Does redundant mitral valve tissue still mean a structurally normal heart?

[fearfactor]

On my echocardiogram report, the result was "anterior mitral valve leaflet appears mildly redundant though no frank prolapse is seen" and "trivial mitral and tricuspid valve regurgitation."  Does this mean my heart is "structurally normal?"  I am asking because I have suspected (never caught on a monitor, Holter or 30 day event) NSVT runs and am concerned because I know that in a structurally normal heart these are benign but in a non-normal heart they can be dangerous.  Do I have mitral valve prolapse and if so do my test results foreshadow sudden cardiac death?

I realize I posted a question last month and am at the end of my 2 per 6 month limit so this will be my last until 6 months, just to let everyone know.

Thank you.

[Cleveland Clinic]

fearfactor,

That is a very subtle finding and depending on the echocardiographer probably would be mentioned by some and not by others. Although I have not seen the study, you most likely do not have prolapse as evidenced by the statement "no frank prolapse is seen".  These results have no implications on the risk of SCD.

good luck

[upbeat63]

I had trivial aortic valve regurg on my echostress and while no nsvt runs were caught on my 48hr holter, I know I get them. I've heard them with a stethescope. But I'm still told everything's a.o.k. even with bigeminy, trigeminy, nsvt etc, the trivial regurg is, well, trivial--to them--just like my 20,000+pvcs--ha ha. It only matters to me.

Hope you are having a better day today fearfactor. Hang in there. Life was really tough when I had both high anxiety and PVCs. Luckily the high anxiety is less often now, but there have been times when it could overtake me. That hole was a dark deep one, but I didn't stay down.

You are strong enough to climb out of it. Give yourself some credit, you've got a ton on your plate. Not only are you going through law school and managing a family, and the million other things that everybody has to do, you've got some conditions that other people (who do less) don't have to contend with while they go through school.

[fearfactor]

Thanks for the encouragement!  I am doing better today.  Just trying to reassure myself.  I'm in therapy for my "cardiac neurosis" and it is helping.  I guess I'm just going to have to learn to live with the fact that I have palpitations and probably always will.  It's a hard pill to swallow but I'm trying!  Thanks again for your kind words!

[Momto3]

Hi!

Hope classes are going well this semester!!  Glad to hear you are "learning" to cope with your palps.  From my experience, it beats letting them rule your life.  You may always have them, at least to some degree, and your ability to "deal with them can only help."  

I don't know if this will help, cuz I'm also a little confused on the phrase that keeps circulating regarding a "structurally normal heart."  Heck, I've picked up on the same phrase.  Guess cuz I've heard it make the rounds here a number of times : )

I have MVP with moderately-severe regurgitation of the mitral valve.  I've known about the valve problem for about 25 years, and so far, it is stable.  Even with that, the doctor was not concerned at all about 22000 pvcs, including nsvt.  I'm actually not sure that MVP/MR constitutes a structural anomoly.  What I do know, is that when my EF dropped, which pointed to a CHANGE in my heart's function, there was a lot more concern.  It turns out that, in my case, the pvcs are thought to have led to the change in function.  Must be true, cuz my EF is back to normal and very few (compared to before) ectopics.

Hope you are feeling better!!
Connie

[kitcurious]

http://www.aafp.org/afp/20010601/2201.html

[Momto3]

Thanks for sharing the link to the article on valve disease.  It was easy to follow and very informative.

Thanks again!

[Fran71]

Hi Connie,
I didn't know PVCs could lead to a change in heart function. Then I guess it's very important to control them with betablockers and such. I always wondered whether it's better to bear with the arrhythmia and take no meds, or the opposite. I've come to the conclusion that on the days when I feel bad, I will take a betablocker. It improves my quality of life and it will also protect my heart.

I have a question for all NSVT experts, which may sound silly. When NSVT occurs, is it like a much longer PVC if you feel your pulse? I mean, the single PVC implies a pause between the beats you feel in your pulse. Does NSVT mean a much longer pause that you can feel in your pulse?

