Ejection fraction and PVCs

Thank you again for this wonderful forum.  I posted a couple of days ago, and thought maybe my question was missed.  Sorry if this caused any inconvenience.  F/45/cauc/slight build/normal wt/BP normally 100-110/55-70; 20+ year HX of MVP/MR and PVCs.

TEE ('00) MVP (anter > post) moderate 2-3+ post. directed MR; normal LV function; EF 55%.

Stress echo ('01) functional capacity normal; no signs of ischemia present. EF 55%.

Holter ('01) showed 92459 QRS complexes, 22531 Ventricular ectopics; 4419 isolated; 2517 couplets; 4 triplets; MANY episodes of bigeminy.

Stress echo (Dec. '02) functional capacity normal; no signs of ischemia; max HR 97%; 8.5 METS; level of stress achieved, imaging showed evidene of a cardiomyopathic process in the entire left ventricle; baseline EF 40%; stress ejection fraction increased; at rest, there is evidence for mild post. leaflet MVP and at least mod. MR on color doppler.  Info is consistent with cardiomyopathy.

Began Flecainide in hosp. (Dec readings may have been affected by frequency of PVCs). Repeat echo -EF 45%. Normal stress test.
Potassium/magnesium good.

Are you aware of any study that frequent PVCs can lead to cardiomyopathy?  Staying on RX and repeating echo in April. Dr. will decide what next (ace inhibitor/flecainide/ablation/other). I have had MVP MR and frequent, consecutive PVC complexes for years, but EF has always been normal. Dr. said because EF increased upon exercise, MVP was not the cause. I have an event monitor for any new arrythmias or unusual feelings. Appreciate any comments/suggestions. THANK YOU : )

[CCF-M.D.-RCJ]

Momto3,

Please refer to my post for your 2/6 question.

Given the further information you have provided, you need to seek a second opinion very soon.  There is every reason to expect that the decline in EF is from the MR, and this needs to be addressed in a timely fashion, and certainly before April.  We frequently see patients at the Cleveland Clinic who tragically were not directed to a mitral valve repair in a timely fashion and who subsequently suffer from unnecessary illness.

Furthermore, flecainide is not recommended, and in fact is contraindicated, in someone with a declining EF.  Seek another opinion before considering this drug.

I would STRONGLY encourage you to seek another opinion from a major medical center.  I would be happy to accept an email from you at my email address (***@****) to help you with your decision and to guide you to a center in your area.

[TSC]

Your question was probably not missed.....maybe they have just not had time yet to answer it.