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High exercise HR, Low BP, PVCs

My wife is 38 years old, not overweight, doesn't smoke, drinks occasionally, and has experienced heart palpitations since she was in her early 20s. She has always had a fairly high heart rate during moderate exercise (eg. 185 bpm when running 3 miles at 10 min/mile). She exercises typically 4-5x per week. Her heart rate goes to 150 and higher very soon after she starts. When she is lying down her heart rate is in the low 50's to mid 60's. When she stands, it goes into the mid 70's, and when walking around, it goes into the mid-80s, up to 100. Her blood pressure is low-normal. Historically it as been ~ (100-110)/(65-72).

The palpitations have been increasing, and she went to see a cardiologist. She had an in-office EKG, Echo, and was given a 30-day monitor to record the palpitations. The in-office EKG was normal, the Echo was normal, except for mild regurgitation of the aortic valve. The cardiologist said the monitor shows PVCs (skipped beats), and has a wide HR range, including high HR during exercise, and she was concerned with just one episode when her heart rate went up to 140bmp after climbing the stairs. The cardiologist perscribed a beta-blocker to control the heart-rate, but my wife and I are concerned about the beta blocker and her fairly low BP.

I'm concerned about the cluster of high exercise HR, low BP and palpitations. The palpitations do diminish if she takes a break from running. I'm wondering what causes her type of physiology, could it be a structural defect that would only be apparent in an exercising echo? She had her blood checked recently and she is not aneimic. Could she just be built with a heart with a low-stroke volume? Her aorta is also on the upper side of normal in diameter, but it has been like that for years. I fear her exercise tolerance is diminishing over time, and there is some deteriorating condition. What should we look for? Or is this reasonably within normal physiology?
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84483 tn?1289937937
Just one more thing as I stated in the first comment  , when mild, aortic regurgitation usually just needs to be followed , but may never progress or cause health problems.
Helpful - 0
84483 tn?1289937937
I didn't mean to worry you unnecessarily, sorry if I did, follow your cardio/doc advice , if in doubt get a second opinion, remember I'm not a MD.
I myself have ankylosing spondylitis, an autoimmune /connective tissue disease, actually it is the cause of most of my symptoms , took years to get diagnosis, in fact it was through my persistence in telling the doctor that I suspected I had AS that the necessary tests was to done to finally get a diagnosis, I'm HLA-B27 positive with an erosion and fusion of the sacroiliac joints, a telltale sign and marker for anklosing spondylitis and reiters syndrome. Good luck in getting a definite diagnosis.
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Avatar universal
Thanks. We are still waiting for the report from the Holter monitor. My wife is perceiving less exercise tolerance (but thinks it may just be that she is "out of shape" since taking a break from running due to the PVCs.

We will ask for an exercise echo to be done.

The member comment above worries me a bit, if the aortic valve leakage is not really a normal variation. I spent some time reading up on Aortic regurgitation, and exercise intolerance, high HR and aorta distention are part of the symptoms. Sounds from the descriptions that it is important to have an aortic valve surgery before LV problems occur to have good prognosis. The other thing that worries us is that her Grandmother died in her 40's from some heart issue, which they said was a weakened heart from rheumatic fever and two pregnancies, but that was so long ago (over 60 years ago), who knows what really happened. They probably got the "heart" part right. My wife does not seem to have many (other) signs of Marfan syndrome. Her aunt has Lupus. These could all be red-herrings, of course.
Helpful - 0
242509 tn?1196922598
MEDICAL PROFESSIONAL
One way to document whether or not she has a good exercise capacity is indeed to perform a stress echocardiogram. If she can workout to a good workload then you can be reassured that this is not impeding her normal function.
But this doesn't mean that she doesn't have an electrical issue. How frequent are the PVcs and does she have any runs of SVT on the holter. If any of these are present then she can undergo an EPS to look for conditions which can precipitate SVT and in the same study to treat them. PVCs if very symptomatic can also be studied and ablated if the foci are found to be amenable to such conditions.
Helpful - 0
84483 tn?1289937937
I'm not a medical doctor, but suffered most of the same symtoms throughout most of my life besides the the BP, mine was high normal or on the high side for years, it is perfectly controlled for years now with medications, I don't have regurgitation of any my valves as per last echo 2005, only mild LVH, everything else within the normal limits. As far as I know trivial or mild regurgitation of the mitral, tricuspid & pulmonary valve are considered a normal finding, even mild regurgitation of the aortic valve is not a normal finding as I understand it, while it needs to be followed , it is does not necessaily main it will progress, I understand it can also be associated with PVCs but these are still considered benign in mild case.
What I have found out there are some persons who tests are completely normal & they always have this type of response to excercise or certain situations, I'm not saying this is problem with your wife, but most go onto to be diagnosed with Orthostatic Intolerance, POTS or some form autonomic dysfunction( also known as Dysautonomia, there are a lot of varying degrees of this contion from mild to severe) as a long time sufferer of the many of the symtoms you describe, I hope you and your wife get a definite diagnosis and treatment to help. The medications that helped me most has been atenolol, escitalopram & clonazepam. Good luck. The doctor here on the forum will give you a good answer or point you in the right direction to get help. I just wanted you know that there is many in similar situation.Take care.
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