Aa
Dilated heart
I am a 34 year old female, 1.75cm, 77kg. I have two children, aged 5 and 3.
About 10 years ago I was investigated for premature ventricular contractions. At the time it was determined (after an ultrasound, 24 hr monitor and stress test) that these were symptoms of a healthy heart and benign, mainly originating from the right ventricle.
Since then I started exercising a lot more and lost a significant amount of weight. Prior to my children being born I was exercising 5-6 times per week, often 1.5 hrs at a time and at quite high intensity. Since the children I have remained active, albeit the frequency is not as great (3-4 times per week) as it used to be and I am obviously a lot heavier than back then. Last year in Jan 2012 I had an extensive health check and part of the check was fitness. The test showed I had a high level of fitness and that my heart performed better than expected for my age and gender under stress. I am active, but I am not an athlete.
About two months ago the PVCs flared up again, this time related to activity and exercise. They have been particularly bad at the start of exercise and during recovery, however once the heart rate is high enough they disappear. I have experienced some during general activity too such as walking and household chores. There are no other symptoms, just the PVCs. My resting pulse is low, between 40 - 50 bpm.
I was referred to a cardiologist and the following tests were done: an ultrasound, which the cardiologist explained showed my heart was structurally ok, 24 hr monitor, which showed 230 PVCs and 200 sinus arrhytmia (?), total heartbeats ~79,000. I also had an exercise test, which showed the PVCs particularly well. I was anxious during the test, which in my opinion contributed to the symptoms being worse. During the test, as normal, the ectopics disappeared once the heart rate increased, and then returned during recovery. The cardiologist was not worried, but decided we'd do an MRI to be safe.
The MRI showed mild to moderate dilation to both ventricles. When asking about the correlation between the MRI and the ultrasound the cardiologist said they were aligned, and that the ultrasound showed the left ventricle was 5.7cm. As said, at the time of the ultrasound he said the structure was fine and he didn't think of this to be of significance. The indexed MRI measurements are as follows:
Left ventricle
EDV (mL/m2) 113
ESV (mL/m2) 37
Mass Index (g/m2) 78
EF (%) 67
Right ventricle
EDV (mL/m2) 125
ESV (mL/m2) 55
EF (%) 56
The cardiologist explained that in his opinion the dilation was likely due to my size (I am tall) and my activity level. He considered it unlikely it was dilated cardiomyopathy. However, as that cannot be ruled out 100% I am to have a repeat MRI in a year's time. No other action to be taken now, just live as normal.
I have since tried to relax about this, but am finding it hard. I am extremely anxious that I may suffer from dilated cardiomyopathy and that I am at risk of sudden death.
Would dilated cardiomyopathy present itself in this manner?
Has my activity level and is it still enough to cause mild dilation?
What is the correlation between the symptoms on activity with the dilation? As said, I am having some ectopics daily, but not 1000s or probably not even hundreds. Since reducing caffeine and not being as anxious about the symptoms they have in fact dramatically reduced. They barely present at start of exercise, but some do come with recovery.
What is the likelihood of dilated cardiomyopathy? Should I be concerned?
About 10 years ago I was investigated for premature ventricular contractions. At the time it was determined (after an ultrasound, 24 hr monitor and stress test) that these were symptoms of a healthy heart and benign, mainly originating from the right ventricle.
Since then I started exercising a lot more and lost a significant amount of weight. Prior to my children being born I was exercising 5-6 times per week, often 1.5 hrs at a time and at quite high intensity. Since the children I have remained active, albeit the frequency is not as great (3-4 times per week) as it used to be and I am obviously a lot heavier than back then. Last year in Jan 2012 I had an extensive health check and part of the check was fitness. The test showed I had a high level of fitness and that my heart performed better than expected for my age and gender under stress. I am active, but I am not an athlete.
About two months ago the PVCs flared up again, this time related to activity and exercise. They have been particularly bad at the start of exercise and during recovery, however once the heart rate is high enough they disappear. I have experienced some during general activity too such as walking and household chores. There are no other symptoms, just the PVCs. My resting pulse is low, between 40 - 50 bpm.
I was referred to a cardiologist and the following tests were done: an ultrasound, which the cardiologist explained showed my heart was structurally ok, 24 hr monitor, which showed 230 PVCs and 200 sinus arrhytmia (?), total heartbeats ~79,000. I also had an exercise test, which showed the PVCs particularly well. I was anxious during the test, which in my opinion contributed to the symptoms being worse. During the test, as normal, the ectopics disappeared once the heart rate increased, and then returned during recovery. The cardiologist was not worried, but decided we'd do an MRI to be safe.
The MRI showed mild to moderate dilation to both ventricles. When asking about the correlation between the MRI and the ultrasound the cardiologist said they were aligned, and that the ultrasound showed the left ventricle was 5.7cm. As said, at the time of the ultrasound he said the structure was fine and he didn't think of this to be of significance. The indexed MRI measurements are as follows:
Left ventricle
EDV (mL/m2) 113
ESV (mL/m2) 37
Mass Index (g/m2) 78
EF (%) 67
Right ventricle
EDV (mL/m2) 125
ESV (mL/m2) 55
EF (%) 56
The cardiologist explained that in his opinion the dilation was likely due to my size (I am tall) and my activity level. He considered it unlikely it was dilated cardiomyopathy. However, as that cannot be ruled out 100% I am to have a repeat MRI in a year's time. No other action to be taken now, just live as normal.
I have since tried to relax about this, but am finding it hard. I am extremely anxious that I may suffer from dilated cardiomyopathy and that I am at risk of sudden death.
Would dilated cardiomyopathy present itself in this manner?
Has my activity level and is it still enough to cause mild dilation?
What is the correlation between the symptoms on activity with the dilation? As said, I am having some ectopics daily, but not 1000s or probably not even hundreds. Since reducing caffeine and not being as anxious about the symptoms they have in fact dramatically reduced. They barely present at start of exercise, but some do come with recovery.
What is the likelihood of dilated cardiomyopathy? Should I be concerned?
Dear Anitha
Thank you for your comments. In the MRI report the charts showed my volume values were off the graphs, after adjusted to age, sex and BSA. Would you still consider the MRI values to be within normal limits considering the adjustments showed I was well off the graphs?
Thank you again.
Thank you for your comments. In the MRI report the charts showed my volume values were off the graphs, after adjusted to age, sex and BSA. Would you still consider the MRI values to be within normal limits considering the adjustments showed I was well off the graphs?
Thank you again.
MEDICAL PROFESSIONAL
Hi, with dilated cardiomyopathy, the pumping capacity of the heart will decrease, this will probably be the first effect. But your ejection fraction values are good and from what I see your exercise tolerance is also good. And as the MRI values are within normal limits, you don't have to worry. Only frequent PVCs associated with underlying heart disease and periods of ventricular tachycardia need therapy. Occasional PVCs require no treatment. So, as planned follow up with your doctor to monitor the PVCs when needed. Regards.
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