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Experiencing pvcs. Had EKG. Explanation?

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Cardiologist
Practicing since : 1998
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I experience a lot of pvcs at times and I just had an ekg. The doctor did not discuss it with me so I do not know if it is ok or not. Can you please interpret my ekg and give me explanations and opinions? I am quite nervous about it.
Posted Sun, 10 Nov 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Sukhvinder Singh 4 days later
Brief Answer:
please see details

Detailed Answer:
Dear Sir
1. The ECG shows Sinus rhythm with prolonged PR interval with Left anterior hemiblock with Non-specific interventricular conduction delay. The findings may result from intrinsic disease of conduction system of heart/ certain medication/ structural heart disease or at times can be a normal variant.
2. If you ever had blackout/ transient loss of consciousness/ unexplained fall, then these finding may be important and you need to see your cardiologist. If none of these have taken place ever, we normally get a cardiac ultrasound or ECHO done in such scenarios. If that also comes to be normal, there is nothing to be done either for these ECG findings or for PVCs.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Experiencing pvcs. Had EKG. Explanation? 2 hours later
Please define the following terms---prolonged PR interval with Left anterior hemiblock with Non-specific interventricular conduction delay.

I would like an idea of how bad these findings are. On a scale of 1 to 10 how good is my heart by what you see on the ekg?

Am I at any danger or risk ?
 
 
Answered by Dr. Sukhvinder Singh 9 hours later
Brief Answer:
please see details

Detailed Answer:
Dear Sir
1. Prolonged PR interval means that the duration between onset of P wave to that of QRS complex is more than normal. This usually happens due to delay in conduction through AV node. Non-technically, The electrical activation of pumping chamber of your heart (ventricle) occurs after a time delay following activation of receiving chamber of your heart (atria). If this delay exceeds a certain time interval , it is called prolonged PR interval or first degree AV block. This has a number of reasons and is usually benign.
2. Non-specific interventricular conduction delay means that ECG shows that total time in activating your ventricles is more than normal but it does not pertain to one of the two specific well defined patterns of delay; namely those two patterns are RBBB and LBBB. Again this may be a normal variant or associated with structural heart disease or disease of conduction system of heart.
3. Left anterior hemiblock- in our conduction system, ventricles are supplied by a number of "electric wires" like nerves. Right ventricle by right bundle and left ventricle by left bundle. Left bundle divides further into two fascicles anterior and posterior. Your ECG shows a conduction defect in let anterior fascicle. More often than not it is benign entity.
4. The heart can not be judged like this (scale of 1-10) on the basis of ECG. ECG only provides indicators towards disease. Uncommonly, it provides the exact diagnosis. I have already explained the clinical relevance of these findings in my first answer. If you did not have any symptoms as yet and your heart is normal on cardiac ultrasound, there is nothing more to be done in this regard. However if you had symptoms or your cardiac ultrasound is not normal, you must consult your cardiologist.
5. Since the ECG points to defects of conduction system, there is theoretical risk of progression of disease of conduction system, which may result in further blockage and need for intervention (like a pacemaker). However it is purely a theoretical risk and may not occur in your life time. In a large number of patients with this ECG pattern (without symptoms) need of a pacemaker will never arise. More importantly, since it is a degenerative process in majority of patients, we can not do anything to stop it.
Please do write, if there is anything else.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Experiencing pvcs. Had EKG. Explanation? 12 hours later
I have uploaded 2 documents of my echo last year.
Please add this information to your evaluation and advise me of my condition.
 
 
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
please see below.

Detailed Answer:
Dear Sir
The ECHO reports reveal enlargement of your left sided chambers and decrease pumping ability of your heart (LVEF 40-45%). Left ventricle also has abnormally thickened walls and decreased relaxability. The exact cause for these changes is not forthcoming from the report. However possible causes can be high blood pressure and obesity.
This is definitely of some concern to me. I would definitely put such a patient on medication in my practice and would like him to reduce his weight also. You need to consult your cardiologist and do get a thorough evaluation.
The non-specific interventricular conduction delay may be secondary to this abnormality on ECHO.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Experiencing pvcs. Had EKG. Explanation? 26 minutes later
Am I in any present danger concerning these findings and can this be reversed with weight loss?
Is the damage permanent?
 
