the first person on this forum to have posted about developing CM in the presence of chronic pvcs.  I agree it's important to understand CM can occur, but for the vast majority of pvcers, they remain benign.  Mine didn't act up (medically) for over 20 years......

Love the nickname.....dog? cat? other?  all creatures great and small?

Connie

[Momto3]

I forgot to mention that after my ablations, EF gradually increased form 40% to 60% where it remains (last procedure 11/2003)

[Lynn8889]

My apologies for adding on this thread....I've been having irreg. beats for almost 2 weeks.  They've suddenly started happening out of nowhere.....I've not changed my diet, no stress, no new meds...nothing.  So my Dr. wanted me on a 24 hr Holter Monitor.  Many of you's on here seem to share alot of problems with these irreg. beats.  But I wanted your opinions about results, or even how you's deal with them.  
I just got results of my Holter Monitor (based on being on it for 22 hours):
*There were a total of 272 mulitformed ventricular ectopic beats.
*Ventricular trigeminy and bigeminy noted.
*There were a total of 53 supraventricular ectopic beats including 3 couplets and 2 runs of ectopic atrial rhythm noted.
*No other abnormalities noted.

I have no idea what this means.  Waiting to hear from my Dr. I figured, since there were many of you's on here who know a great deal about these things......I'd come on here and get your input.  Thanks in advance.

[Momto3]

Ventricular trigeminy is when you have an irregular (ectopic) beat every 3rd beat.  Whereas, bigeminy is when the irregular beat is every other beat.  Ventricular beats originate from the bottom chambers (ventricles) of the heart.

Supreventricular (above the ventricles) beats originate from the upper chambers of the heart, otherwise known as the atrium. In this case, the monitor recorded 53 irregular beats of which 3 were couplets.  A couplet is when the irregular beats occur twice in a row with no regular beat in between.  A run is when you have 3 or more irregular beats in a row with no regular beats in between.

Have a great day!

[Lynn8889]

Thank you for your very informative information - you sure know your stuff!  I appreciate it!

[Momto3]

You're welcome.  I just noticed that I mistyped something in my earlier post.  You actually had 272 "ventricular ectopic beats" AND 53 "supraventricular ectopic beats."  I only picked up the "53."  It's no biggie,b ut I thought I should clarify.  Your test results breakdown the ventricular ectopics and then the supreventricular ectopics.  So, of the 272 ventricular, there were occasions of trigeminy and bigeminy.  Of the 53 supraventricular ectopic beats, there were 3 couplets and 2 runs (3 or more).  The remainder of the ectopics (ventricular and supreventricular) were likley isolated ectopics (single, no pattern). Hope that helps : )

I've learned a lot over the years by walking the walk : )

Connie

[upbeat63]

I too am sorry for busting in on someone else's thread, but I had to ask 4paws how long you've had PVC's prior to the DX of CM? (And another question to momto3 further down).

I've had high frequency PVCs for 22 years, ever increasing to my last holter(48hr)this year which showed 24,000/day. I was afraid of developing CM but echo/stress test is normal. I've heard it is a rare development as the result of PVCs, but still. You are number two on this board alone. And like you, I've developed a cough but thought it was a result of the beta-blocker toperol which I take very infrequently.  

Connie, (and 4paws), how do you feel with CM, I mean, I'm tired all the time. I did have anemia which I am still taking iron for, but geez. I do 30 min treadmill daily (walking not running) which I think helps minimize the sensation of PVCs better than the toperol did. I wonder how quickly CM develops--how frequently should I have echo to monitor? Any other signs to watch for?

[Momto3]

A year prior to finding out about CM, I went for a routine echo and as always, EF and left ventricle were normal (good); still a leaky valve.  Come back in a year.  I was having very bothersome SOB, but that may have been due to anxiety since all tests were normal and it seemed to resolve on its own after a few months.  

The following year, I returned for my annual exam and echo.  I didn't think anything of it since they had always come back the same.  I was feeling fine. I still had pvcs, but that was no different for me.  I had NO SOB; I was not sluggish which I had been the year before; and, I had no chest discomfort, etc.  I was absolutely shocked when my doctor called me at work to tell me my EF was at 40% and the entire left ventricle showed signs of CM. WHAT!!!!  I feel fine!!!  Two additional echo/stress echos confirmed the diagnosis over the next couple of months.  It wasn't until after I underwent RFA, that my CM resolved.  That was two years ago.  Subsequent echos (ever 4-6 months) indicated an increasing EF.  Went from 40-45-50-55 and now it has been 60% for the last two exams.

Hope the holidays is not wreaking havon on your pvcs.  That used to happen to me during the holidays. Too much going on I suppose : )

[upbeat63]

Thanks for your info. I guess shortness of breath can be attributed to so many things. It's just one of my most worrying feelings, (not the PVCs anymore) but I have to say it's very slight. And I always question if it's anxiety and/or hyperventilation. I've been trying to keep fit, but if you can develop CM and feel fine--guess I'll read between the lines and get an echo periodically, yearly (?).

Great, my doctor will really love that since it was at my insistence I even got the first one. You know the whole PVC=benign thing.

Thank you so much for your wealth of infomation and sharing. The holidays don't really jazz my PVCs, thank goodness. Hoping your holiday is a wonderful one.

[madgeOwens]

You must have had other cardiac problems, other than benign pvc's?  I mean if you have benign pvc's and pac's why would you get cardiomyopathy?  Atleast I cannot understand the reason for that conclusion...help me out here momma?

[Momto3]

From "momma"....lol

Aside from pvcs, I do have mitral regurgitation.  However, the leaky valve was ruled out as the cause of the cardiomyopathy.  Initially, it was thought that the leaky valve was probably the cause of the CM.  But, when tests proved otherwise, my doctor took my file and presented my case at a number of conferences and to a number of highly trained EP's who agreed that the valve was not the culprit.  What happened in my case is considered very rare, but not impossible.  I was having so many pvcs, for so long, that I guess, they finally caught up with me.  Even when the monitor recorded over 20,000 pvcs, my EF was 60%.  But, a year later, my annual echo (for the valve) showed a decline in my EF and evidence of CM in the entire left ventricle.  I was shocked!!!  My doctor was going to write up my case, but my "pictures" did not come out clear enough to publish.  What a way to fame!!

In order to confirm the doctor's diagnosis that my PVC's caused a cardiomyopathy, I was subjected to several echos before, during and after the ablations.  Prior to the ablations, my EF remained (3 tests) at approx. 40%.  Immediately after the ablations, my EF rose about 5%.  The doctor did not feel that was enough proof.  So another echo was done a few months later.  EF was now at 50%.  The next echo showed 55% and the last two have been 60%.  My CM has resolved and I am not having anywhere near the number of pvcs that I been been accustomed to.  I was like Upbeat63...I pretty much lived in bigeminy, but got used to it. Now, I feel only occasional pvcs and a short run here and there.  There you have it : 0

Is the medicine still working for you?  Did you put any "oldies" on your grandson's MP3 player?  Think he'd like some of our music?  Maybe you should surprise him with a little Frank Sinatra or Dean Martin : )

Hope you are continuing to feel well.  Hope hubby is doing well also.

Connie

[Momto3]

I forgot to add that I am glad that my doctor was monitoring my leaky valve....Otherwise, the CM may have been much worse.  I had NO idea anything was wrong.

[suze UK]

I hope you dont mind me asking you a question,(i am aware you are not a doctor!)What exactly is a supraventricular ectopic beat as opposed to PVC or PAC,I have just found out I have sinus tachycardia and SV ectopics.Are they the same as PACs?
I have tried to post a Q to the doctors but can never get a slot!I am waiting for a clinic appointment but it could be weeks yet,just wondered if you or anyone else for that matter knew.Thanks for any assistance!

[Momto3]

A "supraventricular" ectopic beat is an extra beat above the ventricles.  The "supra" in the term means "above."

A PVC is a premature ventricular contraction.  These are ectopic beats that occur in the ventricles, or the lower chambers, of the heart.

A PAC is a premature atrial contration.  These are ectopic beats that occur in the atrium, or the upper chambers, of the heart. They are also referred to as supreventricular ectopics.

I found the following definition for sinus tachycardia:

"Tachycardia: A rapid heart rate, usually defined as greater than 100 beats per minute. The tachycardias include sinus tachycardia, paroxysmal atrial tachycardia (PAT), and ventricular tachycardia.

Sinus tachycardia is due to rapid firing of a normal structure called the sinoatrial (sinus) node which is the natural pacemaker of the heart. Sinus tachycardia occurs in response to exercise, exertion, excitement, pain, fever, excessive thyroid hormone, low blood oxygen (hypoxia), stimulant drugs (such as caffeine and amphetamines), etc."

Maybe some others will respond to the question about sinus tachycardia since I can only provide a textbook definition on that topic.

Hope you are able to get a clinic appointment soon.  Have a wonderful holiday!

Connie

[suze UK]

thankyou very much!Believe it or not I am actually a nurse but in urology,not due back at work till tomorrow so couldnt bug our doctors(who arent really that up on arrythmias anyway,they call in the cardiologists)I know about the tachycardia bit(might have to start on "medication" states my GP or just live with it)I live in the uk so I didnt know if our terminology was a bit different.Anyway thanks a million.

[madgeOwens]

Well that was interesting. Thank you.  You have been through the mill and back.
Yes I put some goodies on mp3, and you know he loves Sinatra haha I will add that.

[wirl]

I'm not sure the cause of your PVCs, I have had them in the past.  I had an exercise and beer related a-fib episode, was given Toprol afterward, and then I started having PVCs.  I think it was the Toprol that caused them (PVCs).

Anyway, a client of mine is a cardiologist that teaches cardiologist at Harvard Medical school - so I trust the guy and I trust the guy (electro physiologist) he tells me to go see.

He tells me they are not going to kill me and reiterates this after 3 mos of monitoring me, but he also prescribes an old beta blocker named Acebutolol (Sectral) and tells me to take 1/2 the starting dose of the stuff (200mg).  Well, guess what, no more PVCs.  I have tapered off the Acebutolol and have continued to be symtom free.

So, for what it's worth, ask you doctor for his opinion.  I know if mine ever come back, I will take it again without hesitation.  I know those things can drive you nuts so good luck to anyone with 'em.  If you want to discusss or comisserate you may email me at ***@****

[madgrad92]

I am literally out of my mind with these PVCs. I have anywhere from 20-40 a day (I know, some of you have zillions more than that - I don't know how you manage). I have also been monitored with a King of Hearts that picked up a tachycardia which the Dr. originally thought was VT but is 90% sure is SVT because of what he thinks is a PAC that started it all. I've had these runs of tachycardia for almost 13 years (about one every six months or so). I'm telling you, I dread getting up in the morning, I dread going to bed (I get the tachycardia usually at night), I dread eating, I dread exercising...it's like water torture - I have such anxiety over when the next one is coming. I've been given 25mg of Toprol XL (I have very low BP, so I can't take more than 25mg), and it seemed to work for a while, but I had a run of tachycardia two weeks ago and about 30 PVCs every day since. Could my anxiety cause these PVCs to be so frequent? How many PVCs do most of you get in a day? My Dr. told me my situation is so normal, I'm like a person with no heart issues at all...I just find that hard to believe. Every PVC shakes me to the core. I get shaky and terrified. I am a 35-year old mom to two beautiful children, and all I can think about is what will happen to them if I die. Someone please reassure me! I've been dying to get my question on a post for the Dr., but I can never get in...

[tictock]

sorry to butt in but i've just found this forum. I've been getting pvc for 35 years and have been managing ok with them they flare up now and then if got virus or cold to which i take sotolol 80mg once a day then down to 40mg a day when they subside to just few hundred a day.Eight years ago i had a RF Ablation it seemed to calm things down but not stop them. sometimes they have stopped me doing things because when i'm tired i get them even more, but i tried to live my life the best i could up untill About 4 weeks ago they started up again i was in Bigeming rhythm which i usually get on and off but this time just out of the blue i'm getting it continuously with chest pain and shortness of breath which i've never had before,i remember few months before they started i was getting so tired for no reason. went to the ER they increased my sotolol to 80mg twice a day and said that i may have cm so i'm booked for a ehco. i'm also booked to have another RF Ablation done but i don't have private health care so the wait is long.can cm cause shortness of breath and pain? as i said i only get these symptoms when i'm in bigeminy rhythm and walking. i haven't been to work for 4 weeks because of it as when i start walking pain breathless stops me. sometimes not when i am in sinus rhythm which is not often i can walk about ok.also sotolol not helping this time maybe didn't help in the past as these beats come and go when they please it's hard to tell in my case if they did help.

[d5ok]

Hi, I'm new here. Has anyone ever tried alternatives to drugs for pvc's- such as herbal remedies?

[pchill]

Hi,  I just found this forum because I am very concerned about long runs of PVCs, but the cardiologist says not to worry.  Mine started out just about once a week for 8 years.  Then, last month, just went crazy!  I just wore a 48-hour Holter, not sure of the results, but one day it went on all day.  I get it about lots of people live with them and all but I can hardly function at times.  I am a teacher too, but not working right now, I'm back in school myself.  I can't sit through class somtimes.  I often feel as though I'm going to pass out.  I take 12.5 of Toprol XL every morning, because I am small (105, 5'3") and lowish blood pressure.  Anyone else have spells of almost fainting?  Might it be the med?  I also feel so tired all the time now.  It's great to find people experiencing the same thing as me.

[CMP800]

I had a run of tachycardia (Ave rate on 24hr holter was 118 -echo normal) & my cardiologist put me on 25mg of Toprol.  The 1st 2 days I took it, I got really fatigued & SOB. I began cutting them in half so I could funtion & now I still feel icky. They are notorious for weight gain, cold/swelling feet/hands etc. Now I have a stiff neck. I may have to just deal w/ the tachy bc I didn't feel this bad prior to the meds. My resting heart rate has come down (the highest resting now is about 92) but I can't tell if it's from the Toprol or from finally being able to relax myself. From what I understand this is not life threatening & meds are optional. I have been taking my magnesium supplement in the morning & the Toprol at night. The funny thing is that even though it makes me tired, I still wake up at least once in the middle of the night. It hasn't even been a week yet & ready to wean myself off already. CAN SOMEONE SUGGEST ANOTHER BETA BLOCKER I CAN REQUEST, milder version????  or can I just take these AS NEEDED. I want to follow dr's orders but I want my quality of life restored!!

Thank you & I wish you all the very best of health, ***@****

[Fran71]

My cardio has never recommended an MRI for PVCs. Have many of you had one?

Thanks
Fran

[hyperr]

A related discussion, pvcs are killing me was started.