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Is Premature Ventricular Contraction Of 3.6% A Cause For Concern?
Question: Dear Dr Iliri,
It is XXXX again, needing advice again.
My EP did another holter last week to see where PVC burden is and it was 3.6%. That is exactly what the first holter over a month ago was and a little better than the one after that which was 4.7%. I see my EP on Friday to discuss if 3% is a level he believes he can ablate or not. I am not sure what I am hoping he says. I don't want to have unnecessary surgery especially if chances of success are not high but I am very uncomfortable having thousands of PVCS a day. I know I am not a dr, but it seems that in studies of PVC cardiomyopathy, there are people who had burdens as low as 5% (though rare).
I know it's so much less than the 60% PVC burden I had before but I had very severe heart failure, EF below 25, it was extreme. Couldn't there be more subtle, slower damage with 3-5% burden? I don't know if I can live with that, especially as beta blockers only increase my PVCS. After ablation, on carvedilol I was fine, but when I am having PVCs, beta blockers make them worse.
I will discuss with EP obviously but I am scared. Meanwhile even though my pre-op
Echo was just two weeks ago, I am terrified that my heart is weakening already. I feel sure that I retain water when walking or standing so I keep sitting and trying to keep my feet up. I have been so damaged by this trauma and don't know how to live normally again.
I also had all my pre-op blood work yesterday and I am worried about that too. It has been a year since I've had kidney function checked.
I feel like my body is a very fragile, broken thing like a rag doll. I am someone who never missed school or work, could easily go on a hike for 20
Miles even after not sleeping. I was such a hearty person which is why I didn't fear my subtle symptoms when I had CM. Now I feel without this crazy vigilance I will be back in an ICU, waiting for a heart transplant soon.
I have a psychiatrist and therapist but they don't help
Much. psychiatrist suggested I start Effexor/lithium/neurontin/seroquel on top of buspirone and xanax which I currently take. He gave me all four drugs which I will not start as they all have terrible side effects. I don't have much faith in psych drugs.
Do you think I should wait on ablation? Are my fears of sudden heart weakness so soon after an echo simply signs of anxiety?
Thank you so much,
XXXX
It is XXXX again, needing advice again.
My EP did another holter last week to see where PVC burden is and it was 3.6%. That is exactly what the first holter over a month ago was and a little better than the one after that which was 4.7%. I see my EP on Friday to discuss if 3% is a level he believes he can ablate or not. I am not sure what I am hoping he says. I don't want to have unnecessary surgery especially if chances of success are not high but I am very uncomfortable having thousands of PVCS a day. I know I am not a dr, but it seems that in studies of PVC cardiomyopathy, there are people who had burdens as low as 5% (though rare).
I know it's so much less than the 60% PVC burden I had before but I had very severe heart failure, EF below 25, it was extreme. Couldn't there be more subtle, slower damage with 3-5% burden? I don't know if I can live with that, especially as beta blockers only increase my PVCS. After ablation, on carvedilol I was fine, but when I am having PVCs, beta blockers make them worse.
I will discuss with EP obviously but I am scared. Meanwhile even though my pre-op
Echo was just two weeks ago, I am terrified that my heart is weakening already. I feel sure that I retain water when walking or standing so I keep sitting and trying to keep my feet up. I have been so damaged by this trauma and don't know how to live normally again.
I also had all my pre-op blood work yesterday and I am worried about that too. It has been a year since I've had kidney function checked.
I feel like my body is a very fragile, broken thing like a rag doll. I am someone who never missed school or work, could easily go on a hike for 20
Miles even after not sleeping. I was such a hearty person which is why I didn't fear my subtle symptoms when I had CM. Now I feel without this crazy vigilance I will be back in an ICU, waiting for a heart transplant soon.
I have a psychiatrist and therapist but they don't help
Much. psychiatrist suggested I start Effexor/lithium/neurontin/seroquel on top of buspirone and xanax which I currently take. He gave me all four drugs which I will not start as they all have terrible side effects. I don't have much faith in psych drugs.
Do you think I should wait on ablation? Are my fears of sudden heart weakness so soon after an echo simply signs of anxiety?
Thank you so much,
XXXX
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear XXXX,
Welcome back on HCM!
I am glad about your new Holter results. Now you already know my opinion on this PVC burden: I would not recommend going into cardiac ablation.
It is really unnecessary! You do not need it as this number of PVCs is not going to harm your heart.
Your recent cardiac ultrasound was perfectly normal. Which confirms again my personal opinion.
You should push away from your mind these irrational fears and thoughts. The true, revealed by your performed tests is that your heart is perfectly normal.
So, these are just some bad thoughts, which have no relation to the reality.