 
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
please see details.

Detailed Answer:
Respected Sir
1. The treatment and prognosis (including the reversibility) depends the exact etiology, current status and other existing medical conditions. The damage to heart caused by high blood pressure and obesity is reversible in large number of cases. Definitely whatsoever be the cause for this, weight loss and control of blood pressure are going to be helpful.
2. Since this is an year old report, you need to get a fresh one to look at progression and also need to consult your cardiologist for same.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Experiencing pvcs. Had EKG. Explanation? 1 hour later
One final question.

I have a lot of pvcs sometimes 2 or 3 in a row.
How many pvcs are to many?
 
 
Answered by Dr. Sukhvinder Singh 11 hours later
Brief Answer:
No such limit for PVCs

Detailed Answer:
Dear Sir
PVCs on their own do not have any prognostic value. There is no limit which can differentiate between normal and abnormal. We treat them whenever patient has any symptoms attributable to PVCs , else we do not treat them. A dilated or enlarge heart commonly throws a large number of PVCs. I will be more concerned about knowing other reasons for enlargement of left sided chambers and decreased pumping. Treatment for them will take care of PVCs to a large extent.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Experiencing pvcs. Had EKG. Explanation? 4 hours later
I went to the hospital for evaluation. They said I had moderate heart enlargement but what really frightened me was the bnp blood test. Last year it was about 499 pgml last night it was 3960 pgml.
Please give your opinion of this bnp level.
I will upload images.
I am afraid I am going to have a heart attack any minute and do understand where I am concerning severity in all this.
Thank you.

I mistyped in the question above. I meant to say that I do not understand where I am concerning severity in all this.
 
 
Answered by Dr. Sukhvinder Singh 7 hours later
Brief Answer:
please see below

Detailed Answer:
Dear Sir
1. Stop worrying that you will have heart attack soon. This data does not suggests so.
2. With an accuracy rate of ~75%, this high level of BNP suggests presence of heart failure. In fact the decreased pumping of LVEF 40-45% itself says decreased heart functions but you should have clinical symptoms too.
3. My concern was that a combination of heart enlargement and decrease pumping may represent a cause of heart failure only (cardiomyopthy), hence it needs to be confirmed. Moderate heart enlargement is not a benign entity, especially when associated with decreased pumping. If you really have heart failure it must be treated. Now this BNP level again points to the same thing (although there are many other causes of raised BNP).
Hence, overall scenario says that you need an examination by a cardiologist , a fresh cardiac ultrasound and may be other blood investigations to sort out the things and start appropriate treatment at earliest.
Hope this clarifies my concern as well as the whole issue.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Experiencing pvcs. Had EKG. Explanation? 14 hours later
I would like to thank you for your thoroughness. The information helps me to have more understanding of this. I would like to ask a final question to close the matter.
I have a theory and want your opinion. My BNP level has not been that high in the past (184) last year but I do see that I have some heart issues. I suffer from extreme anxiety disorder and the night they took the blood test I had had two significant panic attacks early that morning. My heart was pounding and my bp was very high. I get these a lot. I also sat in the Emergency room for over 2 hours before the blood test was drawn in high stress. My bp was 197/90. It went down to 140/70 when I left the ER. My heart was surely under a lot of stress from the panic.
My question is, can these incidents of acute anxiety,panic and stress cause the BNP results to go high like that?
My other question is how many hours does it take BNP to release for detection and or lower?
Thank you for your extra time on this.
 
 
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
please see below

Detailed Answer:
Dear Sir
1. Yes, A high BP in the range of 197/90 may result in release of BNP but not due to anxiety or panic. How much will be the release is dependent on many factors. If heart is already compromised the rise will be greater. This may also be true that these levels are there prior to index day. I mean they are elevated chronically.
2. It can be released as early as half an hour after the appropriate stimulus. It's half life is ~20 minutes (lowers to half of index value in 20 minutes) {it has two forms with different half lives}.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
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