Virus, PVC's, continued pain

[tacoma25]

I am a 37 year old female, excellent health, excellent diet, extremely low cholesterol, no family history of heart disease, very active lifestyle. 2 months after a very bad flu, I began having lung and chest pain. A cardiologist diagnosed me with a virus that attacked my heart & lungs. All tests normal. Diagnosed with PVC's and also told no exercise for 4 months to let heart heal from virus. Was having hundreds of PVC's per day every day and constant pain. Took propranolol, kept PVC's to 20 or so per day. After 4 months, saw new doctor. Tried other meds. Now on toprol and cartia. Again, keeps PVC's to 20 or so per day, relatively minimal side effects. Trying to exercise again, but pain never goes away. Its like my heart muscle hurts, aggrivated by talking or exercise. Only laying flat and no talking keeps pain away and I can't live like that. Taking ibuprofin and aleve to help pain. Any other answers? Doctors baffled.

[fwilson]

I also had a virus that attacked my heart and have similar post infection pain and PVCs.

My personal feeling is that virii that attack the heart can also attack the nerves surrounding the heart and leave damage patterns that doctors are not yet able to recognize and treat well.

These damaged nerves, I believe, predispose you to rhythm issues and pain.  The referred pain of the heart is also not so well understood it seems.

On the plus side my infection was nearly 7 years ago and I am still here.

On the negative side I have gotten no better, feel pain daily, and had many PVCs until my ablation last year.  (Which oddly enough was supposed to be a painless procedure but was an 11 out of 10 pain during the time the burn was applied).

Good luck to you.

[Michael J. McWilliams, M.D.]

PVCs are tough to treat -- as you are finding.  The previous post asked a very similar questions about the treatment of symptomatic PVCs.  If medications are keeping you to 20 PVCs per day, I would not advise escalating treatment as the treatments have risks and 20 per day is relatively few.  I saw a holter the other day with greater than 22,000 in 23 hours but this patient had absolutely no symptoms (I am sure you find this hard to believe that they had no symptoms).

I will paste the same answer I gave them below about treatment options for PVCs that are refractory to beta blockers and caclium channel blockers.

If I was seeing you in clinic and you only had 20 PVCs per day, I would try to talk you out of more aggressive therapies like ablation, flecainide and propafenone.

I assume your ejection fraction is normal because you didn't say that it was not.

I hope this helps and thanks for posting.
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If the beta blockers and calcium channel blockers do not help and the PVCs are the same morphology (from the same location) and are frequent enough to map with catheters in the heart, ablation is an option.  The success rate is probably around 70%.  It can be a challenging procedure and does have risks which include rare cases of strokes and even deaths.  These are rare cases, but it is important to know because the risks of the ablation need to be less than your quality of life impairment from them.

Another option is anti arrhythmic medications like flecainide or propafenone.  You can use these medications if you have a normal EKG and no blockages on your stress test.  Again, there are risk to these medications and they should only be prescribed by experienced doctors to make sure that you are a good candidate for them.