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Suggest Treatment For Mild Regurgitation On Pulmonary Valve And Mitral Valve

Posted on Mon, 20 Apr 2015

Question: i have asked several cardiac questions on this site and there is one in particular that ive been thinking about but never asked. I had all cardiac testing done which revealed a structurally normal heart. I was diagnosed with PACS and very rare pvcs. I had 925 PACS on a 48 hour holter and 15 PVCS. With the PACS there was a few bigemy cycles and 2 couplets . There were 0 Runs. My echo showed a structurally normal heart with mild regurgitation in the pulmonary valve and trace regurgitation in mitral valve. CArdiologist says it is absolutely normal. Stress test was very good with 90 percent of target heart rate reached.

My cardiologist says the PACS are nothing to worry about. For a few months they have calmed down quite a bit but last night they started again and really scared me. I just wanted to also know would all the cardiac tests reveal if i had long QT syndrome or something severe? I cant understand why they are back so forceful. Can it be my anxiety and acid reflux?

Answered by Dr. Benard Shehu (3 hours later)

Brief Answer:
Long QT syndrome can't be missed on ecg and holter monitoring.

Detailed Answer:
Hi back XXXX!
Once again I read your query and understood your concerns.

You should be relaxed and don't worry about long QT syndrome. It can't be missed on ecg and holter monitoring. Since these examinations are normal you shouldn't worry about.

Also the fact that stress test and echo are quite normal support my conclusion that nothing severe can happen to you. Your symptoms are related to anxiety and acid reflux and you should focus on treating them properly.

Wish you health!
Dr. Shehu

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

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

HI doctor!! Thank you for clearing that up for me. Is it normal that the pac came back so frequently last night after being much less in the past few months. I was doing better with the CBT Therapy but last night I got so many PACS. Is that common for them t come and go on different nights?

Answered by Dr. Benard Shehu (24 minutes later)

Brief Answer:
Yes this is common...

Detailed Answer:
Hi back XXXX!

Unfortunately for you, palpitations (PAC and PVC) will come and go more frequently some nights. On the other hand you may have entire nights with out any symptoms. This is quite normal with palpitations (PAC and PVC) and you should stay relaxed.

The fact that you were doing better with CBT therapy shows that you are on the right direction. You should believe on that and should be focused on treating anxiety and acid reflux.

Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (1 hour later)

Thank you doctor I will definitely focus on my therapy. I was just wondering is it true that PACS are even less significant than PVCS. I heard from a cardiologist that they do not worry about PACS at all and they are completely benign. Also I appreciate all the help you have given me. It has been a tough year for me. It is very hard to get used to the feeling of a PAC. It is very unpleasant. Do they ever go away or is it a life long thing?

Answered by Dr. Benard Shehu (10 minutes later)

Brief Answer:
Following answer to your query.

Detailed Answer:
Hi back XXXX!

Yes it's true that PAC are less significant than PVC and we (cardiologist) never worry about them, because they are benign.

Unfortunately your symptoms doesn't go away that quickly, they may be relieved but didn't disappear. It requiresa a life long treatment of predisposed factors (anxiety and acid reflux).

Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (8 hours later)

Hi Doctor I have one last question. I have my blood pressure checked regularly at my doctor office. He says it's always normal around 135/80 except during times of anxiety. During high anxiety or panic it has gone up to 175/100 . He says I do not have high blood pressure because my echo would have also showed thick heart mussels which it did not. Is it dangerous for me to get palpitations and the high blood pressure from anxiety? I know everyone with panic attacks gets a spike in BP when they are having an episode

Answered by Dr. Benard Shehu (2 hours later)

Brief Answer:
Following answer to your query...

Detailed Answer:
Hi back XXXXXXX

Your BP is high during anxiety. The fact that the left ventricle wall thickness was normal on echo show that your BP is normal most of the time and it spikes up during panic attack.

My opinion is that you should prevent and treat in time the panic attacks in order that your BP didn't go above 150/90 mmHg. If the BP go above that (175/100 mmHg) i would recommend to add a beta blocker to your therapy (metoprolol).

If you were my patients I would recommend to start 25 mg of metoprolol. This will be of help in stabilizing BP and arrhythmias. Since this is a medication you should
discuss this with your doctor.

Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (6 minutes later)

Hi Doctor we have discussed this and he does not think I need the beta blocker as my blood pressure is usually normal and my anxiety does not spike my BP often. Only during severe panic attacks which I get rarely. Also because of my low resting heart rate, the beta blocker would make it too low. He explained to me that beta blockers are more necessary when people have high BP constantly.

Doctor do you think I will be ok? I have 3 small children and I just had a baby boy 6 months ago. I am very worried about the palpitations. I noticed that I am very sensitive to my heart beat even when I have no pacs. I can sometimes feel it in my chest. Is this common with anxiety?

Answered by Dr. Benard Shehu (7 minutes later)

Brief Answer:
Following answer to your query...

Detailed Answer:
Hi back,

My advice was to take the betablockers only when you have high BP (above 170/100 mmHg) especially during panick attack that is associated with tachycardia. My intention wasn't to use it on a regular bases, you may discuss with him if you can take it during panick attacks with tachycardia and high BP.

To feel heart beatings even in the absence of PACs is very common in anxious patients. You shouldn't worry about that as long as all your examinations were normal.

Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (44 minutes later)

Thank you doctor for the advice. I went to the hospital last year and during panic they gave me beta blocker and it had no effect. However after seeing this they gave me at XXXXXXX and my BP went down. I just want to know, do you think I will be ok? I need to be here for my children.

Answered by Dr. Benard Shehu (14 minutes later)

Brief Answer:
I think that you are ok and you shouldn't worry about.

Detailed Answer:
Hi back XXXX!

I think that you are ok and you shouldn't worry about. You will be fine and will be there for your family.

Hope this will be of help!
Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (6 hours later)

Doctor Thank you for your great response. I appreciate everything you tell me. Doctor is it normal to have tachycardia with acid reflux. I felt some acid reflux while unloading groceries from my car and my bpm was 160.

Answered by Dr. Benard Shehu (25 minutes later)

Brief Answer:
Following answer to your query.

Detailed Answer:
Hi back again XXXX!

Tachycardia is very common in patients with acid reflux and you shouldn't worry about it. Acid reflux cause discomfort that increase anxiety and together increase heart rate (cause tachycardia ).

Hope this will be of help.
Dr. Shehu

Note: For further queries related to coronary artery disease and prevention, click here.

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