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myocarditis or idiopathic RVOT?
I am a casually athletic female, age 49, nonsmoker, bp averaging 130/80, total cholesterol 126. Diagnosed with mild MVP/minimal MR 1985 by 2-d echo, nadolol 40 mg qd, down to 10 last year. No change on yearly echoes, asymptomatic from '87 til this year. No family history of arrhythmia.
Late February had mild afebrile illness, malaise without URI symptoms. Once sudden tachycardia on minimal exertion, then twice prolonged severe chest tightness (4+ hours) radiating into arms. All labs normal (incl ESR and C-RP, cardiac enzymes not checked), no ECG changes. Mild chest discomfort persisted for 3 weeks but returned to brisk walks 3-4 hrs/week. Echo in mid-March unchanged, LVEF 62%. Frequent pvcs started late March, referred to university cardio, 8445 pvcs/24 hours on Holter, no couplets or runs, echo mid April showed normal MV, mild MR, mild TR, mildly dilated left atrium, LVEF 60%. Referred to EP, diagnosed polymorphic pvcs of idiopathic RVOT origin, switched from nadolol to verapamil 80 mg tid, helps but getting some breakthrough. Last week mibi stress test normal at 98% maximal HR, MRI scheduled next week to rule out ARVD.
1. What would be the significance of latest echo findings, if any? EP is unconcerned, should I be?
2. Does this sound like it could be the aftermath of myocarditis? With my history how likely is ARVD?
3. EP has recommended ablation, how likely is this to be successful (assuming no ARVD).
Any other comments or advice would be welcome. Thank you and sorry for the lengthy post.
Late February had mild afebrile illness, malaise without URI symptoms. Once sudden tachycardia on minimal exertion, then twice prolonged severe chest tightness (4+ hours) radiating into arms. All labs normal (incl ESR and C-RP, cardiac enzymes not checked), no ECG changes. Mild chest discomfort persisted for 3 weeks but returned to brisk walks 3-4 hrs/week. Echo in mid-March unchanged, LVEF 62%. Frequent pvcs started late March, referred to university cardio, 8445 pvcs/24 hours on Holter, no couplets or runs, echo mid April showed normal MV, mild MR, mild TR, mildly dilated left atrium, LVEF 60%. Referred to EP, diagnosed polymorphic pvcs of idiopathic RVOT origin, switched from nadolol to verapamil 80 mg tid, helps but getting some breakthrough. Last week mibi stress test normal at 98% maximal HR, MRI scheduled next week to rule out ARVD.
1. What would be the significance of latest echo findings, if any? EP is unconcerned, should I be?
2. Does this sound like it could be the aftermath of myocarditis? With my history how likely is ARVD?
3. EP has recommended ablation, how likely is this to be successful (assuming no ARVD).
Any other comments or advice would be welcome. Thank you and sorry for the lengthy post.
Well I had my MRI today... really two of them because of an equipment failure first time around that forced them to reboot their computer before they had saved my data. This is not a comfortable test, I actually have a sore ribcage from it. Anyway now the anxious wait begins... I should know the results by Friday, or Tuesday at the latest.
Hi!!
WOW! Two go rounds on the MRI! I didn't realize that that test was uncomfortable. Sore ribs...OUCH! I get that after some of my echos because they have to push and probe so much. One of them took 1 1/2 hours because I was in constant bigeminy. This last one was 1/2 hour...so nice : )
I'll bet you are anxious to get the results a.s.a.p. Any idea of when that will be? If you would like, you may also email me at ***@****. I am keeping my fingers crossed that you get great results and relief from your upcoming ablation.
By the way, do you have a "theory" on hormones and their role in pvcs? I'm pretty convinced they are relevant (they are always stirring up some kind of trouble) for many of us women. Thought that was a good question for a PhD...lol
Take Care
Connie
WOW! Two go rounds on the MRI! I didn't realize that that test was uncomfortable. Sore ribs...OUCH! I get that after some of my echos because they have to push and probe so much. One of them took 1 1/2 hours because I was in constant bigeminy. This last one was 1/2 hour...so nice : )
I'll bet you are anxious to get the results a.s.a.p. Any idea of when that will be? If you would like, you may also email me at ***@****. I am keeping my fingers crossed that you get great results and relief from your upcoming ablation.
By the way, do you have a "theory" on hormones and their role in pvcs? I'm pretty convinced they are relevant (they are always stirring up some kind of trouble) for many of us women. Thought that was a good question for a PhD...lol
Take Care
Connie
Thanks for the link to info on ARVD...very interesting!! In my case, the left ventricle was becoming myopathic, but I don't think the right was involved. I cannot believe how different I feel from a year ago...Rare PVCs, no more swelling and renewed energy. I do still tend to tire somewhat easily, but I definitely notice a marked improvement. Kids and hubby agree!!
While you are waiting I hope the verapamil works. Who needs more anxiety? When is your MRI?
Michigan? We're neighbors : )
Good luck with everything. Keep us posted!
connie
While you are waiting I hope the verapamil works. Who needs more anxiety? When is your MRI?
