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Suggest Treatment For Severe Heart Palpitations
Question: Dear dr Iliri,
Thank you so much.
I know you are right about anxiety and this heart rate app but I am so nervous about
Deleting because I don't feel these abnormalities, can only see them in this app.
I saw my EP on Friday. He gave me EKG, which was normal and showed no PVCS. He said I did not need holter. He told me I am cured permanently and that unless I had over 20,000 PVCS a day he wouldn't treat me. He also said that the app, which I showed him would never be capable of showing PVCs. When I showed him the crazy weird looking beats he said that they were not PVCS because that app is not able to pick up on such a thing with such primitive capabilities.
I want to believe him but I can't. Why are these unusual beats only there some
Of the time? If they were artifacts why do they sometimes appear, usually at night, but not other times in identical conditions?
If you see these readings from last night and this morning you'll see many from last night have the "pvc" weird beat. I feel sure they must be PVCS and soon I will be in heart failure again. I cannot get to that again, I won't survive.
Also I found this chart showing PVCS on pulse oximeter vs EKG and BP monitor and my "PVCS" look like the ones from pulse ox.
How can having so many PVCS ever be ok? I was told by so many doctors that PVCS were completely benign but they nearly killed me. I will never believe they're benign.
Is there any way these are something besides numerous PVCS? Why don't I feel them anymore?
Also including my holter from February.
Thank you,
Mia
Thank you so much.
I know you are right about anxiety and this heart rate app but I am so nervous about
Deleting because I don't feel these abnormalities, can only see them in this app.
I saw my EP on Friday. He gave me EKG, which was normal and showed no PVCS. He said I did not need holter. He told me I am cured permanently and that unless I had over 20,000 PVCS a day he wouldn't treat me. He also said that the app, which I showed him would never be capable of showing PVCs. When I showed him the crazy weird looking beats he said that they were not PVCS because that app is not able to pick up on such a thing with such primitive capabilities.
I want to believe him but I can't. Why are these unusual beats only there some
Of the time? If they were artifacts why do they sometimes appear, usually at night, but not other times in identical conditions?
If you see these readings from last night and this morning you'll see many from last night have the "pvc" weird beat. I feel sure they must be PVCS and soon I will be in heart failure again. I cannot get to that again, I won't survive.
Also I found this chart showing PVCS on pulse oximeter vs EKG and BP monitor and my "PVCS" look like the ones from pulse ox.
How can having so many PVCS ever be ok? I was told by so many doctors that PVCS were completely benign but they nearly killed me. I will never believe they're benign.
Is there any way these are something besides numerous PVCS? Why don't I feel them anymore?
Also including my holter from February.
Thank you,
Mia
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear Mia,
I agree with your doctor that this is really a simple application, unable to detect PVC.
Resting ECG or Holter monitoring are much more complicated. They are the only way to detect PVC.
I carefully reviewed all your uploaded images and would explain that most of them seem to be just artifacts.
In fact, I can not explain why they occur during the night.
Besides PVCs are mainly induced by physical activity and their presence during the night, while they are absent during the day can not be explained.
Maybe during the night, you are getting more anxious, as you are waiting for those PVCs to occur. While during the day you are engaged with your normal physical activity.
As all your performed tests have resulted normal, I would recommend just to stay calm.
Nothing bad is going to happen to you! I can assure you about that.
It is really unprofessional to come into conclusions just based on this application findings.
You have a normal ultrasound and no PVC was detected during 15 minutes of your cardiac ultrasound. This means that you have a normal cardiac function and structure.
This is the only real test that indicates your heart function and structure.
In my opinion, your applications findings are just confusing and not showing your real clinical condition (which is quite perfect).
There is no need to perform any Holter monitoring as it will result normal. I am sure about that.
So try to relax and don't think about this any more.
It would be better if you were only based on your doctor examination and tests, because they indicate your real condition.
I am always here is you want to discuss with me about any other uncertainties!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear Mia,
I agree with your doctor that this is really a simple application, unable to detect PVC.
Resting ECG or Holter monitoring are much more complicated. They are the only way to detect PVC.
I carefully reviewed all your uploaded images and would explain that most of them seem to be just artifacts.
In fact, I can not explain why they occur during the night.
Besides PVCs are mainly induced by physical activity and their presence during the night, while they are absent during the day can not be explained.
Maybe during the night, you are getting more anxious, as you are waiting for those PVCs to occur. While during the day you are engaged with your normal physical activity.
As all your performed tests have resulted normal, I would recommend just to stay calm.
Nothing bad is going to happen to you! I can assure you about that.
It is really unprofessional to come into conclusions just based on this application findings.
You have a normal ultrasound and no PVC was detected during 15 minutes of your cardiac ultrasound. This means that you have a normal cardiac function and structure.
This is the only real test that indicates your heart function and structure.
In my opinion, your applications findings are just confusing and not showing your real clinical condition (which is quite perfect).
There is no need to perform any Holter monitoring as it will result normal. I am sure about that.
So try to relax and don't think about this any more.
It would be better if you were only based on your doctor examination and tests, because they indicate your real condition.
I am always here is you want to discuss with me about any other uncertainties!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri.
I know you are right. I have become so frightened of PVCs that I am afraid to take my pulse and then I use that app because I need to know and then I see those squiggles and get scared. I do know that 99% of the time when I briefly take my pulse for a few beats, it is normal. When I had over 50% PVC burden, there were almost no normal feeling beats in my pulse. It was 65,000 per day.
At what level would PVCs be able to weaken my heart again? 20,000? Even 20,000 would be about every 5th beat all day long so there is no way I couldnt know, even without taking my pulse, is that right? I am so agonized now because I do not feel PVCs which I have always felt. When I can feel one in pulse, I dont feel in chest like I used to. I dont know why. But is this probably because they are very infrequent?
Thank you so much Dr Iliri. I must take your advice and listen to you, my cardio, and EP.
Thank you,
Mia
I know you are right. I have become so frightened of PVCs that I am afraid to take my pulse and then I use that app because I need to know and then I see those squiggles and get scared. I do know that 99% of the time when I briefly take my pulse for a few beats, it is normal. When I had over 50% PVC burden, there were almost no normal feeling beats in my pulse. It was 65,000 per day.
At what level would PVCs be able to weaken my heart again? 20,000? Even 20,000 would be about every 5th beat all day long so there is no way I couldnt know, even without taking my pulse, is that right? I am so agonized now because I do not feel PVCs which I have always felt. When I can feel one in pulse, I dont feel in chest like I used to. I dont know why. But is this probably because they are very infrequent?
Thank you so much Dr Iliri. I must take your advice and listen to you, my cardio, and EP.
Thank you,
Mia
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear Mia,
I understand your concern and would explain that there is not a specific number of PVC, which can cause your heart to weaken again.
As, I already have explained you have gone through a rare disorder, which does not reoccur. Fortunately you have recovered completely and nothing bad is going to happen again.
The rare PVC that you are experiencing during this period are related to the emotional stress you are going through. This can happen to every normal and sensitive person.
I recommend you to follow my advise and stop using that application.
You have a normal heart function and structure and some PVC are not going to make harm your heart.
You should just try to calm down and take some deep breath if you experience palpitations. This will help your mind calm down and also make your heart slow down.
You are not at any increased risk for any cardiac disorder.
So just relax and try not to think about it! (I know it is hard, but you should just try).
If you have any other uncertainties, please do not hesitate to ask!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear Mia,
I understand your concern and would explain that there is not a specific number of PVC, which can cause your heart to weaken again.
As, I already have explained you have gone through a rare disorder, which does not reoccur. Fortunately you have recovered completely and nothing bad is going to happen again.
The rare PVC that you are experiencing during this period are related to the emotional stress you are going through. This can happen to every normal and sensitive person.
I recommend you to follow my advise and stop using that application.
You have a normal heart function and structure and some PVC are not going to make harm your heart.
You should just try to calm down and take some deep breath if you experience palpitations. This will help your mind calm down and also make your heart slow down.
You are not at any increased risk for any cardiac disorder.
So just relax and try not to think about it! (I know it is hard, but you should just try).
If you have any other uncertainties, please do not hesitate to ask!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I have followed your advice and deleted that app. My EP and cardio said it would not be able to detect PVCs, just as you said.
My one concern is that I need to know if something is happening with my heart rate/rhythm. Are you quite certain that if I was in constant tachycardia or having many thousands of PVCs, I would know? When I had a holter last year with 900 PVCs, I felt them all day long, like bubbles in my chest. Before my ablation, they felt like hard thumps.
Ive attached most recent holter which was 6 months ago. I had 129 PVCs and 70 PACs. Could the squiggles in my heart app have been PACs? Do PACs typically feel different than PVCs?
I am not due for Holter until February. As my ECG, echo, and physical exam were normal, one was not ordered now. Do you think thats ok? I know when I saw my cardio before being diagnosed, even just by listening to my heart he was alarmed at how many PVCs I was having. Still he estimated I was having 10,000 a day and it was over 65,000! I am just so scared of getting to that dangerous point again.
I have deleted that app, though. Whether or not it was showing PVCs or not, it was causing me deep distress. I try not to take my pulse, though, so I must rely on knowing and feeling if something goes wrong.
Thank you so much, Dr Iliri.
Mia
I have followed your advice and deleted that app. My EP and cardio said it would not be able to detect PVCs, just as you said.
My one concern is that I need to know if something is happening with my heart rate/rhythm. Are you quite certain that if I was in constant tachycardia or having many thousands of PVCs, I would know? When I had a holter last year with 900 PVCs, I felt them all day long, like bubbles in my chest. Before my ablation, they felt like hard thumps.
Ive attached most recent holter which was 6 months ago. I had 129 PVCs and 70 PACs. Could the squiggles in my heart app have been PACs? Do PACs typically feel different than PVCs?
I am not due for Holter until February. As my ECG, echo, and physical exam were normal, one was not ordered now. Do you think thats ok? I know when I saw my cardio before being diagnosed, even just by listening to my heart he was alarmed at how many PVCs I was having. Still he estimated I was having 10,000 a day and it was over 65,000! I am just so scared of getting to that dangerous point again.
I have deleted that app, though. Whether or not it was showing PVCs or not, it was causing me deep distress. I try not to take my pulse, though, so I must rely on knowing and feeling if something goes wrong.
Thank you so much, Dr Iliri.
Mia
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear Mia,
First I would like to say that I am glad that you followed my advice to delete that unnecessary application! It was making you really anxious for nothing!
I carefully reviewed your uploaded test reports and would explain that this number of supraventricular and ventricular ectopic heart beats is really irrelevant.
These rare ectopic heart beats are quite normal in every healthy individual. They are mainly related to physical and emotional stress.
They do not indicate any serious cardiac condition. Just a normal heart function.
You do not need to closely monitor your heart beats, because it is really unnecessary!
Nothing bad is going to happen! Everything will be OK, even if you do not pay attention to your heart beats.
We get through our entire life without paying attention to our heart rate and our respiration. But they continue their physiological cycle without asking for our permission or without being limited by our daily activities.
So, try just not to think about it!
Every cardiac test that you have performed shows a normal heart function and structure!
So take a deep breath and relax!
I am always here, whenever you want to discuss with me about these issues.
Regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear Mia,
First I would like to say that I am glad that you followed my advice to delete that unnecessary application! It was making you really anxious for nothing!
I carefully reviewed your uploaded test reports and would explain that this number of supraventricular and ventricular ectopic heart beats is really irrelevant.
These rare ectopic heart beats are quite normal in every healthy individual. They are mainly related to physical and emotional stress.
They do not indicate any serious cardiac condition. Just a normal heart function.
You do not need to closely monitor your heart beats, because it is really unnecessary!
Nothing bad is going to happen! Everything will be OK, even if you do not pay attention to your heart beats.
We get through our entire life without paying attention to our heart rate and our respiration. But they continue their physiological cycle without asking for our permission or without being limited by our daily activities.
So, try just not to think about it!
Every cardiac test that you have performed shows a normal heart function and structure!
So take a deep breath and relax!
I am always here, whenever you want to discuss with me about these issues.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
That holter report is 7 months old, so couldnt things have changed drastically since then? As I didnt have PVCs on EKG, one was not ordered for me and isnt due for another 6 months.
Would you consider it diagnostically adequate if your patient didnt have PVCs during a physical exam and EKG? Tech didnt mention PVCs during echo, but would my cardio have seen any report of pvcs while reviewing my echo? I know a few pvcs are benign but for me, of course, they were not benign at all so I am scared of having even a few.
I have deleted that app and will not use again but while briefly taking my pulse many, many times a day, I believe I felt a PVC or PAC twice yesterday. I always believed I felt every single PVC but perhaps I only feel when they are so numerous that they can't be ignored. Certainly when I had 65,000 I felt them constantly and even when I had 900 last year on one holter, I felt quite a few. If I had so many as to be dangerous, surely I would feel them?
My EP said I shouldnt worry about heart rate changing and being faster at times. He said heart raye variability is healthy. At what rate is it dangerous? I have reached 90-100 after showers and meals. Usually my heart rate has felt less variable, like 50-75 and lately it's like 55-100 depending on what I am doing. It is probably anxiety combined with paying too much attention.
Do you think this is just anxiety as all tests have been normal and were just one week ago?
Many many thanks,
Mia
That holter report is 7 months old, so couldnt things have changed drastically since then? As I didnt have PVCs on EKG, one was not ordered for me and isnt due for another 6 months.
Would you consider it diagnostically adequate if your patient didnt have PVCs during a physical exam and EKG? Tech didnt mention PVCs during echo, but would my cardio have seen any report of pvcs while reviewing my echo? I know a few pvcs are benign but for me, of course, they were not benign at all so I am scared of having even a few.
I have deleted that app and will not use again but while briefly taking my pulse many, many times a day, I believe I felt a PVC or PAC twice yesterday. I always believed I felt every single PVC but perhaps I only feel when they are so numerous that they can't be ignored. Certainly when I had 65,000 I felt them constantly and even when I had 900 last year on one holter, I felt quite a few. If I had so many as to be dangerous, surely I would feel them?
My EP said I shouldnt worry about heart rate changing and being faster at times. He said heart raye variability is healthy. At what rate is it dangerous? I have reached 90-100 after showers and meals. Usually my heart rate has felt less variable, like 50-75 and lately it's like 55-100 depending on what I am doing. It is probably anxiety combined with paying too much attention.
Do you think this is just anxiety as all tests have been normal and were just one week ago?
Many many thanks,
Mia
Brief Answer:
You have nothing to worry about!
Detailed Answer:
Dear Mia,
I understand that your Holter was performed 7 months ago, but as I have explained to you heart failure is a clinical syndrome and you don't have no one of its clinical components.
From the other hand your resting ECG and cardiac ultrasound performed a week ago showed a normal heart function and structure. The doctor didn't notice any PVC during these tests, including the physical exam. So why are you worried about?!
Everything seems to be OK.
I would not recommend performing a new Holter monitoring as it is not necessary.
Your actual heart rate variability is quite normal for a healthy and normal person.
As I have explained to you before, it is quite normal to have an increased heart rate during anxiety of physical activity. And these heart rate values are perfectly with the normal ranges.
So, just try to relax and do not think about it!
Nothing bad is going to happen. You are going through a lot of stress lately and this is influencing on your emotional situation.
But everything is going to be OK! I can assure you about that as a cardiologist.
You should just try to focus on your anxiety and manage it better.
Hope to have been helpful!
If you have any other questions don't hesitate to ask me!
Wishing a nice weekend,
Dr. Iliri
You have nothing to worry about!
Detailed Answer:
Dear Mia,
I understand that your Holter was performed 7 months ago, but as I have explained to you heart failure is a clinical syndrome and you don't have no one of its clinical components.
From the other hand your resting ECG and cardiac ultrasound performed a week ago showed a normal heart function and structure. The doctor didn't notice any PVC during these tests, including the physical exam. So why are you worried about?!