Thanks so much

Fran

[Momto3]

Hi Fran,

It is extremely rare that pvcs will lead to a change in heart function. I had thousands of pvcs daily, for 25 years and they were never more than annoying and anxiety-provoking.  When a routine test came back showing that my EF had dropped, everyone pretty much assumed it was because the mitral regurgitation had progressed.  However, a TEE and stress echos proved otherwise.  My thought that perhaps the pvcs were the culprit...It is rarely documented, but it has been known to occur.  The results were verified with subsequent echos.  Because of the mitral regurg, I would have to take antiarrythmics for the rest of my life or try ablation. Tried the meds for several months, but didn't like the side effects.  We needed to see if reducing the frequency of pvcs would, in turn, lead to an increase in ventricular function.  Ended up trying the ablation. It took two procedures, but my EF bounced back up into the 50's within a few months.  For the past year or so, it has been 60%.  Although I don't get anywhere near the thousands of pvcs I used to get, every now and again, they occur.  For that, BB's (as needed) does the trick.

Prior to the drop in EF, my doctors have always told me that taking betablockers was for symptomatic relief. Sounds like you have a great grasp of keeping your perspective on your pvcs : )

For me, NSVT it is a sequence of at least 3 pvcs.  It's like a rolling, tumbling kind of thing.  Not like the pause and the thud after a single pvc. If you were to listen with a stethoscope, normally your heart sound is lub-dub, lub-dub, lub-dub...nice and rhythmic.  For me, nsvt is like lub-dub-dub, lub-dub-dub, lub-dub-dub, lub-dub,dub....and eventually back into a normal rhythm.  I don't feel a pause with nsvt; it's more like a rumble.  Hope that makes some sense : )
Connie

[fearfactor]

Hi!  I'm doing better - I'm now 13 weeks pregnant and the pregnancy has been going well. Actually, my palps have been better since I'm pregnant but they are still very frustrating!  Thanks for the kind words and encouragement!

[Momto3]

13 weeks...AND fewer palps....WOOHOO!!!  Great news!

Hang in there fearfactor...You've got wonderful times ahead of you  : )

Take care!  

connie

[Fran71]

Thanks Connie! It's so wonderful that your EF went back and you're getting fewer PVCs. They sure can be anoying. Thanks for sharing this with us, it's always nice to hear successful stories!

About NSVT, I guess we have to try it to really understand how it feels. If you feel your pulse with your finger, does it feel regular? So is there no compensatory pause with NSVT? Sorry I'm asking so many questions on this subject. I'd like to be able to recognize them, if I ever experience them.

Thanks so much for all your help!

Fran

[Momto3]

Fran,

Don't worry about asking too many questions.  I've asked millions : )

During an episode of NSVT, I think I experience two different sensations.  In some cases, my pulse is rhythmic, yet irregular. In other words, each beat is in time, but each beat is a pvc.  The pvcs were strung together in a synchronized manner.  Instead of the typical lub-dub, I think it's more like lub-dubdub repeatedly.  You know how your pulse feels with one pvc?  Well, this is the same only it would be a lot of individual pvcs one after another, with no regular beats in between. Each one has a pause.  Inside, it feels like a rolling, tumbling kind of sensation.

Other times, it was like lub-dubdubdubdubdub.....like my heart get caught and can't resume any type of rhythm.  These episodes are relatively short, probably less than 10 seconds. I'll try to take notice of my pulse the next time it happens so I can give a more accurate explanation : 0

Upbeat,

I've been told nsvt can be defined as 3 or more pvcs strung together with no regular beats in between.  But, each one has its own pause, right?  Also, it can be like a mini episode of VT, right?  When I used to ask my doctor if I had VT, she would look at the strips and say, "not technically."  I think I had more episodes of the strung pvcs.  But strung pvcs feel different to me than when my heart rhythm feels caught, with no atrial contractions.  Does this make sense to you?  I know you've had NSVT, so I thought maybe you could help.

Hope it a great day everyone!

[Fran71]

Thanks Connie, you're so kind and helpful to so many people on this site! Thanks for understanding. I guess we all kind of start asking questions, then we come to terms with the problem and can then help others with similar problems, as you're doing now...

You wrote: "You know how your pulse feels with one pvc? Well, this is the same only it would be a lot of individual pvcs one after another, with no regular
beats in between."
I often have 2 or more PVCs one after another, but I thought that was called bigeminy. During what I think is bigeminy, if I feel my pulse I feel one strong beat followed by a pause, followed by another strong beat followed by a pause, then another strong beat and so on. I thought this was bigeminy. Do you think this is NSVT?

Thanks so much for yur patience!

