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PVC causing NSVT and SVT...dangers?
Avatar_m_tn
by wildcat27, Jul 16, 2007
30yo male, non-smoker, all echos and TEEs show now structural abnormality and mild MR.

I have had PVCs/PACs off and on now for over a year. I traditionally have gone through long periods with none...then I would get several days with quite a few (maybe 100-500) and the a day or two with maybe 1000-3000 max.

I decided to come off cardizem about 6 weeks ago (I had been taking it since last July following a lone bout of A-Fib, for which I was cardioverted).

My ectopics during the last 6 week have been heavy. I have been under more stress at work...but I have still been running 3-4 times a week, etc.

Anyway, during those six weeks I have had maybe 3-4 separate runs of what felt like multiple PVCs without a normal beat in between...NSVT? And then once last week I got a weird sensation in between innings of a softball game...PVC...PVC...then 6-7 very rapid beats...no syncope or dizzyness...but very scary. It went back to normal and I finished playing. I have a 30 day monitor right now (ofcourse hardly any palps since I got it)...anything concerning from what I posted above?

Thanks
Answer:
230125_tn?1193369457
Hi Wildcat,

This is a fairly common question.  I understand how frustrating your symptoms are and that they can have a significant impact on quality of life.

I also want to make sure that in the first sentence you wrote “now” but by context I think you meant “no” structural heart disease.

There is not and never can be a blinded and randomized study to look at structurally normal heart PVCs and long term outcome.  We have to rely on long term follow up studies of people with PVCs/PACs and from these studies there is no increased risk of sudden cardiac death.  Over the long – long term, people with structurally normal hearts and PVCs have a slightly increased risk of cardiac events, but these are rare events and the standard of care still dictates that reassurance is the most appropriate intervention.  

Beta blockers can decrease the symptoms associated with PVCs and have not been shown to decrease the number of PVCs.  If you have tried a beta blocker and stopped because of fatigue, I would encourage you to take it for several months before stopping it because these symptoms tend to decrease with time.

Depending on the clinical circumstances, I will usually perform a history and physical exam, EKG, holter (or event monitor to capture the rhythm while you have symptoms) and an echocardiogram.  If I see anything concerning, other tests may be required depending the circumstances (MRI to evaluate for right ventricular dysplasia) or a cardiac cath.

From what you describe, it sounds like reassurance and possibly a beta blocker is appropriate.  It would be nice to see the events on a rhythm strip so I would order an event monitor (what you already have on).

If all the tests are normal, do your best to move past these symptoms.  They can significantly impact quality of life.

I hope this helps.  Thanks for posting.
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Member Comments (21)
21064_tn?1309312333
by Momto3, Jul 17, 2007
Good morning!

Just wanted to drop by and thank you for taking our heart rhythm related questions!  You'll be plenty busy, I'm sure : )

I joined the board several years ago as a patient with MR and a newly diagnosed cardiomyopathy (a result of frequent pvcs).  The medical advice I received coupled with the friendly dialogue were definite catalysts in my turn for the better.  Two ablations were performed in 2003 and my EF remains normalized!  Can't thank you folks enough!  

Welcome!!

Connie
16292_tn?1189759421
by finetilthree, Jul 17, 2007
"Over the long – long term, people with structurally normal hearts and PVCs have a slightly increased risk of cardiac events, but these are rare events and the standard of care still dictates that reassurance is the most appropriate intervention."

Well if EVERYONE has pvcs, doesn't that mean that everyone has an increased risk of cardiac events?
16292_tn?1189759421
by finetilthree, Jul 17, 2007
84483_tn?1289941537
by tickertock, Jul 17, 2007
Basically everyone has PVCs & PACs and the risks with rare PVCs or frequent PVCs are about on par, though statistically speaking persons with very frequent PVCs are considered at a slightly higher risk for "cardiac events" not because of the "PVCs" but because PVCs are sometimes a marker for underlying cardiac anomalies that have not been diagnosed, again this is not a common occurence even in persons with a very high frequency of PVCs and persons with everyday PVCs shouldn't be concerned once they have been evaluated and reassured. This is a "grey area" concerning PVCs, but in general persons with PVCs and have normal hearts have risks on par with general population.At least this is my understanding concerning PVCs , at least this is how one cardiologist explained to it to be. Anyone can become that rare odd statistic PVCs or not and the risk with PVCs and normal heart evaluation are very very minute .
Avatar_m_tn
by wildcat27, Jul 17, 2007
yes, I did mean to say "NO structural abnormality"

Since I got the monitor on Friday I have had hardly a blip. I asked the doc to come off the cardizem and they were fine with it. I guess I'll have to see if anything shows up during the next 30 days.

BTW...my million dollar question is...how many PVCs and how frequently before docs worry about CM?
Avatar_m_tn
by wildcat27, Jul 17, 2007
BTW...thanks for taking the time to answer my question...Thank you...
230125_tn?1193369457
There is no magic number.  The real measure is do we see dilation in the ventricular chamber or reduction in ejection fraction.  If you pushed me on a number I would say we worry if we start seeing thousands, usually 10,000 to 20, 000 range.  
21064_tn?1309312333
by Momto3, Jul 17, 2007
If it helps, I was having 20,000+ per day for a long time and the pvcs were still benign.  Exactly what the doctor said - when there was a change in the echo (chamber size and EF), then the pvcs were considered something to be dealt with more assertively.  As long as you're getting checkups and don't notice any new symptoms, you are probably just having more pvcs.

Good luck!  Hope the monitor is able to pick up what you're feeling so you can get a definitive dx.  

Have a great day!