Should I push for any additional testing on rhythm issues?

[gnarfle]

I've had a long history of arrythmias (PVCs, PACs, runs of PVCs, suspected PSVT, etc) in my life but have always been told it's all fine and not to worry. However a couple of things have popped up lately that have me a little more concerned. First, last summer my sister died suddenly in her sleep at age 42. It was attributed to hypertension and tachycardia, which to me isn't really a cause of death but given they would have been able to find a stroke, massive heart attack, aneurysm, etc I assume it was sudden cardiac death. It is worth noting, however, that she was schizophrenic and on several drugs that are known to increase heart rate and prolong the qt interval and there is a known correlation with anti psychotics and sudden cardiac death (at least according to Dr. Google).

The second thing that has happened is my new doctor has a web portal where test results are posted and for the first time I was able to see EKG results. There were also EKGs uploaded from 10 years ago (2006). I noted that 10 years ago my QTc was measured at about 464ms, and my most recent EKG a month ago was 460ms. By most accounts I can find, this is considered borderline long.

I saw a cardiologist recently to discuss this and he was not concerned. He made no mention of the QTc (this was before I noticed I could look myself online so I wasn't aware of it) and said my EKG looked great. He has me scheduled for an echo to check up on my mitral valve prolapse (and also to confirm it as apparently the diagnostic criteria for that 20 years ago when I was diagnosed was much more loose). I'm also currently wearing a 30 day event monitor to see if anything pops up.

Beyond that I'm trying to decide if I want to push for any more testing. I guess the two things that may be warranted are genetic testing for Long QT or Brugada syndrome (given my sisters death) and a stress test to check the QTc while exercising. The cardiologist, pending normal results from the echo and nothing concerning on the 30 day monitor, says to not worry and follow up with him in a year. I plan to go back after my 30 day monitor to discuss the QTc and results of the monitor though.

But otherwise I'm not sure... I'm not too worried about it (this may sound morbid, but dying from a sudden cardiac arrythmia seems like a great way to go all things considered) but I'd still like to make sure I cover all my bases. It seems like even if my QTc is a bit long I'm in a low risk category (being that I've never fainted or had other issues and it's only borderline long). And I already avoid stimulants, am not on any QT prolonging drugs, and am on a beta blocker, so I'm essentially already on the treatment regimen I'd probably be on anyway even if long QT was diagnosed...

So anyone in a similar boat, how much testing did you get? What did your doctors say? I live in a pretty small town and my insurance doesn't cover much here so I don't have a lot of opportunity for a second opinion...

[MichelleP_3811]

LOL, not really all that strange.  I have thought the same thing.  If I have to go, and we all do at some point, cardiac arrest seems almost like a pleasant death as opposed to a heart attack.  Until I was diagnosed with SVT I had no clue the two were different.  Cardiac arrest the heart just suddenly stops and you pass out.  Of course we can't know what the person felt prior to the death but seems quick and painless compared to a heart attack where generally one part of the heart is dying off usually from lack of blood getting to it.  Well I am not a doctor so I can't say for sure but you aren't the only one who has had that thought.

I think odds are your sister is a victim to the meds she was taking.  I know being in the same family it can be a concern but she did have a contributing factor with the meds so you can't really compare your situation to hers.  If you do suspect you have a generally long QT, it can vary depending on your heart rate, but if you are concerned about it then I would avoid OTC for colds and allergies.  Those can make it longer but the best thing is to try and not over think things because that will really just cause stress and anxiety that will cause your body to produce chemicals that may affect the heart.  Just try and fix and correct the things you can and not stress about the things you can't control.

Can I ask what kind of SVT you have?  Is it a reentry type of a run of pacs?  Do you notice it start and stop in one beat?  How fast is it when you have an episode?  I had AVNRT and it would start and stop in one beat and beat at rates well into the 200s.  It helps for it to be fairly active at the time but and ablation corrected the issue for me for good.  I haven't  had another episode since my ablation over 5 years ago.  This said, svt and premature beats, (pacs and pvcs) kind of go hand in hand.  I believe my svt was irritating my heart causing me to have premature beats which if timed correctly would throw me into an svt episode.  So they can kind of feed off each other if you have a reentry type of svt.  since I corrected the svt the amount of premature beats has calmed down for me.  So if you have a correctable svt you may help alleviate all or some of your premature beats if you get it fixed.  But again, it does help to be more active when you try an ablation or the EP may not be able to locate where the problem it.

Other than that I would suggest avoiding caffeine, sugar and carbohydrates and anything that upsets the stomach.  Aside from stress and anxiety those are the other big triggers for premature beats.  And drink lots of water.  It will help the heart function better.  

As for tests, so long as you have had the standard tests of echo and possibly a cardiac mri odds are you have nothing to worry about.  Sounds like you are having the test to check on the most concerning issue which is the prolapse valve.  I would suspect if there are any issues with the overall health of the heart they would find them at that time and give you a better idea of the overall health of the heart and how much intervention you need.  As well, if you have frequent psvt episodes you might want to discuss the possibility of an ablation with your doctor.  It may help some of the other symptoms.  Take care and best of luck sorting it out.

[Matiadbueno94]

Since last September ive had 25 EKGs, 1 echocardiogram, 2 stress tests, 2 stress echocardiograms, 1 cardiac MRI, and 1 EP study. The tests were all negative. Ive had anxiety all my life and panic attacks, thats why i was seeing a cardiologist. Ive had episodes of really fast heart rates that my monitor contributed them to panic attacks with regular rhythm. But this one episode that lasted like 5 seconds turned out to be v tach. Which I have never felt anything like it. Even with all te negative tests i had that episode, and they had no idea why. I feel like you should push for more, even though more doesnt mean better. They reassure me its nothing, and it should be bening given all the negative tests. But im terrified as im only 23. Theres no family history or anything. Not knowing is horrible. Theyre confident it isnt long qt nor brugada but theyre afraid to do the tests cause if theyre negative its gonna be worse for me.