Everything seems to be OK.
I would not recommend performing a new Holter monitoring as it is not necessary.
Your actual heart rate variability is quite normal for a healthy and normal person.
As I have explained to you before, it is quite normal to have an increased heart rate during anxiety of physical activity. And these heart rate values are perfectly with the normal ranges.
So, just try to relax and do not think about it!
Nothing bad is going to happen. You are going through a lot of stress lately and this is influencing on your emotional situation.
But everything is going to be OK! I can assure you about that as a cardiologist.
You should just try to focus on your anxiety and manage it better.
Hope to have been helpful!
If you have any other questions don't hesitate to ask me!
Wishing a nice weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much. I am trying to calm down.
Do you think if I were having dangerous levels of PVCs, they would have shown up on EKG, echo, or heard during physical exam?
Yesterday, I briefly took my pulse probably 100 times. Crazy OCD. In those times I believed I felt PVC 2-3 times, just one. I have no palpitations at all and even on days when holter showed 20-50 PVCs I felt those. Could these be PACs? I am so unsettled by not being able to feel these internally yet occasiobally feeling in pulse. 10, 50, even 150 I dont worry about but terrified it could be 10,000 or more, on way to being 65,000 again.
I am scared because even at 65,000, doctors said my PVCs were benign, no holter or echo necessary. I had to fight for testing and then had to make EP appt myself as cardio said PVCS did not cause my heart failure.
Youre quite certain that a high problematic level of pvcs would cause palpitations, constant ability to find in pulse, as well as of course being found in EKG and echo? Do you think its unnecessary for me to insist on holter as cardio and EP both say it isnt necessary?
Thank uou so much. Hope you are enjoying your weekend.
Best to you,
Mia
Thank you so much. I am trying to calm down.
Do you think if I were having dangerous levels of PVCs, they would have shown up on EKG, echo, or heard during physical exam?
Yesterday, I briefly took my pulse probably 100 times. Crazy OCD. In those times I believed I felt PVC 2-3 times, just one. I have no palpitations at all and even on days when holter showed 20-50 PVCs I felt those. Could these be PACs? I am so unsettled by not being able to feel these internally yet occasiobally feeling in pulse. 10, 50, even 150 I dont worry about but terrified it could be 10,000 or more, on way to being 65,000 again.
I am scared because even at 65,000, doctors said my PVCs were benign, no holter or echo necessary. I had to fight for testing and then had to make EP appt myself as cardio said PVCS did not cause my heart failure.
Youre quite certain that a high problematic level of pvcs would cause palpitations, constant ability to find in pulse, as well as of course being found in EKG and echo? Do you think its unnecessary for me to insist on holter as cardio and EP both say it isnt necessary?
Thank uou so much. Hope you are enjoying your weekend.
Best to you,
Mia
Brief Answer:
My opinion:
Detailed Answer:
Dear Mia,
I totally understand the way you feel and would like to reassure you that your symptoms are just related to anxiety.
It is quite common to feel some ectopic heart beats during a stressful situation, like that you are going through.
If this situation were so serious, your doctor would have noticed PVC during the physical exam, ECG and cardiac ultrasound. From the other hand your cardiac ultrasound showed a normal heart function and structure, which means that nothing bad is going on.
Just try to relax!
You do not need to perform a new Holter monitoring. As a cardiologist, I can assure you about that.
Your clinical situation and all your recent cardiac tests are very reassuring that everything is OK with your heart.
All you need is short holiday, in order to help you calm down and have some physical rest.
You need to focus more on your anxiety, because it seems to be out of control during this period.
But your heart is perfectly normal. You should not worry about that any more. I have explained to you before that the cardiac disorder you have gone through, is not going to reoccur. So, just try to relax!
Try to think about something beautiful! You should just try to manage your thoughts. These are just some bad thoughts. But you are the one to guide them. Just try to stop this process. You can guide your mind into beautiful places and leave behind these uncertainties! The reality is quite different: your heart is perfectly normal!
Hope to have been helpful!
I am always here if you want to talk about this again!
Regards,
Dr. Iliri
My opinion:
Detailed Answer:
Dear Mia,
I totally understand the way you feel and would like to reassure you that your symptoms are just related to anxiety.
It is quite common to feel some ectopic heart beats during a stressful situation, like that you are going through.
If this situation were so serious, your doctor would have noticed PVC during the physical exam, ECG and cardiac ultrasound. From the other hand your cardiac ultrasound showed a normal heart function and structure, which means that nothing bad is going on.
Just try to relax!
You do not need to perform a new Holter monitoring. As a cardiologist, I can assure you about that.
Your clinical situation and all your recent cardiac tests are very reassuring that everything is OK with your heart.
All you need is short holiday, in order to help you calm down and have some physical rest.
You need to focus more on your anxiety, because it seems to be out of control during this period.
But your heart is perfectly normal. You should not worry about that any more. I have explained to you before that the cardiac disorder you have gone through, is not going to reoccur. So, just try to relax!
Try to think about something beautiful! You should just try to manage your thoughts. These are just some bad thoughts. But you are the one to guide them. Just try to stop this process. You can guide your mind into beautiful places and leave behind these uncertainties! The reality is quite different: your heart is perfectly normal!
Hope to have been helpful!
I am always here if you want to talk about this again!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much. I have calmed down a little but just three weeks after my normal echo I already feel that maybe there could be detrimental changes that have happened.
Is there any reason that I would suddenly no longer be able to feel PVCs or do you think I am just not having enough to feel them? I am reminding myself that my EKG and echo were normal and that I should relax.
Please remind me again that the crazy things I do like try to keep my feet up after drinking are doing absolutely nothing. As I await clearance notice I am afraid about these rituals which I won't be able to do if I travel. I just feel all the time that I am in grave danger and have to be hyper vigilant to stay alive. I don't want to get to the edge of death again before realizing that I am sick.! Can I truly live like a normal person?
Thank you so much,
Mia
Thank you so much. I have calmed down a little but just three weeks after my normal echo I already feel that maybe there could be detrimental changes that have happened.
Is there any reason that I would suddenly no longer be able to feel PVCs or do you think I am just not having enough to feel them? I am reminding myself that my EKG and echo were normal and that I should relax.
Please remind me again that the crazy things I do like try to keep my feet up after drinking are doing absolutely nothing. As I await clearance notice I am afraid about these rituals which I won't be able to do if I travel. I just feel all the time that I am in grave danger and have to be hyper vigilant to stay alive. I don't want to get to the edge of death again before realizing that I am sick.! Can I truly live like a normal person?
Thank you so much,
Mia
Brief Answer:
You have nothing to worry about!
Detailed Answer:
Dear Mia,
The reason that you do not feel PVCs, is that you do not have them.
Your heart is functioning properly and it is in an excellent shape, based on your last performed tests.
Even the doctor did not notice any PVC during all your tests, because they were really not present.
In fact, you have no reason to be concerned off.
As, I already have explained to you, you have recovered completely by this rare cardiac disorder. It is not going to repeat again, as the chances (based on the medical literature) are really scarce.
You do not need to perform and strange rituals to keep you alive. You should just try to live a normal life. You are not going to prevent anything , even if you perform those rituals. They are really not necessary.
If you are going to travel, this will help you understand that you can live even without these rituals (because you are going to be great, even without performing them).
So, relax!
I am always here for you if you want to discuss again about this!
Best wishes,
Dr. Iliri
You have nothing to worry about!
Detailed Answer:
Dear Mia,
The reason that you do not feel PVCs, is that you do not have them.
Your heart is functioning properly and it is in an excellent shape, based on your last performed tests.
Even the doctor did not notice any PVC during all your tests, because they were really not present.
In fact, you have no reason to be concerned off.
As, I already have explained to you, you have recovered completely by this rare cardiac disorder. It is not going to repeat again, as the chances (based on the medical literature) are really scarce.
You do not need to perform and strange rituals to keep you alive. You should just try to live a normal life. You are not going to prevent anything , even if you perform those rituals. They are really not necessary.
If you are going to travel, this will help you understand that you can live even without these rituals (because you are going to be great, even without performing them).
So, relax!
I am always here for you if you want to discuss again about this!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I am trying so hard to be calm and believe I am ok since I had such recent tests but I had yet another setback and briefly downloaded that heartrate app again after reading they had updated and improved the app to make it more accurate.
These two screenshots are of me and my son. The 61 rate looks to me like I was having bigeminy. Every other beat looks odd like a PVC. In that one reading of 20 beats, 5 look like PVCs. But the 78 reading is my son and he too has these odd looking waves and he definitely wasnt having PVCs. When I took my own readind this morning, I didnt feel any odd sensation when those possible PVCs were happening.
Have you ever known of a patient who could always feel palpitations who suddenly could not feel them? When I had that holter with 129 PVCs in February, I felt most of them. In May 2015 when I had 990 PVCs, I could feel them all day long. I can feel them occasionally when I take my pulse but not otherwise. I just can't tell if I am having 10, 100, 1000, or even 10,000 a day. I figure its not 10,000 as that would be appoximately every tenth beat but the app and being able to feel some in my pule suggest that I am having significant number. Cardio and EP say no holter for 6 more months. Couldnt my heart be weakening every day? I could not survive another bout of cardiomyopathy. I am having trouble functioning as it is.
It is two year anniversary of my diagnosis. There are so many reminders all the time.
Am I wrong in thinking the app must be detecting PVCs? I saw a pulse oximeter in the pharmacy which said it could detect "irregular heartbeats and arrhythmia" so I was convinced again that I am having many PVCs again. Have deleted app again but my anxiety is high.
Thank you so much,
Mia
I am trying so hard to be calm and believe I am ok since I had such recent tests but I had yet another setback and briefly downloaded that heartrate app again after reading they had updated and improved the app to make it more accurate.
These two screenshots are of me and my son. The 61 rate looks to me like I was having bigeminy. Every other beat looks odd like a PVC. In that one reading of 20 beats, 5 look like PVCs. But the 78 reading is my son and he too has these odd looking waves and he definitely wasnt having PVCs. When I took my own readind this morning, I didnt feel any odd sensation when those possible PVCs were happening.
Have you ever known of a patient who could always feel palpitations who suddenly could not feel them? When I had that holter with 129 PVCs in February, I felt most of them. In May 2015 when I had 990 PVCs, I could feel them all day long. I can feel them occasionally when I take my pulse but not otherwise. I just can't tell if I am having 10, 100, 1000, or even 10,000 a day. I figure its not 10,000 as that would be appoximately every tenth beat but the app and being able to feel some in my pule suggest that I am having significant number. Cardio and EP say no holter for 6 more months. Couldnt my heart be weakening every day? I could not survive another bout of cardiomyopathy. I am having trouble functioning as it is.
It is two year anniversary of my diagnosis. There are so many reminders all the time.
Am I wrong in thinking the app must be detecting PVCs? I saw a pulse oximeter in the pharmacy which said it could detect "irregular heartbeats and arrhythmia" so I was convinced again that I am having many PVCs again. Have deleted app again but my anxiety is high.
Thank you so much,
Mia
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear Mia,
I carefully reviewed your uploaded images and would explain that they do not seem to be PVCs.
Artifacts can explain these findings.
Besides, you are able to understand that your son was not having PVCs, even though the application registered a similar finding like yours.
So, what are you worried about!
I totally understand the way you feel as you are still living in your past. But it is time to move on.
You have completely recovered from that heart disorder and it is not going to occur again! I can assure you about that.
I am glad you deleted the application again and this means that you have made some progression. You are able to understand yourself that it is unnecessary.
You are not feeling PVCs, because they are not happening. I can assure you about that.
So, relax and do not worry about it!
You should try to manage your thoughts. They are getting out of the control, and not even helping. They are making you more anxious.
You are the Boss of your thoughts. You are the one that produces them and manages them.
The reality is quite different: You are healthy and your heart is functioning normally. Nothing bad is going to happen.
You should just try to be calm and think only the reality. The others are just suppositions.
But the truth is far away from your thoughts: nothing bad is going to happen, even with your irrational fears.
You should try to keep this into your mind. As a cardiologist, I can assure you about that.
I remain at your disposal, if you want to talk again with me about this!
Regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear Mia,
I carefully reviewed your uploaded images and would explain that they do not seem to be PVCs.
Artifacts can explain these findings.
Besides, you are able to understand that your son was not having PVCs, even though the application registered a similar finding like yours.
So, what are you worried about!
I totally understand the way you feel as you are still living in your past. But it is time to move on.
You have completely recovered from that heart disorder and it is not going to occur again! I can assure you about that.
I am glad you deleted the application again and this means that you have made some progression. You are able to understand yourself that it is unnecessary.
You are not feeling PVCs, because they are not happening. I can assure you about that.
So, relax and do not worry about it!
You should try to manage your thoughts. They are getting out of the control, and not even helping. They are making you more anxious.
You are the Boss of your thoughts. You are the one that produces them and manages them.
The reality is quite different: You are healthy and your heart is functioning normally. Nothing bad is going to happen.
You should just try to be calm and think only the reality. The others are just suppositions.
But the truth is far away from your thoughts: nothing bad is going to happen, even with your irrational fears.
You should try to keep this into your mind. As a cardiologist, I can assure you about that.
I remain at your disposal, if you want to talk again with me about this!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Iliri,
I am trying to calm down but I feel sure that the app is showing PVCs as I can feel sometimes when I take my pulse but not at all internally. It is frightening me very much. I take my pulse frequently but for very brief periods of 5 seconds or so and yet I am still catching in my pulse. Could these be pacs on this app and what I feel in my pulse and thats why I dont feel them in my chest? I always could feel every pvc before. Based on app, it could be even several per minute.
I feel I must insist on holter but my doctors do not think I need one. I didnt have pvcs on EKG but it seemed to be no more than 30 seconds. Echo was longer but I was not told if there were any PVCs. I am so unsettled that I cant feel them without taking my pulse
If I am having thousands I need to know. As you said, you cannot rule out that this app is showing pvcs and its showing so many.
I dont think I am imagining and think I need to get a holter since I cant feel anymore. PVCS almost killed me so I cannot take them lightly and let them weaken my heart again.
Thank you,
Mia
I am trying to calm down but I feel sure that the app is showing PVCs as I can feel sometimes when I take my pulse but not at all internally. It is frightening me very much. I take my pulse frequently but for very brief periods of 5 seconds or so and yet I am still catching in my pulse. Could these be pacs on this app and what I feel in my pulse and thats why I dont feel them in my chest? I always could feel every pvc before. Based on app, it could be even several per minute.
I feel I must insist on holter but my doctors do not think I need one. I didnt have pvcs on EKG but it seemed to be no more than 30 seconds. Echo was longer but I was not told if there were any PVCs. I am so unsettled that I cant feel them without taking my pulse
If I am having thousands I need to know. As you said, you cannot rule out that this app is showing pvcs and its showing so many.
I dont think I am imagining and think I need to get a holter since I cant feel anymore. PVCS almost killed me so I cannot take them lightly and let them weaken my heart again.
Thank you,
Mia
Brief Answer:
There is no need to perform a new Holter.
Detailed Answer:
Dear Mia,
You are being worried for nothing.
It is true that the ECG lasted less then a minute, but the doctor didn't notice any PVC during all the ultrasound and physical exam and this is really reassuring.
From the other hand the ultrasound showed that you have a perfect heart function and structure.
So, you can understand that nothing bad is going on.
Besides, you can understand that the application showed the same on your little boy, but you didn't feel them during pulse palpation.
Why should it be different with you?!
You have made repeated tests in the past and they all have resulted normal.
I know that a Holter monitoring is unnecessary and will result normal, if you perform it. You know it too, but you need it to calm down your anxiety, which is making you so insecure.
I would not recommend it, as I already have done in the past, because as a professional of the field, I can assure you that it will result normal.
The disorder that you have gone through once, is not going to repeat.
Then, why performing unnecessary tests, when even the last performed tests have resulted normal.
You should try to fight with your fears instead.
