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Is Right Ventricle Premature Complexes In An ECG Something To Worry About?

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Posted on Thu, 13 Jan 2022
Question: My father had a follow-up ecg and echo due to family history of HCM four years after his i initial echo which was normal. My father is 57 years old, very active physically, works out 5 times a week in the gym (including muscle building exercises) in addition to walking the tradmill at home everyday. He also maintains a healthy diet.
His echo was normal (septal thickness 0.8cm) bo sign of HCM or any heart issue.
However, his ecg as attached showed right ventricle premature complexes. Doctor explained this as benign and related to his exercise and being athletic over a long period.
I attached the ecg. Is this something to worry about ? As I understand right ventricle is not related to HCM correct ?
doctor
Answered by Dr. Ilir Sharka (43 minutes later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

They really seem very likely to come from right ventricular outflow tract (RVOT PVC).

Such premature ventricular contractions (PVCs) may appear in apparently healthy normal adults and may not signify any specific underlying disorder.

Nevertheless, before getting to conclusions, it is necessary first to investigate the quantity of such arrhythmia and possible more complex arrhythmic events (such as ventricular tachycardia, etc.)

An ambulatory 24 to 48 hours ECG monitoring would be helpful in this regard.

If these arrhythmic findings result frequent, then a rational strategy to follow would be performing a cardiac MRI for excluding a possible right heart cardiomyopathy (such as ARVD).

Regarding HCM, considering the performed cardiac ultrasounds, it doesn't seem to exist evidence supporting its presence. Furthermore no connections could be found with the recent arrhythmic phenomena.

Hope you will find this answer helpful!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (2 hours later)
Is lead v3 showing these PVCs or is this lead normal on his ecg?

Also doctor before his ecg by 2 hours my father walked in hot weather (above 36 degrees) for 40 minutes. Would that be a cause for this?
My father had stress ecg four years ago and it was normal. So would ARVD develop just suddenly? And if so echocardiography cannot detect it?
Is the frequency of PVCs showing on his ecg?
doctor
Answered by Dr. Ilir Sharka (10 hours later)
Brief Answer:
Opinion as follows:

Detailed Answer:

Hello,

As the utilized equipment is a three lead ECG you would see that a single PVC is present at the same moment as it is shown in leads V1 and V2.

An excessive physical stress associated with an increased circulating catecholamines level, especially when coupled with electrolytes imbalances (due to sweating, etc.) may be a cause of such PVCs as well.

At this point, you shouldn't worry about it!

Only in case of frequently repeated PVCs, especially when associated with more complex ventricular arrhythmia, a more detailed clinical investigation including cardiac MRI would be advisable, as echocardiography would not be able to detect the initial subtle histologic changes inside myocardium.

If this is not the case, there is nothing to be concerned about.

Wishing you are having a pleasant weekend!

Regards,

Dr. Iliri


Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9540 Questions

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Is Right Ventricle Premature Complexes In An ECG Something To Worry About?

Brief Answer: I would explain as follows: Detailed Answer: Hello, They really seem very likely to come from right ventricular outflow tract (RVOT PVC). Such premature ventricular contractions (PVCs) may appear in apparently healthy normal adults and may not signify any specific underlying disorder. Nevertheless, before getting to conclusions, it is necessary first to investigate the quantity of such arrhythmia and possible more complex arrhythmic events (such as ventricular tachycardia, etc.) An ambulatory 24 to 48 hours ECG monitoring would be helpful in this regard. If these arrhythmic findings result frequent, then a rational strategy to follow would be performing a cardiac MRI for excluding a possible right heart cardiomyopathy (such as ARVD). Regarding HCM, considering the performed cardiac ultrasounds, it doesn't seem to exist evidence supporting its presence. Furthermore no connections could be found with the recent arrhythmic phenomena. Hope you will find this answer helpful! In case of any further questions, feel free to ask me again. Kind regards, Dr. Iliri