PVCs doublet and triplets with exercise stress test

[De__0__0]

  Thank you very much for your answer to my earlier question.  I'm still just a bit confused, and would like a little clarification.  I want to be sure I ask the right questions when I go to the cardiologist in a few weeks.
  First, I have no objection to just living with the PVCs as long as they are benign.  I have read information that said only when they come in pairs or triplets or runs are they considered a problem.  The exercise stress test I had done years ago did show PVCs in pairs and some triplets, no runs longer than triplets.  That doctor advised me to medicate because of the pairs and triplets.  I did for a while, but quit on my own due to side effects with lowered bp, brachycardia, and increase in asthma.
  Are PVCs still considered benign even if they occur in pairs, triplets when provoked by exercise?  Stress test was done many years ago, doc or results no longer available.  Should this test be repeated, or is it fairly safe to assume that exercise will be no problem for me since I've had only mild symptoms.
  Is mild mitral and tricuspid regurgitation something that should be followed up long term by cardiologist?  Does this regurgitation mean MVprolapse or is there always some mild regurgitation even in normal valves?  The echo does not mention prolapse, only mild regurgitation in mitral and tricuspid valves and mild atrial enlargement.
  Finally, what does trace pulmonic insufficiency mean....is this normal or could it progress?  Could this be related to asthma?
  Thanks so much for your service to the community!
  If everything is OK...I'd much prefer to just live with the symptoms!

[Cleveland Clinic, MD]

Dear Dee,
Thank you for your question.  We get many questions about PVC’s and you can find previous answers on this web site.  Below are answers to your specific questions and a brief summary of what a PVC is, what causes them and the treatment (if any) for PVC’s.  You can find additional information in an article in New England Journal of Medicine, May 7, 1998, Vol. 338, pages 1369-1374. Your local medical library will have a copy of this.  Hope this helps.
Q: Are PVCs still considered benign even if they occur in pairs, triplets when provoked by exercise?
A: Yes.
Q: Stress test was done many years ago, doc or results no longer available. Should this test be repeated, or is it fairly safe to assume that exercise will be no problem for me since I've had only mild symptoms?
A: This would be up to your doctor.
Q: Is mild mitral and tricuspid regurgitation something that should be followed up long term by cardiologist?
A: Either a cardiologist or an internist with an interest in cardiac problems.
Q: Does this regurgitation mean MVprolapse or is there always some mild regurgitation even in normal valves? The echo does not mention prolapse, only mild regurgitation in mitral and tricuspid valves and mild atrial enlargement.
A: Mitral valve prolapse is only one cause of mitral regurgitation (valve leaking) but not all regurgitation is due to mitral valve prolapse.  Other causes include valve calcification, degeneration, congenital, etc.
Q: Finally, what does trace pulmonic insufficiency mean....is this normal or could it progress? Could this be related to asthma?
A: This means leaking of the pulmonic valve (opposite to the mitral valve).  Trace amounts are nothing to be concerned about.  It could progess and is not related to asthma.
Below is further information about PVC’s.
    PVC’s (premature ventricular contractions) are "extra" heartbeats occurring out of sync with the normal regular rhythm of the heart.  PVC’s may cause no symptoms at all or may be felt as a "irregular" heartbeat or as the sensation of a "hard heartbeat".  PVC’s  are common findings in persons with otherwise normal hearts, in which case the prognosis is excellent and there is no decrease at all in life expectancy.  On the other hand, they may indicate that there is an underlying abnormality of the heart muscle (from any number of reasons).  If there is an abnormality, then the prognosis and treatment depends upon the specific problem of the heart.  The usual evaluation of PVC’s is a history, physical examination, and electrocardiogram (ECG).  Also your doctor may wish to check an ultrasound of the heart.  If all those tests are normal, then you would fall into the category of people who have PVC’s but otherwise no underlying heart problem. In that case, treatment depends on how much the PVC’s bother you. If they are essentially asymptomatic, then no treatment is required. If they bother you, then a medication called a "beta-blocker" may reduce the frequency of the PVC’s. PVC’s can’t be "cured", but the medication can decrease their frequency. The potential side effects of beta-blockers are tiredness, impotence in men and breathing difficulties in individuals with underlying lung disease.  Be sure to discuss these issues with your doctor and under no circumstance should you take medications for the heart without the supervision of a doctor.
Below are some web sites with additional information about PVCs.
http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/prevent.html
http://www.nhlbi.nih.gov/nhlbi/cardio/other/gp/arrhyth.htm

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist