PVCs, PACs, V-tach, Echo changes

[lasseire]

Hi,
I am a 41 yr old female, dx'd with very frequent PVCs in Nov. of 2007.  I don't drink alcohol, caffeine or smoke and I exercise 3-5x a week.  I am about 30 lbs. overweight, but I've lost 60 lbs. in the past 2.5 yrs.  Had a basic non-invasive work-up at that time and was told that I had a structurally normal heart and so the PVCs were benign.  Echocardiogram showed NO concerns.
In late Jan. of 2010, I started having a lot of PVCs again, but they felt different.  I ended up in the ER, where I did throw a bunch of PVCs but nothing concerning.  They sent me home w/ a 24 hr. Holter and a cardiology referral.  Cardiologist (different one from 2007) did another echo, an echo stress and then an echo bubble test.  The Echocardiogram showed a few differences from my initial test, the results as follows:
1. Mobile Interatrial Septum
2. No evidence of interatrial shunt(from bubble test)
3. Mild concentric L Ventricular Hypertrophy
4. L Ventricular Function is normal w/ EF btw. 55-60%
5. R Ventricle mildly enlarged at 4.1 cm
6. Mitral Valve is thickened with myxomatous degeneration
7. Mild tricuspid regurgitation.

Stress Echo lasted 12:20 minutes - functional capacity above average (>20%), HR response appropriate, ventricular premature beats, normal wall motion & thickening in all segments at rest & after peak exercise, no evidence of myocardial ischemia or infarct. Resting LV EF 55%.

However, the 24 hr. monitor showed PVCs, PACs and a string of 4 beat V-tach.  We did an event monitor for 72 hours and it showed PVCs & PACs, no v-tach.  I had bigeminy, trigeminy and quadregimeny. (note that I did not press the button for every single 'event' I felt bec. I would have been triggering constantly).

Cardio said there really isn't anything life-threatening about any of this; I saw the EP doc as well and he was less than reassuring, stating that the PACs could lead to A-fib, but that I should just 'go back to cardio if I felt like I was having more PACs"???  

My questions, which no one seems to answer, is why I would have such significant (to me) physical changes on the Echo is 2.5 years and why would I progress from "just" PVCs to now PACs and the string of V-tach?  And how can that not be dangerous, this seeming deterioration??  I feel all of these weird flutters, skipped beats, forceful up beats, etc. and they are especially strong at night.  I am concerned about just brushing this off - the Dr. basically said I have to wait to have some 'significant' event for them to consider any additional testing or treatment.  I have kids, so I can't just walk around waiting to pass out or go into V-fib here!  Also, everything I've read said PVCs, PACs are benign in a "structurally normal heart" but I can't see how these new echo findings are normal?!?

I'd appreciate your take on this and if you think I need a 2nd opinion in person.
Thanks!

[Faberan]

I certainly have empathy for what you are going through; it is for this purpose that I signed up at Medhelp to hopefully make folks like you feel more at ease.

Your cardiologist is right in informing you PVCs (and PACs) are harmless in healthy hearts. If EKG or Echo indicated a healthy heart, then you are mostly out of the woods.

I say mostly because there is one other concern: make sure your electrolytes are in normal ranges. Low potassium or high calcium can cause dangerous tachyarrhythmias. A simple blood test will rule out these problems.

I feel compelled to write because I have had a history (almost ten years, since I was 21) of PVCs and PACs. A normal EKG and Echo ruled out structural heart problems; thus,I know my heart will not ever degenerate into V-TAC.

However, my potassium levels have gotten dangerously low in the past, in which PVCs could become a problem. For me, getting more potassium and less sodium in the diet has been absolutely key to reducing PACs and PVCs. Oranges, bananas, spinach, and potatoes are high in potassium. Any prepared and processed foods are high in sodium. Also, reducing stress and anxiety (a lot of which can be accomplished by understanding PVCs are not dangerous in a structurally normal heart) will reduce PVC and PAC incidence.

At any rate, you should know with a normal EKG or ECHO and normal blood values there is absolutely no threat of a catastrophic heart event, no matter how frequent these PVCs are.  Anthony Faber, Ph.D.

[Jerry_NJ]

Sorry to read of all the complications, and sorry too I don't have a "silver bullet". That said I wonder if you are on any medications.  I'd think a beta blocker might help reduce the frequency an intensity of the odd thumps.  

Are you taking an aspirin, or a low dose aspirin, a day?  I'd think that is a good safety measure and simple with almost no side-effects if you don't have a too sensitive stomach.

All this said, be positive, I read you are uncomfortable, as are many of us with various heart rhythm problems, but you are not in danger of dropping.  I think a real effort to be calm and positive may help reduce the heart dancing... stress and anxiety add to our rhythm problems.

Best of luck, and enjoy your family, that will help you and them deal with your concerns.