PVC risk and treatment

[fwilson]

8 years ago I suffered an acute illness.  As the illness resolved, I started experiencing symptoms of weakness, and chest pressure.  I went to the ER and my cardiac enzymes were very high (Troponin I = 47.0, normal 0.04).

Initial diagnosis was a heart attack, but subsequent cath was clean and with the preceding illness, the final diagnosis was myocarditis.

I suffered with PVCs and low energy following this incident.  The PVCs started up about 3 weeks post incident.  Cardiac workup following was essentially normal with near normal echocardiogram (mildly dilated LA, mild diastolic dysfunction, mild pulmonary hypertension) and normal followup 64 slice CT done 3 years ago.

Two years ago, I had curative rf ablation for PVCs.  Frequency of PVCs had been negligible since.

One month ago, I also got quite ill.  As this illness was resolving I had similar anginal equivalents.  Mild chest pressure, profuse sweating, mild difficulty breathing.  I again had elevated Troponin I (0.4, normal 0.04).  Doc insists neither event was a "heart attack".  Rather this was a small troponin leak caused by the antecedant illness.

No cardiac testing ordered because of the small size of the leak and the clean coronary CT scan 3 years ago.

Once again about 3 weeks out the PVCs have started up again.  They are incredibly painful.

1.  I am to have a cardiopulmonary metabolic stress test in a few days.  Is it safe in your opinion with the new onset PVCs?

2.  I am to start cardiopulmonary rehab following this.  Is it safe?

3.  I already know my treatment options are nothing, beta blocker, anti arrythmic meds, or ablation.  What are the risks of a reablation damaging enough tissue to actually CAUSE heart failure?

4.  Any ideas what I can do to stop simple illnesses of life from damaging my heart?

Thanks

[Cleveland Clinic]

1.  It is safe.
2.  The rehab is also safe.
3.  The fact that the PVC's are so symptomatic would probably push me to recommend abalation.  This PVC may be coming from a different area but even if it is the same area, there is very little risk of cause enough muscle damage to cause heart failure.
4.  There is probably nothing that can be done for that.  You are probably just at higher risk for developing myocarditis from simple viral infections.  

[fwilson]

Thanks you old timer you...miss me?

I have so much backed up I cannot believe these have returned.

Surgery is needed to correct one of the issues involved in the recent illness.  Not emergency surgery, but it probably should be left too long either.

To prepare for the surgery especially after the bed rest with this episode, I wanted to rehab first.  Now I cannot imagine rehabbing and kicking up these painful PVCs even more.

Will look into reablation.  The first time around gave me two years, not PVC free, but PVC tolerable.  I know as I age I will get more of these, and I do not know what to do about them.  I have not found a way to cope with severe episodic pain.

Best of luck to you too.

[tickertock]

Hi, Sorry to know you had a relapse, hope you feel better soon. I know how depressing this can be, fact is most doctors are as baffled as the patient is about these"mystery illnesses" something is wrong , they just haven't come up with a concrete diagnosis, my opinion only. Be well Fred. Take care.