holter results, cardiomyopathy

[bml]

I recently wore a holter monitor, The results were basic rhythm sinus bradycardia, heart rate range from 41 to 95 with a mean of 59. There were 46003 total beats of which there were 2122 ventricular ectopic beats of which 2049 were single isolated ectopics beats and there were 35 pairs of ectopic beats and one run of 3 ventricular ectopics beats at 77bpm. there was one single supraventricular ectopic beat. I was on on 20mg of lisinopril and 6.25mg of coreg bid. 10 months ago before i was on no medication my holter had a few hundred less ectopics single and couplet but no runs of 3 or more. I'm concerned that I've gotten more of them since i started medication and i question putting the defribultor in if my condition is just going to decline leading to numerous shocks from the defribulator. Other then getting tired from the coreg which has since been upped to 12.5bid I can still walk 4 miles a day and have no sob or other symptoms. Before diagnosis I ran 4 times a week. your thoughts would be appreciated.

[CCF-M.D.-MJM]

Hello,

I understand your concerns.  We don’t usually view holter monitor data in that way.  As many people on this forum can attest, there are good days and bad days for PVCs – there are even good weeks or months and bad weeks or months.  I don’t think 2 24 hour holter monitors indicate that your disease is progressing.

Regarding the defibrillator – an ICD would not concern itself with only three PVCs in a row.  Use the Medtronic ICD as an example – you have to have 16 of 18 consecutive beats in the ventricle at a fast rate for the device to recognize the VT and start to charge.  After it starts to charge there is an additional 5-8 seconds while it charges for it follow the rhythm and decide to shock or not.  PVCs alone will not cause an ICD to shock.

Coreg is shown to decrease ventricular arrhythmias.  It is one of the most important medications you can take for a cardiomyopathy.  I would not stop it.

I hope this answers your questions.   Thanks for posting.

[Momto3]

You mentioned that a holter recorded 46003 beats.  Was that for less than 24 hours?  Otherwise, that seems low, and would not be indicative of an avg. HR of 59.  

Your subject line reads "holter results, cardiomyopathy."  Are you taking lisinopril and coreg for CM?  

Are you supposed to be getting a debibrillator b/c of the CM?

Were you symptomatic at one time?

Hope you are doing well today  : )

connie

[bml]

I think it was 23 hours. I take the medication for cm with an ef estimated 30-35. I never was symptomatic.

[Momto3]

46003 beats in 23 hours sure seems low to me.  I'm not a doctor, but I've had a lot of holters and my recorders used to calculate around 95,000 heartbeats in 24 hours with an avg. HR of 61. I think my HR range was around 41-116.  I'd have to look that up to get the exact numbers, but it was somewhere very close to that.  As I recall, the "average" heartbeats in a day is right around 100,000.  Maybe the 46003 is the indicator of the bradycardia???

I'm always amazed when I hear that people can develop cardiomyopathy (me included) and not have any real symptoms.  How did you find out about the CM?  Mine was "discoverd" on a routine echo for a leaky mitral valve.  Definitely a shocker!  Any idea why you ended up with CM?  

Just curiors, did you have any difficulty with dizziness when you first started on the lisinopril?  It took me about 4 months to adjust to lisinopril.  Now, that it is the right dose and I've been on it for over a year, it doesn't bother me at all.  Whew!

[bml]

mine was discovered on a routine echo after my older brother died suddenly. he was sedentary overweight high chlorestoral heavy smoker all of which i am not however there was no autopsy so we dont know the exact cause of death and there doesnt appear to be any cm in prevoius generations. the lisonpril has been ok but the coreg tires me out.

[Carolina03]

Hi,

How does your cardio treat your cardiomyopathy? What's your story, i.e., have you experienced significant symptoms?

I ask because my echo last June revealed mild right ventricle systolic dilation and dysfunction which came to light after my third pregnancy. I was very symptomatic during the last months of my pregnancy, but never enough to warrant hospitalization, bed rest only.

Thanks, and hope you're feeling well.

Carolina

[Momto3]

When the CM was first diagnosed, I was put on anti-arrythmics (frequent pvcs caused the CM).  There was some talk of adding an ACE and/or BB, but since the doctor was almost certain that pvcs were the cause, we watched/waited.  I took the RX religiously for about 7 months.  After I realized I would have to take the anti-arrythmics for the rest of my life, I decided to see if ablation(s) could help.  I was multi-focal, so they were pretty sure it would take more than one procedure.  It took two procedures, but today my EF is back up to 60% (from 40%) and my most recent echos show no lingering CM.  Truly a miracle cure for me.

Prior to diagnosis, I didn't notice any symptoms, but a couple of months into the diagnosis, I started to have swelling and was absolutely exhausted.  I was very short of breath about 1-2 yrs before the diagnosis, but the cause was never discovered and after several months, the SOB went away. During that time, EF was normal.  Somewhere between an echo in January 2002 and December 2002, my EF plumeted and I was diagnosed with CM.

Since the ablations, my BP jumped up above where the doctor wants it to be.  Now, I am back to taking an ACE everyday. She mentioned adding a BB, but since BP is good now, mum's the word on taking the BB everyday.  I can still take it for symptomatic relief of pvcs, but those days are far and few between now.

Are you taking an ACE and/or a BB?  Does your doctor think your CM was related to the pregnancy?  Or, was it just coincidental that you were pregnant when it was diagnosed?  When is your next echo?  I go for echos every 6 months to watch a leaky valve and to be sure the CM does not recur.  I had the ablations in 2003 and my last echo in Nov. 05 still showed EF of 60%. Since I didn't have any real symptoms prior to the CM diagnosis,I get pretty nervous when it's time for a check up.

Three kids and bed rest....uh huh : )
Take care and hope you are doing much better.  

Connie

[jeff 67]

My EF was once 65%, then it went to 80%, then on the last test it was 51%.  The last one had me worried except that I achieved over 14 METS on a stress test at the same time, so I have no idea what it all means!

[tickertock]

In 4 and a half years my Ef went from 70-75% to 53%, that was on the echo printout,though my cardio said he estimated it at 55-60%, I asked him why the drop, he said it can vary even from day to day and is of no significance once it doesn't fall below 50% and you don't indications of dilated cardiomyopathy. I also think my so called PVCs are probably most likely to be PACs with aberrant conduction.Does anyone know if the computerised ECG print can distinguish between PVCs and PACs with aberrancy?

[jeff 67]

I get PACs with aberrancy.  I guess if you get pauses after the ectopic then it is more likely to be PVCs.  If sinus node is reset (no pause), then it is likely to be PAC.  Do you feel the pauses? It can be easy to see them on the trace since if you get an abnormal QRS which is early and proceed by a P wave then it is very likely to be a PAC with aberrancy.

[tickertock]

I get both, though last time it was only documented as PVCs.Sometime I get a pause, then a thump, sometimes a double beat. I know most times with aberrancy a small p wave can be seen, sometimes as I understand it is almost indistinguishable to tell, I know that in general PVCs are usually more symptomatic than Pacs, but I understand in some that has both sometimes they are more bothered by PACs, I guess it just depends on the individual.

[Carolina03]

Connie,

I'm sorry I missed your reply! Yes, I'm on an ACE and was ORDERED to start taking a BB last week. I tried it and felt terrible. It really makes me feel tired and ill, but my doctor called again today saying he really wants me on it. I had worn a Holter monitor which revealed some runs of tachycardia and PVC's.

I have echoes about every six months.

Thanks for your reply! And you're right about resting w/ three kids ... NOT!

Carolina  :-)