PVCs, dialated left ventricle, many questions.

[gismatrix]

I am 33 year old male...6'4" and 238 pounds. I have had 2 ablations for AVNRT SVT tachycardia last year, May and July at UPMC. No more SVT that I have noticed since second procedure.  After the second procedure I developed a PE. I was on warfarin for 6 months and then in Jan 07 I went to a hemotologist and had many tests that were ok, so I stopped warfarin. At the same time, due to daily aspirin and severe anxiety from heart issues, I developed gastric and duodenal ulcers. I went on protonix and was fine in a few weeks. In October 06 I had more abdominal symptoms, had upper endo to reveal small ulcer. I took more protonix and was ok again. I was put on Klonopin for anxiety around that time as well. I also have PVCs, which I always have had a few here and there since I can remember, but they are much worse now...and have been much worse since the SVT appeared in Feb 06.  I have bad pvc attacks and bigeminy, trigeminy at times (usually when I first wake up and a half hour after I eat until about two hours after I eat). I have had MRI for ARVD that was negative.  I have had gastric emptying study which was normal, and a repeat endoscopy showed everything healed and a small hiatal hernia. Had ultrasound for gall bladder/pancreas which was unremarkable.  Had HIDA scan that showed normal gall bladder emptying.  I should also mention that I have had MRI/MRA for headaches I have been having and they revealed nothing remarkable.  An Echocardiogram I had one year ago showed a a left ventricle end diastole measurement of 5.9 cm.  I had another echo 6 months later that indicated the same measurement at 6.3 cm.  Wall thickness measurements and atrium etc... all within normal size limits.  My ejection fraction was 50% and 49% respectively.  The MRI in August of last year showed a EF of 49%.  For over a year I have not had caffeine, or alcohol, and I never have smoked.  I started on Toprol (100mg) six months ago and also take an ACE (20mg)  Here are my questions:  PLEASE SEE NEXT SECTION BELOW:

[Forum-M.D.-bkj]

gis,

thanks for the post.  You need to

1. Is is possible that my PVCs are not benign due to the dilation of my left ventricle? If so, what are some possible causes? I have had alot of tests...had stress test that showed no blockages last year too.

Some people develop cardiomyoapies that are not related to blockages in the  followed by a heart failure specialist. Unless you were having longer runs of PVCs, which would be ventricular tachycardia I wouldnt focus too much on it.

2. Based on what I have written, am I in a severe risk group for SCD?

I have no idea unless I would have all of your information available. Im sure these things have been discussed with you by multiple physicians. If you needed a second opinion, any of the CCF heart failure specialist would be helpful to see.

3. Is my enlargement considered severe or is it only mild?

Without reviewing your data, I cant comment.

4. If the PVCs are causing the enlargement, then what treatment do you recommend? How would you confirm that the PVCs are the cause of the enlargement if that is so?

Unless you were having long period of time where you were having abnormal rhythms, frequent PVCs shouldnt cause enlargment but are more likely a result of it.

5. Is the correlation with eating just a coincidence, or could there be some issue like portal hypertension or a bowel obstruction or something that is obstructing blood flow? I do notice a significantly raised heart rate after eating about the same time the PVCs start to flare up. I have also heard that vagus nerve issues could be causing this...what are your thoughts on this?

Sounds unlikely with all of your negative test. I think you are overly focused on your PVCs.

6. Even with the enlargement of the ventricle, do you think exercise would be ok...and/or helpful in my situation? What exercise regimen do you recommend for your patients with similar issues?

I can't make specific recommendations about exercise.

7. What other medications would you use as a next step to try to better control the PVCs...my EP doc has recommended tikosyn...also would you recommend ablation in my case?

I can't make specific recommendations about medications.

8. Is there any type of systemic infection that could be causing this? I have had alot of testing, but I figure it is worth asking. I work in the environmental field and have been exposed to arsenic, and a co-worker had a bad case of MRSA.

Highly unlikey.

good luck

[gismatrix]

HERE ARE MY QUESTIONS:

1.  Is is possible that my PVCs are not benign due to the dilation of my left ventricle?  If so, what are some possible causes?  I have had alot of tests...had stress test that showed no blockages last year too.

2.  Based on what I have written, am I in a severe risk group for SCD?  

3.  Is my enlargement considered severe or is it only mild?

4.  If the PVCs are causing the enlargement, then what treatment do you recommend?  How would you confirm that the PVCs are the cause of the enlargement if that is so?

5.  Is the correlation with eating just a coincidence, or could there be some issue like portal hypertension or a bowel obstruction or something that is obstructing blood flow?  I do notice a significantly raised heart rate after eating about the same time the PVCs start to flare up.  I have also heard that vagus nerve issues could be causing this...what are your thoughts on this?

6.  Even with the enlargement of the ventricle, do you think exercise would be ok...and/or helpful in my situation?  What exercise regimen do you recommend for your patients with similar issues?

7.  What other medications would you use as a next step to try to better control the PVCs...my EP doc has recommended tikosyn...also would you recommend ablation in my case?

8.  Is there any type of systemic infection that could be causing this?  I have had alot of testing, but I figure it is worth asking.  I work in the environmental field and have been exposed to arsenic, and a co-worker had a bad case of MRSA.  

I apologize for all the questions, but I have tried for over a year to get to ask a question and finally won the question lottery today.  Thanks so much for this service and your very valuable time.  I really appreciate it.

