pvc, ejection fraction

[bml]

How do pvc's affect the ejection fraction on echo's ? Will they tend to raise or lower the ejection fraction?

[Cleveland Clinic]

bml,

Generally the clips on an echo are gated to your ecg. A PVC could potentially cause a mild abnormality in the way the heart beats on an echo but shouldnt not have a great effect on the interpretation of your overall ejection fraction.

[jeff 67]

Strange ... I thought the heart was a very inefficient pump when you have a PVC (apart from the fact that it is premature and not pumping the normal voulme), so it is odd that it would not affect the EF assessment (assuming it was being made on a PVC).

[Karonnie]

I believe that if the damage has already affected the heart's muscle the's a point where some of the damage is irreversible - seperate from the valve damage.  That's why they usually try to do replacements before the EF goes below 55% but with some diseases this is not possible because the EF is affected much more quickly. I'd be happy to hear i'm wrong - i'm in the process of finding out about mine.........

[mmfd]

That's a good point Jeff.  But, since the heart muscle we're talking about is normal, the PERCENTAGE of blood ejected would still be good.  The EF is the percentage of blood ejected with each contraction.  I would guess that the volume is slightly lowered very momentarily and thus maybe the cardiac output as well?

[Momto3]

I asked a very similar question a couple of years ago....Here is part of my question and the relevant part of the doctor's response.

Are you familiar with any study that supports the theory that a high frequency of PVCs could cause change in EF?

CCF-M.D.-RCJ
02/08/2003

PVCs can lead to a real drop in EF if they are so frequent as to cause a fast heart rate, or they can cause a "pseudo-drop" in EF if the echo clips all contain PVC beats and not normal beats.

[upbeat63]

I am unclear as to whether or not there is a connection between PVCs and decreased EF or cardiac output, can anyone provide an answer. My stress-echo in July was "normal" but they refused to calculate EF, "normal is normal" they said.

Momto3, the doc's response to your question seems to indicate "psuedo drop", do you think that means "it appears to drop, but that it is actually ok"?

I have frequent PVCs and currently have constant trigeminy that BBs now do not seem to decrease. I have frequent, but momentary bouts of dizziness throughout the day and I am begining to be unable to concentrate and I lose my words. Very distressing. Of course I'm hoping it's either anxiety, or mental-pause due to premenopause. But it seems to happen more and more.

So is blood being pumped sufficiently with the PVC or not? I am now wondering if my oxygen levels are low because of the frequent PVCs and hence the momentary dizziness.

Does anyone know how quickly a cardiomyopathy can develop if it were to develop because of high frequency PVCs (again, the echo in July was "normal")

Thanks so much, I'm trying to remain upbeat, but sometimes it's hard.

[Karonnie]

Sorry my comment was in reference to PVC replacements - obviously the initial post was not about those from the latest threads!!!

[Momto3]

I don't think there is a true connection between pvcs and and decreased EF.  However, I can tell you that my EF went from normal (55-60) to 40 between yearly exams.

If I understood the doctor correctly, "psuedo drop" would indicate that, as you said, the EF "appears to drop," but, in all actuallity is OK.

I get routine checkups including echo annually.  In January 2002, I had a normal echo (EF 55-60) and a holter which recorded over 22,000 pvcs (24% of my beats were ectopic).  At my next checkup, nearly one year later, my EF had dropped to 40%.  I had a couple of follow up echos over the next month, and they were all the same.  

I didn't have any dizziness until I started on medication, but defintely tired easily, was short of breath (like when I'd walk up a flight of stairs), had slight ankle swelling, and difficulty concentrating.  Since ablations, the SOB and swelling have resolved.  I still tire easily and have some difficulty concentrating, but that may be due to periM. Not sure.

I had pvcs in the thousands for many years, and it wasn't until that one checkup that my EF changed.  Over the years, previous reports were normal.  In general, I believe the blood is being pumped sufficiently despite the pvcs.  I'm not sure why the chronic pvcs became a problem when they did.