Now, returning to your daily maneuvers to reduce fluid retention, I would explain that there is no reason why your body should retain fluids. I know you are obsessed by this fear, but as a cardiologist I can assure you that nothing bad is going to happen. You should just try to live one day like a normal person. Then you will see that nothing bad will happen and will try to live normally again. There is no need to be cautious.
The only thing you need is just some faith and reassurance.
I am trying to help you understand that you are a normal person. It is your turn now to believe in me. I am a professional of the field, and I can say from my experience that considering your clinical situation and your cardiac tests, you can live a normal life, without being afraid of anything.
Regarding the therapy prescribed by your attending physician, I agree with you on the fact that all these drugs have a lot of adverse effects. Unlike you, I believe in the change that these drugs can bring to your life. But, I would recommend introducing one of them at a time. I would not recommend starting them all at the same time.
Regarding Xanax, you should know that it can not be used regularly because it can cause addiction and tolerance, leading to aggravation of your symptoms.
Besides, Lithium, even though a good drug, should be closely monitored by plasmatic levels because it can be really toxic.
I would recommend discussing with your doctor on the possibility of starting effexor in low doses, increasing the dose really gradually in order to avoid possible adverse effects.
Buspirone is a good anxiolytic, but it doesn't seem to be really helpful in this situation.
You should try to move on and your current therapy isn't really showing any good effects.
The most important thing, as I already have explained to you, is to differentiate the reality by your thoughts and fears. I am sure that your doctor will help you guide through the right decision.
You should just try to discuss with him the pros and cons of cardiac ablation, considering your cardiac ultrasound and the last Holter results.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear XXXX,
Welcome back on HCM!
I am glad about your new Holter results. Now you already know my opinion on this PVC burden: I would not recommend going into cardiac ablation.
It is really unnecessary! You do not need it as this number of PVCs is not going to harm your heart.
Your recent cardiac ultrasound was perfectly normal. Which confirms again my personal opinion.
You should push away from your mind these irrational fears and thoughts. The true, revealed by your performed tests is that your heart is perfectly normal.
So, these are just some bad thoughts, which have no relation to the reality.
Now, returning to your daily maneuvers to reduce fluid retention, I would explain that there is no reason why your body should retain fluids. I know you are obsessed by this fear, but as a cardiologist I can assure you that nothing bad is going to happen. You should just try to live one day like a normal person. Then you will see that nothing bad will happen and will try to live normally again. There is no need to be cautious.
The only thing you need is just some faith and reassurance.
I am trying to help you understand that you are a normal person. It is your turn now to believe in me. I am a professional of the field, and I can say from my experience that considering your clinical situation and your cardiac tests, you can live a normal life, without being afraid of anything.
Regarding the therapy prescribed by your attending physician, I agree with you on the fact that all these drugs have a lot of adverse effects. Unlike you, I believe in the change that these drugs can bring to your life. But, I would recommend introducing one of them at a time. I would not recommend starting them all at the same time.
Regarding Xanax, you should know that it can not be used regularly because it can cause addiction and tolerance, leading to aggravation of your symptoms.
Besides, Lithium, even though a good drug, should be closely monitored by plasmatic levels because it can be really toxic.
I would recommend discussing with your doctor on the possibility of starting effexor in low doses, increasing the dose really gradually in order to avoid possible adverse effects.
Buspirone is a good anxiolytic, but it doesn't seem to be really helpful in this situation.
You should try to move on and your current therapy isn't really showing any good effects.
The most important thing, as I already have explained to you, is to differentiate the reality by your thoughts and fears. I am sure that your doctor will help you guide through the right decision.
You should just try to discuss with him the pros and cons of cardiac ablation, considering your cardiac ultrasound and the last Holter results.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I saw my EP yesterday and he canceled ablation but promised he will monitor me closely and would ablate as soon as it seemed pvcs were getting worse.
I am honestly a little disappointed as I was afraid but also looking forward to having no PVCS. Is 3% really no danger? Is it no more dangerous than having 100 pvcs as I did some months ago? Over time, though, would 3-5% damage my heart? Many months or years? Beta blockers do not help.
My echo was two weeks ago but already, of course, I fear there is new damage. How often do you think I need echoes? Does the return of PVCS make a difference?
MY EP said the new location of PVCs are making them happen at a point in the heart beat cycle when I dont feel them. The other focus which was ablated gave me very obvious palpitations. I preferred that as I could monitor the situation.
I have my blood test results. All looks good except my neutrophils seem high? Perhaps I was so nervous it happened?
Last question- kidney function was good on labs. If I was having fluid retention from poor blood flow to kidneys from bad heart as I always fear, would that show up in kidney function tests or only after long term loss of blood flow which would lead to kidney damage? Labs are attached.
Thank you so much Dr Iliri. You gave me so much good advice. I am starting neurofeedback for PTSD and OCD next week.
Hope uou have a great weekend.
