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Have palpitations with a slightly enlarged heart. EKG was abnormal. Can I have a sound heart? Treat stress?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
Hi I am a 38 year old male who weighs 210 or so and has recently been bothered by palpitations.
I am very active- Played college basketball- still exercise and lift weights- and overall feel good-
Growing up and some over the last few years- There were times when I would feel that cant get my breathe sensation- but it seemed to usually be related to stress and anxiety. Now I rarely feel that sensation and feel overall very relaxed most of time

After telling the doctor about my recent palpitations I wore a holter monitor and had 226 in 24 hours. Doctor was not worried and said he thought they were nothing to be concerned about- Doctor wanted to see results of my last echo- and found out i had a slightly enlarged heart but wasnt too concerned due to my size (i am tall- 6foot 5) and fact I played college basketball-
My ekg was abnormal both times in last 6months- but had two doctors look at it and they felt it was a "normal variant" - they were not worried at all- for last two months I cut caffeine and chocolate out of my diet and i had thought they had gone completely away- but the other day noticed them- when I was checking my pulse after exercising- this concerned me because of a study in 2008 that dealt with recovery pvc's- I had ran 30 minutes and then done some weights and then some pullups and felt them in my pulse- about 4 in around 20 seconds or so- and seem to have them after exercising for a little bit-
So I think over the last two months I have still been having them but they have not been as pronounced due to no caffeine- when they are pronounced I can sense when I am having one without checking my pulse-

So my question is in light of all this- do you feel like I have issues? I plan to get a stress test regardless of your opinion by a cardiologist along with another echo- Just wanted to see if you think I could still be ok? Also my recent bloodwork showed my cholesterol higher than normal at 230 blood pressure usually 120/80
I have read not to be worried about pvcs if echo showed structurally sound heart- So another question is can you have a structurally sound heart with a slightly enlarged heart on echo? thanks
Posted Fri, 13 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 18 hours later

Thank you for your query.

You have given a detailed description of your problems.

1) However, I would like to see the latest 12-lead ECG. Can you scan the ECG and upload it to the website?

2) I would also like you to scan the Holter report and upload that as well.

3) If you can also upload the complete echo report, that would be fantastic.

4) I would also like to know the complete lipid profile report (total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol).

You might upload the reports using the upload feature available on this webpage. Alternatively you can send the reports to my attention at YYYY@YYYY

As you rightly said, most PVCs in a structurally normal heart are benign. However, if there is ventricular hypertrophy, one has to be a little cautious. "Slightly enlarged" heart is a bit vague. I need to know the chamber dimensions, Left ventricular mass and if there is left ventricular hypertrophy. The shape and morphology of the PVC, its timing in the cardiac cycle, the site of origin of the PVC, the frequency of occurrence, and the presence of couplets/triplets/salvos, etc., will determine whether they are likely to be benign or not.

I would also advise you to do aerobic exercises, running/jogging/swimming/riding, etc., and not too much of weights, since lifting weights can worsen the hypertrophy and increase the strain on the heart muscle.

You need to reduce the total cholesterol to less than 200mg/dl. A good, nutritious diet which is low in fat, avoidance of fried food and junk food, plus a regular exercise regimen should work. If a lipid profile repeated after 3 months shows a persistently elevated cholesterol level, you may need some drugs to control the levels.

I look forward to hearing from you again about the details that I have asked for, so that I can give you a more specific and useful answer.

With regards,
DR RS Varma
Above answer was peer-reviewed by
Follow-up: Have palpitations with a slightly enlarged heart. EKG was abnormal. Can I have a sound heart? Treat stress? 8 hours later
I am uploading the report which includes echo from 2006, holter monitor from late October and 2 recent ekgs

Being almost 6 foot 5 does that make a difference on size of my heart?

You said you would be concerned of LVH- does mild LVH make a difference?

Do you think I have a structurally sound heart?

How should I be slightly cautious at this point?

I look forward to your response- I will upload the report-
Answered by Dr. Raja Sekhar Varma 12 hours later
Thank you for the reply.

The electrocardiogram (ECG) that you have uploaded shows only minor T wave inversions. These may be related to the left ventricular hypertrophy (LVH) and may even be nonspecific changes or normal variants. The ECG has not captured any premature ventricular complexes (PVCs).

The Holter report needs to be uploaded again since I could not open the file. It shows only a blank page.

The Echo report shows mild concentric LVH with mildly dilated left atrium. These changes can be due to your build, your athletic pursuits and exercise training with weights. You are right that your height and weight also influence the heart size. Thus I can reassure you that your heart seems to structurally sound.

However, an annual echocardiogram is recommended to monitor the LVH. I would also recommend that you do not do weight training and consider aerobic exercises instead. Your cholesterol levels also need to be regulated as indicated before.

I need to see the Holter report and the PVCs before I can give you any specific advice. It is probable that they are benign. You could consider a repeat Holter monitor to know the current status.

I hope this answers most of your doubts. I await your response.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Have palpitations with a slightly enlarged heart. EKG was abnormal. Can I have a sound heart? Treat stress? 8 hours later
Dr. Varma,
Thanks for the response.
I sent on email the holter report in 4 different attachments. Maybe the original attachment was too large.

The question I have after looking at the Holter is:

In light of the reports you have seen is my heart structurally sound and should I have any fear of exercise?

I noticed recently some recovery pvcs after exercise. Does this mean that I am in danger due to many times exercise bringing on the Recovery pvc's?

I am scheduled to have an echo and a stress test on Monday- do you think that is wise?
Based on my earlier reports- do you feel good about these upcoming test?

Thanks again,
Answered by Dr. Raja Sekhar Varma 32 hours later

Thank you for the reply.

I have gone through the Holter report. It is reassuring to see that there have been no runs of VT (Ventricular Tachycardia). There does appear to be a relation between exercise and the frequency of premature ventricular complexes (PVCs). Since it was a three channel ECG (Electrocardiogram) not much can be said about the site of origin. They appear to be monomorphic and mid diastolic.

I do think that you can safely go through the stress test and echo. If the stress test does not show significant increase in the frequency of PVCs, you can safely do your daily exercises.

If there are any further findings during the test, then you may need tests like EP (Electrophysiological) Study with stimulation protocols for VT, and angiography. Sometimes these arrhythmias respond well to drugs like calcium channel blockers or beta blockers. Rarely ablation may be done as a curative procedure.

Overall, you do have a good prognosis. I do hope that I have been able to address your concerns. Feel free to contact me for any further clarifications.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
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