recent exercise induced PVC's in MVP male

Male, 49 yo, mild MVP (no regurgitation). 10 years ago, after stressful period (marriage, 1st child), began suffering from PVC's, worse when heart rate went up. My exercise tolerance has always been very low. ECGs, Holter (256 PVC's per 24 hours), echos & treadmill (few PAC's), all normal. Quit caffeine, Colas, tea etc & had been almost totally PVC free since!

Over the last 3 months (another stressful situation at home), I noticed that when I walked vigorously I got few extra beats (felt like PVC's). Slowing my pace and heart rate down, made extra beats disappear. Following a week of Clarithromycin a month & a half ago, I got significantly more PAC's that lasted a couple of weeks after the antibiotic was stopped. Some of my PVC's came back, but mostly it was PAC's (no Holter, just my feeling). 10 days ago, I started exercising on recumbent bike for 45 minutes daily. When I get my heart rate in aerobic zone (120-137), I get a few extra beats (that feel like PVC's). When I walk vigorously, even downhill, only a couple of mins into the walk, I get quite a few PVC's that scare me and I reduce tempo to get heart rate down.

Cardiologist performed ECG & Doppler heart echo (w/ sounding of carotid & stomach arteries) that were normal. Heart dimensions were exactly same to those of echo 10 years ago (performed by same physician), of importance because I am mildly hypertensive (145/95 morning, 135/85 afternoon, 125/80 when relaxed). Cardio doc did NOT suggest that I do treadmill test due to low cholesterol (<180) and absence of heart disease in paternal & maternal parents and said that a hypertensive patient is more likely to receive a false positive result & "unnecessary extra testing".

Does it sound like the ectopic beats I get when my heart rate goes up may be attributed to CAD? May they be caused by mild MVP? Is anxiety causing them ("Oh my God, I am going to get them again") when I start walking vigorously? Should I have a treadmill test?

John P.

[Michael J. McWilliams, M.D.]

Ectopic beats are rarely attributed to CAD.  We sometimes order a stress test to make sure in higher risk patients, but not on all patients.  If you are low risk, it is true that a stress test is more likely to yeild a false positive test.

MVP is associated with more pvc's.  It doesn't sound like your MVP is that bad though.

It is also true that stress (emotional or physicial like exercise) can cause some people to have more events.

We are rarely able to pinpoint the exact explanation for why people have them.  They do come and go like you describe and can be associated with stressful times, as you describe.  They will likely go away again.

The stress test decision is a clinical one.  There are no specific guidelines.  You will probably have to trust your doctor on that one.  If you are very concerned about this, explain why to your doctor and they may agree with you.

I hope this helps.

[paravantis]

Thank you very kindly for your response.

Kudos on medhel for this wonderful online service.

John P.

[samuel165]

A related discussion, MVP was started.