Frequent PVC's and decresed EF

[gbsnelson]

I am a 39yr old female in good health.  I am about 40lbs overweight and I don't exercise regularly, although I am a busy mom of 3 and a labor nurse.  I have had an annoying little dry cough for a few months which seems to be worse when talking or when I raise my voice.  About 1 1/2 weeks ago I noticed I was in a ventricular bigeminy when I listened to my lungs due to my cough and heard my heart!  This was confirmed by EKG a few days later when I had a preop appt for an elective surgery.  I saw a cardiologist who ordered a exercise echo.  The echo showed resting EF 50% (I was also still in bigeminy) but I was not able to get my HR up enough during exersise due to SOB so my stress EF was not accurate.  I continued to throw PVC's while exercising and even a few couplets which I don't normally have, but they did decrease.  My doctor also said I have a small amount of back flow into my lungs, but this did not show on CXR.
I do not tolerate exercise well due to SOB, not fatigue.  When hiking or walking with the family, I am very short of breath, but I always thought it was because I am out of shape.
Questions-

My physician indicated maybe my EF was decreased due to me being "deconditioned" (out of shape).  This annoyed me because I told her I was out of shape, but she never questioned me about my activity.  I am a busy person, I just don't exercise 3 days a week.

She said the test indicated CAD which she doesn't feel I have.  She is considering an angiogram.  Should I have this?

She is going to start me on a beta blocker.  I told her I have been noticing my radial pulse is in the 30's and 40's, but she contributed this to the PVC's and didn't seem to mind.  Is that normal?

Can't frequent PVC's decrease EF especially if I have had them a long time?  I really don't know how long I have had them.....I have just had the little cough for a few months.

My thought is that I should try the beta blocker, hold off on the angiogram and recheck the EF in a month or two.  Are there other conditions with my heart I should be concerned about.  What about cardiomyopathy?

Any advice would be greatly appreciated.  I just don't want this condition to be blown off because I am a 39yr old female who shouldn't have heart disease.

Thank you!!

[Flycaster305]

From my perspective, any alteration  in heart rate, breathing ability during exercise needs to be investigated, I do think that because I exercise at least 1/2 hour daily is why I'm still standing on the sunny side of the planet.  Going back to your posts, you mentioned all the reasons you couldn't exercise daily, but I'm betting the kids, job, etc might give reason why you should do so going forward.  1/2 hour of walking exercise a day is an easy task for almost everyone.  Changes are quite signifcant, certainly riding herd on your health is important.  Brisk walking 20 to 30 minutes a day not only makes your heart healthier, but gives you information, and keeps you informed of your heart health.  
Keep us informed.

[gbsnelson]

I just saw the EP specialist at Abbot Northwestern....Minneapolis Heart Institute...Dr Melby.  He was fantastic and completely validated everything I have been feeling over the last few years...long before I even knew I had a problem.  I asked him why doctors don't reconize PVC's as a problem.  He said generally PVC's aren't a problem, but there is a certain subset that do cause problems.  He said that once someone is over 15-20 thousand a day, they can start having symptoms.  He also mentioned my pulse being so low and my cardiac output being decreased by the PVC's.  Wow.  So, the ablation is scheduled for October 19th.  I am very excited to be done with all of this and I am so thankful for such an easy fix.
I am taking the time to write this in hopes it will help someone else.  It is a terrible feeling when you know something is wrong and your doctor treats it as nothing.  And to think, my first doctor told me I was "deconditioned" to explain my shortness of breath.

[gbsnelson]

