VT

I am a 25 year old male, very active runner. I was born with a hole in my heart that closed up on its own by 12 months. I was hospitalized numerous times as a toddler for croup (once for 10 days) between 18months and 3 years old. No family history of heart disease.

This past summer I began feeling a lot of "skips" in my chest.  One prompted an emergency room visit.  During that episode, my heart slowed way down, skipped, and then my pulse jumped to, what felt to me, around 180 bpm while I was sitting down.  The EKG in the emergency room was fine, Blood work on my thyroid came back normal.  Cholesterol was normal, as well.

I was on a 24-hour EKG (normal), 3-day holter (normal) and 30-day event monitor. There were many PVCs and one recording of 5-7 beats of v-Tach.

This prompted a few more tests as follows:

EKG(asymptomatic) - normal
Echo - normal  
MRI, of which I only made it half-way through the test (before I started to feel very sick and numb all.  The nurses contributed this to anxiety.) They did not get to the contrasting-dye.  Also normal.

I am currently on 120mg of Verapamil.  I will be taking a stress test in one week.

1)  Are there any more tests that I should seek to determine the cause of the PVCs or the V-Tach?
2)  Do many people slip in and out of V-Tach on their own?
3)  Are there any other causes of V-Tach that may not be seen through the test that I have been given?
4)  Am I at a higher risk for SCD or SAD?   I am still running, not as frequently though because I have been anxious and apprehensive about the symptoms occuring while I run.  (They have only occurred once, however, while I have been exercising, and it was a PVC.)  It is very limiting as I go through the day worrying about the run of V-Tach and the thought of my heart just stopping.
5)  What other warning signs should I be aware of?
6)  Final question - Are there any heart diseases or arrythmias that can affect an otherwise healthy heart?

[Michael J. McWilliams, M.D.]

1)  Are there any more tests that I should seek to determine the cause of the PVCs or the V-Tach?

You will probably not get an answer to why you had PVC and non sustained VT.  It sounds like they are appropriately doing a right ventricular dysplasia work up.  This is an uncommon cause of VT in young people, but one of the few conditions that can be dangerous.

If you have a normal echo, stress test, and MRI and no family history of sudden death, seizures, drownings or sudden infant death syndrome, no other tests are definitely necessary.  Sometimes a signal averaged EKG is done, but it sounds like you don't have enough risk factors that it would matter if it where positive.


2)  Do many people slip in and out of V-Tach on their own?

I want to clarify that not all VT are created equal.  There is a big difference between non sustained VT (short runs of VT) and sustained VT (greater than 30 seconds).  If you are reading about this on the internet, most articles about VT do not apply to you.

Some people with structurally normal hearts have non sustained VT.  If the work up for other causes is negative, the only recommendation is a beta blocker.  The vast majority of people with non sustained VT never have and are not at risk for sustained VT.

3)  Are there any other causes of V-Tach that may not be seen through the test that I have been given?

Rarely, non sustained VT in a normal heart is the first sign of future heart problems and this can be missed on the tests you have had.  At this point there is no way to know who is at risk of progressive disease.  Sometimes hypertrophic cardiomyopathy doesn't present until mid 20's or later, but again, this is rare.


4)  Am I at a higher risk for SCD or SAD?   I am still running, not as frequently though because I have been anxious and apprehensive about the symptoms occuring while I run.  (They have only occurred once, however, while I have been exercising, and it was a PVC.)  It is very limiting as I go through the day worrying about the run of V-Tach and the thought of my heart just stopping.

Lots of people that exercise have PVCs.  If your work up is negative, you do not need to stop exercising and should do your best to not allow this to affect your quality of life.  In a way it becomes a battle in your mind.  If you start worrying about dying everytime you exercise, you will stop exercising.  If your work up is negative and your doctor determines you are low risk, you are going to have to do your best to fight the negative thoughts or it will control, perhaps ruin, your life.


5)  What other warning signs should I be aware of?

If you feel your PVCs or non sustained VT, that is what it would feel like.  If you doctor determines that your risk is very low, you probably don't have to concerns yourself with any warning signs.

6)  Final question - Are there any heart diseases or arrythmias that can affect an otherwise healthy heart?

There are normal heart VTs, but there is no evidence you have this.  They are typically sustained arrhythmia.

The best piece of advice I a can offer you is that if all your tests are ok and your doctor assesses you low risk, move on with your life.  you will probably have non sustained VT again, but don't worry about sustained VT if you don't have it.  This is similar to having a mole that you are afraid is cancer and finding it out it isn't cancer but then you worry that every freckle is the first sign of the end.  Don't fall into this trap because it can consume you.

I hope this helps.  Good luck and thanks for posting.

[gcb00001]

Thanks Doc.  I have just spoken some more with my cardiologist.  He is narrowing down the PVCs to Idiopathic Right Ventricular Outflow PVC.  He says they are benign, and I should not worry about them.

What exactly are Right Ventricular Outflow PVCs?  Are there any dangers associated with them?

Also, should I be concerned that my BP for the past week has been 122-135 over 82-90, even with Verapamil?  (I forgot to ask my cardiologist about this when I spoke with him).

Thanks.

[anon10]

122/82 is normal. Where did you get the idea this was an abnormal BP? It sounds as if you are suffering hypochondriasis. If you cannot control your anxiety with benzodiazepines and SSRIs, the only solution will be to install an implantable-cardioverter defribrillator, which will monitor you constantly and deliver therapy when appropriate. However, I know of know cardiac electrophysiologists who would install one for psychiatric reasons. Even if you found one who would, insurance would not likely cover it, but it would be $30,000. There is at least a 1% risk of death from installing an ICD.