PVC, Borderline EF and Short PR

[DivineX]

Over the past few years I keep experiencing PVCs which gradually increased. My last holter last year recorded just under 4K in a 24 hour period. This seemed to be the highest recorded holter to date. I also have good and bad days.

I’ve gone through all tests minus EP studies at this stage. This includes holters event monitors Echos blood work etc. The only findings so far have been a short PR no delta wave, a borderline EF at 54/56 based on an MRI and Echo, blood work with low vitamin D and the PVCs

I have found that my life has become sedentary in which I seem to be in a loop of fear of exercise where I get PVCs during exercise and during cool down periods. I swear for a day or two after is some very mild chest pain in the left side. I don’t know I am simply imagining it at this stage or not. I also seem to have an increase of PVCs at night when sleeping. I definitely feel more just as I wake up.

Anyway would love to hear some feedback on this or if you have any questions. My main battle is getting exercise without fear of these things.

Cheers

[Mrstejeda]

I am also suffering from pvc’s and the only abnormality in my blood test was low vitamin D. Have you found any research that vitamin D deficiency can cause pvc’s?

[2210485]

Not in particular. I wouldn’t put it outside the realm of possibility though.

Just bear in mind blood tests don’t always test for every conceivable abnormality or every possible condition. They’re very limited panels.

Triggers for PVC can still be just about anything. Having Vitamin D be the only deficiency sadly doesn’t necessarily signal that this is the problem.

[2210485]

As for the 4K number.

This isn’t nearly as important as the burden percentage.

What matters is what PERCENTAGE of total heart beats are ectopics. If your heart rate is really slow, 4K May be a higher burden than if it’s a bit faster at rest.

On the report this should be labeled.

[DivineX]

Thanks for your feedback and comments. They are very appreciated! The holter report was about a 2.8 percent burden based on about a 129k total beats in a 24 hour period. I guess it is small in the grand scheme of things.

I do have one question. I decided to start participating in an exercise class that does cardio for about an hour and a half. Given that I am relatively out of shape I have noticed that at rest my resting heart rate is about in the mid 80s after this class even six hours later. Is it safe to assume that this is simply just not being conditioned? I noticed that I am in a trigeminy or quadrigeminy pattern at night but this was happening even before the class. Perhaps over time this will improve as I lose weight and get more conditioned again?

Thanks again for your responses.

[2210485]

Possible. Although the opposite is also possible and in fact probably just as likely. Your PVC burden can go up or down and hyperconditioning, should you become a marathon runner, is more likely to increase rather than decrease burden.

You will however probably feel much better with exercise as the better conditioned heart is better prepared to compensate for a PVC.

As for what constitutes a high burden:

A High Burden of NORMAL PVC’s (e.g. outdoor tract PVC) is roughly 25% or more.

A “Borderline” burden would be approximately 15%-24%

I say “approximately” and “roughly” because the precise cutoff is somewhat controversial. No one has been able to prove that there is any one “magic number” and every doctor/author seems to have a different opinion on it, based on their experience.

These figures are therefore the “average”  estimates given by the particular authorship I subscribe to (Zipes) but can vary with some individual practices and may be taylored to each individual patients circumstances.

It would not be unusual to find one doctor who treats a 12% burden aggressively and another who insists on 15%. It would be uncommon to find one who treats a 4% with that same degree of aggression however.

Lastly, aggravation of a PVC/ Ectopic pattern at night or in waking hours is a positive sign of a “type” of ectopy which is more likely to be benign or associated with brain chemicals/Hormones/the nervous system as opposed to heart disease. So there’s that bit of good news at least

[2210485]

25% or higher however is almost universally treated with the maximum therapeutic options. Be it Ablation or more potent medication. Whatever is most appropriate for the patient.

Few, if any, physicians will let a 25%+ burden go unanswered. So this is a good cutoff to use for perspective.