[anacyde]

I'm sorry about your findings, I had similar (pregnancy-related).  I know how worrisome it can be and how it makes the palpitations scarier.  In light of normal Holter monitors, my doctor encouraged normal physical activity and exercise but said NO WEIGHTLIFTING, nothing that made me "grunt".

It sounds like you have many questions regarding your health, understandably so.  I know I did.  I suggest jotting these down on a post-it note and taking it with you and giving it to your doctor.  I do that, and my doctor keeps them in my file.

Good questions to ask are probably:

Can I exercise?
Is this reversible?
Am I on all of the appropriate medications?
Are my PVCs considered benign?

I know you want answers, something to wrap this into a neat package.  I think we all do.  Try not to overthink it though, trust me.  

If you want to know exactly how enlarged your heart is for you, you can calculate it using your BSA (body surface area) and end diastolic dimension.  Just divide your EDD of 6.3 by whatever your body surface area is.  You can Google a BSA calculator easily, just keyword "BSA Mostellar Calculator" and a few will undoubtedly pop up.

Normal less than 2.7 cms per meter squared body surface area.

[Fran71]

Hello, I too tend to get lots of PVCs after meals, unless I take the beta blocker right before the meal. I get a fast rate with them. I also notice I do get some PVCs as I wake up. Maybe it's about hormonal cycles? I've never been checked for GI problems but I don't seem to have trouble with digestion. I was told that digestion increases HR in everyone. Some are moe sensitive to this and have a higher increase. In my case, when my HR increases I usually also get PVCs

Hang in there

Fran

[gismatrix]

Thanks for you comments and suggestions.  I will calculate my BSA and see what that gives me.  I am rather big (tall and well, not thin) so maybe that will help me put things into perspective a little more.

I know worrying about it makes things worse.  I posted a question on another board and someone wrote in that i could have a year or a week to live since the lisinopril I am on is exacerbating my heart enlargement.  I am hoping he is terribly wrong.  If so, that is upsetting to me that someone would write that without being at least educated through experience as are the people here on this forum.  

PVCs suck, but I've gotta somehow carry on...and hopefully reverse some of this and get better.

[anacyde]

Lisinopril is prescribed for people with dilated cardiomyopathy, among other conditions.  It is an ACE Inhibitor and a first line TREATMENT for an enlarged heart.  It's probably the best thing for you.  I don't know who wrote that it could be making you worse and killing you but can I suggest never going to that board again?

ACE Inhibitors make it easier for the heart to pump, reduce the workload on the heart and thus allow a weakened heart more of a chance to heal.  It's actually a wonderful medication given the benefits it can provide for people who need it, please don't let some random person scare you like that.  Your doctor knows what he/she is doing by prescribing this for you.

[GreenEyedMama]

im a 20 female slightly overweight.i get weird feelings in my chest .a somewhat sudden heart jump off beat,my heart feels weird ,the only thing i can do is to make myself burp all day,it happens most times after food or caffine.i dont think it has to do with my stomach.i get it more and more now its all day every day.the other day my heart jumped i felt heat go up my back then a sudden sharp pain in my head.please help me !!!!!!!!!!WHATS WRONG with me i havent found any that has to make trhem selfs burp like i do!!!!!!!my stomach feels fine.i dont think my stomach has anything to do with it.my back hurts like hell

[Fran71]

Hi anacyde, do ACE inhibitors work for PVCs as well? I never heard doctors prescribe them for PVCs but I was wondering, since you said they reduce the heart's workload. My PVCs seem to increase when my heart is under stress, with increased heart rate (but I have no cardiomyopathy). Just wondering, in case my BB ever stops working...:-)

Thanks

Fran

[mary2]

ACE inhibitor are not prescribed for PVC. They are used for cardiomyopathy, heart failure or hypertension. Beta blockers and  calcium channel blockers are most commonly used for PVCs. There are also antiarrhythmic agent, in case everything fails, and of course ablation.
So there are many options left.....

[Fran71]

Thank you very much for the encouragement! My cardio mentioned he would try antiarrhythmics if the beta blocker ever stopped working for me. He never mentioned calcium channel blockers (great to know there would be another option to try!). He wouldn't like to do an ablation because my PVCs come from the left ventricle and he said that might be dangerous.
I know I'm making the same old mistake of worrying ahead about things that might never happen. Maybe the BB will help me all my life, maybe my PVCs will get better, as I can go for months without them so who knows...
Let's all hope for the best!

Fran

[mary2]

The only time calcium channel blockers are not adviced is if you EF is low.
Left sided PVCs are more difficult to reach but if neccessary can be done. My husband had PVC ablated on the right, but they also check everyhing on the left side. They were even ready to go into pericardium if PVC would be coming from more surface myocardium. No problems.
The important issue is if you have 'only' symptomatic PVCs in structurally normal heart (in which case it is not worthwhile doing ablation since they do not do any harm) or do they cause ventricular tachycardia or cardiomyopathy (in which case you may want to find a very experienced EP doc that did many ablations; not your 'usual' EP doc). In 90% of the cases is the former.  I understand your concern but if you have structurally normal heart you will be fine.

[Fran71]

That's it. I only have PVCs, no VT or other issues, so that's why my cardio almost laughed out when I mentioned ablation. I'm glad your husband had a successful ablation!
I'm not really scared by PVCs anymore - though they do cause some anxiety when they strike - but I'm worried about my quality of life, if the BB should ever stop working for me. Of course I know rationally that it's pointless to worry in advance...LOL

Thanks for listening!