exercise induced PVC's in MVP patient

[paravantis]

I am male, 49 years old and have been diagnosed with very mild MVP (with no regurgitation) for at least 15 years now.

10 years ago, following a stressful period (marriage, 1st child), I began suffering from frequent PVC's that got worse when my heart rate went up, e.g. running, playing soccer etc. My exercise tolerance has been very low for as long as I can remember and, apart from walking frequently, practically did not exercise at all (completely sedentary lifestyle). At the time, I did ECGs, Holter (registered 256 PVC's per 4 hours when I felt them to be at their worst), echos and treadmill test (negative, a few PAC's).

I quit completely on caffeine, Colas, tea and the like, I forgot about the PVC's and, voila, they forgot about me too! Thus I had been almost totally PVC free for about 10 years! I ate the occasional chocolate but no coffee, tea or other caffeine drinks.

Over the last 3 months, following another very stressful situation at home, I noticed that five minutes after I started walked vigorously, I got extra beats that felt like PVC's, perhaps a couple in a row or a strong one every few seconds. Slowing down my pace would get my heart rate a bit down and the extra beats disappeared. If I persisted with vigorous walking though, the extra beats would not go away.

Following a weekly course of Clarithromycin a month and a half ago, I got significantly more PAC's (I think I am pretty good at telling the difference between PAC's and PVC's) that lasted a couple of weeks after the antibiotic was stopped. And some of my PVC's came back, but mostly it was PAC's (no Holter, just my feeling of what they were).

I finally bought a recumbent bike and started exercised daily for about 45 minutes (10 days now). When my heart rate is between 86-103, no problem with extra beats; same with the 103-120 zone. When I get my heart rate in the aerobic zone though (120-137), I get a few extra beats (that feel like PVC's). But especially when I walk vigorously, even when I walk downhill (!) and only a couple of minutes after having started to walk, I get quite a few PVC's that scare me and make me reduce my tempo to get my heart rate down.

I visited a cardiologist who performed an ECG and a Doppler heart echo (in which carotid and stomach arteries were also sounded AT REST)  that came back normal. In fact, he commended me on the fact that the dimensions of my heart are exactly the same to those of a heart echo 10 years ago (performed by the same physician). These findings were especially important because I am mildly hypertensive (140/90 morning, 150/10 when in a stressful situation, 135/85 afternoon, 125/80 when relaxed at night) and it was good to see that my heart does not appear to be damaged by my slightly elevated blood pressure so far.

Here comes my main concern though. The cardio doctor did NOT suggest that I do a treadmill test for now. He told me that my low cholesterol (<180) with good ration of good/bad cholesterol, absence of any heart disease in both paternal and maternal parents and grandparents and very good results especially in the stress echo reassured him that I DID NOT NEED a treadmill test for now. He also told me that, with hypertensive patients, one is more likely to receive a false positive result, that would subject me to unnecessary extra tests.

I would appreciate your experienced take on my case. Does it sound like the ectopic beats I receive when my heart rate goes up may be attributed to coronary artery disease? May they be caused my MVP (even in a very mild case like mine)? Am I causing them (by being stressed and thinking "Oh my God, I am going to get them again") when I start walking vigorously? Should I have a treadmill test?

I ask that you kindly bear with me and my long winded message.

Much obliged to you for maintaining this online forum,
John P.

[ozmi]

I'm sorry for the delay in my response.  I was just released from the hospital.

I had no prior angina symptoms.  I did have very occasional PVCs.  I underwent a nuclear stress test, holter monitor,  and echo three years prior to my attack which were negative.

My latest bout with PVCs, I just discovered were due to a re-narrowing of my angioplastied right artery; which I theorize caused more thrombosis at the site of my earlier damage.  I have been complaining of symptoms to my cardiologist for the past two months.  He attributed those to med side effects.  My new docs stented the site and changed my meds.  So far, so good.

[paravantis]

Ozmi, thanks for posting.

I too am inclined to go ahead with treadmill testing regardless of what my cadiologist thinks. I forgot to mention that I live in Athens, Grece and luckily one can easily cover such a test with own expenses.

I would like to ask you a few things though.

Among your set of symptoms prior to your heart attack, I surmise you had pain (angina type) repeatedly, correct? Did you ever experience arrhythmia (irregular beats of any kind)? Did exercise seem to induce irregular beats? In my case, for the last couple of months, every time I go above 120 beats per minute, I get irregular beats that feel like PVC's, quote oftern a couple in a row. I have lived with occasional PVC's for the last 15 years that were attributed to my mild mitral prolapse but this is A NEW SYMPTOM for me.

Also, you would please relate to us what TESTS did you have exactly PRIOR to you heart attack? Did you have a treadmill test (either of the plain variety of with thalium)? Stress echo? 24 hour Holter?

It would be amiss to close this note for THANKING YOU for sharing your experience with us. I look forward to receiving your response and wish you a healthy and prosperous 2009!

Kind regards from Athens, Greece
John

[Jerry_NJ]

I believe the stress test (tread mill) is best for discovering possible blockage in the heart arteries.  I don't think it does much more than that, and your cardio may believe there is nothing in your set of symptoms that suggest such problems.  

I think in general doctors prescribe too many tests, many believe they do this to protect themselves or to generate return on investment (support their testing facilities).  Many believe this is at the root of the very high medical costs in the USA.  

So, while I can't tell you what is right, I see very little reason for a doctor to NOT prescibe testing.

[ozmi]

2 words - second opinion!  As a new cardiac patient following a heart attack, I'm learning quickly that no one really cares about our health, or ever will as much as we do.  We need to, just about, become doctors ourselves on our conditions in order to ask informed questions.  When we start that, often, diagnosis, and treatment often changes.  In other words our doctors don't become proactive unless we are.  Sounds to me like your doc is in those initial phases, and left you hanging.  Get educated as best you can, including seeing other doctors.  I saw specialists three years ago with various "heart" complaints only to be told I'm too young to have any real concerns and to take TUMS when I feel my chest pains after I had the tests (only snapshots in time, by the way.) that disproved any problems.  I had a heart attack (MI) this past September.