Michigan? We're neighbors : )
Good luck with everything. Keep us posted!
connie
Actually I did get it captured and it wasn't a-fib, just lots of ectopics. But it wasn't one time, it was an every morning thing that was getting worse and worse until I started verapamil. I really was becoming a walking pvc and if the meds stop working, I'll be back there again and that's a very scary thought.<BR><BR>
Connie, http://www.arvd.com has lots of info on ARVD, probably more than you wanted to know. Basically it is a progressive myopathy that starts in the right ventricle and is hard to distinguish clinically from RVOT-VT. My ep thinks it is too often missed and orders at least a MRI whenever he sees frequent ectopics from the RVOT. It sounds like the Cleveland docs need a higher index of suspicion.<BR>
I don't want anti-arrhythmics either and my ep hasn't even suggested them, the verapamil is just to keep me comfortable until July. The more I think about it I am more scared of what I might have than of the ablation... this just seems so vicious and aggressive.
My ep is in Michigan and so am I... I would get a second opinion at Cleveland if I thought I had time, and if my insurance would allow it.
Thanks for all your support, I really appreciate it. I'm sure I will be okay as long I don't have some active carditis or myopathy. Waiting for tests and then waiting for the results is the worst part.
Connie, http://www.arvd.com has lots of info on ARVD, probably more than you wanted to know. Basically it is a progressive myopathy that starts in the right ventricle and is hard to distinguish clinically from RVOT-VT. My ep thinks it is too often missed and orders at least a MRI whenever he sees frequent ectopics from the RVOT. It sounds like the Cleveland docs need a higher index of suspicion.<BR>
I don't want anti-arrhythmics either and my ep hasn't even suggested them, the verapamil is just to keep me comfortable until July. The more I think about it I am more scared of what I might have than of the ablation... this just seems so vicious and aggressive.
My ep is in Michigan and so am I... I would get a second opinion at Cleveland if I thought I had time, and if my insurance would allow it.
Thanks for all your support, I really appreciate it. I'm sure I will be okay as long I don't have some active carditis or myopathy. Waiting for tests and then waiting for the results is the worst part.
Hola!
Sounds like you are also a "walking pvc." Too bad you weren't able to capture the presumed afib...would have been nice to rule afib in OR out. Hopefully, that was a one time experience. I think that RVOT sites are good for ablating.
I hope that I can give you some encouragement about your upcoming ablation. We are very close in age and I was really frightened, but I would do it again in a heartbeat! Not sure how they ruled out ARVD because I am not really familiar with what it is. I do know that I was having shortness of breath and I had a number of tests to see what was going on. I also remember when my beta blocker was becoming ineffective. It actually worked better for me on an "as needed" basis (more recently). Has your EP considered antiarrythmics? Personally, if I had to decide again between the meds and the ablation, the ablation would be my first choice. However, everyone is different so I am sure there are many people who would prefer the medicine. I have not had to take a single pill for pvcs since August 2003...Remarkable after all these years!
Where will you be having the ablation done? (what state?)
Sure hope you are feeling better. Hang in there!
Sounds like you are also a "walking pvc." Too bad you weren't able to capture the presumed afib...would have been nice to rule afib in OR out. Hopefully, that was a one time experience. I think that RVOT sites are good for ablating.
I hope that I can give you some encouragement about your upcoming ablation. We are very close in age and I was really frightened, but I would do it again in a heartbeat! Not sure how they ruled out ARVD because I am not really familiar with what it is. I do know that I was having shortness of breath and I had a number of tests to see what was going on. I also remember when my beta blocker was becoming ineffective. It actually worked better for me on an "as needed" basis (more recently). Has your EP considered antiarrythmics? Personally, if I had to decide again between the meds and the ablation, the ablation would be my first choice. However, everyone is different so I am sure there are many people who would prefer the medicine. I have not had to take a single pill for pvcs since August 2003...Remarkable after all these years!
Where will you be having the ablation done? (what state?)
Sure hope you are feeling better. Hang in there!
I have frequent pvcs (9.7%), suspected afib at one time but got on a monitor in time and it was not. My ep says that everything he has seen is coming from the RVOT and so far is hopeful he can cure me on the first go.<BR><BR>
<BR><BR>
I'm nervous because I have read so many ablation horror stories. Also very scared of what the MRI will show (how did they rule out ARVD for you Connie?) and whether I will make it to my July ablation date because verapamil is becoming less effective at suppressing them. Echo in April showed mildly dilated left atrium (normal dimensions in March before the pvcs started), so things seem to be progressing very quickly which is also scaring the heck out of me.<BR><BR>
<BR><BR>
That 9.7% was in early April and the pvcs were getting more frequent all the time. I was also getting easily winded and had constant chest pain just before going on the verapamil, that's why I am concerned about induced myopathy. The chest pain/SOB persisted for a few days after suppressing the ectopics and my exercise tolerance is still a little impaired.<BR>
<BR><BR>
I'm nervous because I have read so many ablation horror stories. Also very scared of what the MRI will show (how did they rule out ARVD for you Connie?) and whether I will make it to my July ablation date because verapamil is becoming less effective at suppressing them. Echo in April showed mildly dilated left atrium (normal dimensions in March before the pvcs started), so things seem to be progressing very quickly which is also scaring the heck out of me.<BR><BR>
<BR><BR>
That 9.7% was in early April and the pvcs were getting more frequent all the time. I was also getting easily winded and had constant chest pain just before going on the verapamil, that's why I am concerned about induced myopathy. The chest pain/SOB persisted for a few days after suppressing the ectopics and my exercise tolerance is still a little impaired.<BR>
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