Even if you make this Holter and it will result normal, after a week or two you will have again this sensation. What are you going to do next? A new ultrasound?
This circulus vitious has to stop. You should try to live free of these fears, free of these compulsions. It is the OCD that is guiding you through these repeated tests.
Because the truth is that you are quite healthy now and there is no reason to worry about.
Hope to have been helpful!
Let me know about everything!
Regards,
Dr. Iliri
There is no need to perform a new Holter.
Detailed Answer:
Dear Mia,
You are being worried for nothing.
It is true that the ECG lasted less then a minute, but the doctor didn't notice any PVC during all the ultrasound and physical exam and this is really reassuring.
From the other hand the ultrasound showed that you have a perfect heart function and structure.
So, you can understand that nothing bad is going on.
Besides, you can understand that the application showed the same on your little boy, but you didn't feel them during pulse palpation.
Why should it be different with you?!
You have made repeated tests in the past and they all have resulted normal.
I know that a Holter monitoring is unnecessary and will result normal, if you perform it. You know it too, but you need it to calm down your anxiety, which is making you so insecure.
I would not recommend it, as I already have done in the past, because as a professional of the field, I can assure you that it will result normal.
The disorder that you have gone through once, is not going to repeat.
Then, why performing unnecessary tests, when even the last performed tests have resulted normal.
You should try to fight with your fears instead.
Even if you make this Holter and it will result normal, after a week or two you will have again this sensation. What are you going to do next? A new ultrasound?
This circulus vitious has to stop. You should try to live free of these fears, free of these compulsions. It is the OCD that is guiding you through these repeated tests.
Because the truth is that you are quite healthy now and there is no reason to worry about.
Hope to have been helpful!
Let me know about everything!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much. I am trying so hard to believe this and wish so badly that I had never ever been introduced to that horrible app. I had deep anxiety but I had not been thinking about PVCs as I had not been feeling any for a long time. But since that app, I've been taking my pulse compulsively and every day, maybe 3-4 times a day I feel a skipped/extra beat in my wrist or neck without feeling anything internally. So I am worried sick because I can no longer judge by my feeling of palpitations. Now I can have a PVC and only know by taking my pulse. I have no way to quantify how many I am having anymore and it scares me.
Could I be having pacs instead and that's why I dont feel them? Holters have shown I have had some pacs.
My dr friend (not a cardio) asked me to take my pulse for a full minute. I was afraid to do so, so I took video of visible pulse in wrist and showed him. He said there were no pvcs and I am fine. Here is the video:
https://www.dropbox.com/s/rwk6fmgydtsh8sr/File%20Oct%2010%2C%2010%2023%2044%20PM.mov?dl=0
Even the day I was diagnosed with cardiomyopathy my cardio wasnt going to do holter, said pvcs were benign and he said I wasnt having that many to be worrisome. He only gave holter after reading my echo and knowing EF was 25. I feel like maybe I need to insist on holter as I have always had to insist on getting tests/treatments.
Do you think I am just anxious and the evidence shows I cant be having a dangerous level of ectopy? I am so unsettled by not being able to feel my pvcs/pacs internally at all anymore. Shouldnt I have a holter to make sure?
Many many thanks,
Mia
Thank you so much. I am trying so hard to believe this and wish so badly that I had never ever been introduced to that horrible app. I had deep anxiety but I had not been thinking about PVCs as I had not been feeling any for a long time. But since that app, I've been taking my pulse compulsively and every day, maybe 3-4 times a day I feel a skipped/extra beat in my wrist or neck without feeling anything internally. So I am worried sick because I can no longer judge by my feeling of palpitations. Now I can have a PVC and only know by taking my pulse. I have no way to quantify how many I am having anymore and it scares me.
Could I be having pacs instead and that's why I dont feel them? Holters have shown I have had some pacs.
My dr friend (not a cardio) asked me to take my pulse for a full minute. I was afraid to do so, so I took video of visible pulse in wrist and showed him. He said there were no pvcs and I am fine. Here is the video:
https://www.dropbox.com/s/rwk6fmgydtsh8sr/File%20Oct%2010%2C%2010%2023%2044%20PM.mov?dl=0
Even the day I was diagnosed with cardiomyopathy my cardio wasnt going to do holter, said pvcs were benign and he said I wasnt having that many to be worrisome. He only gave holter after reading my echo and knowing EF was 25. I feel like maybe I need to insist on holter as I have always had to insist on getting tests/treatments.
Do you think I am just anxious and the evidence shows I cant be having a dangerous level of ectopy? I am so unsettled by not being able to feel my pvcs/pacs internally at all anymore. Shouldnt I have a holter to make sure?
Many many thanks,
Mia
Brief Answer:
You do not need to perform a new Holter monitoring.
Detailed Answer:
Dear Mia,
I saw your video and I am glad to confirm that there are no PVC.
So just relax and do not worry about it!
You are not feeling PVCs or PACs because you do not have them.
I can assure you about this!
You should not compare this situation with the previous one, because it is quite different.
You have a recent cardiac ultrasound and a resting ECG, coupled with a careful physical exam that were quite normal.
It is a lot different from that period. Your heart is perfectly normal now.
There is no need of a new Holter monitoring.
As a cardiologist I would not recommend performing it.
As a psychiatrist I would not recommend performing it too, because it will help calm your anxiety just for a moment. But the next day or week your fears will come back again and you will need further tests to calm down your anxiety and reassure you that your heart is perfectly normal.
You should try not to depend on those repeated cardiac tests any more.
All you have to do is focus on your anxiety.
Nothing bad is going on! So relax and do not worry about it. Repeated tests are not going to prevent anything, because nothing bad is going to happen. I can assure you about that.
So relax and do not worry about anything!
I am always at your disposal whenever you need to talk about this again!
Regards,
Dr. Iliri
You do not need to perform a new Holter monitoring.
Detailed Answer:
Dear Mia,
I saw your video and I am glad to confirm that there are no PVC.
So just relax and do not worry about it!
You are not feeling PVCs or PACs because you do not have them.
I can assure you about this!
You should not compare this situation with the previous one, because it is quite different.
You have a recent cardiac ultrasound and a resting ECG, coupled with a careful physical exam that were quite normal.
It is a lot different from that period. Your heart is perfectly normal now.
There is no need of a new Holter monitoring.
As a cardiologist I would not recommend performing it.
As a psychiatrist I would not recommend performing it too, because it will help calm your anxiety just for a moment. But the next day or week your fears will come back again and you will need further tests to calm down your anxiety and reassure you that your heart is perfectly normal.
You should try not to depend on those repeated cardiac tests any more.
All you have to do is focus on your anxiety.
Nothing bad is going on! So relax and do not worry about it. Repeated tests are not going to prevent anything, because nothing bad is going to happen. I can assure you about that.
So relax and do not worry about anything!
I am always at your disposal whenever you need to talk about this again!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much. Because I was so worried I saw my cardio today. He heard pvcs though he said just "rarely" and wanted to do holter. So I am wearing a 24-hour monitor. Holter is terrifying to me as it uncovered my 60% PVC burden two years ago. What if I am headed in that direction again?
I would not be concerned at all with 120 PVCs, as I had in February but would be worried if I had 1000 or more. At 10,000 I would panic. Do you think that given I definitely have periods with no pvcs as you saw on video that it's unlikely I am having thousands of PVCs
I am trying to balance anxiety with what is actual concern. Given my history of malignant PVCs, I at least wanted to see my cardio and I was going to follow his advice. Im scared and upset that this time he did hear pvcs and wanted to do Holter. It will be at least Friday before I get the results.
When listening on physical exam, is it possible to discern pacs from pvcs? I am hoping I am having Pacs which I hope explain why I dont feel them internally and I have heard are much more benign than PVCs. Is this true?
One hour down, 23 to go. I am trying to remain calm and hope that this holter finds only rare PVCs. I worry because my EP said that he wouldnt ablate unless over 20,000 but I would be very uncomfortable with 10-20k PVCs. At what level would uou say PVCs are ablatable? I dont want to have any. I am too scared and afraid my EF may be falling even since my echo of just one month ago.
I will pray and hope that this
Holter doesnt show anything too bad.
Thank you so much,
Mia
Thank you so much. Because I was so worried I saw my cardio today. He heard pvcs though he said just "rarely" and wanted to do holter. So I am wearing a 24-hour monitor. Holter is terrifying to me as it uncovered my 60% PVC burden two years ago. What if I am headed in that direction again?
I would not be concerned at all with 120 PVCs, as I had in February but would be worried if I had 1000 or more. At 10,000 I would panic. Do you think that given I definitely have periods with no pvcs as you saw on video that it's unlikely I am having thousands of PVCs
I am trying to balance anxiety with what is actual concern. Given my history of malignant PVCs, I at least wanted to see my cardio and I was going to follow his advice. Im scared and upset that this time he did hear pvcs and wanted to do Holter. It will be at least Friday before I get the results.
When listening on physical exam, is it possible to discern pacs from pvcs? I am hoping I am having Pacs which I hope explain why I dont feel them internally and I have heard are much more benign than PVCs. Is this true?
One hour down, 23 to go. I am trying to remain calm and hope that this holter finds only rare PVCs. I worry because my EP said that he wouldnt ablate unless over 20,000 but I would be very uncomfortable with 10-20k PVCs. At what level would uou say PVCs are ablatable? I dont want to have any. I am too scared and afraid my EF may be falling even since my echo of just one month ago.
I will pray and hope that this
Holter doesnt show anything too bad.
Thank you so much,
Mia
Brief Answer:
Everything is going to be OK!
Detailed Answer:
Dear Mia,
I totally understand the way you feel and would like to reassure you that your next Holter is going to be withing the normal ranges.
Some few PVC or PACs can occur in every normal individual.
Besides, will all your fears and anxiety (considering your troubled mind today), I can not exclude this possibility as adrenaline is running through your veins during these feelings.
But, still you have nothing to worry about! They are not so much to be concerned.
This test will help you calm down for some time. Hope it will last longer this time!
Regarding PVCs and PACs they can both be felt by you. It is not true that you do not feel PACs.
So, just try to close your eyes, take a deep breath.
Everything is going to be OK! I am sure of this.
Let me know about everything!
Best wishes,
Dr. Iliri
Everything is going to be OK!
Detailed Answer:
Dear Mia,
I totally understand the way you feel and would like to reassure you that your next Holter is going to be withing the normal ranges.
Some few PVC or PACs can occur in every normal individual.
Besides, will all your fears and anxiety (considering your troubled mind today), I can not exclude this possibility as adrenaline is running through your veins during these feelings.
But, still you have nothing to worry about! They are not so much to be concerned.
This test will help you calm down for some time. Hope it will last longer this time!
Regarding PVCs and PACs they can both be felt by you. It is not true that you do not feel PACs.
So, just try to close your eyes, take a deep breath.
Everything is going to be OK! I am sure of this.
Let me know about everything!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
THank you so much for all your help through my continuing journey to recover emotionally from severe heart failure from PVCs. I returned my holter today, and was told that I may not get the report until next week, and the earliest will be Friday. That is a very long time for me to wait and I will be extra anxious (if you can imagine that) until I know the results. I certainly hope it will be Friday so the entire weekend won't be full of my not knowing the report.
In your experience if you can hear a PVC during exam, is that indicative of a fairly high PVC rate on holter? My holters since ablation have shown 22 PVCS, 50 PVCs, then 990 one time, and the last time was 129 in February of this year. I don't know if any doctor has heard a PVC during exams at that time, or it wasn't mentioned to me. Do you think there's a chance my holter will still show just rare PVCs? I am so afraid of a rate over 900. When I take my pulse, as I said, repeatedly throughout the day, I can feel a PVC, just a single one, about 2 or 3 times a day. Of course I know I must now wait for holter report but I am not sure if I can expect 1, 100, 1000, or even 10,000 pvcs. I think 10K would be unexpected since that's roughly every 10th beat and I can't imagine I'd be having that many without feeling at least some.
I know PACs can be felt, as well as PVCs, but my concern is that I, oddly, can no longer feel PVCs internally after being able to feel them so well. I always knew when they were happening but now only through checking pulse can I tell they're happening. Have you ever heard of that? I am so sensitive, especially to PVCs, and yet I can no longer feel them. I was wondering if perhaps that might mean I was feeling PACs in my pulse, as perhaps I may just feel them differently than I do PVCs.
When I had 65,000 PVCs (and this was on metropolol, so probably it was even higher) I felt each one constantly thumping. Even the day I had 990 I could feel all day long, that weird flutter although it was less noticeable than in the past.
I hope this means I am simply not having very many.
I am very worried I will have 1000+. I read this and hoped for your opinion:
"Over a follow-up period of about 15 years, those who had the most frequent PVCs were more likely to develop congestive heart failure. When heart failure occurs, the heart does not function normally, limiting blood flow and oxygen delivery through the body. XXXXXXX found that half of those who had PVCs that made up from 1.24 to 3.5 percent of total beats went on to develop heart failure. That percent, he says, "would roughly translate to about 1,000 to 4,000 PVCs in 24 hours."
http://www.everydayhealth.com/heart-failure/living-with/new-clues-predict-congestive-heart-failure/
------------------------------------------------------
I know this study doesn't seem to separate those with other problems such as heart attack history, or other things from those who only have PVCs like I did, but it scares me, in case I have over 1000. My EP says he can only ablate over 20,000 and I will not want to walk around without some sort of treatment. Carvedilol didn't seem to affect my PVCs. My PVCs didn't stop until I had an ablation.
Okay, I must be patient but hope your feelings are that my holter result will be similar to last time- 129 PVCs, 80 Pacs, nothing else bad at all. My chest feels calm but I know there is at least an occasional PVC. My cardio said he was hearing them "rarely" as he listened so I don't know if he heard more than one or how many exactly. The next day will be hard until I get my results.
Thank you so much for all your help, as always,
Mia
THank you so much for all your help through my continuing journey to recover emotionally from severe heart failure from PVCs. I returned my holter today, and was told that I may not get the report until next week, and the earliest will be Friday. That is a very long time for me to wait and I will be extra anxious (if you can imagine that) until I know the results. I certainly hope it will be Friday so the entire weekend won't be full of my not knowing the report.
In your experience if you can hear a PVC during exam, is that indicative of a fairly high PVC rate on holter? My holters since ablation have shown 22 PVCS, 50 PVCs, then 990 one time, and the last time was 129 in February of this year. I don't know if any doctor has heard a PVC during exams at that time, or it wasn't mentioned to me. Do you think there's a chance my holter will still show just rare PVCs? I am so afraid of a rate over 900. When I take my pulse, as I said, repeatedly throughout the day, I can feel a PVC, just a single one, about 2 or 3 times a day. Of course I know I must now wait for holter report but I am not sure if I can expect 1, 100, 1000, or even 10,000 pvcs. I think 10K would be unexpected since that's roughly every 10th beat and I can't imagine I'd be having that many without feeling at least some.
I know PACs can be felt, as well as PVCs, but my concern is that I, oddly, can no longer feel PVCs internally after being able to feel them so well. I always knew when they were happening but now only through checking pulse can I tell they're happening. Have you ever heard of that? I am so sensitive, especially to PVCs, and yet I can no longer feel them. I was wondering if perhaps that might mean I was feeling PACs in my pulse, as perhaps I may just feel them differently than I do PVCs.
When I had 65,000 PVCs (and this was on metropolol, so probably it was even higher) I felt each one constantly thumping. Even the day I had 990 I could feel all day long, that weird flutter although it was less noticeable than in the past.
I hope this means I am simply not having very many.