Thank you,
XXXX
I saw my EP yesterday and he canceled ablation but promised he will monitor me closely and would ablate as soon as it seemed pvcs were getting worse.
I am honestly a little disappointed as I was afraid but also looking forward to having no PVCS. Is 3% really no danger? Is it no more dangerous than having 100 pvcs as I did some months ago? Over time, though, would 3-5% damage my heart? Many months or years? Beta blockers do not help.
My echo was two weeks ago but already, of course, I fear there is new damage. How often do you think I need echoes? Does the return of PVCS make a difference?
MY EP said the new location of PVCs are making them happen at a point in the heart beat cycle when I dont feel them. The other focus which was ablated gave me very obvious palpitations. I preferred that as I could monitor the situation.
I have my blood test results. All looks good except my neutrophils seem high? Perhaps I was so nervous it happened?
Last question- kidney function was good on labs. If I was having fluid retention from poor blood flow to kidneys from bad heart as I always fear, would that show up in kidney function tests or only after long term loss of blood flow which would lead to kidney damage? Labs are attached.
Thank you so much Dr Iliri. You gave me so much good advice. I am starting neurofeedback for PTSD and OCD next week.
Hope uou have a great weekend.
Thank you,
XXXX
Brief Answer:
My opinion as follows:
Detailed Answer:
Dear XXXX,
I am glad that your EP has cancelled the cardiac ablation. You should be happy about this, because this means that your EP too, thinks that the situation is much more benign.
As, I already explained to your before, this number of PVC (3%) is not dangerous and will not harm your heart. It is not a matter of time. So relax and try not to think about it any more. Anxiety is not going to help you!
I would recommend follow up with periodically scheduled cardiac ultrasound and Holter monitoring every 6 months.
I carefully reviewed your blood lab tests andwould explain that the total number of white blood cells is withing the normal ranges. This means that the increased portion of neutrophyles may just be an incidental finding. Another possible option would be an infection.
Do you have fevers? If you have no symptoms, there is nothing to worry about. I recommend repeating the complete blood count with white blood cell formula after a week, to be sure that everything is OK.
Regarding your renal function tests they are perfectly normal. Of course, if fluid retention would be present, alteration of the renal function tests would be present too.
So, you have nothing to worry about!
Hope to have clarified some of your uncertainties!
Good luck with your neurofeedback!
Let me know about everything!
Wishing a pleasant weekend,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Dear XXXX,
I am glad that your EP has cancelled the cardiac ablation. You should be happy about this, because this means that your EP too, thinks that the situation is much more benign.
As, I already explained to your before, this number of PVC (3%) is not dangerous and will not harm your heart. It is not a matter of time. So relax and try not to think about it any more. Anxiety is not going to help you!
I would recommend follow up with periodically scheduled cardiac ultrasound and Holter monitoring every 6 months.
I carefully reviewed your blood lab tests andwould explain that the total number of white blood cells is withing the normal ranges. This means that the increased portion of neutrophyles may just be an incidental finding. Another possible option would be an infection.
Do you have fevers? If you have no symptoms, there is nothing to worry about. I recommend repeating the complete blood count with white blood cell formula after a week, to be sure that everything is OK.
Regarding your renal function tests they are perfectly normal. Of course, if fluid retention would be present, alteration of the renal function tests would be present too.
So, you have nothing to worry about!
Hope to have clarified some of your uncertainties!
Good luck with your neurofeedback!
Let me know about everything!
Wishing a pleasant weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you dr iliri.
Absolute neutrophils was 4000 and I have no symptoms. Probably ok?
I am confused by conflicting information about 3% pvc burden. I find information saying 3000 csn weaken heart. One such item I attached. also my office ekg showed pvcs so I worry they are increasing or it is much more on some days. I am worried some say 3000 can weaken heart and I may reschedule ablation.
So if kidney function is fine then my water obsession is truly unfounded? I am getting anxious about echo now headed towards being 3 weeks past. Feels like heart can be weakening all the time. I always feel so scared and unsure and having return of pvcs makes it much worse.
Are you sure 3% isnt dangerous? So many different opinions.
Thank you,
XXXX
Absolute neutrophils was 4000 and I have no symptoms. Probably ok?
I am confused by conflicting information about 3% pvc burden. I find information saying 3000 csn weaken heart. One such item I attached. also my office ekg showed pvcs so I worry they are increasing or it is much more on some days. I am worried some say 3000 can weaken heart and I may reschedule ablation.
So if kidney function is fine then my water obsession is truly unfounded? I am getting anxious about echo now headed towards being 3 weeks past. Feels like heart can be weakening all the time. I always feel so scared and unsure and having return of pvcs makes it much worse.
Are you sure 3% isnt dangerous? So many different opinions.
Thank you,
XXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear XXXX,
I understand your concern, and would like to reassure that 3% PVC burden is not a concerning matter.
