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Suggest Treatment For PVC And Accelerated Idioventricular Rhythm

Posted on Mon, 24 Mar 2014

Question: Dear Doctor, I have consulted in the past concerning pvcs. I am 50 year old male. I am overweight but losing. I do not smoke and all my blood work is very good. I have been having some arrhythmia most of my adult life. It has been mostly pvcs. The last year I have had some more complex looking arrhythmia. I have seen some nsvt in the past. I own my own monitor and I have captured some of them for you to look at. The doctors do not seem to much concerned at present with what they have seen. I am fearful I am having episodes of VTACH. I do not know if some of it is NSVT. I would like you to look at everything and give me your opinions. Please identify the arrhythmia types I captured and rule out VTACH if possible. I am very afraid of what I feel and need some confidence if it is possible to give any. This is a cause of great anxiety for me. This month I have had more than ever but I do realize I have had bronchitis and have been battling extreme pain from sciatica. I have been very fatigued this month. I wonder if this is increasing my arrhythmia. I have also noticed the worst runs I have are almost always after eating and or resting after exertion.

Answered by Dr. Benard Shehu (8 hours later)

Brief Answer: Refer to the following answer. Detailed Answer: Hi, I read your query and understood your concern! I have run through your examinations and fortunately I didn’t see any NSVT. There are only PVC and accelerated idioventricular rhythm, which are related to dilated heart and low cardiac function. I recommend stabilizing your blood pressure and to run the following examinations: - Holter monitoring for a month - Stress test - Coronary CT angiography - Angiography This will help to determine if ischemia is the cause of dilated cardiomyopathy and heart failure. Treating ischemia with angioplasty and stenting will treat the arrhythmia to. Hope it answered to your query! Dr. Benard

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (2 days later)

I am uploading a new report tomorrow with a question.

Answered by Dr. Benard Shehu (4 hours later)

Brief Answer: Looking forward to have your new report&question.. Detailed Answer: Hi, I have gone through your reports and noticed extrasystolic ventricular arrhythmia and dilated cardiomyopathy. There are indirect data that indicate that you may have ischemic heart disease. Looking forward to have the new report and to answer to your next query! Happy to be assisting you! Dr.Benard

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (33 hours later)

I uploaded images 082 and 083 Please evaluate items with arrows and question marks and give commentary. Thank you

Answered by Dr. Benard Shehu (19 hours later)

Brief Answer: Suggested to run further cardiac tests... Detailed Answer: Hi, I have gone through the reports you have uploaded and can comment as following: 1. In the first EKG, there are noticed ventricular extra systoles (all the 3 marked). The third premature ventricular complex is different from the first two and is sign for multifocal premature ventricular complex. 2. In the second EKG, there is seen ventricular run tachicardia (non-sustained ventricular tachycardia), that should be further evaluated and to find out possible causes. Possible ischemic heart disease should be ruled out through stress test, angiography. Also i suggest to run electrophysiological studies (to determine the exact nature of arrhythmia). I also suggest starting anti-arrhythmic drug therapy. Hope it was of help! Dr.Benard

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (2 hours later)

Hi, I uploaded images of what I caught today. Please identify the rhythms marked A,Band c. I have noticed this occurs in some form or another 90% of the time after eating. Is there any significance to this. My final question to you would be,do you feel I am in any serious danger by what you have seen. The cardios I have seen here don't seem to think I have ischemic disease but the problems are weight related. Please comment.

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer: Insist to run further cardiac tests... Detailed Answer: Hi, I have gone through the last images you uploaded and can say as following: - The C letter gives the idea of a possible sinusal tachycardia, but it is not; it is an artifact. - The letter A is a ventricular extra systole; while the letter B is a run of non sustained ventricular tachycardia. To my opinion, the arrhythmia you are experiencing should be further evaluated to exclude ischemic heart disease. If the tests mentioned earlier will result normal, then, and only then, I can admit it is because of being overweight or stressed out. Again, to my opinion, you need a further urgent evaluation to exclude ischemic heart disease as mentioned earlier. Dr.Benard

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar