Dilated Cardiomyopathy, High Cardiac Output, Chronic Ventricular Ectopy, ...

[Robert S.]

Dear Sir(s):

I am a 46 year old nonsmoking, nondrinking male. I had been quite physically active and healthy until 4 years ago when I noticed fatigue associated with palpitations. Upon physical examination with my GP, an irregular heartbeat was noticed. I was referred to a local cardiologist who performed a routine series of diagnostic tests. He dianosed my problem as a benign arrhythmia (28,000 b/min.). Due to several episodes of near syncope and increased breathlessness, disorientation, tachycardia, and lasting feelings of unwellness, I saw him again the following year for another Q&A appointment. Again, after the same exams, he surmized benign arrhythmia.

During the subsequent year, I experienced more episodes of near syncope and had two episodes of frank syncope. The fatigie, breathlessness, etc., continued to get worse and I requested a second opinion. The second opinion indicated that I had cardiomyopathy based on a cardiolite stress test and a poistive echocardiogram. I was hypertrophic, hypokinetic and had mild diastolic dysfunction. I was referred for EP studies.

I have undergone two invasive catherterizations including a bilateral angiogram, two cardiac volume studies, and an electro-physiological protocol. I was found to have high cardiac output (9.6 l/min), a chronic nonvagal arrhythmia (40,000 b/min), a moderate hypokinesis of the LV, myocardial disarray of LV, chronic near syncope and moderate LV hypertrophy. I have been dianosed as having dilated cardiomyopathy. Apparently, I am not a candidate for heart transplant due to my EP parameters. My EP spcialist now wants me to undergo a MUGA scan to determine heart function capabilities.

Is the MUGA test the way to go? I feel that there may be a neurological basis to my arrhythmia problem - is this a reasonable assumption? Am I a lost cause or is there hope wherre the prognosis is quite grim?

Thank you for your assitance.

[CCF CARDIO MD - DLB]

I think a MUGA is reasonable. I do not think there is any neurological basis to your arrhythmia. Nothing you describe sounds particularly sever, so there is no reason to give up hope.

[Robert S.]

A comment on the above scenario. I should have also mentioned that the angiogram showed normal coronary arteries. I have been put on Atenolol, Verapimil, and Amiodarone, each exacerbating my symptoms. My thyroid panels have all come back negative.

[CCF CARDIO MD - DLB]

I think the MUGA will be useful. Regarding your comment about heart tranplantation, it would only be an option if you were in severe heart failure unresponsive to medications.