I am very worried I will have 1000+. I read this and hoped for your opinion:
"Over a follow-up period of about 15 years, those who had the most frequent PVCs were more likely to develop congestive heart failure. When heart failure occurs, the heart does not function normally, limiting blood flow and oxygen delivery through the body. XXXXXXX found that half of those who had PVCs that made up from 1.24 to 3.5 percent of total beats went on to develop heart failure. That percent, he says, "would roughly translate to about 1,000 to 4,000 PVCs in 24 hours."
http://www.everydayhealth.com/heart-failure/living-with/new-clues-predict-congestive-heart-failure/
------------------------------------------------------
I know this study doesn't seem to separate those with other problems such as heart attack history, or other things from those who only have PVCs like I did, but it scares me, in case I have over 1000. My EP says he can only ablate over 20,000 and I will not want to walk around without some sort of treatment. Carvedilol didn't seem to affect my PVCs. My PVCs didn't stop until I had an ablation.
Okay, I must be patient but hope your feelings are that my holter result will be similar to last time- 129 PVCs, 80 Pacs, nothing else bad at all. My chest feels calm but I know there is at least an occasional PVC. My cardio said he was hearing them "rarely" as he listened so I don't know if he heard more than one or how many exactly. The next day will be hard until I get my results.
Thank you so much for all your help, as always,
Mia
Brief Answer:
Opinion as follows:
Detailed Answer:
Dear Mia,
I know you are anxious about the last Holter results; and your thoughts get around certain hypothetical ectopic beats percentages (numbers).
But, the discussion shouldn’t be reduced to such simplified mathematical schemes.
As we have discussed before, heart structure and function are always walking jointly and permanently as close friends.
When one of them doesn’t feel well, the other will also show some concerns.
The same is with the heart. If we are in front of a certain cardiomyopathy, almost invariably there would exist some sort of cardiac rhythm disturbances or cardiac conductance abnormalities.
In your case, after recovering from such a specific cardiac rhythm disturbance, it is logical to feel frightened and anxious as the problem was serious.
So many premature beats led what is called “arrhythmia-induced cardiomyopathy”, a notion that is better elaborated in recent years.
In this regard, an abnormal cardiac focus (badly structured myocardial area) led to arrhythmia which in turn yielded deleterious implications to the rest (healthy myocardium).
Once the triggering cause was eliminated, the heart returned fortunately and completely to its normal previous conditions.
Now, what you are feeling are quite few palpitations, which do not any clinical significance.
Remember, rhythm disturbance could not be judged apart. It is in fact the expression of something getting wrong with the heart structure.
And your heart structure is quite perfect. So, no serious cardiac disorders are warned by those rare extrasystoles.
Listening to the beating heart may be a valuable clue to evaluate the presence of rhythm disturbances at a certain moment.
But, it would be misguiding to draw generalized conclusions by just some minutes heart auscultation.
Extrasystoles, especially when they have a rare appearance, are not homogenously distributed throughout the day-night period.
So, whatever your doctor has heard, it could serve only as a rough guide in deciding the right diagnostic strategy (concluding about Holter monitoring indication, as it is right to do in every patient with palpitations).
In my personal experience 1000, 2000 or even 3000 extrasystoles could hardly cause serious cardiac implications to the extent of causing cardiomyopathy and heart failure.
What the above mentioned doctor has revealed is nothing new but only an observation which concludes the previous reports (heart rhythm disturbances are an expression (cardiac symphony) of primary structural cardiac disorders which denote an obvious predisposition to a future and clinically important cardiac implication (and even heart failure).
Coming to your situation, a few extrasystoles are an expression of what you have experienced (medically and psychologically); in fact they signify nothing clinically important.
You are going to feel rare premature beats but this is not an issue to worry about.
As long as you are keeping this careful attitude toward XXXXXXX issues and stay periodically under medical supervision, everything will be completely reviewed time after time.
On my opinion, I don’t expect any different result from this last Holter compared to the previous ones.
As your other cardiac tests have concluded perfect results, this cannot be a different tuneless violin from the whole musical band.
I would advise to relax and have fun, as your Holter test will conclude what in fact is your cardiac condition; perfectly normal functioning.
Wishing you a pleasant time!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Dear Mia,
I know you are anxious about the last Holter results; and your thoughts get around certain hypothetical ectopic beats percentages (numbers).
But, the discussion shouldn’t be reduced to such simplified mathematical schemes.
As we have discussed before, heart structure and function are always walking jointly and permanently as close friends.
When one of them doesn’t feel well, the other will also show some concerns.
The same is with the heart. If we are in front of a certain cardiomyopathy, almost invariably there would exist some sort of cardiac rhythm disturbances or cardiac conductance abnormalities.
In your case, after recovering from such a specific cardiac rhythm disturbance, it is logical to feel frightened and anxious as the problem was serious.
So many premature beats led what is called “arrhythmia-induced cardiomyopathy”, a notion that is better elaborated in recent years.
In this regard, an abnormal cardiac focus (badly structured myocardial area) led to arrhythmia which in turn yielded deleterious implications to the rest (healthy myocardium).
Once the triggering cause was eliminated, the heart returned fortunately and completely to its normal previous conditions.
Now, what you are feeling are quite few palpitations, which do not any clinical significance.
Remember, rhythm disturbance could not be judged apart. It is in fact the expression of something getting wrong with the heart structure.
And your heart structure is quite perfect. So, no serious cardiac disorders are warned by those rare extrasystoles.
Listening to the beating heart may be a valuable clue to evaluate the presence of rhythm disturbances at a certain moment.
But, it would be misguiding to draw generalized conclusions by just some minutes heart auscultation.
Extrasystoles, especially when they have a rare appearance, are not homogenously distributed throughout the day-night period.
So, whatever your doctor has heard, it could serve only as a rough guide in deciding the right diagnostic strategy (concluding about Holter monitoring indication, as it is right to do in every patient with palpitations).
In my personal experience 1000, 2000 or even 3000 extrasystoles could hardly cause serious cardiac implications to the extent of causing cardiomyopathy and heart failure.
What the above mentioned doctor has revealed is nothing new but only an observation which concludes the previous reports (heart rhythm disturbances are an expression (cardiac symphony) of primary structural cardiac disorders which denote an obvious predisposition to a future and clinically important cardiac implication (and even heart failure).
Coming to your situation, a few extrasystoles are an expression of what you have experienced (medically and psychologically); in fact they signify nothing clinically important.
You are going to feel rare premature beats but this is not an issue to worry about.
As long as you are keeping this careful attitude toward XXXXXXX issues and stay periodically under medical supervision, everything will be completely reviewed time after time.
On my opinion, I don’t expect any different result from this last Holter compared to the previous ones.
As your other cardiac tests have concluded perfect results, this cannot be a different tuneless violin from the whole musical band.
I would advise to relax and have fun, as your Holter test will conclude what in fact is your cardiac condition; perfectly normal functioning.
Wishing you a pleasant time!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I have just heard from my cardio and gotten my holter results. I had a 3% PVC burden, but dr was reluctant to tell me the exact number so I'm guessing it was over 3000, with greater number of total beats. He told me not to worry, and that we will repeat in three months time. He thinks perhaps it may be good to consider going back on beta blockers. During my last holter, when I had just 120 PVCs, I had already been off beta blockers for over 12 weeks so I don't know how much the beta blockers actually do. If I am on beta blockers, then my medical clearance will definitely be denied. I do think this is very much anxiety because as soon as I felt a PVC in my pulse, and believed I saw one on that iPhone app, I became very much aware of my heartrate and pulse and started to focus on it obsessively.
I have made an appointment with my EP for next week. He may want to do his own holter which I hope will show fewer PVCs. Only 8 months ago, at last holter, I had just a handful of PVCs, so what could be happening other than anxiety? Could the irritable focus in my heart which causes PVCs be coming back alive after the successful ablation? Is it possible to do ablation for 3000 PVCs? I don't think I can live with the anxiety of knowing I have so many PVCs and that they could be increasing more and more daily without me feeling them.
It turns out that I had many PVCs at night, between 12-2 am which is when that horrible iphone app was showing many PVCs. I don't know if app simply alerted me to the PVCs, or if it actually caused them by making me so anxious at that time of night.
My cardio told me that my heart can only weaken with PVC burden about 40%. Do you believe this to be true? I was well over 50% when I was diagnosed and I know I'm nowhere near that but what if it keeps going up?
For now I will see my EP next week, show him the holter, although I may repeat holter next week before my visit with him, which hopefully will be better.
I don't know if carvedilol ever helped my PVCs or not. When I had 65,000 PVC holter, I was in the hospital on high-dose metropolol (started that day), and I felt the constant feeling of PVCs until after my ablation.
Dr Iliri- what do you think it means that I can no longer feel my PVCs? I was so shocked, as my chest feels calm and only through taking my pulse or using that app could I detect PVC activity. I have always been reassured that I would know the minute I was having PVCs because I always felt them. This is most unsettling to know that I had 3000 and yet if I was told I had none I would have believed it because my chest felt calm. Well I had felt a few in my pulse but if I was told I had only 20 (as in one of my previous recent holters) I would not have been surprised.
What do you advise? I am very very scared. I'm scared this is the beginning of the whole saga of PVC-induced cardiomyoapathy beginning again.
Many many thanks,
Mia
I have just heard from my cardio and gotten my holter results. I had a 3% PVC burden, but dr was reluctant to tell me the exact number so I'm guessing it was over 3000, with greater number of total beats. He told me not to worry, and that we will repeat in three months time. He thinks perhaps it may be good to consider going back on beta blockers. During my last holter, when I had just 120 PVCs, I had already been off beta blockers for over 12 weeks so I don't know how much the beta blockers actually do. If I am on beta blockers, then my medical clearance will definitely be denied. I do think this is very much anxiety because as soon as I felt a PVC in my pulse, and believed I saw one on that iPhone app, I became very much aware of my heartrate and pulse and started to focus on it obsessively.
I have made an appointment with my EP for next week. He may want to do his own holter which I hope will show fewer PVCs. Only 8 months ago, at last holter, I had just a handful of PVCs, so what could be happening other than anxiety? Could the irritable focus in my heart which causes PVCs be coming back alive after the successful ablation? Is it possible to do ablation for 3000 PVCs? I don't think I can live with the anxiety of knowing I have so many PVCs and that they could be increasing more and more daily without me feeling them.
It turns out that I had many PVCs at night, between 12-2 am which is when that horrible iphone app was showing many PVCs. I don't know if app simply alerted me to the PVCs, or if it actually caused them by making me so anxious at that time of night.
My cardio told me that my heart can only weaken with PVC burden about 40%. Do you believe this to be true? I was well over 50% when I was diagnosed and I know I'm nowhere near that but what if it keeps going up?
For now I will see my EP next week, show him the holter, although I may repeat holter next week before my visit with him, which hopefully will be better.
I don't know if carvedilol ever helped my PVCs or not. When I had 65,000 PVC holter, I was in the hospital on high-dose metropolol (started that day), and I felt the constant feeling of PVCs until after my ablation.
Dr Iliri- what do you think it means that I can no longer feel my PVCs? I was so shocked, as my chest feels calm and only through taking my pulse or using that app could I detect PVC activity. I have always been reassured that I would know the minute I was having PVCs because I always felt them. This is most unsettling to know that I had 3000 and yet if I was told I had none I would have believed it because my chest felt calm. Well I had felt a few in my pulse but if I was told I had only 20 (as in one of my previous recent holters) I would not have been surprised.
What do you advise? I am very very scared. I'm scared this is the beginning of the whole saga of PVC-induced cardiomyoapathy beginning again.
Many many thanks,
Mia
Brief Answer:
My answer as follows:
Detailed Answer:
Dear Mia,
From your question, I can completely understand how you feel.
But try to close your eyes and calm down now!
Nothing serious is going on!
I will try to answer to all your answers:
a) 3% PVC is a low number of PVC and could be related to anxiety of physical activity. Considering that there were mainly in the hours when you were "playing" with your application, I am sure that they are caused by anxiety. So relax.
b) The reason you do not feel them may be because they are rare, or because you are too stressed to feel your body organs. You are thinking all the time that you are sick and you are focused on your pulse or application. But I do not see anything concerning in this situation (including the fact that you do not feel them).
c) Regarding carvedilol, this is really a low dose and not really significant for your heart rate. I would not recommend it.
d)Regarding chinese hawthorn, I would explain that there are several studies on this herbal medicine. It is mainly used to increase coronary blood flow, to help treat arrhythmia or atherosclerosis. But it can cause aggravation of the palpitations, agitation and anxiety. So, I would not recommend taking it during the next Holter.
e) Stopping carvedilol does not cause fluid retention. So relax!
I am sure that if you calm down and try to make some meditation or yoga, take Xanax three times daily during the next Holter, it will result with less PVCs. I am sure about that.
Anyway, 3% PVCs are really not a significant number to lead to your past medical problems.
They could be just related to anxiety. Any you have been really anxious lately.
Hope to have clarified some of your uncertainties!
Feel free to ask me again whenever you need!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear Mia,
From your question, I can completely understand how you feel.
But try to close your eyes and calm down now!
Nothing serious is going on!
I will try to answer to all your answers:
a) 3% PVC is a low number of PVC and could be related to anxiety of physical activity. Considering that there were mainly in the hours when you were "playing" with your application, I am sure that they are caused by anxiety. So relax.
b) The reason you do not feel them may be because they are rare, or because you are too stressed to feel your body organs. You are thinking all the time that you are sick and you are focused on your pulse or application. But I do not see anything concerning in this situation (including the fact that you do not feel them).
c) Regarding carvedilol, this is really a low dose and not really significant for your heart rate. I would not recommend it.
d)Regarding chinese hawthorn, I would explain that there are several studies on this herbal medicine. It is mainly used to increase coronary blood flow, to help treat arrhythmia or atherosclerosis. But it can cause aggravation of the palpitations, agitation and anxiety. So, I would not recommend taking it during the next Holter.
e) Stopping carvedilol does not cause fluid retention. So relax!
I am sure that if you calm down and try to make some meditation or yoga, take Xanax three times daily during the next Holter, it will result with less PVCs. I am sure about that.
Anyway, 3% PVCs are really not a significant number to lead to your past medical problems.
They could be just related to anxiety. Any you have been really anxious lately.
Hope to have clarified some of your uncertainties!
Feel free to ask me again whenever you need!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you very much. Yesterday was shocking for me as I could never have imagined my PVCs had increased so much without me noticing them. In the past, Ive been able to somewhat accurately predict what my holters would show since I felt my PVCs and would count them. Could never have imagined that I could have 3000 and not feel them. I just wonder what has changed and it concerns me because I will no longer be able to know if I am having PVCs without a holter.
Are you sure 3% is not enough to give me heart failure? I've read even 500 can weaken heart so I am scared.
My cardio says I can start carvedilol again at 3.125 or wait until holter in 3 months. I dont know if carvedilol helped my PVCs since I had an ablation as well. Do you find that carvedilol controls pvcs? If I start today, perhaps it will help my holter on Monday. I will relax and take xanax as well.
I am scared, as I fear PVCs will increase and I will need ablation or get cardiomyopathy again. I so wish I had never had this. I fear I will never feel safe again or be free of this disease.
Perhaps I should have not had holter and allowed myself to calm down but then maybe its good to know they have increased. Do you think repeating Monday is a good idea? MY EP prefers to do his own holters.
Are you sure this isnt the beginning of a new heart failure episode? I am so scared. I know I must stay calm though.
Many many thanks.
Mia
Thank you very much. Yesterday was shocking for me as I could never have imagined my PVCs had increased so much without me noticing them. In the past, Ive been able to somewhat accurately predict what my holters would show since I felt my PVCs and would count them. Could never have imagined that I could have 3000 and not feel them. I just wonder what has changed and it concerns me because I will no longer be able to know if I am having PVCs without a holter.
Are you sure 3% is not enough to give me heart failure? I've read even 500 can weaken heart so I am scared.
My cardio says I can start carvedilol again at 3.125 or wait until holter in 3 months. I dont know if carvedilol helped my PVCs since I had an ablation as well. Do you find that carvedilol controls pvcs? If I start today, perhaps it will help my holter on Monday. I will relax and take xanax as well.
