UPDATE on Results of Echo and Monitor

For those of you that had asked me to post the results of the meeting with my cardio  yesterday...

On Monday, the last day of my monitor, I actually caught a 9 beat run of VT (NSVT) at about 190 BPM.  At the time I recorded it, I wasn't overly concerned because it had only lasted the span of about two normal heartbeats and I didn't feel the 9 beats, just pressure in the hollow of my throat.  Well, what a surprise that was!!!

Cardio said that it looked very monomorphic and that he believed it was more than likely to be coming from my RVOT.  Of course, I had a mini nervous breakdown when I saw the report and realized he'd been consulting with an EP doc about my case before I came in.

He was able to get me into an EP this morning at 7:00am and after speaking with him have decided, at his suggestion to: a) have an EP study on 9/9/10 b) after that have a cardiac MRI and stress test.

I'm kind of freaking out at this point, because he told me that echo's aren't always good at picking up structural abnormalities that could cause VT.  He said that he wanted to be very certain there were no hidden problems with my heart - even though my echo was pristine.  For this I am grateful, even though it means I have to go thru the EP procedure.

He's been doing them since 1981 and has logged approximately 100 per year personally with no deaths, so I feel fairly confident that I'm in good hands.  

Trying to keep my head up until then.

[Jerry_NJ]

Sounds like you are in good medical hands... you should be confident.

Your young age should work to your benefit.

Be positive, I'm sure you will come through this in great shape.

[itdood]

The good news is that RVOT as a source is rather common.  RVOT ectopics have a higher success rate for ablation cure too.  Hang in there, this stuff is so stressful.

[Mom2four85]

glad to hear it's monomorphic and you're getting an EPS quickly

couple of questions though - are you having your MRI & stress test right after your EPS? If you are or even in the next day or two, I would make sure they're aware of it and ask your doctor if he can do the MRI and stress test first

this is my reason - I went in for my ablation and had complications then had a cardiac cath & MRI and it was excruiciating to lay there for 1 1/2 hours the day after surgery - I was in pain and still hurting all over from being resucisitated (sp) a few times during the procedure.  

yours may not be that way and may go smooth and easy, but still having to do a stress test & mri after surgery is not soemthing I would want to do again and something to ask about =)

[bypeep]

I think that he's doing MRI and Stress after the EP, but not the same day.  He wants to do EP first because he said it's the most direct route to uncover what all these arrhythmia's I'm having are.  The MRI is more for reassurance I guess?  My echo is perfect, but maybe his reasoning is that something is causing all these runs lately?  I should probably have clarified this but I had only gotten a few hours of sleep and I was so stressed that I wasn't thinking as clearly as I usually do.  

I guess this brings up my latest question... How is it that some cardio's are comfortable sending peeps on their way with NSVT and a clean echo, while others (my new one included) telling me that echo's don't always show problems that can cause this sort of thing.  Doesn't that in and of itself make it kind of a roulette situation for those who've just had echo alone?  Just tossing some things out there for consideration is all.  

I do feel better knowing that he didn't send me home on  any meds or request that I up my Nadolol - I'm hoping that if he felt this was a huge threat to my safety that would have been something he did immediately?  

If it's not RVOT, what other possibilities are there for an NSVT?  And, are these other types as benign as that one?  He had mentioned one other type of NSVT that is quite harmless, but I can't remember what it was - definitely not RVOT though.

[Mom2four85]

I was suggesting you ask about having those done first because even an EP study if they don't ablate or do anything else, you will still be a bit sore and the closure on your leg from the cath being inserted may cause some discomfort during your stress test, unless I misunderstood and it's not a treadmill stress test

Have you ever had a cardiac MRI done? maybe it was just me, but so soon after surgery was painful because they strap you in the table and you cannot move an inch for at least 1 -2 hours; mine was alitte over 1 1/2 hours and every min or so they have you breathe in and hold your breath for 15 - 20 seconds

just a thought to discuss with your doctor and having gone through it, I wish someone had suggested I do my tests before my surgery

[itdood]

Hi  bypeep,

I pretty sure the only other type they haven't ruled out yet is re-entry.  

Since you don't have prolonged QT syndrome I think the chances are pretty good that they will find what they think they see on the EKG.

I think the reason Docs have very different approaches is because of what will they do if they conform monomorphic NSVT in the RVOT?  Will they ablate that if the NSVT is benign?  If I was the doc this is a very serious question.  Suppose I find the smoking gun?  Ok this person has a heart with a patch of cells in the RVOT that are too excitable but not causing any serious issues, otherwise everything is good.

Do I buzz them out of there and risk an unwanted outcome?  Do I leave them and send the person home?  Do I take the chance and hope for the best?  It's a tough decision and hard to consider the risks.  After all, having an ablation is like having a heart attack.  They are killing cells but on a much smaller scale.   Ablations are not without risk.

That why I think some docs error on the side of "wait and see".  Maybe it will get worse, maybe it will get better. If it gets worse we'll deal with it then.  The data suggests this has the same outcome as being more aggressive.  

Other docs want to be extra cautious.

There's no data to imply either direction is better than the other that I'm aware of.  A conservative doc will take the "if it aint broke don't fix it" approach.  Other docs will take a more aggressive approach.

I personally think you are doing the best thing.  I'd want an EP study too.  Whether that moves to ablation is a decision I'd like to be a part of though.

Try googling "enhanced automaticity", this is probably what's going on for you, it might help with any decisions.

[jsuter69]

Thank you for responding to my post the other day, I tried to reply back, had this really good reply actually..lol...I hit the wrong key and the whole thing was gone!! Needless to say I was a little mad...lol! But anyway, I'm here, thank you again!
I really hope you get this heart situation figured out...at least they did catch something, my bad ones have never been caught...so I still live in fear, now I don't have insurance...so I just have to trust my cardio's...all 3 of them :)
Goodluck and stay positive!
Your in my prayers!
Jules