Your doctor thinks the same, as he decided to cancel cardiac ablation.
Your recent cardiac ultrasound was perfectly normal and you have no symptoms of any weakening heart (or heart failure).
So, relax! You should try to focus on your anxiety, which is certainly not helping you!
Your kidney function tests are quite normal, which means that there is no fluid retention.
So, try not to think about it any more. You can live a normal life and perform as much physical activity as you like during the day. There is no need to stay with your feet up, because these are just some irrational fears, which are limiting your life.
I understand that there may be a lot of information on the internet, but you should try not to base on them, because Dr. Internet can be really confounding sometimes, considering the fact that the information is very wide, non-specific and sometimes not very professional.
Hope to have calmed a little your anxiety!
I remain at your disposal whenever you want to discuss again on these matters.
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear XXXX,
I understand your concern, and would like to reassure that 3% PVC burden is not a concerning matter.
Your doctor thinks the same, as he decided to cancel cardiac ablation.
Your recent cardiac ultrasound was perfectly normal and you have no symptoms of any weakening heart (or heart failure).
So, relax! You should try to focus on your anxiety, which is certainly not helping you!
Your kidney function tests are quite normal, which means that there is no fluid retention.
So, try not to think about it any more. You can live a normal life and perform as much physical activity as you like during the day. There is no need to stay with your feet up, because these are just some irrational fears, which are limiting your life.
I understand that there may be a lot of information on the internet, but you should try not to base on them, because Dr. Internet can be really confounding sometimes, considering the fact that the information is very wide, non-specific and sometimes not very professional.
Hope to have calmed a little your anxiety!
I remain at your disposal whenever you want to discuss again on these matters.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much for your continued help.
I have started neurofeedback and hope it will be helpful.
Meanwhile, I remain highly anxious from knowing I am having PVCs. I wish that beta blockers worked for me for lessening PVCs or that the other drugs were safer.
Three weeks after my perfect echo, I am so scared that there have been changes. I dont trust my body at all; I feel as if my heart could just suddenly fail. Do you think that because my echo actually improved while having PVCS, that is evidence that they are not harming my heart? Why is it that one can so easily check blood pressure, blood glucose etc from home but heart function can only be assessed by a cardiologist? I feel so unsure and scared everyday, especially now that I have PVCs again.
Thank you, Dr Iliri, I am trying to remain hopeful.
Hope you are well,
XXXX
Thank you so much for your continued help.
I have started neurofeedback and hope it will be helpful.
Meanwhile, I remain highly anxious from knowing I am having PVCs. I wish that beta blockers worked for me for lessening PVCs or that the other drugs were safer.
Three weeks after my perfect echo, I am so scared that there have been changes. I dont trust my body at all; I feel as if my heart could just suddenly fail. Do you think that because my echo actually improved while having PVCS, that is evidence that they are not harming my heart? Why is it that one can so easily check blood pressure, blood glucose etc from home but heart function can only be assessed by a cardiologist? I feel so unsure and scared everyday, especially now that I have PVCs again.
Thank you, Dr Iliri, I am trying to remain hopeful.
Hope you are well,
XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Dear XXXX,
I understand how you feel, but you should know that the heart function is not so fluctuating like blood work or blood pressure.
In fact the heart has its language to show us how it works. The tests do not need to be performed so frequently, because the changes in the heart are quite more gradual that on blood lab tests or blood pressure.
Coming to this point, I would like to reassure you that based on your recent performed cardiac tests, you should try to feel more calm and optimistic.
Your cardiac ultrasound showed a perfectly normal heart function, which means that this number of PVCs has really no clinical significance. It is not going to make harm to your heart. As a cardiologist, I can assure you about that.
Besides, you have no symptoms of any cardiac disorder (so your heart seems to be quite comfortable during this period).
So, what are you afraid of?!
Nothing bad is going to happen! You should just try to relax and focus on your anxiety.
I am always at your disposal whenever you want to discuss about this!
Regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear XXXX,
I understand how you feel, but you should know that the heart function is not so fluctuating like blood work or blood pressure.
In fact the heart has its language to show us how it works. The tests do not need to be performed so frequently, because the changes in the heart are quite more gradual that on blood lab tests or blood pressure.
Coming to this point, I would like to reassure you that based on your recent performed cardiac tests, you should try to feel more calm and optimistic.
Your cardiac ultrasound showed a perfectly normal heart function, which means that this number of PVCs has really no clinical significance. It is not going to make harm to your heart. As a cardiologist, I can assure you about that.
Besides, you have no symptoms of any cardiac disorder (so your heart seems to be quite comfortable during this period).
So, what are you afraid of?!
Nothing bad is going to happen! You should just try to relax and focus on your anxiety.
I am always at your disposal whenever you want to discuss about this!
Regards,
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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