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Question:

Can you help me determine my probability for dilated cardiomyopathy (DCM)?

I would be very interested in and would value your opinion of my situation, which I detail below. I am a 34 year old female, 1.75m (roughly 5'9"), currently 76kg (167lbs). I have two children, aged 5 and 3. About 10 years ago I was investigated for premature ventricular contractions. At the time it was determined (after an ultrasound, 24 hr monitor and stress test) that these were symptoms of a healthy heart and benign, mainly originating from the right ventricle .... Since then I started exercising a lot more and lost a significant amount of weight (I was 143lbs at my lowest). Prior to my children being born I was exercising 5 times per week ... at quite high intensity .... Since the children I have remained active, only ... frequency is now not as great .... Last year in Jan 2012 I had an extensive health check and part of the check was fitness. The test showed I had a high level of fitness ... and that my heart performed better than expected for my age and gender under stress .... About two months ago the PVCs flared up again, this time related to activity and exercise .... My resting pulse is low, between 40-50 bpm .... Since recently reducing caffeine and starting with extra magnesium the symptoms have dramatically reduced .... I was referred to a cardiologist and the following tests were done: - an ultrasound, which showed my heart was structurally ok- 24 hr monitor, which showed 231 multifocal PVCs and 200 sinus arrhythmia, total heartbeats ~79,900. During sleep my HBPM was 35 at its lowest - an exercise test, which showed the PVCs particularly well. ... MRI showed mild to moderate dilation to both ventricles ... The cardiologist explained that in his opinion the dilation was likely due to my size (I am tall) and my activity level. He considered it unlikely it was dilated cardiomyopathy. However, ... I am to have a repeat MRI in a year's time. No other action to be taken ... I am trying to understand what the probability of early DCM is in my situation. Has my activity level been and is it still enough to cause mild dilation? Your advice would be much appreciated. [Edited for brevity.]   

submitted by M from United Kingdom on 10/13/2013

Answer:

by Texas Heart Institute cardiologist, Mohammad Saeed, MD    

Mohammad Saeed, MDThe problem in your case is that the data is discordant and prevents us from making a simple diagnosis. On one hand you have excellent exercise capacity and are very active. On the other hand you have multifocal PVCs and slightly enlarged heart. This could be interpreted as early cardiomyopathy or just a result of high endurance exercise. Best option would be to reduce or eliminate your caffeine intake and cut back drastically on your exercise and recheck an MRI in 6 months to 1 year. If heart enlargement and PVCs get better, then it's benign; otherwise,  an early form of cardiomyopathy. 

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Updated October 2013
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