Electrophysiology study?

I am a 24 year female, old non smoker, non drinker.

My saga started last January, when I started having high blood pressure. I went to the doctor because I saw that my blood pressure was constantly high. Was given medication.

Between February and March, I was feeling a bit..not right. I noticed that I was more aware of my pulse, and started experiencing chest pain and tachycardia.

In March, I was rushed to the hospital because my heart was 140+ bpm. Was diagnosed with Pericarditis. I don't know the real cause, but I did have a UTI at the time and was put on strong antibiotics (Levaquin), was given Lopressor. I know Pericarditis can be cause by bacterial infections, so maybe that was it.

Between March and September, I still was not feeling right. I still had palpitations, and chest pain.

September of this year, I underwent an Echocardiogram, which revealed Mitral Valve Prolapse, Mitral Valve Regurgitation, Aortic Regurgitation, and Pulmonary Regurgitation. Either the Pericarditis caused it, or I had it all the time without knowing.

After my Echo results came back, my PCP referred me to a Cardiologist. I was given a Holter because I was still having problems. I never got the report of the Holter though, but I will see it on Monday.

On my first EKG, I had Ventricular Bigeminy. I could feel my chest flip-flop and both my mom and my sister can read EKG's (one is a nurse, one is an EMT, almost Paramedic), and that's how I knew what the rhythm was called.

I was also given a cardiac event monitor, and a stress test, I guess that's standard Cardiology practice.

Even before the stress test began, my blood pressure was 130/90, my baseline heart rate was 101, which quickly went up to 180 bpm. I was not nervous, and neither the doctor or the assistant was in the room at this point.

When the doctor came in, he saw my heart rate was at 150 bpm and I was experiencing SVT.

At first, the doctor told me he was not going to do the stress test. He asked me how I felt and I told him I was having very strong palpitations and that I felt my heart race. I told him that I would at least like to try going on the treadmill, because if there was anything else going on, I figured it would show up.

The doctor said okay and I did the test. My heart rate went up to 200 bpm, 30 seconds to a minute after I hopped on the treadmill. My blood pressure was 190/90, when I got off the treadmill, and 150/90 after cooling down.

The doctor ended the test after the first stage, and I was tired, out of breath, and still had the palpitations. The doctor told me I couldn't leave until my heart rate went down, but it never went down past 120 bpm, so I left.

(This was in January)

My doctor called me the next day and referred me to an Electrophysiologist.

I originally had an appointment with him on Jan 28th, 2009, but had to cancel due to bad weather. The earliest appointment that was available was for March 2nd, so I took it.

Two nights ago, I had two bad episodes of SVT. My heart rate was in the 160's and stayed that way for over 40 minutes. I had a really really intense flip flopping sensation, and my heart rate went down into the 120's, but then it started racing again.

(This was at 1 am)

I was going to call an ambulance, but I decided that I should try and wait it out until Monday, since I'm meeting the EP that day and I have an appointment with my regular Cardiologist on Tuesday as well.

I have also noticed that I am experiencing chest pain more frequently and a little more intensely as before. I don't know if this has to do with MVP or what.

My questions are as follows:

-Do you think I'll end up with an EP study? My doctor suggested ablation but I suppose it depends on what is found during the EP study, if I do get one.

-Doesn't MVP cause arrhythmia? If so, isn't the only cure to repair the valve? I don't have any hypertrophy and the last time I checked (a few months ago), I had mild PR, trace AR, and mild MVP and MR, so I don't know if that's the real cause of my SVT or what.

-Does having an EP study increase the chances of more deadlier arrhythmias such as A-Fib or V-Tach, after the procedure? I figure that since catheters are being stuck inside the body, and the heart is being manipulated, that something might happen after the procedure that would provoke arrhythmia.

-Do I have to worry about taking prophylactics? My PCP mentioned something about having to take antibiotics before certain procedures, but I am not sure if antibiotics are recommended for mild cases of MVP, or if it's only for people with artificial valves or severe regurgitation.

Thank you so much for your time and patience. If you have any questions, please don't hesitate :)

[Jerry_NJ]

I thought I'd "jump in" before you post goes off of the first page.  Unfortunately I many not know what an EP study is.

I have consulted an EP, referred by my Cardiologist, and did a long term monitor and he had a recent echo and X-ray information.  If that's a study, then my answer to your question about an EP study causing problems is NO.  What I went through couldn't possibly have any affect on my heart other than unwanted affects of trial medications.  He had me on a high dose of Rythmol SR, but it didn't stop my AFib, so we stopped.  He does not recommend an ablation for me because of my minimal symptoms.