As for how quickly a cardiomyopathy can develop - for me, it was about 11 months between a normal exam and one which showed CM.  However, prior to that, I had many normal echos despite the high frequency of pvcs.  I don't think it is a typical course to go from high frequency PVCs to CM.

It's a real balancing act, knowing when to follow up and when to sit it out.  If I didn't have mitral regurg, I doubt I would have had yearly echos and the CM may not have been "caught" when it was.  I've been told that new and/or change is symptoms warrants a call to the doctor.  Hope that helps you to get back to being "Upbeat"!

[upbeat63]

Thank you.

While I'm fatigued, all the time, I have pretty good exercise tolerance, and no swelling. I have a suspicion the increase in dizziness is that I have been taking toperol daily to try and end a constant trigeminy pattern.

Even though it's only 12.5 to 25 mg of toperol, I think I'm pretty sensitive to it. I might try a different BB. I seem to think you took Inderol, momto3, and I have heard others say atenolol worked well for them. Maybe some experimentation is in order.

I'm hoping the SOB and concentration problems are either anxiety or periM too. But, jeepers, I just can't seem to shake the trigeminy right now, so having anything else in addition to PVCs is maddening. Most days I don't mind them, some days aren't so great.  But every day is a new opportunity. I'm very upbeat when I get 5 or 6 regular heart beats in a row without any PVCs. I'm ecstatic when I get 10--It doesn't take much to make me happy!

Momto3, do you think that your combination of mitral regurg and the high frequency was the reason for the CM? I'll get another echo in late spring to keep an eye on things. Thanks again everyone, you all help to keep me sane, especially you momto3 my PVC twin.

[Momto3]

Hello there : 0

I have also been dealing with more than normal fatigue, and I was actually very nervous prior to my echo in November.  I kept thinking, not again!  Thank goodness, my EF and other cardiac numbers were great!!  So, I'm leaning toward periM...blah!

I've tried a couple of different BB's and Inderal worked(s) best for me.  Atenolol was a disaster for me...weird since so many have good luck with it.  Within twenty minutes of the very first dose, I started shaking all over.  I was scared to death! Called the doctor and he said the RX was having an effect on my central nervous system.  He advised me to stop taking the medicine and sleep off the initial dose.  (NO need to tell me to discontinue!!!  Like so many others on the board, I seem to need very little medication (low doses) for positive effects.  So, it wouldn't surprise me to find out the toporol is causing the dizziness (despite the low dose).  Last year, when I started taking lisinopril, it took me about 4 months to get past the dizziness...ugh! The first several weeks were tough, and each time I would "adjust" the dose was increased until it reached a point where it was most effective.  Now, it doesn't bother me at all.

My exercise tolerance and ankle swelling was "late in the game," and real subtle at first.  Sounds like you know what to watch for and have a healthy attitude toward your own healthcare.  WTG!

Yeah, the periM stuff slammed me at the same time my pvcs were nearly constant.  Like you, I had them ALL day...they were chronic and most of the time didn't bother me, but some days were pretty crazy.  It makes me laugh (in a good way) when I read about having 5-10 normal beats in a row!  What a luxury that was!!  I felt the exact same way.  Funny story -- After my ablations, my doctor was listening to my heart and said, "I think that's the first time I've ever heard your heart in sinus rhythnm.  I listened for about 30 seconds and you didn't have one pvc!!"  I can SO relate to your comment!  LOL

The doctors do not think that my mitral regurg played any role in the CM.  Initially, that's what the thought, but as they did more tests and such, they became focused on the high frequency of pvcs.  My doctor took my case to a number of conferences around the country, and had a "world expert" review my file and the consensus was that it was the pvcs.  My EF went up gradually, from 40 to 60 percent and has remained there for the last several echos.  

Take care and stay UPBEAT!! Your PVC twin : )
connie

[upbeat63]

It's nice to know you were a celebrity of sorts, at least your heart, world conferences and all!

