1614122 tn?1298434688

PVCs - Next Step

32 y/o female, 5'3, 110.   PVCs (LV), PACs, mild MVP, sinus arrhythmia, sinus brady & tachy, & asthma.  Daily runs of trigeminy & bigeminy since July, lasting as long as 8 hours.  Made an appt. with an EP in Oct. b/c the palpitations, lightheadedness, fatigue, & SOB became unmanageable.  I do not smoke, take drugs, drink caffeine or alcohol, etc.  After the results of a 30-day event monitor came back, EP ordered a stress test & a Holter.  I had an unusually good day in terms of symptoms & it only showed 10,000 PVCs.  EP reviewed the Holter & the stress test & I told him that my symptoms were worse. He said “I really need to get in there to see what’s going on.” Thought he could “find at least a few spots to ablate.”  Thought they were coming from the LV.  
I came to my next appointment with a list of questions.  EP walked in & says “I will only do it if you can’t live with the PVCs.”  No intervening tests that could account for his change in tone.  After going back & forth, I had the EPS on Mon.  For whatever reason, there were no PVCs at baseline, so he used Isuprel.  He came out of the control center & told me that they were coming from the LV & that he wasn’t going to ablate them because it would pose “too much of a risk to inflate a balloon in someone with such a small frame.”
--Same size as I was in Dec.  EP thought he could find at least a few spots & that they were in the LV.  Monday, he would not do it because of the risks of LV ablations in smaller people.  He is inconsistent about major things.  Seems like my case is too complex for him, but he won’t admit it. Cleveland does pediatric ablations, so you have smaller balloons. My friends, many of who are in the medical field are telling me to switch.  Would you recommend switching docs?
--Paradoxical reaction to Versed 11 years ago.  Monday, they used 75mg of Demerol & that immediately stopped the PVCs.  Possible for Versed reaction to be normal now?
--EP is now blaming symptoms on  "mild" MVP??

4 Responses
469720 tn?1388146349
Hello Jenn
Reading your question and the tone it almost comes down to what all interactions are based upon...confidence, trust and communication.  Just like other relationships, sometimes in the doctor patient interaction there are calculations that we make so often, so fast, with so much information that we fail to convey how we came to a conclusion. Furthermore, medical decision making is a process that requires art in addition to the science of the particular problem.  In my opinion, I agree with your friends, that you should consider a second opinion to either verify or clarify you condition.  You have CCF and OSU as two great health resources for advanced cardiac care and they are both within a short drive. I know, Ive made the columbus to toledo and toledo to cleveland when I lived there

Its your health. It's symptomatic and to some extent disabling and its obviously impacting you to a great deal. Gather your studies to date. Round up your support network and go get yourself taken care of.
Best of health counsel

1614122 tn?1298434688
Thank you so much for your response!

The TTT this morning was a lot more revealing and replicated my symptoms much more accurately than some of the other tests.  As the R.N. administering it said, "you passed it and you failed it too." I passed it in that it showed that unexplained, rapid changes in blood pressure or actual heart rate are not present.  I failed it in that, and I'm quoting from the report, "symptoms during challenge (introduction of Isuprel at 1 MCG per minute ): Multifocal, bigeminal and paired PVCs, palpitations, lightheaded, and weak." I almost passed out when it had been in bigeminy for about two minutes and the nurse turned off the Isuprel.  He held me up and said that we were continuing because he wanted to see what it did when the Isuprel was off. It stayed in bigeminy for another few minutes. I felt EXACTLY how I felt in real life when I do anything other than just sit around.  The nurse said that he was going to talk to my electrophysiologist this afternoon.  He asked me when my next appointment was and I told that it is in early April.  He told me not to be surprised if someone calls to bump it up. Apparently, they are  concerned because it used to be primarily in a trigeminal pattern with occasional bigeminy and couplets.  Today, the nurse was able to induce  bigeminy without too much trouble.  I explained to the nurse that it rarely goes into the arrhythmia and I don't have the attendant symptoms when I am not doing anything.  I do have PVCs at rest, but I don't feel them and there are no symptoms. The EPS and the TTT both prove that.  During the EPS, he had a hard time inducing the arrhythmia because I was lying flat and not moving, and then the Demerol slowed everything down and there was very little, if any arrhythmia for the rest of the study.  I need to somehow figure out if I still have a paradoxical reaction to Versed.  Today, there was no arrhythmia to speak of at baseline when I was lying down.  There was also nothing significant when they first tilted the table up because I was not moving.  I do have times when just standing up is enough to knock it into its funky beats, but not today.
Anyway, when they started the Isuprel infusions to attempt to mimic what happens when I walk around and do my day to day activities, the arrhythmia started. The nurse printed out the ECG strip and is going to show it to my EP and talk to him about what happened during the TTT.  He and I agree that it is nothing to do with my blood pressure and heart rate, and he doesn't think that my EP will have any trouble believing that it's the PVCs now after he reviews the ECG. It's good that someone in the medical field saw it as it was happening and I was hooked up to monitors at the time.  They have seen more than enough of usual PVCs, but no one was sure what was different the times when they make me lighheaded or completely faint.  The thought now is that it is bigeminy runs.  

I guess sometimes you have a test for one thing and it proves revealing in other ways.
The nurse who administered the test knows that I am an attorney and a professor at UT and he acknowledged how inappropriate, among other things, it is when I stumble in front of my class toward the end of lecture. You can only blame it on tripping over your own feet so many times...

469720 tn?1388146349
Glad that you're closing in on resolving the problem. Hopefully they can get you in sooner and again I would suggest seeking a second opinion in this complex problem if you don't feel the utmost confidence in the ways tthings are being managed including the communication.


1614122 tn?1298434688
I hope you are doing well!

To make a long story short, my electrophysiologist referred me to a world renowned expert on syncope and ANS dysfunction who happens to also be on the faculty at the University of Toledo.  I am not sure whether we are permitted to mention names of specific doctors in here, but I am sure you know who I am talking about.  My EP freaked out after what happened during the TTT.  He basically, kind of, sort of, in a really roundabout sort of way admitted that they likely missed something during the EPS, but then he referred me to his colleague.  He said he knows that I have very frequent PVCs and that I am highly symptomatic with them, but he thinks there may be something else going on to explain the syncope and near syncope events.  

My old EP mentioned that the new EP will probably implant an internal recording monitor because it is more sensitive than the traditional monitors.  The waiting list to see this expert is six months to one year, but they were able to bump my case up and get me in toward the end of June.  I did meet with his NP a week and a half ago. She is excellent!  She mentioned that I will need to have an echo every year because there is mild-moderate regurgitation with the MVP.  I wonder if the MVP with regurgitation is at all related to the PVCs which originate in the left ventricle with me?  

I did two 24-hour Holter monitors (they do not do 48-hour ones at UTMC) last Monday and Tuesday.  I am hoping they will get what they need from those so I can avoid another costly invasive procedure.  

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