Heart trouble =/

[ChicagoDude617]

First, a little bit about me:
I am a 20 year old male, 135 pounds. I don't smoke, drink and I eat healthy. I work out every once in a while.

My problems started out when I was 16. I started to feel chest pain while I was running during cross country practice and races. I ignored it for a while until I started to feel lightheaded and had couple of episodes of my heart rate going over 150 beats per minute when I was just sitting on the couch watching TV.

After seeing a few cardiologists, I got some tests done. They found an episode of non-sustained ventricular tachardyia while I was sleeping and a lot of PVC's. I had an echo done and it showed that I had tricuspid valve insufficiency and mild mitral valve regurgitation. My Ejection Fraction was 57%.  I also had a CPET test, or MET test and it showed that I had a low VO2 max.

The cardiologist told me then that he felt like the NVST was no big deal and that the problems with my valves were mild and didn't need treatment.  I continue to feel very lightheaded, fatigued and I have a lot of palpitations. How can nothing be wrong?

So these are my questions:
1. Are NSVT's serious? Does having them show up on an event monitor mean it can lead to something life-threatening or can it be benign?
2. Is an ejection fraction of 57% normal for a 20 year old? Does it get worse with age?
3. Is a low VO2 level something to be concerned about? Mine was 53%
4. Why do I keep feeling lightheaded, fatigued if nothing is wrong?

[Mom2four85]

you probably have monomorphic VT  - here's some info on VT/NSVT that one of the dr's here gave me back in 2009 http://www.medhelp.org/user_journals/show/284968/Ventricular-Tachycardia-VT---Vtach

also, you can read through the expert heart rhythm and expert heart diease forums for more info - there's alot of q & a about arrhythmia's there from cardiologists and EP's  http://www.medhelp.org/forums/Heart-Rhythm/show/91  http://www.medhelp.org/forums/Heart-Disease/show/114

if you notice any changes I would go back just to the dr to make sure nothing has changed health wise or if you still think something is not what the dr thinks, you could get another opinion

def keep a log/journal it may help the dr's with your case

[ChicagoDude617]

I emailed my doctor and asked a question about NSVT. His response was

"Nonsustained VT in the absence of symptoms caused by the VT and in the absence of structural heart disease is of no concern. Under those circumstances it is inordinately rare for the VT to ever progress to sustained VT IF it is not provocable by exercise stress testing. It sounds to me that you have little cause for concern."

So is what he saying mean that if you have NSVT, but don't feel symptoms and it happens without exercise, that it's no big deal?

[Mom2four85]

I've never heard NSVT referred to as paroxysmal ventricular tachycardia but have heard paroxysmal ventricular tachycardia called PSVT or SVT...confusing; but that's easy to do with all the abbreviations and medical terms.. what do I know =) I'm just a patient who has them all and 17 dr's still can't figure it all out with me.

Make sure you ask your dr since he said it was no big deal - we're just patients here so don't rely on what we have to say - find a dr you can trust who will give you the answers you need and find a cause.

Read in the Dys forums - there are alot of people with POTS there who go through similar things.  "Although it is difficult to determine the true prevalence of POTS, current estimates suggest that at least 500 000 patients are affected by the disorder in the United States alone." http://www.circ.ahajournals.org/content/117/21/2814.full.pdf+html you may need to travel to one of the Autonomic clinics for answers.

If it is NSVT and 10 seconds and you have no structural heart problems and your dr says no big deal; it may just be a mixed signal between the heart, ans and brain; just watch for changes in your symtpoms and report anything to your dr...it also may help to keep a journal/log of dates, times & symptoms

[MichelleP_3811]

PSVT is paraoxysmal supraventricular tachycardia with the S standing for Supra meaning over the ventricles so more of a problem with the atria not the ventricles.

NSVT is nonsustained ventricular tachycardia with the S standing for sustained but the problem relating the the ventricles.  It is characterized by having more than 3 ventricular beats in a row as opposed to having simple pvcs (premature ventricular contractions) which are ventricle beats in between normal beats.  You would not want sustained ventricular tachycardia for any length of time (over 30 seconds or more) because it could degenerate into ventricular fibrillation which is deadly in a matter of minutes.

On that note I am not sure the protocol on when it is important to manage nsvt closely.  There is not much the doctors do for pvcs unless you have more than 21,000 a day.  Then they might be able to do an ablation to try and correct the problem but ablations in the ventricles are met with mixed results.  That all being said, if you are unsure about your doctors' diagnosis and next steps please go seek a second opinion.      

[ChicagoDude617]

Yeah, the VT lasted about 10 seconds.

[is_something_wrong]

They are the same.

Mom2four you are referring to paroxysmal supraventricular tachycardia, which is something different (and more benign).

How long did the VT last? if less than 30 sec, it's NSVT.

[ChicagoDude617]

So is paroxysmal ventricular tachycardia more serious than NSVT? I couldn't really tell by reading the link, although the link was very informational. Thank you.

and does paroxysmal ventricular tachycardia stand for PSVT?

Unfortunately for me, there are no autonomic dysfunction specialtists near me that accept my insurance. =/

and can POTS cause irregular heartbeats like the ones I have mentioned?