Have a great day everyone
Fran

[tickertock]

That beat-pause-beat-pause-beat-pause is typical of bigeminy PVCs. I had the feeling documented on ECG and it was a bigeminy, I really don't know what a "salvo" or run of PVCs of PVCs feel like.

[Momto3]

You're welcome.  You're right, once we travelled a road and become kind of familiar with it, we can show others the path.  Fortunately, we all travel different roads with different roadblocks and some throughways : )

Two pvcs in a row, with no regular beat in between, is called a couplet. Three in a row is a triplet, or some call it a run. Three of more can be referred to as nsvt, run, salvo.  Bigeminy is when every other beat is ectopic...Like this...lub-dub, lub-dubdub, lub-dub, lub-dubdub and so on.

It sounds like you might be experiencing a couplet.  Have you ever worn an event monitor?  Those are nice because you can press the "record" button when you feel the unusual beat. The recorder runs in a loop, so when you press record, it backtracks something like 30 seconds and records one minute (or more) of your heartbeat.  The event monitors are nice b/c the doctor can correlate what you are feeling to the recorded strip.

Feel free to post here or email anytime.  Have a great day!
Connie

[Momto3]

Hi Hank and Everyone!!

Can anyone help with the explanation of nsvt?  I posted a couple of comments above to Upbeat...I've heard nsvt is a run of 3 or more pvcs OR a somewhat minimized version of VT where the heart does not catch up with itself right away.  Is that the way others understand it?

[Momto3]

Sorry for the earlier post to "Hankstar."  I understand he no longer posts on this board.  I remembered that he used to be great with the definitions and explaining some of the oddities that go along with ectopics.  Oh well....Next time, I have a run of ectopics, I'll try and catch what my pulse is doing.

[Fran71]

I agree with you tickertock that what I'm experiencing is bigeminy. I think the regular beat inbetween the 2 PVCs is the strong beat that I can feel between the pauses. I've experienced lots of those when I wore holter, and many bigeminy were recorded but no couple or triplet.

Connie, when you said above that NSVT gives you two kinds of different sensations, couldn't it be that the first one you described is actually a long string of bigeminy PVCs, and only the second is actually NSVT? Maybe you're having NSVT more seldom than you thought! :-). I know you know much more than I do about this, but your description of the first type of NSVT really sounded like bigeminy to me.
BTW Connie, did you get my email I sent about 1 week ago?

Smiles to all!

Fran

[Momto3]

Prior to the ablations, I was in bigeminy a good part of each day.  24% of my heart beats were ectopic.  Not any more :)

Bigeminy felt kind of "normal" to me. Whereas, the runs were like a bunch of irregular beats, but like my heart was stuck.
I'm almost certain the second type of episode I described was NSVT, and now I'm rethinking my first description.  YIKES!  My memory is going :(  I'm thinking bigeminy is probably right.  Sorry for any confusion.  I'll try and take note of my pulse next time I feel a run. I still get bigeminy, but not nearly as often.  At least, I don't think so : 0

I did get your email and sent a response.  I'll try resending it. Let me know if you get it : )

Connie

[upbeat63]

There is not really much more I can add to any of your posts, you've all done a wonderful job of describing the various PVCs. Connie, you were also very descriptive and right on when you said that you've been down this road and are just trying to show others the path, and that we all have our own roadblocks to deal with--that was great.

I guess there is one thing I can add, bigeminy is a normal beat, then a beat with a PVC, then back to a normal beat, then a beat with a PVC (like you said: lub-dub, lub-dub-dub, lub-dub, lub-dub-dub). Sometimes the pause is not as evident so you might get confused if you are taking your pulse and your pulse is faint.

NSVT is lub-dub-dub, lub-dub-dub (well that's a couplet), but NSVT continues lub-dub-dub, lub-dub-dub, lub-dub,dub, lub-dub-dub, etc. but for under 30 seconds in duration. Depending on how fast your heart beat is during all of this, it could techinically be VT.

I think Connie, your lub-dubdubdubdubdub, may be just shorter pauses, coming from different foci? which may feel like they are strung closer together. Or, could it be you have had a PAC in the middle of the PVCs? I don't really know what a PAC feels like, my holter didn't show any, but I've heard them described as having a shorter pause than a PVC--tickertock maybe you can answer that one, you get both right?

[Momto3]

Thanks!  That's what I originally thought.  Maybe I'm not cracking up : )

I don't generally get pacs either.  Seems strange with so many pvcs.  I can only recall seeing one report that indicated pacs, and there were only 4 of them...