I am scared, as I fear PVCs will increase and I will need ablation or get cardiomyopathy again. I so wish I had never had this. I fear I will never feel safe again or be free of this disease.
Perhaps I should have not had holter and allowed myself to calm down but then maybe its good to know they have increased. Do you think repeating Monday is a good idea? MY EP prefers to do his own holters.
Are you sure this isnt the beginning of a new heart failure episode? I am so scared. I know I must stay calm though.
Many many thanks.
Mia
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear Mia,
You should try to calm down!
This is not the beginning of heart failure, because this number of PVC is not high.
Besides, I have explained to you before that heart failure is a clinical syndrome and you have not a single sign of this disorder. So relax.
There is nothing wrong in the fact that you have not felt them. It is because you are too anxious.
Regarding carvedilol, I would not recommend starting it before the next Holter monitoring.
Monday would be OK for the new Holter.
I recommend taking Xanax 0.25mg three times daily during that day.
I am sure that everything will be OK.
You should just try to remain calm and stop these bad thoughts that are pushing into your mind! Remember that they are just thoughts and not the reality.
Please make yourself a present and go to a spa center for a massage or beauty treatment during this weekend!
It will help you relax!
Hope to have been helpful!
Let me know about everything!
Wishing a nice weekend,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear Mia,
You should try to calm down!
This is not the beginning of heart failure, because this number of PVC is not high.
Besides, I have explained to you before that heart failure is a clinical syndrome and you have not a single sign of this disorder. So relax.
There is nothing wrong in the fact that you have not felt them. It is because you are too anxious.
Regarding carvedilol, I would not recommend starting it before the next Holter monitoring.
Monday would be OK for the new Holter.
I recommend taking Xanax 0.25mg three times daily during that day.
I am sure that everything will be OK.
You should just try to remain calm and stop these bad thoughts that are pushing into your mind! Remember that they are just thoughts and not the reality.
Please make yourself a present and go to a spa center for a massage or beauty treatment during this weekend!
It will help you relax!
Hope to have been helpful!
Let me know about everything!
Wishing a nice weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Iliri.
I am currently wearing a holter and have taken two doses of xanax.
On advice of cardio, not ep, I have started 3.125 carvedilol twice a day. Do you think this will help PVCs? And do you think I will be able to go off of the meds again? I will not report to medical board as I have many pills from prior use but they will eventually request my RX records which will show carvedilol use. When I stopped in December after slow taper from 9.375 bid, I had no problems at all and had great echoes and great holter. Do you think it was mistake to re-start? My intention is to get anxiety and PVCs down and then go off again, though i dont know how you taper 3.125 dose.
As long as my heart is not in danger from 3% pvcs I know I must stay calm but it is hard! I felt so relieved to have great echoes off meds and now fear I may never be able to stop meds again.
Thank uou so much. I will have holter results Wednesday but likely will wait to have them explained by EP on Friday instead of having report sent to me with no explanations.
Praying for far fewer PVCS this time.
Many thanks!
Mia
I am currently wearing a holter and have taken two doses of xanax.
On advice of cardio, not ep, I have started 3.125 carvedilol twice a day. Do you think this will help PVCs? And do you think I will be able to go off of the meds again? I will not report to medical board as I have many pills from prior use but they will eventually request my RX records which will show carvedilol use. When I stopped in December after slow taper from 9.375 bid, I had no problems at all and had great echoes and great holter. Do you think it was mistake to re-start? My intention is to get anxiety and PVCs down and then go off again, though i dont know how you taper 3.125 dose.
As long as my heart is not in danger from 3% pvcs I know I must stay calm but it is hard! I felt so relieved to have great echoes off meds and now fear I may never be able to stop meds again.
Thank uou so much. I will have holter results Wednesday but likely will wait to have them explained by EP on Friday instead of having report sent to me with no explanations.
Praying for far fewer PVCS this time.
Many thanks!
Mia
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear Mia,
As I already explained to you before, it would be better performing this Holter without starting carvedilol, which can be a little confounding in this clinical situation.
Anyway, now that you started it you should inform your EP that you are taking it while performing the Holter ( this fact should be considered during the interpretation of the Holter results).
Only after the interpretation of the results, he will decide to continue or not carvedilol.
Anyway, this is a really low dose and can be stopped easily without any problems.
Let me know about everything!
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear Mia,
As I already explained to you before, it would be better performing this Holter without starting carvedilol, which can be a little confounding in this clinical situation.
Anyway, now that you started it you should inform your EP that you are taking it while performing the Holter ( this fact should be considered during the interpretation of the Holter results).
Only after the interpretation of the results, he will decide to continue or not carvedilol.
Anyway, this is a really low dose and can be stopped easily without any problems.
Let me know about everything!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr iliri,
I know you are right and I behaved impulsively when my cardio said I could re-start coreg now or wait. My EP will certainly say I should not have restarted but it will be 4-5 days of taking 3.125 BID when I see him on Friday so it will have been very short term.
My thought was more about calming my acute anxiety and I did not think about the consequences. Could carvedilol potentially increase PVCS because of lower heartrates or does it usually decrease them? I dont know if beta blockers helped my PVCs because my only holter while sick was on the day I was hospitalized and diagnosed and given heavy dose of metropolol with all the other meds. So perhaps PVCs were even higher than 66,000 without beta blocker, I dont know.
Do you see a lot of variability in PVC burden in same person? Two months after having 990 a year ago, I had only 50 again. I am scared because my holters have been so good and I have ALWAYS been anxious and always had many burdens (terminally ill parents) but this one showed so many more PVCs.
I hadnt had holter in 8 months, though, and that was just two months after stopping carvedilol. Could it be that without carvedilol, PVCs were slowly coming back?
I know I will know much more when I see my EP on Friday. This week marks exactly two years since my diagnosis so I am very scared and yet hopeful the holter will be much better.
Are you certain 3% wont harm me and lower my EF? I know I must calm down.
Thank you,
Mia
I know you are right and I behaved impulsively when my cardio said I could re-start coreg now or wait. My EP will certainly say I should not have restarted but it will be 4-5 days of taking 3.125 BID when I see him on Friday so it will have been very short term.
My thought was more about calming my acute anxiety and I did not think about the consequences. Could carvedilol potentially increase PVCS because of lower heartrates or does it usually decrease them? I dont know if beta blockers helped my PVCs because my only holter while sick was on the day I was hospitalized and diagnosed and given heavy dose of metropolol with all the other meds. So perhaps PVCs were even higher than 66,000 without beta blocker, I dont know.
Do you see a lot of variability in PVC burden in same person? Two months after having 990 a year ago, I had only 50 again. I am scared because my holters have been so good and I have ALWAYS been anxious and always had many burdens (terminally ill parents) but this one showed so many more PVCs.
I hadnt had holter in 8 months, though, and that was just two months after stopping carvedilol. Could it be that without carvedilol, PVCs were slowly coming back?
I know I will know much more when I see my EP on Friday. This week marks exactly two years since my diagnosis so I am very scared and yet hopeful the holter will be much better.
Are you certain 3% wont harm me and lower my EF? I know I must calm down.
Thank you,
Mia
Brief Answer:
Your EF and cardiac structure could not be affected by the actual PVCs.
Detailed Answer:
Dear Mia,
Let me start with your last question: Are you certain 3% won’t harm me and lower my EF?
I assure you that that rate of judged premature contractions will not harm your heart.
So relax, as nothing dangerous is happening.
PVCs may frequently follow a variable pattern; that’s you could see a lower number of them if a repeated Holter is performed.
Nevertheless, your actual PVCs are not clinically significant at predicting any dangerous or life-threatening cardiac event.
Regarding beta-blockers, of course they may exert a beneficial effect on extra-systoles, but I don’t believe that stopping Carvedilol has been associated with a possible reversion of PVCs.
Instead, the most reliable alternative seems to be the explanation with extra-systoles variability.
The only drawback of starting immediately Carvedilol would be a potential masking of the real number of PVCs in a repeated Holter.
Anyway, you should discuss with your EP doctor before deciding to perform a new Holter; your actual daily Carvedilol dose is small and it may be proceeded with its gradual withdrawal before/or to go through Holter monitoring without stopping the drug (considering minimal effects on the results).
An important issue to consider is your persistent anxiety; it may produce a favorable triggering factor for those rare extra-systoles.
As those PVCs don’t produce life-threatening effects (they also can not lead to any arrhythmia-induced cardiomyopathy and heart failure relapse at those minimal numbers), one thing is sure: those rare PVCs may be a source of increased anxiety and from the other side, anxiety may interfere on PVCs variability.
So, finally, my advice goes for being conscious that at your actual clinical conditions, the best thing to do is staying calm and relax.
If your EP decide for a new Holter, I would be glad to review both of your last Holters (when they become available).
Meanwhile, try to relax and don’t worry too much about!
Best regards,
Dr. iliri
Your EF and cardiac structure could not be affected by the actual PVCs.
Detailed Answer:
Dear Mia,
Let me start with your last question: Are you certain 3% won’t harm me and lower my EF?
I assure you that that rate of judged premature contractions will not harm your heart.
So relax, as nothing dangerous is happening.
PVCs may frequently follow a variable pattern; that’s you could see a lower number of them if a repeated Holter is performed.
Nevertheless, your actual PVCs are not clinically significant at predicting any dangerous or life-threatening cardiac event.
Regarding beta-blockers, of course they may exert a beneficial effect on extra-systoles, but I don’t believe that stopping Carvedilol has been associated with a possible reversion of PVCs.
Instead, the most reliable alternative seems to be the explanation with extra-systoles variability.
The only drawback of starting immediately Carvedilol would be a potential masking of the real number of PVCs in a repeated Holter.
Anyway, you should discuss with your EP doctor before deciding to perform a new Holter; your actual daily Carvedilol dose is small and it may be proceeded with its gradual withdrawal before/or to go through Holter monitoring without stopping the drug (considering minimal effects on the results).
An important issue to consider is your persistent anxiety; it may produce a favorable triggering factor for those rare extra-systoles.
As those PVCs don’t produce life-threatening effects (they also can not lead to any arrhythmia-induced cardiomyopathy and heart failure relapse at those minimal numbers), one thing is sure: those rare PVCs may be a source of increased anxiety and from the other side, anxiety may interfere on PVCs variability.
So, finally, my advice goes for being conscious that at your actual clinical conditions, the best thing to do is staying calm and relax.
If your EP decide for a new Holter, I would be glad to review both of your last Holters (when they become available).
Meanwhile, try to relax and don’t worry too much about!
Best regards,
Dr. iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I have just seen my EP. My newer holter, with low dose carvedilol and xanax, showed 4.7% PVCS, up from 3%. My EP was not worried but very surprised as all my holters have shown close to 0% since ablation. He said we could watch and wait but when I was so concerned he said he would go ahead and do the ablation now. He thinks a new focus has appeared and he can ablate it.
Now I had echo 6 weeks ago so certainly my heart is still ok? Can ablation actually hurt me in any way other than not working? Will my EF be affected? Will I need more echoes?
I am veey scared.
Ablation will be in about two weeks. EP believes from reviewing EKG from holter report that it's a single focus He can zap.
He suggested echo but when I said my last echo was 5 weeks ago, he said there was no need. He also said that anxiety doesn't cause my PVCS, that instead of blaming myself I need to accept it's a quirk of my body that will have to be monitored. It does seem that at high anxiety times I have had zero PVCS and this time the anxiety was caused by my detecting PVCS in my pulse rather than PVCS starting because I was anxious.
Given my prior successful ablation, and my EP's general high success rate, do you think there is any downside to doing this now before the PVCs can go higher?
After first ablation, the next echo in 3 weeks was crucial to see if heart function had improved. This time, would that be an issue considering that my heart function is normal?
Thank you so much,
Mia
Thank you,
Mia
I have just seen my EP. My newer holter, with low dose carvedilol and xanax, showed 4.7% PVCS, up from 3%. My EP was not worried but very surprised as all my holters have shown close to 0% since ablation. He said we could watch and wait but when I was so concerned he said he would go ahead and do the ablation now. He thinks a new focus has appeared and he can ablate it.
Now I had echo 6 weeks ago so certainly my heart is still ok? Can ablation actually hurt me in any way other than not working? Will my EF be affected? Will I need more echoes?
I am veey scared.
Ablation will be in about two weeks. EP believes from reviewing EKG from holter report that it's a single focus He can zap.
He suggested echo but when I said my last echo was 5 weeks ago, he said there was no need. He also said that anxiety doesn't cause my PVCS, that instead of blaming myself I need to accept it's a quirk of my body that will have to be monitored. It does seem that at high anxiety times I have had zero PVCS and this time the anxiety was caused by my detecting PVCS in my pulse rather than PVCS starting because I was anxious.
Given my prior successful ablation, and my EP's general high success rate, do you think there is any downside to doing this now before the PVCs can go higher?
After first ablation, the next echo in 3 weeks was crucial to see if heart function had improved. This time, would that be an issue considering that my heart function is normal?
Thank you so much,
Mia
Thank you,
Mia
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear Mia,
I am sorry to hear that you have concluded to finalize a new cardiac ablation after discussing with your EP, because my opinion I agree with your first EP opinion for a watchful waiting and monitoring of your actual extrasystoles amount.
Because on my personal professional opinion, I don't think that this PVCs number is going to be harmful to your heart in any way.
In can not effect your LVEF and even your cardiac structure.
Your EP has concluded on a single myocardiac focus generating PVCs after reviewing your PVCs morphology on ECG and Holter.
I am not sure if a new cardiac ablation will be quite efficient to eliminate even the fewest number of PVCs and it will not be necessary for a new future procedure if PVCs (even in such a small number) will appear again; because that would be challenging.
Cardiac ablation, when performed by experienced hands such as in your case is almost safe.
But there are a few potential adverse effects (myocardial injury, bleeding complications, phrenic nerve injury, etc.) due to this procedure that should be considered and weighted against the expected beneficial effects, when deciding to proceed with it.
Generally speaking, even if the cardiac ablation will result unsuccessful, your EF will remain quite normal (just it is actually). So, you shouldn't worry about that.
I recommend discussing once again with your EP before following the last recommendation of cardiac ablation.
Does he really think that cardiac ablation is a medically justified indication or is he influenced also by your excessive anxiety due to those PVCs?
I would like to review personally your last two Holter reports (and associated recordings), just to have a more detailed overview of your PVCs situation.
I remain at your disposal for any other questions!
Wishing you a nice weekend,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear Mia,
I am sorry to hear that you have concluded to finalize a new cardiac ablation after discussing with your EP, because my opinion I agree with your first EP opinion for a watchful waiting and monitoring of your actual extrasystoles amount.
Because on my personal professional opinion, I don't think that this PVCs number is going to be harmful to your heart in any way.
In can not effect your LVEF and even your cardiac structure.
Your EP has concluded on a single myocardiac focus generating PVCs after reviewing your PVCs morphology on ECG and Holter.
I am not sure if a new cardiac ablation will be quite efficient to eliminate even the fewest number of PVCs and it will not be necessary for a new future procedure if PVCs (even in such a small number) will appear again; because that would be challenging.
Cardiac ablation, when performed by experienced hands such as in your case is almost safe.
But there are a few potential adverse effects (myocardial injury, bleeding complications, phrenic nerve injury, etc.) due to this procedure that should be considered and weighted against the expected beneficial effects, when deciding to proceed with it.
Generally speaking, even if the cardiac ablation will result unsuccessful, your EF will remain quite normal (just it is actually). So, you shouldn't worry about that.
I recommend discussing once again with your EP before following the last recommendation of cardiac ablation.
Does he really think that cardiac ablation is a medically justified indication or is he influenced also by your excessive anxiety due to those PVCs?
I would like to review personally your last two Holter reports (and associated recordings), just to have a more detailed overview of your PVCs situation.
I remain at your disposal for any other questions!