25% of heartbeats over 24 hours time is the point at which pretty much everyone agrees that a PVC is a pretty big problem to address.

[2210485]

The pattern in which these appear is sort of the hallmark of a “Benign PVC” associated with shifts in the balance of hormones and brain chemicals floating around. Unfortunately there’s not much that can be done because the cause for these things is not the heart per se. Good news is they won’t kill you at least!

Also 55% is not a “Borderline EF”, whoever labeled that is just wrong. Depending on literature used the normal number changes but the guidelines are pretty clear as to what constitutes a “Bad” EF.

A concerning EF for a PVC patient is 40% or less (with symptoms). 50% - 80% is completely normal.

Without symptoms we really need to see an EF lower than 30% or at least sub 35% to be concerned.

[nanmglenn]

Just FYI, even though with an EF of 55% you don't need to worry, but the information above is outdated. A 2020 study of over 400,000 EFs has shown that there is a u-shaped curve for heightened risk of death with ejection factors over 70%. Low EF is a risk for systolic heart failure while EF over 70% is a risk of diastolic heart failure. The probability of death is as high as someone with an EF of 35-40%.

https://www.reliasmedia.com/articles/146090-hyperdynamic-left-ventricular-function-good-or-bad-news?fbclid=IwAR2gwcsBgZ7BK0Hu8Yc1HT_NoVuogm2D2IEIm97cMVbe4uu6zcw-05qkfMg

https://watermark.silverchair.com/eurheartj_41_12_1249.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAt4wggLaBgkqhkiG9w0BBwagggLLMIICxwIBADCCAsAGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMWqY-0k0zBkjGczk1AgEQgIICkYKR0WS9lc4nEXvneILc-STcAKp1jdKLNgq7EfWIxnxEUkzmX-wJ-pVB2EXw5e_wmqkBgZcqfCh-EnnmsztSIdBe6z_odnEebX271wYpPD42wevqjBxWAsiVpkZVMvAQRUid5YvebCi3PERCYm3lD4YDl88UiBAp2eLuwCrY71CgutUoH5TYkybPp7csuet4LpM07Gd61xYxb9cooSDRIaT8jKIfTlz3lSWUqab3OE7D4uVQv7Sham1RFxodbtOEWh9x19c3fEYGUE7K67KzUPSR76AZe0q23lOEW93mUkZ4EJLxiTavcC-ScwCx6tN_PGxR2EuVl1cKi_bua8ubSe3gCmmBGTD-mjY2Tz7ttSb2ySqJk2U--xsSKgn3MWhFvd4vt95AldDh5LB1h5i5vmDt2LBl8ANuZEtO1XcBsgipovhJT6if1_UpifY_bx2JRzhupYcIsgD-oDXOBenp_43i_TT5-ZcbzdQhETtMH86W85G08OdVUPlEY7zmgtWVjwlVFjlcHIXLV94s-8Ba6r_qC5EpDk2BIf_RbLVNO8h_3hvfL70sp4dhnmKUD9haUp3YSIwuV0555OAU0vG7pTY9lV1YNSYdrIuec-oM74KR1ZBdSOly6dfmLnWtALOtEmDRb1eVifk1-ZeZftIgJPvIujsxli2BlA-DAwfyBWg85Z5U6C2oGe6dwZt8DF8NAMQe0SkNiqU5GGqZVy5l6gq9q7ZoPvnowXG9hwev_xgXg0--oH2xY5HAZBxvSVTag10uLveImVSbuy4TpEW-5Sqa68-ygFwqdBKagaC_ywxbEJm8tpxyNejYWGS8Vwpy7ldqt5mKV-woHJwfXSq-2GJ-l2gRcmMmD3q3Z5wkKBdlDg

[2210485]

In layman’s terms I’m presuming (haven’t read the study yet) the findings were EFs over 70% may be concerning?

EFs of 40%-70% however are fine?

[2210485]

Also thanks for sharing. It’s good stuff.