Ectopic beats, etc.

[Bodoni]

I am male. 64 years old. My LDL is low, my HDL better than average. Cholesterol is below average. I weigh 183 lbs. 5' 10.5" tall.

I have a L-BBB, some PVC's, ectopic 'skipped' beats and a few bigeminies mixed in for fun. My pulse is 48-60 at rest. I have low BP [ 115/70 ] most times. [ Atenolol does that, I guess. ]

Oh, and not to forget - I have Dilated Cardiomyopathy. I take an ACE Inhibitor - Zestril, Atenolol and a baby aspirin.

My Ejection Fraction is probably around 35 - 40. I will be getting another echo in about five months.

I did well on the tread-mill stress test. And too, I had a Heart Catherization and they said my arteries were pretty clean and I do not need a stent or a by-pass. I have no chest pain. I have good circulation in my legs with no swelling. My doctor wants me to begin doing some mild exercising. Walking, etc.

1. Do you think I am okay to live with the ectopic beats, etc.?

2. From what I have stated, do you think my overall heart health - even with the cardiomyopathy - is not all that bad?

3. How much exercise do you think I should do and should I try and get my pulse rate up to a certain level? That may be hard with the Atenolol.

4. What do you think of my drug regimine?

5. Does it make all that much difference if my EF is 35% or 48%, etc.? Or is it more important to deal with the symptoms. I have heard that the EF can be different depending on the time of day. Meds. If you exercised that day, etc., etc.

[Forum-M.D.-ppb]

1.  Depends on how many beats you have.  If they are very frequent and there are many of them, they themselves could have caused the cardiomyopathy.  There is a condition known as tachycardia induced cardiomyopathy where atrial fibrillation or frequent PVC/PAC's are the cause.  Treatments include medications or if needed even an ablation procedure.  
2.  I agree that your heart health is not all that bad.  You just have to make sure that you keep it this way.  Make sure to take your medications and have close follow up.  The fact that you have no symptoms and there is no evidence of heart failure are very encouraging.  Look into the PVC's with your cardiologist.
3.  You can exercise as much as your body lets you.  Use common sense.  Don't overexert yourself.  You should take things slowly though.  The atenolol will limit your maximum heart rate.  As an aside comment, you should probably be on metoprolol XL or carvedilol given the cardiomyopathy.  Atenolol is not as good as those two in cardiomyopathy.  They are, however, considerably more expensive.  
4.  You are correct about the ejection fraction.  It can vary with exercise, etc.  It also really does not matter all that much as long as you have no heart failure symptoms.  Patients with lower EF's, however, <30 are at an increased risk of lethal arryhythmias and are more likely to benefit from ICD's.  Also, currently, we only recommend Bi-V pacers to those with low EF's (<30) and heart failure symptoms.  Fortunately, none of those apply to you.  EF's, therefore, are more for your physician so that he or she can follow your progress objectively.

[Bodoni]

PS: Thank you so much for giving your time on this site. Also, I forgot to add - I do not drink alcohol, no coffee and I do not smoke or hang around smokers. My genes could be better. I lost 2 older brothers to heart disease.

[wildcat27]

It's always disconcerting when a doc or anyone else mentions that ectopics can cause CM. It feels like we are always being told that these things are benign or that you have to have 20 or 30K a day for them to cause damage to the heart...and sometimes not even then.

Some clarification would be appreciated.

Thanks

[Gabby46]

The doctor said "very frequently" and probably meant in the 25-30thousand per day range.  That is the amount my electrophysiologist told me they start to get concerned with.  So if you are having less than that they are benign in an otherwise normal heart.