Wishing you a nice weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Iliri,
Thank you for your thoughtful response. I will upload the holter reports just as soon as I have copies. My doctors do know of my anxiety and I believe were reluctant to give me the reports as they are so detailed and easily can be interpreted fearfully. My early holters when sick were terrifying. Maybe I will request them and wont look at them.
I have one EP and my first dr is classic cardiologist. Cardio wanted to do more frequent holters, about once every two months or sooner if symptoms increased. He also is in favor of carvedilol.
So my EP did holter last week when I was taking 3.125 carvedilol twice a week. The PVCs increased to over 5000 from 3000 the week prior. EP said I didnt need to worry but did say we must keep a close watch, with monthly holters as we had seen the increase. He said anxiety cannot cause such an increase from 0% to 4.7% and that I shouldnt blame myself or blame my anxious personality.
EP said at first he wasnt sure if ablation was in order yet and he told me my heart was not in danger but as I was so weak and in such danger by the time I saw him two years ago, he didnt want to let it get to a dangerous point either. After reviewing tracings he felt confident he could find the focus and eliminate it. He says he can do it but more careful monitoring would also be fine right now.
Honestly my anxiety is certainly what makes me choose ablation now instead of constant uncertainty and such frequent tests.
I have not yet told my main cardio, who I trust very much, about ablation. He hasnt seen the newer holter yet.
Oh my EP looked at records to
Show that even at highest dose, carvedilol didnt control PVCs at all. On carvedilol 9.375 twice daily, before ablation, PVCS went from 65,000 to 68,000 which I know is probably variation from nature, not meds.
Do you really think this is premature? My feeling is that ablation will need to happen again ar some point and if EP is confident he can do it, and he is really really good so I trust him, I would like to proceed.
If your feelings are that this is a bad idea, I have come to trust you very much, and I will think it through. Ablation is being scheduled and will probably take place in about two weeks.
Thank you so much for all your help through all of this.
Mia
Thank you for your thoughtful response. I will upload the holter reports just as soon as I have copies. My doctors do know of my anxiety and I believe were reluctant to give me the reports as they are so detailed and easily can be interpreted fearfully. My early holters when sick were terrifying. Maybe I will request them and wont look at them.
I have one EP and my first dr is classic cardiologist. Cardio wanted to do more frequent holters, about once every two months or sooner if symptoms increased. He also is in favor of carvedilol.
So my EP did holter last week when I was taking 3.125 carvedilol twice a week. The PVCs increased to over 5000 from 3000 the week prior. EP said I didnt need to worry but did say we must keep a close watch, with monthly holters as we had seen the increase. He said anxiety cannot cause such an increase from 0% to 4.7% and that I shouldnt blame myself or blame my anxious personality.
EP said at first he wasnt sure if ablation was in order yet and he told me my heart was not in danger but as I was so weak and in such danger by the time I saw him two years ago, he didnt want to let it get to a dangerous point either. After reviewing tracings he felt confident he could find the focus and eliminate it. He says he can do it but more careful monitoring would also be fine right now.
Honestly my anxiety is certainly what makes me choose ablation now instead of constant uncertainty and such frequent tests.
I have not yet told my main cardio, who I trust very much, about ablation. He hasnt seen the newer holter yet.
Oh my EP looked at records to
Show that even at highest dose, carvedilol didnt control PVCs at all. On carvedilol 9.375 twice daily, before ablation, PVCS went from 65,000 to 68,000 which I know is probably variation from nature, not meds.
Do you really think this is premature? My feeling is that ablation will need to happen again ar some point and if EP is confident he can do it, and he is really really good so I trust him, I would like to proceed.
If your feelings are that this is a bad idea, I have come to trust you very much, and I will think it through. Ablation is being scheduled and will probably take place in about two weeks.
Thank you so much for all your help through all of this.
Mia
Brief Answer:
Everything is going to be OK.
Detailed Answer:
Hello again, dear Mia,
Thought my opinion is that your actual number of PVCs could not cause any harm to your heart, I would also add that a cardiac ablation appears a safe option, especially when performed by such experienced and high-level hands, as your EP doctor seems to be.
During the cardiac ablation procedure, the patient is fully monitored and under close medical supervision of all the hemodynamic parameters; so you shouldn’t worry about that.
EP area is tremendously evolving and actually with the application of ultra-high density electro-anatomic mapping of the heart, it is possible to identify even small arrhythmogenic myocardial focuses.
So, the success rate is quite high and the complication rate quite low.
Keeping in mind all the above mentioned facts, you should not be anxious about the procedure proposed by your EP doctor.
As he has decided for the cardiac ablation alternative and possesses high professional competence in the field, I believe that the recommended procedure will be carried with the maximal possible success.
Regarding the subsequent cardiac ECHO, it may be performed after cardiac ablation procedure: the following day(s), confirming that the cardiac structure is well-preserved.
I believe that the high-level EP competence coupled with the advanced technology are the best prerequisites for maximal beneficial results, and it seems that you are in the right place of having them.
Wishing everything is going to be OK!
Kind regards,
Dr. Iliri
Everything is going to be OK.
Detailed Answer:
Hello again, dear Mia,
Thought my opinion is that your actual number of PVCs could not cause any harm to your heart, I would also add that a cardiac ablation appears a safe option, especially when performed by such experienced and high-level hands, as your EP doctor seems to be.
During the cardiac ablation procedure, the patient is fully monitored and under close medical supervision of all the hemodynamic parameters; so you shouldn’t worry about that.
EP area is tremendously evolving and actually with the application of ultra-high density electro-anatomic mapping of the heart, it is possible to identify even small arrhythmogenic myocardial focuses.
So, the success rate is quite high and the complication rate quite low.
Keeping in mind all the above mentioned facts, you should not be anxious about the procedure proposed by your EP doctor.
As he has decided for the cardiac ablation alternative and possesses high professional competence in the field, I believe that the recommended procedure will be carried with the maximal possible success.
Regarding the subsequent cardiac ECHO, it may be performed after cardiac ablation procedure: the following day(s), confirming that the cardiac structure is well-preserved.
I believe that the high-level EP competence coupled with the advanced technology are the best prerequisites for maximal beneficial results, and it seems that you are in the right place of having them.
Wishing everything is going to be OK!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for the reassurance. Your opinion is very important to me. I feel better and feel sure my EP feels very confident he can find this new focus and would not attempt ablation if he felt doubt or if it was for my anxiety only.
Dr Iliri, are you saying that echo should be performed after ablation because the mapping process cannot show what echoes can or that the procedure can actually affect the function/ structure of my heart? As I had mentioned, because if my recent normal echo about 6 weeks ago, my pre-ablation echo was canceled and a follow up is not scheduled. My next echo is not planned until next September, actually, although I was hoping dr would perform at 6 months, in March. Should i have one soon after ablation? Last time i had ablation, the one month post ablation was so critical as we were checking to see if pvcs had caused cardiomyopathy. At 3 1/2 weeks post surgery, my EF had gone from 25 to 60 and badly enlarged LV was normal and moderate mitral regurgitation was only trace.
This time, do I need follow up echo too?
EP says I am probably having a 2-7% PVC burden variabilty most days, based on two holters of last two weeks. Are you sure that level wont harm me? So ablation is this time preventing damage in the future instead of repairing it?
I cant wait for ablation to be over and PVCs gone so I can concentrate on my work plans. I hope to figure out a way in which I can still get medical clearance. I will certainly tell my manager who will decide if my case needs to be updated.
Thank you so much. Hope you are having a wonderful weekend.
Mia
Thank you so much for the reassurance. Your opinion is very important to me. I feel better and feel sure my EP feels very confident he can find this new focus and would not attempt ablation if he felt doubt or if it was for my anxiety only.
Dr Iliri, are you saying that echo should be performed after ablation because the mapping process cannot show what echoes can or that the procedure can actually affect the function/ structure of my heart? As I had mentioned, because if my recent normal echo about 6 weeks ago, my pre-ablation echo was canceled and a follow up is not scheduled. My next echo is not planned until next September, actually, although I was hoping dr would perform at 6 months, in March. Should i have one soon after ablation? Last time i had ablation, the one month post ablation was so critical as we were checking to see if pvcs had caused cardiomyopathy. At 3 1/2 weeks post surgery, my EF had gone from 25 to 60 and badly enlarged LV was normal and moderate mitral regurgitation was only trace.
This time, do I need follow up echo too?
EP says I am probably having a 2-7% PVC burden variabilty most days, based on two holters of last two weeks. Are you sure that level wont harm me? So ablation is this time preventing damage in the future instead of repairing it?
I cant wait for ablation to be over and PVCs gone so I can concentrate on my work plans. I hope to figure out a way in which I can still get medical clearance. I will certainly tell my manager who will decide if my case needs to be updated.
Thank you so much. Hope you are having a wonderful weekend.
Mia
Brief Answer:
I would explain:
Detailed Answer:
Dear Mia,
Electro-anatomic mapping and cardiac ECHO are not the same, as electro-anatomic mapping is intended for arrhythmia investigation, while ECHO helps in exploring cardiac anatomy and function.
I am not expecting any impairment of cardiac function from ablation.
The reason why a post procedure ECHO should be done is to ensure that no pericardial effusion, or mechanical abnormalities, etc. are present after ablation (sometimes they may appear as rare complications).
May be cardiac ablation would be helpful in preventing any increasing number of your PVCs, though, I am not sure they are going to increase.
Meanwhile, I have already let you know my opinion about your actual number of PVCs.
Regards,
Dr. Iliri
I would explain:
Detailed Answer:
Dear Mia,
Electro-anatomic mapping and cardiac ECHO are not the same, as electro-anatomic mapping is intended for arrhythmia investigation, while ECHO helps in exploring cardiac anatomy and function.
I am not expecting any impairment of cardiac function from ablation.
The reason why a post procedure ECHO should be done is to ensure that no pericardial effusion, or mechanical abnormalities, etc. are present after ablation (sometimes they may appear as rare complications).
May be cardiac ablation would be helpful in preventing any increasing number of your PVCs, though, I am not sure they are going to increase.
Meanwhile, I have already let you know my opinion about your actual number of PVCs.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for your advice. I Know that the risks, while unlikely, are potentially very serious so I must think this over very very carefully. I know that in most people, an ablation at this pvc level would not be the right choice. I had over 50% burden so its not the same situation.
My EP says he believes it is right move because EKG shows a site that he can get. Also he is surprised at sudden increase as I have had 0% for nearly 2 years. Holter went from 0% to nearly 5%.
Because I didnt have holter or echo for over 20 years before cardiomyopathy diagnosis, I dont know for sure if I was having PVCs and how long it took for cardiomyopathy to develop. Based on my other health checks and symptom history, though, it seems as though PVCs came on aggressively and quickly and cardiomyopathy developed within months. I know it is impossible to know for sure but I dont feel comfortable having this level of PVCs and beta blockers dont help and I know the other anti arrhythmic drugs have potentially harsh side effects and Im drug sensitive.
I was called to schedule my pre-ablation echo as EP thought most recent echo was a year ago. When I informed them it was just 6 weeks ago, they said I only needed blood work. I am now, not surprisingly, thinking I should get the echo. Do you think it's completely crazy to think I could have had any significant changes in just 6 weeks? I will schedule post ablation echo for the week after ablation. I have attached September echo report. I know I have OCD about EF but as I was in severe heart failure before first ablation, I am having terrible flashbacks.
Thank you so much, for everything. I am thinking this through very carefully before scheduling surgery. I dont want to do it if not necessary, but monthly holters also are a daunting and anxiety ridden alternative.
Thank you so much.
Mia
Thank you so much for your advice. I Know that the risks, while unlikely, are potentially very serious so I must think this over very very carefully. I know that in most people, an ablation at this pvc level would not be the right choice. I had over 50% burden so its not the same situation.
My EP says he believes it is right move because EKG shows a site that he can get. Also he is surprised at sudden increase as I have had 0% for nearly 2 years. Holter went from 0% to nearly 5%.
Because I didnt have holter or echo for over 20 years before cardiomyopathy diagnosis, I dont know for sure if I was having PVCs and how long it took for cardiomyopathy to develop. Based on my other health checks and symptom history, though, it seems as though PVCs came on aggressively and quickly and cardiomyopathy developed within months. I know it is impossible to know for sure but I dont feel comfortable having this level of PVCs and beta blockers dont help and I know the other anti arrhythmic drugs have potentially harsh side effects and Im drug sensitive.
I was called to schedule my pre-ablation echo as EP thought most recent echo was a year ago. When I informed them it was just 6 weeks ago, they said I only needed blood work. I am now, not surprisingly, thinking I should get the echo. Do you think it's completely crazy to think I could have had any significant changes in just 6 weeks? I will schedule post ablation echo for the week after ablation. I have attached September echo report. I know I have OCD about EF but as I was in severe heart failure before first ablation, I am having terrible flashbacks.
Thank you so much, for everything. I am thinking this through very carefully before scheduling surgery. I dont want to do it if not necessary, but monthly holters also are a daunting and anxiety ridden alternative.
Thank you so much.
Mia
Brief Answer:
No significant EF changes could result on your clinical conditions.
Detailed Answer:
Dear Mia,
I know you have passed through non-pleasant situations with all those repeated medical & cardiac tests for the last two years after experiencing the successful cardiac ablation.
But, you should know that even in the case of a new efficient and uncomplicated cardiac ablation, again it will be necessary to closely and repeatedly monitor heart rhythm and several other parameters.
It is very important that your EP doctor feels professionally apt to properly handle your specific arrhythmic heart beating, as the level of expertise is the strongest predictor of a successful and uneventful outcome.
Regarding your cardiac performance, I would like to assure you that your normal cardiac function (LVEF) could not be impaired in such a few weeks under such unimportant number of PVCs.
So, relax and don’t worry about it!
Hope you will be more relaxed and comfortable in a couple of weeks after the new ablation.
Please, let me know how things are going on!
Kind regards,
Dr. Iliri
No significant EF changes could result on your clinical conditions.
Detailed Answer:
Dear Mia,
I know you have passed through non-pleasant situations with all those repeated medical & cardiac tests for the last two years after experiencing the successful cardiac ablation.
But, you should know that even in the case of a new efficient and uncomplicated cardiac ablation, again it will be necessary to closely and repeatedly monitor heart rhythm and several other parameters.
It is very important that your EP doctor feels professionally apt to properly handle your specific arrhythmic heart beating, as the level of expertise is the strongest predictor of a successful and uneventful outcome.
Regarding your cardiac performance, I would like to assure you that your normal cardiac function (LVEF) could not be impaired in such a few weeks under such unimportant number of PVCs.
So, relax and don’t worry about it!
Hope you will be more relaxed and comfortable in a couple of weeks after the new ablation.
Please, let me know how things are going on!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
As always thank you so much for your continued help throughout my journey of recovering from cardiomyopathy and PTSD. The PTSD and OCD has been even more disabling than the cardiomyopathy.
Yeaterday was the two year anniversary of my diagnosis and my emergency hospitalization. It was terrible remembering how dire it seemed, that I would need a transplant to have any chance to see my child grow up. I should embrace the miracle but fear is still so strong. How could I have walked around so sick without knowing? I was so busy taking care of my son and parents.
The hospital Called to say there is a 10 day delay in scheduling EP procedures. It means certainly I won't have ablation next week. They also say I must have an echo within 30 days of procedure so as mine is almost 2 months, I will have to have it done.
I am terrified that the PVCs could have lowered my EF. As I have consistently been at 65-70, I will be shattered if it is even 60. I will see my regular cardio, and it will be rhe same machine, and hopefully the same tech. I've attached last 5 echoes, which are with same dr but at two locations, with two different machines and techs. I can see how even they vary somewhat.
But Dr Iliri, if with the same dr, echo machine, and tech, there is a difference in EF then wouldnt it signify a real change?
Every night I run up 12 flights of stairs to see if I get winded. When sick, I couldnt even run up one although I didnt experience SOB normally. Is this effective at all at determining if I could be getting a weak heart again? I run up 120 steps with no feeling of effort. I wish I had no idea what EF was. It is so scary to think it could drop again.
