Hello,
Thank you for your query.

You have provided a very good history about your health status, but I would like to know some more things which would help me in suggesting you better.

1) Please do upload the ECG.
2) Please upload the full results of the lipd profile - total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol and VLDL cholesterol.
3) What is your height ? This is to calculate your body mass index.
4) Do you smoke/drink alcohol/take excess of coffee, tea, cocoa ?
5) Is there any stress/anxiety/sleeplessness ?
6) What is recent your BP reading?
7) Has an echocardiogram been done?

Kindly provide the details that I have requested so that I can give you a specific answer.

Awaiting your response.

With regards,
Dr RS Varma

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Hello,

Thank you for the update.

I have seen your ECG. It shows a sinus rhythm with frequent monomorphic ventricular premature complexes (VPCs) in bigeminy pattern. The VPCs appear to arise from the right ventricular outflow tract and time in mid- to late-diastole.

Such ectopic beats are usually benign in character. However, to be on the safe side, I would recommend that you get an echocardiogram done with special focus on the right ventricular outflow tract. Some conditions like ‘Arrhythmogenic Right Ventricular dysplasia’ can produce ectopics similar to this. Also, it is important to confirm that there is no structural heart disease.

The other essential test would be a 24 hour Holter monitor. It will tell us about the total number of ectopics as a proportion to the total number of normal beats. It will also tell us if there are any non-sustained runs of tachycardia. The presence of such runs is an indication for definitive treatment with drugs/ablation.

The cholesterol value of 210 is marginally high (200 mg/dl is the upper limit of normal). You need to tell me the details of the full lipid profile to determine if you need any medicines for dyslipidemia. You do need to regulate your diet and exercise regularly to reduce the cholesterol levels.

I hope this answers your query. Feel free to contact me again for any further clarifications. Please accept my answer if you do not have any further queries.

With regards,
Dr RS Varma

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Hello Dr XXXXXXX Hayes,
Thank you for the feedback. I am sorry for the delay in replying since I was engaged elsewhere.

The vast majority of VPCs in structurally normal hearts are benign and do not need active treatment.

Having said that, there are two conditions. A structurally normal heart should be proven not by the absence of cardiac symptoms, but by a reliable imaging study like echo. Also, the VPCs should be isolated occurrences and not as part of short salvos, runs of NSVT, etc.

Thus, I would say it is mandatory to do at least two tests - echo of the heart and a 24-hour Holter test. Both are non-invasive, relatively inexpensive and widely available.

If both these tests show no high-risk features, you are relatively safe in ignoring the VPCs.

Please remember that one of the first "symptom" could be a sudden cardiac arrest due to ventricular tachycardia or ventricular fibrillation. This is rare, but the consequence is devastating and hence, the need for extra caution and even err on the side of over-investigations and over-treatment.

I hope this will help you to decide. Feel free to contact me again for any further clarifications.
With regards,
Dr RS Varma

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