PFO/PAC's

35 Year old female, now 7 months postpartum with third child.  Six days postpartum I had afib that lasted one hour and converted on its own in the ER.  Three days later had afib again only for about 10 minutes.  Event monitor showed 1 minute of afib, PACs with aberrant conduction, 1 interpolated PVC.  Doctor put me on 25 mg. Toprol XL, no additional episodes of afib since.  Echo with doppler shows pfo with small left to right shunt.  All other tests normal except for inverted t waves and ST segment depression on thallium stress test, no perfusion defects. EKGs still show inverted t waves and 1mm st depression in leads II, III, AVF, V3-V6.  Now having daily PAC's and PVC's.  Holter monitor showed 13 PAC's and 2 PVC's in 24 hours.  Doc suspects that afib was caused by hormones, strain of childbirth.  My questions:
1.  Can pfo be opened during the strain of natural childbirth? I had no epidural this time and pushed extremely hard.
2.  PACs never noticed until after starting metoprolol to control afib.  Could metoprolol be causing extra beats?
3.  Is there any significance of inverted t waves and st depression even though perfusion images were normal?
4.is it safe to wean off and see what happens?
5.  Why would the afib/PACs/PVCs suddenly start after the birth of my third child?
6. If I lay down suddenly or bend over quickly, I can cause PACs to start.  Could this be mechanical?  Holter monitor confirms more ectopy when laying down.
7.Could I die from these extra beats?
8.Is PFo causing this?
Two cardiologists have told me I will not die, but I am consumed with this.

[Cleveland Clinic]

finetilthree,

thanks for the post. Congrats on another child.

1. Can pfo be opened during the strain of natural childbirth? I had no epidural this time and pushed extremely hard.

PFOs are very common. It is possible that a shunt through a PFO could happen with strenuous activity. None of the symptoms you mention could really be attributed to a PFO.

2. PACs never noticed until after starting metoprolol to control afib. Could metoprolol be causing extra beats?

Some people have more PAC/PVC at a slower heart rate. It might be possible that the motoprolol could contribute in this way.

3. Is there any significance of inverted t waves and st depression even though perfusion images were normal?

It is a finding on the ECG. If it is not dynamic and you've had an ischemic evaluation, there really is no significance.

4.is it safe to wean off and see what happens?

I cant make specific medication recommendations without seeing you in person. Usually its not an issue.

5. Why would the afib/PACs/PVCs suddenly start after the birth of my third child?

Hard to say. I would make sure your thyroid is ok. Most of the time we dont know why people develop PACs and PVCs or why they fluctuate over time.

6. If I lay down suddenly or bend over quickly, I can cause PACs to start. Could this be mechanical? Holter monitor confirms more ectopy when laying down.

Changes in position can cause fluctuation in the filling pressures of the heart and positional changes in the thoracic structures. one could postulate that either could play a role.

7.Could I die from these extra beats?

No.

8.Is PFo causing this?

No.


good luck

[finetilthree]

I omitted the word beta blocker in question 4.  Thank you so much for your time.