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Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 772
Experience:  MBBS/FCPS/MRCP U.K(R), Senior Registrar Cardiology
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Two years ago I was diagnosed with severe heart failure at

Customer Question

Hello,
Two years ago I was diagnosed with severe heart failure at age 44 with no history of heart problems at all. It turns out I had pvc-induced cardiomyopathy from having an over 50% PVC burden at over 65,000 PVCs per day. Although I had to fight for it, I received an ablation procedure which eliminated the PVCs and within 3 weeks my heart had recovered completely. My EF went from 25 back up to 60 and my enlarged LV and mitral regurgitation resolved as well. It was deemed a miracle and since then I have maintained normal echoes no more than 120 PVCs a day on holter. My EF has stabilized at 65-70 for the last two years. My last echo was just 6 weeks ago, with EF 68 and normal LV.
Here's where the problem lies- three weeks ago, I started seeing a trainer at my gym. They used a chest strap heart monitor on me to see my fitness levels. To my surprise, when I had cooled down to normal heart rate the "irregular heartbeat" alarm buzzed several times. I immediately suspected PVCs, though oddly, I could not feel them internally, and I have always been able to feel my PVCs, or believed that I could. I pretty accurately predict the PVC number on my holters.
I went to see my cardiologist who did a holter and I had 3% PVCs. He told me not to worry at all, as 3% can't damage my heart but I sought a second opinion with my EP who did another holter, in case that day had been an anomaly. I had 4.5% PVCs on the follow-up holter just a few days later, leading my EP to say that I am probably fluctuating between a 2-7% PVC burden at the moment. He too, says that I am in absolutely no danger of a return to cardiomyopathy at this level but said more frequent holters (now scheduled just annually) wouldn't be a bad idea. I have very bad anxiety about my heart and my EP took a look at some of the EKG bits from the holter, and said he could ablate the new focus (just one spot).
He said normally he wouldn't ablate such a small amount of PVCs, but with my history, he thought it wouldn't be a bad idea to nip this spot in the bud, before it could do any damage. Also, while I hadn't had echoes/holters for 20 years before my diagnosis of cardiomyopathy, by symptoms, it appears my PVCs came on very suddenly in that huge amount and heart failure resulted within a few months. It's the best guess, in any case, though I can't know for sure. I wasn't really symptomatic even at EF 25.
Sorry for the verbosity. Here is the question: Could my heart be getting damaged by the low level (presently 3-5% of PVCs and could I have had any changes since my echo of just 6 weeks ago? Because the echo is so recent, I am not scheduled for a pre or post ablation echo- just one next September though certainly I hope I can get one at 6 months or sooner. I am terrified that I could have a lower EF or have enlargement or something going on. I was so shocked with my first diagnosis and as I said, even at EF 25, I had barely any symptoms though I can see I definitely had some for a very short time (orthopnea, SOB on climbing stairs).
How can I tell if my EF is declining? I am not fatigued, do not have swelling, or have SOB even during workouts. But I'm terrified my heart is weakening. Is this completely crazy with such a recent echo? I will attach it if I am able. Should I insist on a pre-ablation echo?
Thank you so much. My doctors are not concerned, they say I am completely normal now and my heart is in no danger, this is just a prophylactic procedure but I am so scared.
I am on no meds, btw. I had been on lisinopril for three months, and carvedilol for 14 months, but have been off of even the carvedilol for the last year.
Thank you so much. I dont know if my fear is just fear or I'm justified in worrying so much about my heart function.
Mia
Submitted: 10 months ago.
Category: Cardiology
Expert:  Dr. David replied 10 months ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 10 months ago.

your heart would not be getting damaged significantly by low 3-5% PVC

you would need repeat heart echos in 3-6 months to check on your EF if you are worried about it declining.

you don't have to worry about your heart weakening so quickly.

Customer: replied 10 months ago.
Significantly? But it could be doing something? My cardiologist and EP disagree and I won't have an echo for almost another year even though I am having surgery in two weeks to ablate the PVCs
Expert:  Dr. David replied 10 months ago.

best to have the echo after your ablation procedure.

I bet your echo will stay good.