PVCs, PACs, Tach, LVEF, low BP, PFO, global hypokinesis, & aortic sclerosis

I have had arrhythmias for years. Been told it was stress, because I was pregnant, etc. then I bagman getting serious thumps in my chest, chest cramping & exhaustion with activity. Had a busy hot couple days where my feet swelled huge & very bad chest pain recently as well. I was dx'd with POTS/OI a couple years ago so assumed most of these issues were related to that. They also found a PFO in 2008, but was told it was not a good idea to close it & I am on low dose aspirin. I am in my late 30's. I was on metropolol & inderal for a while & did relatively well. I had a very difficult surgery in March & felt my arrhythmia seemed worse, but I was always told not to pay attention to it, so I ignored it. I recently went to my yearly check up with my cardios & had a routine echo which showed a low EF, global hypokinesis & mild aortic sclerosis. They did a bunch of EKGs because echo was showing rhythm issue (afib again, but my current electrophysio says its not afib) & said I get lots of PVCs by talking or moving. They were concerned by the change & took me off inderal & metroplolol & put me on Rhytmol. I am concerned about being on this drug, but was told since I am having symptoms Lof dizziness & fatigue & can feel the arrhythmia, I should take it, so I am. I have not noticed anything but my bp BP & HR rise. I still feel awful. I am having a repeat holter monitor in a couple weeks & another echo to see if the EF is better on the Rhythmol. If not, I was told, they would "look for other causes of the low EF". Can the arrythmia cause all this? Or is there probably something else lurking? I had a blood clot scare 2 months after surgery & had high d-dimer & they noticed tons of PVCs then but said its "weird" but didn't mean anything & since the chest CT didn't show anything that there was no clot, so the d-dimer was wrong. What could cause such a change in EF & echo? What can cause aortic sclerosis & global hypokinesis at such a youngish age? Is it all the arrhythmia? Or is the arrhythmia due to another issue?

[SillyZebra]

Help! Concerned still. Don't like the rythm meds...

[Jerry_NJ]

I have a different set of heart rhythm problems, mine are all atrial fibrillation and related.  But, I was on Rhytmol 425 SR twice a day (best I can recall at the moment) - it neither converted my AFib nor could it even hold me in normal sinus rhythm following a successful electrocardioversion.  So I am off, but to your side effects I can say I was not aware of any side effects, then too I was in permanent AFib except for about a week following the electrocardioversion - so I may have overlooked the Rhytmol.   It is a powerful drug, I understand, and does cause some people problems.... but, little I know, I can't see any reason it would cause a change in the hearts EF, that is a measure of how efficient the ventricle is at moving blood through the body.  I have no problem in that area either, even with atria chambers in fibrillation, not helping.  I now take metoprolol and a calcium channel blocker to lower my HR (suppose it lowers my BP too, but that has never been a problem and it seems my body has adjusted to the BB/CCB and my BP is just in the good range, about 115/75 or thereabout.

Sorry I don't have any specific help but maybe my posting will help others pitch in.   I read you have all the specialists (doctors) and that should be your path to an answer, not this panel.  Still, someone may have an experience that relates to your issues.  Good luck, you deserve it - I have particular sympathy to people so young as yourself who have health problems, people my age are just worn out, not bad luck with health.

[SillyZebra]

Thanks for your reply. The EF is low & there were new structural problems on my echo, so they think if my rhythm improves, then my EF will as well. I think it may be a shock in the dark, but who knows. I'm just trying to figure out the cause of the low EF...  I guess I will find out in the next few weeks as I have my repeat echo & holter & see my new local general cardio. I just wondered if others had problems with low EF & if getting the rhythm under control helped at all...?

[michellepetkus]

I do not have experience with Rhytmol.  I do have pvcs and felt very sick from them when I was experiencing them in a storm pattern.  They have eased up now so they do not cause me much trouble.  I wonder if having the baby and the difficult surgery simply got your heart a bit tired and now it is a bit under the weather but will improve with some time.  I know it took close to a year to feel as strong as I do now from the effects of years of svt episodes so it does take the heart a bit of time, sometimes a lot of time to improve and heal.  So I would keep my fingers crossed that slowly but surely your heart will get stronger again and you can get off the meds.  Take care.  Let us know how your new tests come out.  Good luck.

