PVC's and inverted t waves

[cutiger]

I've had t wave inversion in V3-V6 for over 20 years and very frequent PVC's with stress.  Had been told everything was benign when they were found.  Recently had stress test followed by cath (left and right) that revealed normal coronaries but ef of 40%.  Slightly enlarged left ventricle with no valve problems, normal CO over 6, pulm pressures normal, etc.  I was told that i have a cardiomyopathy and placed on coreg and altace.  I have no symptoms except PVC's.  I assume the beta blocker will help the PVC's and prevent/help sudden death.  Should i have further testing? Can I expect a normal life.

[Michael J. McWilliams, M.D.]

Cardiomypathies with no significant blockages and no heart wall motion abnormalities are called non ischemic cardiomyopathies.  We understand the causes for some of the conditions be absolutely not all of them.  There are sometimes genetic predispositions, viral infections, auto immune, and a host of other causes, but we are often left with no definite cause for the cardiomyopathy.  There are rare cases reports or PVC induced cardiomyopathies, but it is unclear who is at risk and how many you have to have to induce the cardiomyopathy (usually in the tens of thousand ran).

The standard of care is beta blockers and ace inhibitors and to treat any underlying cause if known.  Medications have been shown to improve heart function, decrease progression, improve symptoms and prognosis.  The risk of sudden death increases with lower ejection fractions and the common break even point is around 35% where the benefit of an ICD is greater than the risk.  

Because you have a lower than normal ejection fraction, your risk of cardiovascular events is higher than a normal populations, but you should not allow a number to interfere with your quality of life.  I saw a patient in clinic a few days ago with an EF of 10% and is still walking 18 holes and carrying his own clubs.

It is important that you follow up with your cardiologist, get on the maximum doses of coreg and acei.

It does not sound like further testing is helpful at this point unless there is something that turns up on a detailed history and physical examinmation.

I hope this answers  your questions.  Good luck and thanks for posting.

I assume the beta blocker will help the PVC's and prevent/help sudden death.  Should i have further testing?

[tickertock]

If nothing else is found that caused your cardiomyopathy, you might be one the rare cases in which the cardiomyopathy is caused by frequent PVCs, in this case you might be a candidate for a PVC ablation which from what I understand usually has shown good success and a return of normal heart function usually within 6 months to a year if successful. Good luck, this just my personal opinion only.