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Heart & Cardiology/Myocarditis or ectopics?

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QUESTION: I have been referred to a cardiologist with an irregular heartbeat, expecting to be told it was simply ectopic beats and not to worry about it.  He however immediately suspected a virus and has told me to rest or else I could end up needing a heart transplant and that I shouldn't even use stairs if there is a lift! Is he just being over cautious whilst waiting for tests?  I thought myocarditis is rather rare? I have no heart pain or breathlessness, an echocardiogram showed a very small amount of fluid on one part of my heart but 'no structural damage'.  I do however get a heart rate as low as 33 beats/min and low blood pressure with lightheadedness when this happens, other times just missed beats (most of the day  every 3rd beat is missing with a 'double beat gap' pattern).  I'm currently waiting for an appointment for the results of a 24 hour holter test.

ANSWER: Hello Kim.

With your echo being normal, I can't see any reason to suspect myocarditis.  Ectopics are no threat to someone with a normal echo, no matter how frequently they occur.   Please let me know what you find out, and

Please write back if this note doesn’t answer all your questions.

David Richardson


---------- FOLLOW-UP ----------

QUESTION: Hello David

Went to see my cardiologist this week, turns out he had some concerns on the echo (a 'sparkly' heart!) which he said could indicate a virus.  My holter also indicates I had heart block on 2 occasions whilst I was asleep, he said normally it would suggest you would need a pacemaker but  as I'm young(ish) (46) and otherwise healthy we're not going there.  If it is a virus, can the heat block get better over time or am I stuck with it?  Is it likely to get worse? Thanks.  I know I should have asked him these questions but you tend to be a bit shocked when someone tells you you may need a pacemaker and don't really think right at the time....

Answer
Ask the cardiologist what your LVEF is on the echo.  If over 50%, your heart is fine.  Also ask if it was first degree heart block.  If so, that is quite unimportant and it doesn't matter if it clears up or not.  If second degree, it will probably clear up by itself.  Also ask him for my benefit what sparky heart is.

Best wishes,  David

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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