One more thing- my friend I met through heart support group and also had PVC CM, now has mitral valve prolapse. Her LV is mildly enlarged as well. Her dr told her she just needs yearly echo and not to worry. I thought of how my mitral valve showed mild thickening and calcification. Could it be a problem oncoming for me? Also if I look at my echoes, my lv size (walls and mass) keep changing. Is that normal or is my LV enlarging again? Echoes are attached.
Thank you so much Dr Iliri. I will let you know how my echo and ablation go.
Many many thanks,
Mia
As always thank you so much for your continued help throughout my journey of recovering from cardiomyopathy and PTSD. The PTSD and OCD has been even more disabling than the cardiomyopathy.
Yeaterday was the two year anniversary of my diagnosis and my emergency hospitalization. It was terrible remembering how dire it seemed, that I would need a transplant to have any chance to see my child grow up. I should embrace the miracle but fear is still so strong. How could I have walked around so sick without knowing? I was so busy taking care of my son and parents.
The hospital Called to say there is a 10 day delay in scheduling EP procedures. It means certainly I won't have ablation next week. They also say I must have an echo within 30 days of procedure so as mine is almost 2 months, I will have to have it done.
I am terrified that the PVCs could have lowered my EF. As I have consistently been at 65-70, I will be shattered if it is even 60. I will see my regular cardio, and it will be rhe same machine, and hopefully the same tech. I've attached last 5 echoes, which are with same dr but at two locations, with two different machines and techs. I can see how even they vary somewhat.
But Dr Iliri, if with the same dr, echo machine, and tech, there is a difference in EF then wouldnt it signify a real change?
Every night I run up 12 flights of stairs to see if I get winded. When sick, I couldnt even run up one although I didnt experience SOB normally. Is this effective at all at determining if I could be getting a weak heart again? I run up 120 steps with no feeling of effort. I wish I had no idea what EF was. It is so scary to think it could drop again.
One more thing- my friend I met through heart support group and also had PVC CM, now has mitral valve prolapse. Her LV is mildly enlarged as well. Her dr told her she just needs yearly echo and not to worry. I thought of how my mitral valve showed mild thickening and calcification. Could it be a problem oncoming for me? Also if I look at my echoes, my lv size (walls and mass) keep changing. Is that normal or is my LV enlarging again? Echoes are attached.
Thank you so much Dr Iliri. I will let you know how my echo and ablation go.
Many many thanks,
Mia
Brief Answer:
My answer as follows:
Detailed Answer:
Dear Mia,
I know you are scarred by the decision of making cardiac ablation and terrified by the idea of cardiomyopathy and heart failure relapse and this is more pronounced actually as you are badly experiencing your first hospitalization anniversary.
But meanwhile, I would like to let you know that nothing worrisome and dangerous could happen in just two months after your last normal echo.
I assure you about that.
Regarding echo testing, I would explain as previously done that even when the echo machine, technician and doctor is the same, there would always have some variations even when the same patient is examined within the same day.
And this is not because of any pathological disorder altering the heart dimension and overall function, but because of the mild variability inherent in echo exam.
And this is the same reason of your slight variations in several echo reports.
EF could not change in the case of a small PVC number even if we choose a longer period than two months.
So just relax and don’t worry about it!
The reason why the medical team has asked a recent echo (within 30 days from the procedure) is purely explained by the underlying protocols of cardiac procedures and this is not because there is any doubts of cardiac function impairment.
Now, returning to your mitral valve, I would explain that there are so mild changes and there is no evidence predicting any future dangerous complications.
Returning to your possible PVCs during echo exam, I would explain that it is true that there are some adverse influences when making measurements, but at your PVC level it is quiet impossible that they could significantly influence echo investigation (they are so rare to influence an average twenty minute lasting exam).
Hope to have clarified some of your uncertainties!
Let me know about everything!
Wishing you a pleasant weekend,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear Mia,
I know you are scarred by the decision of making cardiac ablation and terrified by the idea of cardiomyopathy and heart failure relapse and this is more pronounced actually as you are badly experiencing your first hospitalization anniversary.
But meanwhile, I would like to let you know that nothing worrisome and dangerous could happen in just two months after your last normal echo.
I assure you about that.
Regarding echo testing, I would explain as previously done that even when the echo machine, technician and doctor is the same, there would always have some variations even when the same patient is examined within the same day.
And this is not because of any pathological disorder altering the heart dimension and overall function, but because of the mild variability inherent in echo exam.
And this is the same reason of your slight variations in several echo reports.
EF could not change in the case of a small PVC number even if we choose a longer period than two months.
So just relax and don’t worry about it!
The reason why the medical team has asked a recent echo (within 30 days from the procedure) is purely explained by the underlying protocols of cardiac procedures and this is not because there is any doubts of cardiac function impairment.
Now, returning to your mitral valve, I would explain that there are so mild changes and there is no evidence predicting any future dangerous complications.
Returning to your possible PVCs during echo exam, I would explain that it is true that there are some adverse influences when making measurements, but at your PVC level it is quiet impossible that they could significantly influence echo investigation (they are so rare to influence an average twenty minute lasting exam).
Hope to have clarified some of your uncertainties!
Let me know about everything!
Wishing you a pleasant weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr iliri,
Thank you for your help and advice. When you say "adverse influences" if there are pvcs do you mean that it can be harder to get good images and accurate images or that it can directly affect EF reading? At over 50% pvcs it was very difficult to get EF reading, but was EF accurate at 25 on echo? MRI could not even do the EF.
I believe at my last echo, I had already started to have these occasional pvcs though no one mentioned it to me.
Very scared about this next echo!
Thank you,
Mia
Thank you for your help and advice. When you say "adverse influences" if there are pvcs do you mean that it can be harder to get good images and accurate images or that it can directly affect EF reading? At over 50% pvcs it was very difficult to get EF reading, but was EF accurate at 25 on echo? MRI could not even do the EF.
I believe at my last echo, I had already started to have these occasional pvcs though no one mentioned it to me.
Very scared about this next echo!
Thank you,
Mia
Brief Answer:
I would explain:
Detailed Answer:
Dear Mia,
Regarding PVCs, I would say that a very frequent appearance may interfere with an accurate Doppler evaluation of trans-valvular flows and also ventricular measurements.
Nevertheless, real difficulty would be the case of very frequent PVCs, such as in the case of persistent bigeminy of trigeminy rhythm.
But, this is not your case; as 3000 or even 5000 PVCs could not disturb importantly the persistent normal sinus rhythm and all the above mentioned measurements would be unaffectedly performed.
I am sure that your previous echo measurements are done quite correctly and also your new test will come unaffected by those rare PVCs.
Don’t be afraid of your echo results, as it will be performed just for a routine protocol.
Kind regards,
Dr. Iliri
I would explain:
Detailed Answer:
Dear Mia,
Regarding PVCs, I would say that a very frequent appearance may interfere with an accurate Doppler evaluation of trans-valvular flows and also ventricular measurements.
Nevertheless, real difficulty would be the case of very frequent PVCs, such as in the case of persistent bigeminy of trigeminy rhythm.
But, this is not your case; as 3000 or even 5000 PVCs could not disturb importantly the persistent normal sinus rhythm and all the above mentioned measurements would be unaffectedly performed.
I am sure that your previous echo measurements are done quite correctly and also your new test will come unaffected by those rare PVCs.
Don’t be afraid of your echo results, as it will be performed just for a routine protocol.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr ilir,
Thank you. Hypothetically (echo on tuesday) if EF were say 55 when it was 68 under two months ago, wouldnt that be a true decline rather than just normal variation. I am worried about effects of PVCS Ive had. In 6 echoes with my cardio over last two years EF has always been 65-70 with just mildest of variation- like 68, 70. Do you think it will continue in same range as I will be on usual machine with same dr and tech? I notice the other machine with different tech does make small difference.
So scared and want it to be unchanged so I can relax and have ablation without worry.
Thank you so much,
Mia
Thank you. Hypothetically (echo on tuesday) if EF were say 55 when it was 68 under two months ago, wouldnt that be a true decline rather than just normal variation. I am worried about effects of PVCS Ive had. In 6 echoes with my cardio over last two years EF has always been 65-70 with just mildest of variation- like 68, 70. Do you think it will continue in same range as I will be on usual machine with same dr and tech? I notice the other machine with different tech does make small difference.
So scared and want it to be unchanged so I can relax and have ablation without worry.
Thank you so much,
Mia
Brief Answer:
Just relax and don't think too much!
Detailed Answer:
Dear Mia,
I could not see any reason why your EF would come down from 68 to 55. The only explanation would be an inaccurate measurement.
Because, as I said, your PVCs are rare and could not produce arrhythmia-induced cardiomyopathy.
Small differences always exist, but they could not be considered clinically significant.
Coming to this point, I would advise you to relax and do not think too much about EF!
The reason why an echo is performed is to evaluate all cardiac structure components, valves functionality, and several parameters of cardiac performance.
EF is only a traditional parameter and you should not be obsessed with it.
Even in the worst hypothetical alternative of a very low EF (which is categorically not your case), cardiac ablation could be performed safely.
So, don’t worry about that issue!
Your cardiac echo will result with quite a normal cardiac performance (including EF) and everything is going to be OK.
Hoping you are having a pleasant weekend!
Regards,
Dr. Iliri
Just relax and don't think too much!
Detailed Answer:
Dear Mia,
I could not see any reason why your EF would come down from 68 to 55. The only explanation would be an inaccurate measurement.
Because, as I said, your PVCs are rare and could not produce arrhythmia-induced cardiomyopathy.
Small differences always exist, but they could not be considered clinically significant.
Coming to this point, I would advise you to relax and do not think too much about EF!
The reason why an echo is performed is to evaluate all cardiac structure components, valves functionality, and several parameters of cardiac performance.
EF is only a traditional parameter and you should not be obsessed with it.
Even in the worst hypothetical alternative of a very low EF (which is categorically not your case), cardiac ablation could be performed safely.
So, don’t worry about that issue!
Your cardiac echo will result with quite a normal cardiac performance (including EF) and everything is going to be OK.
Hoping you are having a pleasant weekend!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Dr Iliri,
I have a dilemma. I just heard from my cardio's office. My cardiologist has a family emergency and will not be in the office this week. As I need my echo for ablation clearance, I need to go in anyway to get it done. I can wait to get results which could be too long for ablation clearance as we dont know when dr will return. Most likely my cardiologist's partner will have to read the echo. With the same echo machine and tech, but different dr/interpreter isnt it possible for quite a different result or would it be expected to be the same? I am so upset and dont know what to do. I trust my cardio and he knows my anxiety levels so he is careful with me. I know other cardio will have my old echoes and the dr's notes but what if he interprets EF as much lower? Or is it mostly in the quality of the echo? Could it differ greatly?
Thank you so much,
Mia
I have a dilemma. I just heard from my cardio's office. My cardiologist has a family emergency and will not be in the office this week. As I need my echo for ablation clearance, I need to go in anyway to get it done. I can wait to get results which could be too long for ablation clearance as we dont know when dr will return. Most likely my cardiologist's partner will have to read the echo. With the same echo machine and tech, but different dr/interpreter isnt it possible for quite a different result or would it be expected to be the same? I am so upset and dont know what to do. I trust my cardio and he knows my anxiety levels so he is careful with me. I know other cardio will have my old echoes and the dr's notes but what if he interprets EF as much lower? Or is it mostly in the quality of the echo? Could it differ greatly?
Thank you so much,
Mia
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again dear Mia,
I am sorry to hear that your attending cardiologist is not accessible in these crucial moments for you. As it is very important the presence of firm confidence on known professional skills of your doctor.
But you shouldn’t worry about this issue, as your cardiac ablation is not an emergency.
From my personal opinion, the best way to follow is waiting for your attending cardiologist to return and check the new cardiac echo with him. As he knows all the previous medical history and has reviewed periodically your cardiac tests, it would be more appropriate to have also this echo performed and revealed by the same doctor.
This opinion is not because I do not believe on the accuracy of the other cardiologist’s skills, but because I do not overestimate the information provided by a routine cardiac ultrasound.
I do believe that building psychological bridges between the patient and the doctor is much more important than some simple diameter and fractional measurements.
Though I have previously explained to you, I would like to reassure you that even though the echo report review is done by another cardiologist, there could not be clinical important changes in the same patient within a short period of time and in the absence of any important pathological process.
So, my opinion is that it could not differ greatly.
You should just relax!
Let me know about everything!
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again dear Mia,
I am sorry to hear that your attending cardiologist is not accessible in these crucial moments for you. As it is very important the presence of firm confidence on known professional skills of your doctor.
But you shouldn’t worry about this issue, as your cardiac ablation is not an emergency.
From my personal opinion, the best way to follow is waiting for your attending cardiologist to return and check the new cardiac echo with him. As he knows all the previous medical history and has reviewed periodically your cardiac tests, it would be more appropriate to have also this echo performed and revealed by the same doctor.
This opinion is not because I do not believe on the accuracy of the other cardiologist’s skills, but because I do not overestimate the information provided by a routine cardiac ultrasound.
I do believe that building psychological bridges between the patient and the doctor is much more important than some simple diameter and fractional measurements.
Though I have previously explained to you, I would like to reassure you that even though the echo report review is done by another cardiologist, there could not be clinical important changes in the same patient within a short period of time and in the absence of any important pathological process.
So, my opinion is that it could not differ greatly.
You should just relax!
Let me know about everything!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr iliri,
Thank you again, so much. I did have Echo and EKG yesterday and despite my efforts to exactly replicate the same scenario as all my other echoes, I ended up not only with different dr, as expected, but a different tech. Then the machine wouldn't turn on so I had a different machine too! But results were the same, and perhaps better as this dr didnt note mitral thickening at all. EKG and echo report attached.
My anxiety is another issue though as I am still worrying today about fluid, PVCs, etc.
If this level of PVCs hasnt caused damage in the 2-3 months I've been having them, do you think it means they won't hurt me unless numbers go up? My ablation was scheduled for November 23rd. I was thinking of perhaps asking for another holter to see if perhaps the number has gone down. I did stop the carvedilol after it didnt help my PVCs at all.
I am happy my heart is ok but know that within a few weeks I will be worrying again. I am not eager to rush into another ablation but am afraid to have so many PVCs.
Thank you so much,
Mia
Thank you again, so much. I did have Echo and EKG yesterday and despite my efforts to exactly replicate the same scenario as all my other echoes, I ended up not only with different dr, as expected, but a different tech. Then the machine wouldn't turn on so I had a different machine too! But results were the same, and perhaps better as this dr didnt note mitral thickening at all. EKG and echo report attached.
My anxiety is another issue though as I am still worrying today about fluid, PVCs, etc.
If this level of PVCs hasnt caused damage in the 2-3 months I've been having them, do you think it means they won't hurt me unless numbers go up? My ablation was scheduled for November 23rd. I was thinking of perhaps asking for another holter to see if perhaps the number has gone down. I did stop the carvedilol after it didnt help my PVCs at all.
I am happy my heart is ok but know that within a few weeks I will be worrying again. I am not eager to rush into another ablation but am afraid to have so many PVCs.
Thank you so much,
Mia
Brief Answer:
I would recommend as follows:
Detailed Answer:
Dear Mia,
I am glad that your recent cardiac ultrasound have resulted normal.
I reviewed them and I am glad to confirm that everything seems to be OK.
This means that all these PVCs that you have had during this period have not caused any significant changes to your heart and the situation is not so concerning.
Coming to this point, I agree with you that a new Holter would be the best choice before performing a new ablation. If it results better than the other, you should reconsider the ablation procedure with your doctor.
Let me know about everything!
Regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Dear Mia,
I am glad that your recent cardiac ultrasound have resulted normal.
I reviewed them and I am glad to confirm that everything seems to be OK.
This means that all these PVCs that you have had during this period have not caused any significant changes to your heart and the situation is not so concerning.
