Questions on Echo/Catherization and arrhythmia's

[Mom2four85]

In 2009 I had an EP Study because I had roughly 50,000 pvc's; VT runs, shortness of breath, chest pain, recurring Syncope, Hypotension, Bradycardia and some EKG abnormalities that keep showing up such as multi focal pvc's, long qt, then short qt, low voltage QRS, non specific Septal T wave changes, nonspecific T wave abnormalities, IRBBB.

Exertion & exercise makes my symptoms worse (noted on my treadmill stress test).  I've fainted quite often for about 35 years - since age 9; both with and without exertion/exercise.

My EP ablated the pvc's and diagnosed me with malignant pvc's - Polymorphic VT, implanted a Pacemaker/ICD; due to long sustained runs of Polymorphic VT. A few hours after surgery, I developed PAC's and PSVT and within a few months frequent PVC's and VT came back.  

I was tested for ARVD and other infiltrative disease, but my MRI was inconclusive due to wall motion degradation. I had a tilt table test that showed when they gave me nitro I had no palpable pulse and my bp tanked - dx was neurocardiogenic syncope & orthostatic intolerance. All of my Xrays and CTA shows I have Cardiomegaly and vascular crowding.

I'm confused though; why do my echo's and catherization show my EF and CM so differently? and why could an echo be technically difficult to do?

My LVIS, LVPW and EF increased yet my LVESD and LA decreased; any idea why this would happen? Should I just accept the new echo that I'm "cured" of CM, DD and my other problems? should I ask for other tests such as MUGA, TEE, CT since my symptoms have not changed?

Different cardiologists & ep's disagree with the DX of ARVD, and I just need to find out what's caused all of this so I can have my children tested if it's genetic.

Can you recommend anyone in FL to go to who may look at all of my tests I've had done and figure out what's going on with me since I do have a complicated case?

Thanks for any help or insight you can give me. (listing my test results below for reference)

[Mom2four85]

thanks for the info =) I'll definitely see if he's in my insurance.

[tickertock]

I've seen Dr. John Rozanski 2 times In 87 & 92, he was rated on of the best EPs at that time. He now works in the Ft. lauderdale area as far as i know just type his name on google search, hope this helps, needless to say your case is quite complex and complex. Take care.

[Mom2four85]

thanks, they'll never answer - my question is too old and case too complicated - no reason to post here again

[is_something_wrong]

Bumping this for Lisa, she's doing a great job at the Heart Rhythm community and I hope a cardiologist may answer her question :)

[Mom2four85]

good to see we didn't break the dr's forum =)

[Mom2four85]

7/6/2009 Echocardiogram results:
LVEDD      44 (35-57)
LVESD      36 (23 - 40)
Left atrium 39 (19-40)
LVIS         12  (6-11)
LV posterior wall 11 (6-11)
Ascending Aorta 29 (21 - 34)
Mild Tricuspid insufficency
Trace Mitral valve in sufficency
Pulmonic valve was not well visualized due to a technically difficult 2D echo
Mild Concentric left ventricular hypertropy  with EF rate of 55 - 60%
Dilated left atrium with normal left atrial pressures
LV diastolic function: E/A 1.0, DT a140 msec, E' 10/cm/sec E/E' 8

3/17/2011 Echocardiogram - (notes: this is a technically difficult study)
LVEDD       46.2mm [35-56]
LVESD       27.4 mm [22-43]
Left atrium  30.5 mm [19-40]
LVIS          12.3  [8-12]
LV posterior wall 12.5 mm [8-12]
Aortic Root 31.2 mm [26-36]
EF 71%
Aortic Valve Velocity 1.30m/s

Left Ventricular Hypertrophy
Mitral valve regurgitation
Tricuspid valve regurgitation with a peak velocity of 1.76 m/s w/peak gradient of 12.3 mmHG
Estimated PA pressure is 22.3 mmHG

8/28/2009 Cardiac Catherization
Hemodynamic assessments demonstrates mild systemic hypertension and moderately elevated LVEDP.
The coronary circulation is co-dominant.  There was no angiographic evidence for CAD.
EF: 40%
Aortic Pressure (S/D/M) 120/70/90
Left Ventricle (s/edp) 120/34