But I'm betting you prefer the "lack of attention" you get now because you have much fewer PVCs and a better EF!  

Hope it stays that way for a long long time, if not forever! Thanks for the support and information.

[Momto3]

You've got that right!  That kind of fame I don't need : )

[4paws4me]

Sorry to hijack.  Haven't checked in for a while.  I'm also a mom to 3 (humans) and several (currently, 7) canine and feline creatures.  Also named Connie.  35-40% EF with dilated cardiomyopathy due to constant, frequent ectopy over a long period of time.  I'm a little scared of the ablation.  ICD was implanted in 2002, but haven't been "under the knife" since then.  I see the doctor 9 February.  I need to come to grips with the fear before then.  I need to make the right decision.  It gives me a great feeling to know that you had such a good outcome.

[Momto3]

WOW!!  A triplet (to Upbeat and me)!!  The similarieites are uncanny!!!  I can tell you that prior to the first ablation I was scared outta my mind.  I'd never been "under" except for when I was very young and that was with ether!!  They don't even use that anymore.  I was given plenty of "take me away" medicines and got through both procedures well. Each procedure lasted around 6.5 - 8 hours and it felt like twenty minutes.  If I understand correctly, an ICD comes into play when you drop below 40%.  Does that correlate to what you have been told?

Oh, before I forget -- yep, I'm also mom to 3 (humans) and 1 big canine!  This is off the subject, but my dog just had his pericardial sac (around the heart) removed!!  It was so weird hearing all the familiar terms for my youngest "baby."  He had thoracic surgery and was in ICU...It was nice to be able to understand the doctors' explanations and drawings, but it was scary too.  Fortunately, he is doing great!  Has much improved appetite and excercise tolerance.  Sorry, I digress.....

AND, your name is Connie?  WHOAH!!!  Did your doctors conclude that it was the chronic ectopies causing the CM?  I was told that was a very rare occurence, but that it can happen in the setting of very frequent ectopies.  I'm here to tell ya....it happens, but there is hope : )   Are you an antiarrythmics?  I tried flecainide and rhythmol.  I figured it was only temporary, so when the doctor said I'd be on them forever, we started pursuing the possibility of ablation.  It worked wonderfully for me.  I'm glad to hear that my story gives you some hope for a positive outcome!  I had my ablations done in Cleveland, but not at the CCF, though I do have doctors there too.  It has been 2.5 years since the first one and a little over 2 years since the second and still only have an occasional pvc.  After being in constant bigeminy, trigeminy patterns, it was very strange to adjust to my NEW heartbeat....Now, I like it : )

Good Luck!!  Please keep us posted.  Feel free to ask anything about the ablations....no question is too silly.  If you're worried about something, maybe I can tell you how it was for me...If it helps, I'd do it again, in a heartbeat if I needed to.

Take care
Connie

[4paws4me]

The similarity is frightening. I, also, have mitral valve regurgitation, but never had problems with it - didn't even know I had it until my first echo after I was already in heart failure.  I was diagnosed with idiopathic CM with EF of 35% in 1999.  Holter Monitor showed 40,000 PVCs/24 hours.  Told to expect decompensation and that most die within 5 years.  I was put on Coreg - nothing else.  Over a three year period, EF increased to 40-45%, but felt terrible and had episodes of syncope.  Doctor ordered another Holter with same results and referred me to an EP doctor in Columbus, Ohio.  During EP study, they provoked an episode of NSVT, debated ablation, and finally decided to implant an ICD and put me on sotalol and accupril.  Interestingly, during the EP study, my EF was calculated to be 28% - after consulting my last echo result (40%), the doctor concluded the the frequent ectopy was skewing the EF results.  At any rate, the sotalol reduced the number of PVCs in the first year or so, but since then seems to have gradually stopped working.  Recently, I changed my heart failure doctor to OSU (my oldest graduated med school there).  The new doctor looked at my history, and told me that he believed that instead of the CM causing the PVCs, he believed that the PVCs were causing the CM.  He said it was very rare, but that it has been documented to happen.  I was stunned.  He contacted my EP - they talked.  My EP agreed that I may be one of the rare people who have PVC-induced CM and now I'm on my way to attempt an ablation.  It's been a long road.  I'm excited and scared at the same time.  It's almost too much to hope for.  Do you still take medication?  I haven't talked to the doctor yet, so I'm really in the dark as to why they decided not to ablate before, but are willing to try now.  Was the recovery from the procedure pretty easy?  Did it hurt after the drugs wore off?