MVP most likely is not causing heart arrhythmia, but prolapse that becomes lets too much "back pressure" into the atrium, such as a leaky mitral valve, can cause enlargement of the atrium and thus cause AFib/Flutter.  I believe that's what happened in my case.  

[musikbox]

sorry to hear about A-Fib! I don't know if I have ever had it or not, because my heart jumps around constantly every second, but I def feel with you about having an arrhythmia.

An EP study is when they insert catheters in various areas (neck and groin usually), and guide the catheters to the heart using several monitors (called a fluoroscopy), and then the doctor tries to provoke an arrhythmia to see how the heart handles it, through medication or cardiac pacing.

then, based on the results, the doctor might perform an ablation.

it's all very interesting and I hope that I do end up with it, because it can pinpoint the cause of arrhythmias.

[Jerry_NJ]

Thanks for the information on the EP study, the name now makes sense.

I have had two catheter examinations to check for blockage, none were found.  Both times the entry was via the groin.  I had almost no after affects, all healed up without hardly a notice on my part.

Wish you good luck, and sorry this all had to start so early in your life.  My heart behaved well for 60 years, then, well age caught up with me it seems.

[banglamom]

I was 24 when my issues first started too.  The good news is... now I'm 41.  An EP study is not ENTIRELY without risk but it is rare that there are any complications.  They may be able to gather a whole lot of info that would not otherwise be available.   If it is just the EP without even the ablation, it is less risky.  They use conscious sedation generally, so during the procedure, it isn't too uncomfortable.  If it can be fixed at your young age, you should get to it now so it won't be a huge problem for a prolonged period of time.  Good luck with it.  Come often with questions and for support here.  There is nearly every test and med experienced by people on this forum.

[Momto3]

Sounds like you're in good hands : )

My situation is similar in some ways and different in others.  Here's what I have found:

You may have an EP study to try and identify the foci that is causing the SVT.  I've had 2 EPS and 2 ablations and was diagnosed with PVC-induced cardiomyopathy.  

Although many people with MVP experience arrythmias, the MVP is not likely the cause (they just kinda coexist).  I've had MVP/MR for over 30 years, but never had any problems until about 6 years ago.  MVP does not generally require surgery.  The regurgitation can range from trace (insignificant) to severe (possible surgical intervention).  The MR is generally graded on a scale of 1-4, with 4 being severe.  I've been in the 2-3+ range for years and I am not a surgical candidate.  Fingers crossed!  Mild MR is generally not anything to be concerned about.  However, in the setting of all that is going on, your doctor will likely follow you with serial echos and possibly stress or stress echos.

EPS is a pretty safe procedure.  There are risks, but the risk of serious complications in a healthy patient are minimal.  The doctors will usually try to provoke the arrhythmia during and EPS to see if it is amenable to ablation or treatment.

The American College of Cardiology and the AHA are no longer recommending prophylactic antibiotics to most people with valve disease. It is now believed that the risk of pre-medicating is greater than the risk of potential pericarditis.  That said, each situation is different so your doctor will be able to give you more info on that.  I took prophylactic antibiotics for close to 30 years and I no longer need to : )

Here are the new guidelines for preventive antibiotics:  http://www.americanheart.org/presenter.jhtml?identifier=3047051

Please let us know what you find out.  Have a great day!

Connie

[musikbox]

Well, I saw the EP today.

He's really, really nice and was very thorough.

I had an eventful EKG today, which I suppose is good because the more evidence I get of these arrhythmias, the better the diagnosis.

I had Sinus Tachycardia (heart rate 111), prolonged QTc (154 ms), possible left atrial enlargement, and nonspecific ST and T wave abnormality.

Had my sister look and it and my my mom, and they agree that there is something going on that is seen in all leads, but they don't know exactly what. I have a Cardio appointment tomorrow though and will no doubt bring it.

Am schedule for a table tilt test. Doctor wants to rule out something called POTS (Positional Ortheostatic Tachycardia Syndrome), which is an abnormal neurological response when someone goes from laying down, to standing up.

Two of the key things to look out for in POTS is an increase of heart rate in the standing position, greater than 30 beats, and a drop in blood pressure.

