Multiple PVC and Low Ejection Factor

I am 37 years old (M) and in okay shape (I should exercise more...), but have a stressful job.  I have been experiencing mupltiple PVCs and recently had a holter test.  In 48 hours, I had about 1500 PVC episodes.  My heart rate ranged from 40 bpm to 140 bpm.  I followed up with an Eco and all was normal; except, the Dr. mentioned I had a low ejection factor (50).  I have good cholesteral (165) and good blood pressure (120/70).  My concern is this...  The PVCs annoy me (I just worry about them because the happen in groups).  I cut out caffeine and the PVCs are still fairly regular.  They occur with a PVC, three beats, a PVC, three beats...often for several minutes.  Also, the Dr.'s nurse didn't inform me about what I should/could do about my low Ejection Factor - can this be improved?   Should I worry about the combination between the PVC and EF?  How can I improve either?  
Do these factor indicate a higher risk for heart attack?  Cardiac failure?  

[Michael J. McWilliams, M.D.]

1500 PVC is not that many, but I do recognize that it feels like a lot if they cause symptoms.  It is true that PVCs in the setting of reduced heart function is a risk factor for cardiac events.  It does not mean tthat you are increased risk for heart attacks.

Situations like yours fall thought the cracks because 50% is not that abnormal and is probably normal when you are under stress or exercise.  Some people will refer to 50% as low normal.  Low heart function does increase the risks for heart failure, it just depends on if your heart function is truly low.

There is not great treatment for PVCs.  Beta blockers are the safest treatment and if you do have heart problems, it is a good treatment for that as well.  It would be unlikely for 1500 PVCs over 2 days to cause a cardiomyopathy or reduced heart function.

If I saw a patient like yourself in clinic, I would consider a stress echocardiogram to make sure that your heart function increases with exertion.  If it did not, I would be more aggressive about threating you for the low heart function.

I would recommend follow up to make sure your heart function is stable.  You doctor will probably want to do this in 6 months to a year.

I hope this helps.  Thanks for posting.