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Question:
When I experience PVCs/PACs, should I be concerned about sudden cardiac death?
Greeting Cardiologist. I am a 45 y/o male who has been exercising regularly for the last 5 years. Let me preface my commentary by stating that between 21 - 25 years of age, I engaged in . . . episodes of . . . free-basing (which I deeply regret). I've always been reasonable healthy and free of MD visits. About 3 months ago, I started experiencing lightheadedness and . . . a cardiologist, via TTE [transthoracic echocardiogram] and TEE [transesophageal echocardiogram] has given me a diagnosis of MVP [mitral valve prolapse] with mild MR [mitral regurgitation]. He does not believe these conditions caused the lightheadedness and other reported symptoms, such as exercise intolerance (heart beat reaches 155 bpm with minimal exercise). I do not necessarily experience fatigue or dyspnea, just an elevated HR with minimal aerobic exercise. I'm actually in reasonably good shape. My BP and HR has been up-and-down over the last 3 months, ranging from 90/60 - 130/85 and 43 - 99, respectively, at rest. Lately, I've been experiencing PVCs/PACs [premature ventricular contractions] . . .. I experience the premature heart beat followed by pause, then forceful HR with pharyngeal tightening (off-and-on for about 10 - 20 minutes couple of times per day at most x 2 -3 episodes over the last week). I'm concerned about cardiac arrest and continued exercising, given my current heart disease. Also, my . . . uncle was diagnosed with idiopathic hypertrophic cardiomyopathy when he experienced cardiac arrest at age 50. He has been living a healthy life as a cardiac transplant patient for 21 years . . . neither of my parents have ever been diagnosed with HCM. My cardiologist is not very detailed in terms of testing, such as quantifying LVEF, ventricular wall thickness, etc. . . . These symptoms have devastated my level of daily function over the last 3 months. I am not working and do not plan on re-establishing employment until my medical problems are resolved. When I experience these PVCs/PACs, should I be concerned about sudden cardiac death? Should I go to the ER? I am scheduled for a Persantine stress test, 24-hr Holter monitor (to be worn during the 22 hrs between the two stress tests), followed by rest stress test. Thank you in advance for your response. [Edited for brevity.]
submitted by Stephen from California, on 11/3/09
Answer:
by Texas Heart Institute cardiologist, Ali Massumi, MD
There is an extremely small percentage of patients with mitral valve prolapse (MVP) who have sudden cardiac death (SCD). The QT interval on ECG should be checked to be sure it is normal. In the absence of any hypertrophic changes on echo, the risk associated with PVCs is markedly decreased. One must make sure he doesn't have any coronary disease by proper stress or CT angio. A 30 day event monitor is also appropriate to document PACs or PVCs or any runs of PVCs.
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Updated November 2009