Coming to this point, I agree with you that a new Holter would be the best choice before performing a new ablation. If it results better than the other, you should reconsider the ablation procedure with your doctor.
Let me know about everything!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for reviewing my echo. Does the EKG show any ectopic beats? I see it says only "within normal limits". I see my anxiety is high as normally my office EKGs show heartrate in the 50s or 60s. Would any PVCs during an echo be noted? Neither tech nor doctor mentioned that they were present, and as I've said, I can't feel my PVCs anymore which is both a blessing and very bad, as I can't monitor how many I am having without a holter.
Dr Iliri, your advice, your predictions have always been 100%. I have come to trust you as much as the doctors I see in person. I only wish that you could be my doctor in life. I think I would be a less nervous person as you are simply the most reassuring doctor I have met, because of the depth/breadth of your knowledge and your total confidence, all while remaining kind despite my excessive questions. I hope to be out of your life soon for both our sakes!
My point here is that your telling me to be careful about ablation, as it is not risk-free, is becoming more and more an issue for me. I know that serious complications are rare, but there are smaller ones like infection. For my first ablation, I had no choice, as my heart was very very weak and beta blockers were not controlling my PVCS at all. I had nothing to lose and in fact, I was completely better just three weeks later. It was the right choice. As I saw my perfect echo, I realized this time things are very different. Nothing is wrong, at this point, and my strong heart is something I want to protect fiercely!
To make things worse, I read somewhere that fluid retention is possible after ablation. Why would this be? I don't think I experienced this after my ablation, but I had very low EF and was very sick so things were very different then. I have to admit that my water fear is so strong that that alone makes me want to think this through a bit longer. Is this only for AF ablations? Also hearing "heart inflammation" makes me think of enlarged heart and makes me worried. I know this is all silly- the ridiculous interpretations of a non-medical pro reading too much.
I am going to ask my cardio for another holter if he thinks there could be any change. I am hoping having a clear EKG and good echo indicates perhaps the level has come down a little and that in fact anxiety is playing a part. If a holter shows anything less than 3%, I will probably not do ablation now. If it is higher than the 4.7% of 2nd holter, I am not sure.
I believe I have been having this level of PVCs for approximately 2 1/2 months, but I cannot be sure as my last echo before this month was in February 2016. So in this time there have been no negative consequences, but do you think over time, if not treated, they could cause damage at 3-5%? Beta blockers do not help with PVCs and I am very wary of the stronger anti-arrhythmics like sotalol or amiodarone as I know they can cause problems and have terrible side effects. Am I ok if I am unmedicated and just having 3000-5000 PVCs a day? I certainly hope it's less or that they will go down, but I am scared.
I will talk to my cardiologist's nurse tomorrow about possible new holter. Then I will think more about ablation. I don't want PVCs but I don't want to rush in if this isn't really necessary now. I just can't risk getting cardiomyopathy again.
Thank you so much,
Mia
Thank you so much for reviewing my echo. Does the EKG show any ectopic beats? I see it says only "within normal limits". I see my anxiety is high as normally my office EKGs show heartrate in the 50s or 60s. Would any PVCs during an echo be noted? Neither tech nor doctor mentioned that they were present, and as I've said, I can't feel my PVCs anymore which is both a blessing and very bad, as I can't monitor how many I am having without a holter.
Dr Iliri, your advice, your predictions have always been 100%. I have come to trust you as much as the doctors I see in person. I only wish that you could be my doctor in life. I think I would be a less nervous person as you are simply the most reassuring doctor I have met, because of the depth/breadth of your knowledge and your total confidence, all while remaining kind despite my excessive questions. I hope to be out of your life soon for both our sakes!
My point here is that your telling me to be careful about ablation, as it is not risk-free, is becoming more and more an issue for me. I know that serious complications are rare, but there are smaller ones like infection. For my first ablation, I had no choice, as my heart was very very weak and beta blockers were not controlling my PVCS at all. I had nothing to lose and in fact, I was completely better just three weeks later. It was the right choice. As I saw my perfect echo, I realized this time things are very different. Nothing is wrong, at this point, and my strong heart is something I want to protect fiercely!
To make things worse, I read somewhere that fluid retention is possible after ablation. Why would this be? I don't think I experienced this after my ablation, but I had very low EF and was very sick so things were very different then. I have to admit that my water fear is so strong that that alone makes me want to think this through a bit longer. Is this only for AF ablations? Also hearing "heart inflammation" makes me think of enlarged heart and makes me worried. I know this is all silly- the ridiculous interpretations of a non-medical pro reading too much.
I am going to ask my cardio for another holter if he thinks there could be any change. I am hoping having a clear EKG and good echo indicates perhaps the level has come down a little and that in fact anxiety is playing a part. If a holter shows anything less than 3%, I will probably not do ablation now. If it is higher than the 4.7% of 2nd holter, I am not sure.
I believe I have been having this level of PVCs for approximately 2 1/2 months, but I cannot be sure as my last echo before this month was in February 2016. So in this time there have been no negative consequences, but do you think over time, if not treated, they could cause damage at 3-5%? Beta blockers do not help with PVCs and I am very wary of the stronger anti-arrhythmics like sotalol or amiodarone as I know they can cause problems and have terrible side effects. Am I ok if I am unmedicated and just having 3000-5000 PVCs a day? I certainly hope it's less or that they will go down, but I am scared.
I will talk to my cardiologist's nurse tomorrow about possible new holter. Then I will think more about ablation. I don't want PVCs but I don't want to rush in if this isn't really necessary now. I just can't risk getting cardiomyopathy again.
Thank you so much,
Mia
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear Mia,
I agree that it is important to be more prudent and perform a new Holter monitoring, before continuing with the ablation procedure.
It is true that this procedure does not seem to be so necessary this time compared you your previous one (two years ago).
From the other hand, the possible complications of this procedure should be weighted against the benefits, with the aim of getting more benefits with the least possible complications.
In your case, I am afraid that the potential benefits could not be so markedly perceived as to justify any eventual complications (even though they appear to be in a low frequency).
You already know my opinion that your actual PVCs number could not harm your perfectly functioning heart and also there is no indication for any antiarrhythmic drug use.
During cardiac ablation, as a result of the isolation and burning of the arrhythmogenic focus the surrounding cardiac muscle may become temporarily stunne and this may lead to a transient decrease in the myocardial performance.
But in your case, with your actually perfect LV EF these minimal implications could not lead to important decrease in cardiac function and subsequent fluid retention.
So, you shouldn’t worry about fluid retention as it is unlikely in your clinical conditions.
Finally, I would recommend you to discussing again with your attending cardiologist (after having the results of Holter monitoring) to carefully reconsider the indication of cardiac ablation.
Wishing to you a pleasant weekend,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear Mia,
I agree that it is important to be more prudent and perform a new Holter monitoring, before continuing with the ablation procedure.
It is true that this procedure does not seem to be so necessary this time compared you your previous one (two years ago).
From the other hand, the possible complications of this procedure should be weighted against the benefits, with the aim of getting more benefits with the least possible complications.
In your case, I am afraid that the potential benefits could not be so markedly perceived as to justify any eventual complications (even though they appear to be in a low frequency).
You already know my opinion that your actual PVCs number could not harm your perfectly functioning heart and also there is no indication for any antiarrhythmic drug use.
During cardiac ablation, as a result of the isolation and burning of the arrhythmogenic focus the surrounding cardiac muscle may become temporarily stunne and this may lead to a transient decrease in the myocardial performance.
But in your case, with your actually perfect LV EF these minimal implications could not lead to important decrease in cardiac function and subsequent fluid retention.
So, you shouldn’t worry about fluid retention as it is unlikely in your clinical conditions.
Finally, I would recommend you to discussing again with your attending cardiologist (after having the results of Holter monitoring) to carefully reconsider the indication of cardiac ablation.
Wishing to you a pleasant weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
When you say the heart can be stunned and lead to some temporary decrease in performance, is this the same as lowering of EF? And is this always the case or would that be if there was a complication?
I believe my EKG didnt show PVCS and I dont know how if I can find out if I had any on echo. It was not mentioned.
If I have 3% or fewer PVCs on new holterI will not do ablation. I will pray for lower number. As this echo was actually better than 7 weeks ago, would you think that was evidence that this level of PVCs is not dangerous? I believe the entire time between echoes I have been having similar amount of PVCs.
Thank you so much, wishing you a happy weekend.
Mia
When you say the heart can be stunned and lead to some temporary decrease in performance, is this the same as lowering of EF? And is this always the case or would that be if there was a complication?
I believe my EKG didnt show PVCS and I dont know how if I can find out if I had any on echo. It was not mentioned.
If I have 3% or fewer PVCs on new holterI will not do ablation. I will pray for lower number. As this echo was actually better than 7 weeks ago, would you think that was evidence that this level of PVCs is not dangerous? I believe the entire time between echoes I have been having similar amount of PVCs.
Thank you so much, wishing you a happy weekend.
Mia
Brief Answer:
My answer as follows:
Detailed Answer:
Dear Mia,
Stunned myocadial muscle, means that there is a low performance of the cardiac muscles and the heart is not able to pump the blood properly for a short period of time. This could be associated to a temporary decrease in EF. But, as I explained, it is just temporary after the ablation procedure.
Regarding your cardiac ultrasound, I can assure you that there have been no PVCs during this test. As the doctor has not mentioned them, it means that they did not occur.
So relax and don't worry about it!
I agree that the next Holter will help make a better decision on performing or not the cardiac ablation procedure.
As your last cardiac ultrasound was better than the others, I don't expect your PVCs to have worsened.
So, just try to relax! Anxiety is not going to help you!
I recommend practicing some meditation during this period. It will help manage your bad thoughts! I know you can do this! You should just try!
Hope you will find this answer helpful!
I am always at your disposal whenever you need!
Regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear Mia,
Stunned myocadial muscle, means that there is a low performance of the cardiac muscles and the heart is not able to pump the blood properly for a short period of time. This could be associated to a temporary decrease in EF. But, as I explained, it is just temporary after the ablation procedure.
Regarding your cardiac ultrasound, I can assure you that there have been no PVCs during this test. As the doctor has not mentioned them, it means that they did not occur.
So relax and don't worry about it!
I agree that the next Holter will help make a better decision on performing or not the cardiac ablation procedure.
As your last cardiac ultrasound was better than the others, I don't expect your PVCs to have worsened.
So, just try to relax! Anxiety is not going to help you!
I recommend practicing some meditation during this period. It will help manage your bad thoughts! I know you can do this! You should just try!
Hope you will find this answer helpful!
I am always at your disposal whenever you need!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
There is always stunned myocardial tissue even with one focus burned? This is inevitable with every ablation? My dr claimed no EF effect although mine went from 25-60 last time because of CM. Even temporary decrease scares me way too much. I may not be able to do it.
Thank you,
Mia
There is always stunned myocardial tissue even with one focus burned? This is inevitable with every ablation? My dr claimed no EF effect although mine went from 25-60 last time because of CM. Even temporary decrease scares me way too much. I may not be able to do it.
Thank you,
Mia
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear Mia,
It is difficult to say if there is always stunned myocardial tissue around on focus burned. It depends on the technique used. You should discuss with your doctor on this issue.
Anyway, this is not the main issue to consider before the cardiac ablation. It is not the most concerning issue.
This procedure can cause a lot of possible complications and it should be performed only if it is really necessary.
That is what I am trying to tell you!
You shouldn't focus on every possible adverse effect of the procedure. It is very unlikely that all the adverse effects are going to occur in your case. They are reported in a small percentage of patients (in big studies). So relax and try not to worry too much.
Besides, as we discussed before, the next Holter will be decisive. You have not decided yet. So why to worry so much?
Just try to enjoy this weekend, without so many bad thoughts and fears.
Remember: the reality is that your echo is excellent. All your fears and thoughts are just irrational suppositions. Try to think just the reality. That is the only true fact.
I hope you will try to relax a little!
Let me know if you have any other uncertainties!
Greetings,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear Mia,
It is difficult to say if there is always stunned myocardial tissue around on focus burned. It depends on the technique used. You should discuss with your doctor on this issue.
Anyway, this is not the main issue to consider before the cardiac ablation. It is not the most concerning issue.
This procedure can cause a lot of possible complications and it should be performed only if it is really necessary.
That is what I am trying to tell you!
You shouldn't focus on every possible adverse effect of the procedure. It is very unlikely that all the adverse effects are going to occur in your case. They are reported in a small percentage of patients (in big studies). So relax and try not to worry too much.
Besides, as we discussed before, the next Holter will be decisive. You have not decided yet. So why to worry so much?
Just try to enjoy this weekend, without so many bad thoughts and fears.
Remember: the reality is that your echo is excellent. All your fears and thoughts are just irrational suppositions. Try to think just the reality. That is the only true fact.
I hope you will try to relax a little!
Let me know if you have any other uncertainties!
Greetings,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr iliri,
If I have similar number of PVCs on next holter (3-4%) and Since echo was great, and I dont do ablation now, what should I do? Of course holters to check on PVCs but carvedilol increased my PVCs before ablation and when I took for two weeks last month before 2nd holter. The other anti arrhythmics are so strong. If I keep having just a similar amount am I safe or do you think they will slowly do damage? Can I just do nothing for now without damaging my heart? I cannot get CM again, my spirit would not survive.
I will
Hope holter is better but if it's not I dont know what I will do.
An anesthesiologist friend of
Mine said any effect of heart being stunned after ablation should only last while I am still in the hospital and I should be ok when released. My friend had an echo right after ablation, at bedside, but they dont do that at my hospital:
So nervous and feeling like perhaps each day my heart is being damaged a little. I dont feel safe at all.
Thank you,
Mia
If I have similar number of PVCs on next holter (3-4%) and Since echo was great, and I dont do ablation now, what should I do? Of course holters to check on PVCs but carvedilol increased my PVCs before ablation and when I took for two weeks last month before 2nd holter. The other anti arrhythmics are so strong. If I keep having just a similar amount am I safe or do you think they will slowly do damage? Can I just do nothing for now without damaging my heart? I cannot get CM again, my spirit would not survive.
I will
Hope holter is better but if it's not I dont know what I will do.
An anesthesiologist friend of
Mine said any effect of heart being stunned after ablation should only last while I am still in the hospital and I should be ok when released. My friend had an echo right after ablation, at bedside, but they dont do that at my hospital:
So nervous and feeling like perhaps each day my heart is being damaged a little. I dont feel safe at all.
Thank you,
Mia
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear Mia,
I understand your concern and would like to reassure you that nothing bad is going on!
In my professional opinion 3-4% of PVCs in the Holter have no clinical significance and there is no need for any treatments (including cardiac ablation or betablockers).
So, even if your new Holter shows this number of PVC, I would not recommend any treatment.
So, relax and don't worry about. This number of PVCs can not damage your heart.
And in fact your cardiac ultrasound is perfect.
Regarding the stunned miocardium, as I already explained to you, it is not a matter of concern. It is true that is is temporary and in fact the patients does not feel any change. It is a matter of interest only for your doctor during your hospitalization, but nothing to be concerned of. So relax and try not to think about it!
I am always at your disposal if you want to further discuss on these issues.
Kind regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear Mia,
I understand your concern and would like to reassure you that nothing bad is going on!
In my professional opinion 3-4% of PVCs in the Holter have no clinical significance and there is no need for any treatments (including cardiac ablation or betablockers).
So, even if your new Holter shows this number of PVC, I would not recommend any treatment.
So, relax and don't worry about. This number of PVCs can not damage your heart.
And in fact your cardiac ultrasound is perfect.
Regarding the stunned miocardium, as I already explained to you, it is not a matter of concern. It is true that is is temporary and in fact the patients does not feel any change. It is a matter of interest only for your doctor during your hospitalization, but nothing to be concerned of. So relax and try not to think about it!
I am always at your disposal if you want to further discuss on these issues.
Kind regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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