Diastolic Dysfunction 37 years old

Question

Hello,  I am a 37 y/o male.  I have been an ICU nurse for 8 years and have a pretty knowledge base of cardiac medicine and have a good amount of common sense.  I have had PVC's for 3 years now in the range of 14000-18000 per day.  14% or so of all heartbeats.  I recently had an echo because they were getting worse and I was diagnosed with Grade I diastolic dysfunction.  I sense that this is becoming more common in younger people because cardiologists are now looking for DD on echos.  I have in the past 6 months developed hypertension from SBP 120-130 now 130-150 and DBP 65-80 now in the 85-95 range.  I feel the PVCs and DD are related although there doesn't seem much evidence to suggest this.

I have decided to start Flecainide 100 mg BID for the PVCs (after Bystolic, Inderal LA, and Verapimil did nothing for PVCs).  The EP started me on Lisinopril 5 mg daily and I can increase that to 10 daily if SBP > 140.  My biggest question is what are the chances of the grade I DD progressing?  My cardio says "not much" but I'm not for sure what to make of that.  Neither him nor the EP seem very excited about it.  I am from the standpoint my symptoms have all occured in the past 3 years and my BP in the past 6 months.  I do have a high lipid profile for which I have changed my diet, don't smoke, red rice yeast 1200 mg daily, niacin 500 daily and will get a lipid profile and liver function tests in 6 weeks or so.  Thats about it.  I don't feel I need an ablation at this time it seems a bit drastic.  What is your opinion of Flecainide, BP control and medications I should be on and the longterm prognosis if I can control my BP?

This discussion is related to Arrhythmia and Diastolic Dysfunction of LV  (E/A<1).

Mom2four85 · Answer

I'm curious, how did you get dx with DD? I'm pretty sure I have it and my dr's just overlooked it due to some other problems.  What do they look for specifically?

thanks

ac542 · Answer

Clatytex,
I just stopped the flecainide last week and as 150 BID did nothing.  I've been taking Bystolic again but at a much lower dose.  I was taking up to 10 mg /day and my BP was fine with it but it made PVC's worse and exercise was tough.  I switched to 2.5 mg/day and the PVCs appear less and my resting HR is still in the 40's but can exercise up to 130's now.  Lisinopril 5 mg for HTN and everything seems to be much better.  See the EP in 10 days but I'm satisfied for the first time in years with the PVCs.  I'm not by any means ready for an ablation and hope I never am.  Glad it worked well for you!

claytex · Answer

Dear AC:  I took 50 mgs of flecainide twice daily for 1 year and it worked fine for me... however I would still have a bout of afib about every 5-6 months and could take 300mgs of flecainide and it would convert me back to regular rhythm in about 2-3 hours... however I am 69 and in good physical condition and decided to have an ablation in july .... so far it has been great... I do not take flecainde any more...and have had -0- afib problems since the ablation.. my heart is very regular now..no pvcs no nothing ... beats about 64 times a minute just as regular as can be.. I had afib for about 13 years and had about 15 electro cardio versions before the flecainide.. I was just tired of afib.. my cardiologist tried to discourage me from having the ablation.. said it was dangerous and might not work... Well I finally decided he was making his mercedes payments shocking me back..I went to an EP that I knew of who had done about 2000 ablations proceedures and most were successful and he told me I had about a 75-80 % chance of having a successful ablation... Life is great now... I never figured my heart would be normal again... I would do it again in a heart beat..uhhhh so to speak...laffin.. Later Claytex

ac542 · Answer

Thanks for all the posts I wanted to see what others expereiences had been.  I have not checked a Vit D level and my thyroid was normal.  I hope the flecainide will work and then I can effectively find out what my actual BP is.  I have a very hard time finding my own manual BP and a machine is all over the place because of the PVCs!

jrbon · Answer

I have no experience with  PVC and DD but ... you mention Grade I Diastolic, is this a Canadian terminology? In any case have you checked your Vit. D levels?

Also any check of your thyroids?

Jesus

kevk · Answer

I Have been taking Flecainide 150 mg 2 x day for PVC`s and V-tach since 1995 it has worked great for me. Some of the side effects were fatigue,blurred vision that comes and goes but got better after a little time. It will not help your BP or DD. I take 50 mgs of metropolol  3 x day for my DD it took a good while to help but has made my heart function better and my bp droped to normal limits. Everyone is different and responds to the meds differently.
It sounds like you are taking the right approach  and I wish you the best of luck.

kenkeith · Answer

I read the link that has been noted and there isn't much I can add. Heart rhythm irregularity can be caused by DD.  DD can distort electrical impulse pathway especially an enlargement of the septum.  

My DD and dilated LV was due to high blood pressure, and medication that treated the high blood pressure reversed remodeling and EF returned to normal.  If your DD is related to high b/p, medication can/will reduce the heart's workload and at least stop the progresion

If your DD is related to a pathological source such as heart muscle disease, there may be less favorable expection of a positive outcome.  Also, probably as know a well-conditioned athlete has an enlarged LV wall which is not pathological.  The difference pathoplogical and non-pathiological can be seen at the cell level.  The cardiomyocytes'
physiology are different....pathologically the new cells are added side by side, and the enlargement of LV walls, the myoctes are added end to end.   

My DD may have been non-pathologically and reversed remodeling the same as an athlete's heart size would reverse remodeling if the there is a discontuation of rigorous activity.  

Hope this helps and thanks for sharing.  If you have any further questions or comments, you are welcome to respond.  Take care.