[SillyZebra]

I had my baby 16 years ago. I have had arrythmias since I was a teenager. The surgery was now 5 months ago. But why sclerosis of the aorta & low EF & global hypokinesis? Does anyone get those problems from PVCs?

[michellepetkus]

I do not have experience with your issues but I looked the terms up online and this is what I found.

Global  Hypokinesia means that heart muscle in general are not contracting as perfectly as it should. Left ventricular ejection is the measurement to check the efficiency of heart on how much blood the heart is able to pump each time it contracts.The Higher the ejection rate the more is heart efficient ,The lower it is less is the output .

Normal is variable but 37% is considered abnormal

EF % is the ejection fraction .It is a test that determines how the heart pumps with each beat.

Left ventricular ejection fraction is the measurement of how much blood is being pumped out of left ventricular .

50% to 70% EF is considered normal 36 to 49% is below normal.

It sounds to me like Global Hypokinesis is a possible cause of the EF.  Why your heart is weakened is to be determined.

Aortic valve calcification is a condition in which calcium deposits form on the aortic valve in the heart. These deposits can cause narrowing at the opening of the aortic valve. This narrowing can progress to become severe enough to reduce blood flow through the aortic valve, a condition called aortic valve stenosis.

Aortic valve calcification may be an early sign that you have heart disease, even if you don't have any other heart disease symptoms.

Calcification and stenosis typically affect people older than age 65. When it occurs in younger people, it's often caused by:

    A heart defect that's present at birth
    Other illnesses, such as kidney failure
    High cholesterol

Aortic valve sclerosis — thickening and stiffness of the valve — and mild aortic calcification usually don't cause significant heart problems, but require regular checkups to make sure your condition isn't worsening. It's important to have your cholesterol checked because you may need medications to lower cholesterol and help prevent aortic valve sclerosis from getting worse. If the valve becomes severely narrowed (stenotic), aortic valve replacement surgery may be necessary.

The arotic sclerosis sounds like it may also be a contributor to low EF if the flow is being blocked by the calicium deposits.  The fact that you had swelling in the feet and fatigue are also possibly symptoms of a weak heart.  Do you have frequent High Blood pressure?  You mention that you have had heart rhythm issues for years, what are they, tachycardia or an irregular beat?  Are you over weight?  I wouldn't think pvcs would cause this unless you are having thousands and thousands of them every day but this is all based on a lay person's research so I can't say for certain that it is or isn't from pvcs, a birth defect or heart disease but it sounds like your doctors are trying to find out the cause of your weakened heart to try and treat it and hopefully reverse your issues.  I would definitely follow whatever orders your doctor gives you on diet and rest if necessary.  I personally would take it slow until you get this resolved.

Best of luck with your new tests.  I do hope they show improvement.

[itdood]

There is a study out that showed impriovement in left ventricular function when a high load of PVCs (>15%+ of beats were PVCs) were reversed.  In other words, the heart's muscle worked better when the PVCs were reduced.  Though from what I recall this was specific to the left ventricle which might not apply to you since the hypokinesis is global.

Do you know what your PVC load is?  what percentage of your daily beats are PVCs?

There many reasons the heart muscle may not work as well as it should.  It could be related to blood flow to the heart, it could be a virus, it could be a genetic disorder such as ARVD (though this is very specific to the right ventricle only and would not be global), or it could be idiopathic (meaning no known cause), it could be high blood pressure, or it could be valvular.  It's rather complex.  Your doctor is going to work through diagnosing this probably by a process of elimination.  

[SillyZebra]

I am underweight. I am 38. I have never had an abnormal echo, the structure of my heart has been normal my whole life, I had a normal echo 2 years ago. I do not have high cholesterol or kidney failure or congenital defect. I do have a connective tissue disorder but my geneticist said this is a separate issue that is not connected to my collagen disorder. I have POTs (postural orthostatic tachycardia syndrome) so my bp is usually 105/68. I never have high bp. I am tachycardic though. I was on inderal & metroplolol before my rhythm got worse & they put me on the rythmol. My left ventrical has the most dysfunction. I'm not sure how many pvcs... She said every time I moved or breathed I would have a bunch more. My last holter only showed a few pvcs (over 8,000 PACs) but in the office it was crazy. Echo said afib but they said it was frequent pvcs. This has been a change in the last year or so... : (