So, the lub-dubdubdudubdub and so on may be strung so close togehter that I don't feel the pause.  Not sure.  

Hope you are still well despite the "flip flops."

Take care and thanks again.

connie

[Fran71]

I think we're basically saying the same thing about bigeminy. Bigeminy is 1 regular beat, 1 PVC then 1 regular beat. Since when I feel my pulse without a stetoscope I can't hear the ventricular contraction, to me it feels like this: strong beat - pause - strong beat.
I assume that a triplet, for instance, would feel like this: strong beat - long pause (with 3 ventricular contractions hard to feel by pulse alone) - strong beat. Does it make sense?

Oh isn't this tricky?!

Fran

[tictock]

Hi Connie, can i just ask you how often do you get your bigeminy rhythm since you have the ablation done?to be honest it's because of this bigeming rhythm that i'm going for 2nd ablation. I can put up with sporadic pvc's but this bigeminy make me breathless with chest pain when i walk. Have not been to work for 5 weeks because of it. would you have another ablation?

[Momto3]

Once in awhile I notice a short spell of bigeminy. But, it does not go on and on like it used to.  The last longer episode I had was last summer the night before we moved out of state...anxiety for sure! Just lasted a few hours.

I have been with my current EP for about 8 years. It wasn't until about 2 years ago (few months after 2nd ablation) that she had ever heard my heartbeat withOUT ectopics.  I was pretty much always having pvcs...I was so accustomed to my own heart's peculiar patterns, that after the 2nd ablation, the normal, somewhat faster, regular rhythm felt really strange. That took some getting used to.  

If I needed another ablation, I wouldn't hestiate to have one. I had no complications and for me, a successful procedure meant I could stop taking antiarrythmics.

Maybe the bigeminy will disappear as quickly as it came on.  I never really knew when my pvcs would kick into high gear, or when they would quiet down.  Therein lies the million dollar question : )

Take care and hope you are feeling better

Connie

[tictock]

Thanks for that Connie, i'm happy for you that things are going good. I just got a letter from my cardiologist saying that he will try get it done as soon as possible mean time increase tablets. but i have noticed bigeminy is weaning off not as bad as before more so when i'm walking. i just hope it's there when they call me in hospital to do ablation otherwise they will not be able to finD where foci is coming from and i'll be back to square one. quess i'll cross that bride when i come to it.Thanks again.Kat

[fearfactor]

Hey...this is off the subject but I have a question about beta blockers.  I'm right now taking Toprol XL 12.5 mg a day (I have low blood pressure anyway so I can't take more).  I'm thinking of trying Corgard as the Toprol doesn't really help my palpitations and may really make them worse than they were before.  I'd go med-free but I hate for my heart to race during panic attacks which happens if I'm not on betas.  Anyone taken Corgard or have any advice about the best beta blockers for palpitations?

[upbeat63]

Tictock I'm glad the bigeminy is slowing down for you. Strange isn't it, you just want it to go away so bad, but what happens if it's gone just before the ablation!! ugh. A blessing in disguise.

I had a similar thing happen last summer when I was in constant bigeminy so I had an echo scheduled. The very day of the echo (which was also my 42 birthday) the bigeminy stopped. Just like that. Stopped. And the PVCs were so infrequent I thought I didn't have any (maybe 4/minute). I was amazed and confused. BUT my blood pressure shot up. It was about 135to140/90 and I never--ever go above 130mmhg, ever. I'm sure the echo tech and physicians assistant thought I was exaggerating when I said I had high frequency PVCs and low blood pressure. Surrrrre, they probably thought to themselves.

The bigeminy never did return (might have been the toperol but that doesn't make sense in light of my BP). High frequency came back the very next day, and toperol isn't doing a thing for my current trigeminy. What a weird and wonderful thing the body is.

Fran if you are reading through the posts--I haven't tried inderol yet. I have a 12month RX for toperol and to get another RX would mean a doctors office visit, which is out of my pocket. I know I shouldn't attach a price tag to it, but I just finished paying off the clinic for all the tests in summer. I'll try to combine a few things into the next office visit. If I thought it was a sure thing I wouldn't hesitate to go in now. There was a gal, MadgeOwens who seemed to have the same response to inderol as you did--miracle that slowly faded. Well, even a little break is better. Have a wonderful day everyone.