[Momto3]

Holy cow!!  It continues to amaze me how familiar your story is to mine!  I cannot believe you have MR also. Initially, when my EF dropped from 55-60 down to 40 the doctors were nearly certain it was because of the mitral valve.  BUT, further research and several tests and lots of docs later - NOT!!  MY EF improved upon exercise which is contradictory to MR being the problem.  Scratching their heads, they considered the pvcs...My EP was convinced that the PVCS were the culprit and trekked my file all around the country.  My case had been "presented" at a number of conferences and lo and behold - PVCS were thought to be the problem! It was indeed interesting to the me AND the doctors since it just doesn't usually happen.  

Your oldest graduated from OSU medical school? CONGRATS!! My cousin went to OSU for medical school, but that was in the 70's. It is a GREAT school!! Go Buckeyes!! Sorry -- couldn't resist :)
Our oldest got her teaching degree from Kent State and the next one graduated from OU.  Last one is finishing up at Kent. WOOHOO!!  

Right now, I take lisinopril, and rarely, a 20mg Inderal for breakthrough days.  Fortunately, they are very rare.  I can't even remember the last time I took one.  I do know that if the CM has not improved, I would have been on both of those meds, daily.  The doctors were MUCH more concerned about the CM than the frequent pvcs...UNTIL they decided that the pvcs were likely the cause of the CM.  All indications are that they were right on the money!!

The recovery from the ablations was relatively easy.  The first procedure was a bit easier to recover from.  I think because they only entered the right side and were using veins.  I had the procedure done on a Friday and was at work on Monday.  BUT, that was because my boss was easy going and I knew I could leave at any time.  In hindsight, I should have stayed home a few days - just kind of off balance.  The second time around, they had to ablate a different area on the left, so they had to enter the femoral artery.  They put some sort of a plug in after they were done (it disolved in 90 days) and that was a little sore. I stayed off work for a few days that time...but wasn't confined to bed or anything.  Just moved around a little slower.  Wait, that could be age-related.....lol.  Oh, it did NOT hurt at all after the meds wore off.  Both times, I stayed overnight and kept a sandbag on the affected side of the groin to keep from bleeding.  I had absolutely no problems with recovery..

I know what you mean about the ablation being almost too good to hope for...But, it worked for me and I'm hoping it will work for you too.  I hope you have the best possible outcome!!!

Please feel free to email me anytime.  Put something in the subject line so I'll know it's someone from the CCF Forum.  My email is ***@****

Connie

[upbeat63]

Hello, 4pawsfor4me, welcome to the frequent PVC flyer club, although it's a club I'm hoping I won't be a life member.

I know if Momto3 can discontinue her membership, well, there's hope. I hope your upcoming procedure(s) are successful and you experience the same relief as she has.

I am curious though, that when you went through the EP study and they stimulated nsvt, that they decided to implant a pacemaker. Did I read that right? I have had many episodes of nsvt, but was told that as long as they are isolated events, it's not any worse than the "benign" pvcs.

Did you experience a gradual increase in your PVCs or did they come on quickly at 40,000/day? I've had mine for 22 years around 10,000/day, but last year they more than doubled for no reason.

Thanks for any info. Momto3 has been a great help to me, I hope she's given you some ease also. Let us know how it all goes.

[Momto3]

There you are...You definetly belong in this thread! We have found a long lost sib (there are now 3 of us with similar stories!!)  I've been talking to 4paws4me and she experienced a VERY similar thing as I did....Blown out of the water with a DX of CM!!!