[ChicagoDude617]

Thanks. I'll talk to my doctor about doing some more tests. Hopefully my insurance doesn't get in the way

[Mom2four85]

PSVT and NSVT are two separate things.  Here's some info on arrhythmia's http://my.clevelandclinic.org/heart/disorders/electric/arrhythmia.aspx

I asked about autonomic dysfunction like pots because some of your symtpoms seemed familiar but I didn't want to say pots specifically or point to another ANS disorder.  If you're still having problems you should look into an ANS specialist and go for a check up and eval again just to make sure you don't have it.  

For some reason; so many dr's dismiss ANS issues and think that's the last thing that it could be when in so many of us ANS patients that's what it is and we get misdiagnosed and go years without help or treatment.

Here's a list of dr's that have been referred by the DYS community, as well as symptoms and disorders related o the ANS http://www.medhelp.org/health_pages/Neurological-Disorders/Autonomic-Dysfunction--Dysautonomia-Index-Page/show/857?cid=196

[is_something_wrong]

Yes, that's usually the same.

To answer your questions again:

1. A young healthy man should be able to handle a ventricular tachycardia at rate 150-170, that's slow. But ask a cardiologist for a second opinion, like I suggested.

2. In a healthy heart, EF rarely drops below 50. In an unhealthy heart EF rarely goes above 50. Also, EF is not the only measurement your doctor use to determine heart health. In the setting of heart failure, more things than EF would be wrong.

3. I would ask for a stress test to see if there's actually an arrhythmia causing your exercise intolerance or what it is. If nothing is wrong with your heart you need to get in better shape.

[ChicagoDude617]

and the report actually said paroxysmal ventricular tachycardia, not NSVT.

Is that the same thing?

[ChicagoDude617]

I did have a stress test. I don't remember my results exactly, but the doctor never told me anything was wrong with it. This was 2 years ago.

My BP varies. Sometimes it would be 115/75, and sometimes it would be 90/50. And the way I feel isn't consistent with my BP. Sometimes my BP would be 115/75 and I would feel terrible, other times I would feel great. sometimes my BP is 90/50 and I feel terrible, other times I feel fine.

I have never fainted, but I have felt faint many times... and I have never had a sleep study as the doctor never brought it up.

And yes, my doctor dx me with POTS about 16 months ago with the tilt table test. But there was a problem with that... I was in the ER for 3 days, and he gave me the test on the 3rd day after laying down all that time.. So a year after I got dx with POTS, both he and another doctor second guessed it and changed their minds.

[ChicagoDude617]

1. I'm not 100% sure, but I think he said it was around 150-170

2. So does that mean that my 57% EF could have been a good day and that I would get.. let's say a 40% EF on another day?

3. Yes, I meant 53% of what was predicted... which the guy who evaluated the test said was pretty terrible, but my cardiologist isn't familiar with the test, so he didn't say anything about it.

[Mom2four85]

have you had a exercise stress test done and a sleep study? was anything found on the exercise test if so? have you ever fainted or felt faint during exercise/exertion; how is your bp?

young in shape individuals can have OSA/CSA but it's not common; my oldest daughter (24) has it from scarred lungs from asthma ...just a thought since your NSVT and pvc's were found at night. (were any pauses found on your holter at night also?)

Dr. Park in the sleep disorders community gave me some great info about NSVT and OSA when I asked about NSVT/VT, pauses during sleep and pvc's.  if you don't have it - great, but it may be something worth checking into just to rule out

did your cardiologist mention anything about autonomic dysfunction? if not ask him about it with your HR spikes and check into that - could be something simple or different things causing the symptoms.

mild mvp and TR are nothing to worry about until they reach the moderately severe stage; which I was told may never happen - there's a lot of factors that may or may not affect you so they can't really say if yours will get to that stage.  

my father in law never had a symptom at all with mvp and found out by accident when he went in for gallbladder surgery and had the worst mvp the dr had ever seen so sometimes there's no symptoms with mvp

if you're in doubt and want to make sure, you can always get a 2nd opinion from another cardiologist but they may tell you the same thing the original dr did

[is_something_wrong]

I'm sorry that I'm not able to provide a good answer to your questions, because 1) I'm not a physician, and 2) We don't have access to your complete test results. I would ask the cardiologist who did this test those questions (but it seems like you already have done that). You can always ask another cardiologist for a second opinion.

If I should try to answer (generally) my answers would be:

1. Not necessarily. Usually benign, but all ventricular arrhythmias should be individually examined by a cardiologist. It also depends on how rapid the arrhythmia was. At rate 100 most of them are benign. At rate 250 they are usually not.

2. Yes (easy to answer) normal. EF will vary through the day. On two echos, my EF was 58% and 80%, it depends on lots of factors, like heart rate, stress level, fluid intake, food intake, etc.. EF usually won't decrease with age.

3. I've never seen VO2 expressed in percent. If you mean % of normal (expected for your age), 53% is indicating that you are in really bad shape and should exercise more given that your doctor tells you to. Or you may have another disease that should be investigated. If your VO2 is 53 (in absolute numbers) you are in good shape. A VO2 of 53 (absolute number) is equivalent to 15 MET and you should be able to jog/run long distances with no problems. I guess expected for a 20 y/o man is approx 50, so 53% of that is 26 (7,5 MET). That's the work load when going up hills at 5-6 km/h or jogging very slowly (7,5 km/h)

4. Could be "everything and nothing". You can't tell for sure that what you experienced at age 16 is VT, neither what is causing the lightheadedness. If you get NSVT with exercise, it can be more serious.