Since I'm hypertensive, and not hypotensive, I am very confident that I will test negative.

If I do, then my doctor is going to go through with the EP study.

[musikbox]

I mean QTc of 454 ms, sorry!!

[BionicBabe]

I had an EP study and I had some of the same concerns as you...I worried about the doctor tinkering with my ticker (as my husband liked to say). My understanding is that the EP study can't cause an arrhythmia to occur on its own after the procedure (if I'm understanding your question correctly)...now I don't know that for sure, perhaps it's blind stupidity on my part;  I'm just assuming that if an EP study could cause arrhythmia then it wouldn't be allowed and insurance companies certainly wouldn't cover it. I had my EP study almost one year ago and if anything my arrhythmia has been less active...of course I take a beta blocker, so that definitely helps. As for the EP study procedure, I was out of it for the most part. Make sure you have an opportunity to ask your EP all of your questions prior to the procedure. I'll be curious to read how it turns out. Good luck; it sounds like you have a positive perspective. That will really be helpful in dealing with whatever comes your way.

[Momto3]

I wondered about the QTc....LOL.  Glad you clarified that : )

I'm glad the doctor was nice!!  I know some people don't really care, but I'm one of those who feels more comfortable when the doctor is friendly : )

Did the doctor give you a diagnosis?  It sounds like you may be going by what is printed out on the EKG report.  If so, the "diagnoses" are not necessary accurate.  My EKGs say essentially the same thing...with possible MI and a QTc of over 500.  Turned out that the machine was spitting out DX based on just the recording, but not taking into account anything about me, the specific patient.  Something is likely going on, and hopefully, you will know more today.  Have you worn a Holter and had a signal averaging EKG?  

Good luck today!!  

[musikbox]

I didn't get a diagnosis from the EP, which is why I'm bringing the EKG today to the Cardiologist, because my sis and mom confirmed there is indeed something going on. They even told me what as far as the waves go (something about having a weird T wave), and whatever it is that's not right, is showing up in all the leads.

Yes, computer printouts are wrong, which is why it's best to wait for the doctor to say something about it. I guess the EP wanted to talk more about my medical history/go through my other tests, but my Cardio will hopefully shed some light on it.

Yes, I've had a Holter done. I haven't gotten the report for whatever reason though, so what I am going to do is get a copy of it because my Cardio never faxed it over to the EP. My Echo was also missing and that would have been nice to have since I do have the leaky valve thing.

whats a signaling average EKG? never heard of it before :)

[Momto3]

Sounds like a great plan!  Your cardio sounds awesome!!

Nasty old T waves..  : (

Here's a little info on a signal-averaged EKG:

"A signal-averaged electrocardiogram is a more detailed type of ECG. During this procedure, multiple ECG tracings are obtained over a period of approximately 20 minutes in order to capture abnormal heartbeats which may occur only intermittently. A computer captures all the electrical signals from the heart and averages them to provide the physician more detail regarding how the heart’s electrical conduction system is working."  My doctor said it is used to help determine if the patient is likely to have future "events."

Good luck with the tilt table test.  Hopefully, you will have a much better idea of what's going on after your cardio visit.  Hope you're feeling better very soon and that the doctor can pinpoint what's going on.  Let us know what you find out.  In the meantime, take care.

[musikbox]

well I did find out two things from the ECG.

I'm 90 percent sure that I do have left atrial enlargement because now my P waves look funny too! kinda like someone drew an M, or at least, something very very close to that (thought it doesn't look as cut and dry). Going to have this confirmed by the EP when I see him next, or the Cardio, whichever comes first.

the other thing I found out that the cardio did confirm was that I do have prolonged QTc intervals for some reason. I had sinus tachycardia on the ecg today.

I am thinking my prolapse is causing the enlargement, but I am not quite sure. I will have to ask more questions, but I am not very worried at all :)

[Momto3]

Sounds like you are headed in the right direction for getting some answers...That's awesome!!  

I will be interested to see if the MVP is playing a role.  I love that you're being so proactive : )  I think it is so important (and fascinating) to try and understand what's going on with our own health.  I find it so beneficial to learn and stay as informed as I can; sounds like you are the same way...LOL.

I just remembered that I think my QTc's were prolonged when I first started taking flecainide.  I'd have to dig out the old reports, but in any event it was not a problem.  I had my ablations in 2003 and I am amazed at how successful they were!  It sounds like you have great doctors!!  Keep us posted!
connie