I've stepped down from my executive position in the "Frequent PVCer Club" and will take on the role of a former flyer...lol.  If I don't laugh about some of this stuff, I'll go crazy.  It really helps to offset the fears and frustrations of dealing with these issues.

I was thinking about any symptoms that I was having at the time of the CM diagnosis.  The more I thought about it, the more it came back to me.  At the time of the DX, I was feeling fine!!! It was about 2 years prior that I was having SOB and significant fatigue...never really did figure all that out.  When the doctor first called to tell me about the CM, I was absolutely floored!! No idea that anything had changed.  After a couple of months, and during the time I was on the antiarrythmics, I started to get swollen ankles and the fatigue returned.  I'm not sure that the fatigue is related since I still get really tired.  The swelling has been gone since the second ablation so I KNOW that was a side effect of the CM.  Anyway, I guess what I'm saying is just keep on like you're doing and stay on top of your own health.  Do you have insurance to cover a repeat echo in the event your doctor would order a followup? I'm betting you're gonna be just fine, but it's best to keep tabs : )

I also had nsvt and it wasn't significant until the CM...then, it seems as though it was pretty important.  The pvcs didn't really bother me, but the runs felt really weird...YIKES!!

Take care and keep us posted!  Your positive outlook and upbeat personality keep me smiling : )

Connie

[upbeat63]

Thanks for the extra comments, I sooo appreciate your experience on this one.

It does put my mind at ease now that I re-read your post and that of Connie (#2). Of course nsvt isn't that bad "unless it's in the presence of an abnormally structured heart", and CM would qualify for that wouldn't it!

I do have insurance, but with a $2500 deductible, it's all out of my own pocket anyhow. No matter, there's nothing more important to spend my money on, even though I can think of a few choice things that I would like before another echo!!

Laughter doesn't always come easy, but it's worth the extra effort, thanks for keeping me upbeat.

[Momto3]

You know, I never thought of the CM as being the part that was "structurally abnormal."  Seriously, until you mentioned that, it never crossed my mind, not once.  I was always thinking that the valve was the "abnormalilty."  Now, you've got me thinking :)  

Yeah, I'll bet you could think of a lot of things you'd rather be spending money on rather than an echo...lol.  A $2500 deductible is quite a financial obligation!  OUCH!  Our deductible just went from $350 to $1000, and I thought that was steep.  I remember having to pay seveal thousand dollars out-of-pocket for my part of the ablations...That really stung, but was worth every penny.  It's too bad that healthcare has become so expensive.  I guess it's the price we have to pay for the latest medical technology.  I imagine it wasn't too long ago that an ablation for pvcs was unheard of.

Stay warm and enjoy the good moments : )

Connie

[Sunrize]

I'm 44 year old Mom of 2. I had an Ep study and 8 hr ablation in 2001. Had Atrial tachycardia, atrial fllutter & AV nodal reetrant tachycardia. Underwent slow AV nodal pathway ablation & 2 of 3 PVC spots in the right ventical were ablated. He told me I had a very strong heart. I was left with Bigeminy, which I take Verpamil to control and also have Mitral regurgtation.
I havent been feeling well. My heart feels like it's working too hard when I'm doing nothing (not stress), get tired, chest is mildly sore, sometimes have trouble catching my breath. I've moved, so had to see a new Dr and he acted like he knew eveything already and I should stop drinking carbonated beverages. He repeated my Echo and 3 weeks later I finaly hear from him.
My Ejection fraction is down to 45-50% but valves are doing better.  EF has never been an issue before. I don't know how good this dr is, I just dont like his personality and dont want to go back. I need to feel better. He wants me to do a GXT w/ cardiolite (4hr test to check for blockages) My colesterol is 150.
Is this a test of value? I have to wonder: did the Dr who did the Ablation "fry" too much of my heart? Can I find another Dr. even though I've got a problem?