I just thought I would update this for anyone who is interested or experiencing the same problem.  After all of the tests I had done, my heart is structurally normal, which is great news.  I did begin doctoring at the Minneapolis Heart Institute after there was not any follow up with my previous cardiologist.  My new doctor reassured me that most people with frequent PVC's have no symptoms, so I was to come back in a year to do another echo to check left ventricular function.  I also continued on metoprolol, I lost 10lbs and was tolerating mild exercise without any difficulty.  I also had surgery, which started all of this, without any problems...except freaking all of the nurses out with my constant bigeminy.
This spring we went bike riding in Itasca State Park.  My husband and I hopped on a tandem bike, which we have always loved to do.  Within a few minutes, I was short of breath and sick to my stomach and was desperate to quickly get off the bike.  There were some other problems.  We live on an elevated lake lot.  Walking up the stairs from the lake was torture.  I would be so short of breath at the top, I avoided going down to the lake.  I would just think to myself, I guess I really am out of shape.  Then I was at my neighbors and we walked up her gradual slope from the lake and I felt as if I would pass out when I got to the top.  Being a previous cardiac nurse, she said, you really need to call your doctor.  I was hesitant because I didn't want them to tell me I was out of shape again.
Anyways, I did and they decided to put me on flecainide.  Initially, I needed frequent EKG's, which always showed bigeminy.  Then they increased my dose and we went camping and hiking on The North Shore.  I felt like a kid again!  I was able to run up steps that would have killed me previously.  I was able to hike and only felt burning in my legs...no shortness of breath.  The change in me was especially noticed by my husband who would always sit back with me when I used to have to rest.  Now I was doing better than him on the trails!!
When we got home, I had another EKG which showed a normal sinus rhythm!!  Then I worked a 12hr shift and instantly noticed a difference in my lower legs and feet.  No more pain and swelling!!  I was elated and relayed to the doctor how great I felt.
About a week later I received a phone call from my cardiologist that flecainide interacts with another medication I am on and may cause a fatal arrhythmia, so I need to have frequent EKG's.  I have decided to remain on the medication for now, because it makes me feel so much better, but am following up with a electrophysiologist to persue ablation.  The medication is just too risky for me.
I am excited to be done withh all of this.  I am just too young to be doctoring with this all of the time and I am so sorry for those of you that don't have an easy fix to your heart problems.
To the person who contacted me with a similar problem I wish you well and hope they figure it out!

[gbsnelson]

Welcome to the world of medicine, I guess.  I'm a nurse and now I know how my patients feel!!!  The nurse called to tell me that my ccta was fine and basically goodbye.  Umm, excuse me???  They have started me on a beta blocker and there is really no follow up here?  She had talked about ablation.  I am still in bigeminy.  A PA friend of mine read my ccta results at the clinic which said I have a generous right ventricle.  I think I will get a 2nd opinion.  Ugh, I'm disgusted.

[gbsnelson]

I had a coronary ct angiogram today and was in ventricular bigeminy the entire time.  Awaiting results.

[Mom2four85]

We must have gone to some of the same dr's - I've been told nothing was wrong or given lackluster excuses for things that were wrong with me from age 9 - 42, heck I still have dr's who do this even after testing proved what I have.

I've had hr's at 20-25 awake before and caught during a tilt table test on ekg's and up until my TTT dr's told me it was nothing until I had no palpable pulse during the TTT and they finally took my complaints seriously enough

Back in June 2009 I fell breaking my foot and had to have my foot checked out (broken metatarsil) the dr wasn't anyone I had seen before and he saved my life - all those cop outs the other dr's gave me finally scared a dr enough he sent me to a cardiologist right then.

I had a full cardiac workup but the Echo showed small things wrong not adding up to much (Concentric LVH) but a normal EF of 55-60% so I was told not to worry about it but I needed to have an abltion to try and get rid of the 50,000 pvc's I was having.  

In Nov 2004 I complained of fainting, shortness of breath, dizziness, chest pains and they did an ekg but it was normal so they sent me on my way.  In April 2007 again I complained of constant chest pain, shortness of breath, fainting etc dr did an EKG and saw things there yet said I was fine and never thought to send me for a cardiac workup.  Had he done that I may not have suffered the damage I did.

I had an ablation 2 hours after my TTT, had Asystole and then 2 VF arrests after my heart stopping during the TTT.  I then went through more testing - CT, MRI, Xrays, catherization that showed not much wrong until my cath.  

My EF was down to 40% and my LVDEP was up to 34 and I was dx with HOCM.  The explanation was the echo's were probably wrong and chalked it up to "tech" error saying that the measurements may have been off due to the tech and dr that read them.

From research for myself, it seems that echo's can be +/- 8-15% and there are not set parameters for different body types so the echo may not be fully correct.

I just had this happen again - my echo showed my EF was at 60%; my cards said oh your EP was wrong and you got a pacemaker/icd implanted for nothing your EF is fine and the reason for the CM was due to long term HBP...what he failed to realize after 6 months of treating me is I've had life long LOW blood pressure and didn't start having HBP until widespread inflammation was found in March 2011.

I would find another dr who can figure out what's going on before it's too late like with me.  It may be nothing but the dr is crazy if he thinks hr's in the 30's is no big deal and just attributed to pvc's.  Keep searching until you find the answers.

[grendslori]

I don't know what your doctor is doing with you. Normal EF% range from 50-70% period....that's across the board for everyone. 50% is low normal. Even if the EF% was in the mid to high 40%s most doctors wouldn't be overly concerned. Simply being dehydrated can lower EF%s, that's why I mentioned the kidney and lung issues. Most cardiologists consider more than just EF% when diagnosing CHF or conversely HCM. I thought your statement "....and mumbled something under her breath'" really interesting. I think the beta-blocker improving the cough, is probably just a coincidence and nothing more. The timing on or off the drug is probaly what happened. Beta blockers lower heart rate, primarily and have even been used to control migraines. It is not a diuretic of any sort and fluid in the lungs or irritation in the lungs is what causes you to cough in the first place. You wrote earlier that your doctor told you that you had some fluid back-up in your lungs, but not enough to even show up on the chest x-ray. Chances are you didn't have enough fluid back-up to really be a problem and you cleared that up on your own. I understand what you wrote about being over weight and not exercising 3 times per week but that you are busy. I'm the same way; somewhat over weight, don't exercise 3 times a week yet I keep very busy running a kennel of Great Pyrenees dogs. We show them and we spewnd a lot of time running around! I too have a big problem with being SOB and I didn't even want to bring it up to my doctor figuring she'd fall back on the 'not being in shape'. One thing that I have in my favor is I really do have a fabulous GP! She takes all the time in the world with her patients (no one cares if their appointment time comes and goes because they know she'll spend time with them when she walks through the door) Anyway, she ordered the EKG (normal) and chest x-ray (no change from my last one) and an echo which showed I have HCM (hypertrophic cardiomyopathy, a disease my daughter also had and had to be transplanted for) So they found the reason I have such a problem with SOB. I really think you need to be seen by a good cardiologist who will take you seriously. Do I think you have a problem? I don't know; one thing I do know is that heart rates in the 30s while you are awake, especially, is NOT normal and can be very dangerous because once rates get down into those rates, the heart can actually stop beating. (my daughter went through this as well. She had Sick Sinus Syndrome and when I took her to Houston they wanted to put a pacemaker in but not before she was also evaluated by a pediatric nuerologist to make sure her symptoms were heart related. They expected me to return to Houston in a couple of days for the pacer. I got mad and figured I wasn't going back. Within two days they called me and told me to get her back there; that rates in the 30's like she had, could cause the heart to stop beating! Needless to say, four hours later we were back in Houston) Ask your doctor if you can have a 30 day King of Hearts monitor and that way you can push a button when you have these symptoms; Holters will only catch something IF you have a problem while wearing it. The good thing about having th Holter is that it would record non-stop during sleep which would also be good in light of the rates you are having. Take care    

[gbsnelson]

Thanks so much for your comment.  She told me my EF should be about 65, but I also saw on some websites that 50 was the low normal.  The beta blocker improved my cough about 90% in about 48hrs of starting it, which I was not expecting.  I was walking into a theater last night with my husband and I had a funny sensation in my chest and abdomen and I felt briefly out of breath.  I realized I have been having this sensation off and on for quite some time, but never really thought about it.  Today I felt tired as usual.....I used to think I was just lazy.
Anyway, when I told her my pulse was in the 30's, she didn't seem concerned and mumbled something about the PVC's.  I will have a holter later this week and plan to schedule the CT angiogram.  I'm not sure what the plan will be after that.  I just want to know what is wrong so I can fix it and get my mind off of it!!  Thanks again.  Any other thoughts are appreciated.

[grendslori]

A cardiomyopathy does come to mind, however, if that were the case, it would have shown up on the echo and if severe enough on the x-ray and EKG as well. Bigeminy isn't going to cause a low EF%. Your EF% of 50 is a low normal actually. Normal EF% are 50-70. If you had a cardiomyopathy involving CHF your EF% would be low and there would be lung as well as kidney issues to go along with that. At your age it would be very unusual for you to have CAD because a woman's hormones protect her for heart disease due to her ability to carry and deliver children. Once menopause hits, it's a different story. I would certainly consider the angiogram because it is obvious if your doctor  wants this to be done and wants you to start taking beta blockers. She is already questioning something going on. Doctors don't put patients on beta blockers without just cause; beta blockers can slow you down even more and you can gain weight on them as well. Also you should never be on a drug that lowers heart rates if your rates are that low without a pacemaker put in. (Remember the saying: "Doctors, first, do no harm"?) The bradycardia is questionable, a rate being in the 30's, while awake can be downright dangerous. What did the cardiologist say about those rates? Being a nurse, the doctors are probably trying to sugar coat this a bit for you; you know too much and you also have access to medical information are your hospital library. I would consider doing as your doctor asks, but not before asking some really good questions first.