testing

I'am a long time sufferer{17 years} of PVC's who's had all the non-invasive tests including a "normal" thallium stress test. With the basic understanding that at least some arrhythmias are caused by some type of cardiac problem such as CAD etc at what point does one request more invasive testing testing like cathierization{sp} to rule out blockage? I mean if I were to explore ablation shouldn't one positively rule out all root causes before a procedure like ablation is undertaken? Also I'll ask you to speculate; the docs on this forum have often stated that PVC's can be associated with hypertension or a result of it. Do you think this is because high BP in some way effects the heart to precipitate the PVC's or is it that the type of person who is prone to high BP {"type A", etc} is also prone to PVC's? And why then when BP is controlled to normal levels do PVC's not stop? I realize these last couple of questions likely have no real answers just wondering what your intuition leads you to believe. AS always Doc thanx much for your time we all appreciate it Gaspipe

[Cleveland Clinic]

gaspipe,

1) at what point does one request more invasive testing testing like cathierization{sp} to rule out blockage?

Structural heart disease from hypertension and coronary disease can cause arrythmias.  Presumably, stress testing would help rule out the latter.  With no evidence of ischemia on a stress, we would have to be convinced from a good story for angina, or other evidence that there was ischemia in order to expose you to the risk of catheterization.

The most common cause of all arryhtmias is structural heart disease due to hypertension.  Hypertension causes slow changes inthe heart that leads to abnormal circuits and conduction. These changes are often permanent,  Thus, once the damage is done, the arryhtmias can still occur despite good blood pressure control. Strict blood pressure control can reverse some of the damage and should always be the goal.

Even though hypertension is a common cause, some people are predisposed to arrythmias. This is probably somewhat due to the interplay between inborn predisposition (genetic) and environemntal facotrs (stress, etc....).

hope this is a start.

[hankstar]

I am of the opinion that hypertension , even mildly elevated hypertension for years do contribute to an environment where your heart muscle can remodel itself mainly the left ventricle, causing left ventricular hypertrophy and thus contribute to the development of PVCs, I myself had uncontrolled mild hypertension for years and was starting to development marginal/mild LVH, it was during this time that i noticed and developed an extreme increase in PVCs, now my B/P is perfectly controlled with cozaar and atenolol, the mild LVH has apparently regressed and the PVCs are almost non existent. Any thickening, dilation,or stiffing of the heart muscle can create an environment in the heart for PVCs to develop or increase. PLEASE NOTE: This is my personal opinion and experience and may not apply to your PVCs at all.

Regards.

[Gaspipe]

Yes it sure is a great place and it's always the case where if one person has a question or problem many others are in the same boat. So it's great your husband sees the light. Take care Gaspipe

[Mel22]

Would the damage you describe show up on a stress echo?

[hankstar]

Yes , a thickening of the heart muscle LVH, the echo is the "gold standard" for such a diagnosis.

Keep in mind that a lot of well trained athletes have some degree of LVH, also persons with prolong uncontrolled hypertension even when mild usually have some degree of LVH, others are lucky and don't develop the condition.

Also PVCs when associated(please note it is only assumed that this condition might aggravate PVCs) with this condition once it is not HCM(hypertrophic cardiomyopathy)a famalial inherited disease does not portend an adverse prognosis but might serve as a wake up call to bring your B/P under control.

Since my B/P has been under control , the PVCs are almost non existent. I take cozaar and atenolol for ultimate B/P control, now averaging around 110/70 most the time. The marginal LVH has apparently regressed also, I understand Cozaar is almost described as a wonder drug for this .

PLease refer or consult with your doctor as the best guidance to treat your condition as we are all different and respond differently.

Good luck.