Heart & Cardiology/Cardiology
I am 53 yr with h/o rheumatic fever at age of 16 yrs .NIDDM since 17 yrs ECG finding RBBB with LAHB since last 12 yrs TMT NEGATIVE ,STRESS ECHO NEGATIVE ,Holter ocassional VES.Feeling of skipe beats regularly with sensastion in chest ,throat with anxity .i am takinf OHA, METOPROLOL 25MG.FENOFIBRATE .KINDLY EXPLAIN THE PROGNOSIS OF SKIP BEATS AND ECG CHANGES THANKS
I'd start by saying that hopefully you are seeing a cardiologist in some way or form who has taken a full history and physical and can follow you over time, and who has direct access to the tests and information and can therefore manage your condition appropriately.
It seems there are three things here 1) A history of rheumatic fever 2) EKG findings of RBBB and LAHB (bifascicular block) and 3) Skipped beats with PVC's seen on monitoring. They may all be independent of each other or related.
With the history of rheumatic fever once concern would be valve involvement. However you have not mentioned any significant valve disease in your history and you mentioned that your treadmill test and stress echo were normal, so i'm assuming they are not significantly diseased. In some cases rheumatic heart disease can affect the conduction system of the heart leading to BBB particularly when there is a lot of calcification of the valves. Many people however may have this without a history of rheumatic heart disease, its difficult to be sure in your case.
The combination of RBBB and LAHB is known as bifascicular block. Basically 2 of the 3 main conduction channels of the heart are diseased. Your heart will be able to conduct from the remaining channel however. The fact your exercise treadmill did not show any abnormality or worsening of the conduction, and the fact that your LV function is normal on your stress echo is reassuring and the treatment would generally be observation (if recommended by the cardiologist that has seen you) and of course you should seek immediate help if you developed very slow heart rate, dizziness or passing out for example as that may be a sign of progression of disease. The chance of the bifascicular block progressing to complete heart block is generally low with studies suggesting that is less than a few % over a few years. The chance is lower in the case of LAHB (as you have) as compared to LPHB. So while I would not worry, I would ensure you have regular follow up.
Finally the skipped beats. It sounds like you have had a holter monitor that showed some PVC's only. PVC's are a common cause of sensation of skipped beats and are generally not dangerous especially in the presence of normal heart function and stress test. If you did not have the symptoms during your holter then you could always repeat the test or wear a monitor for a longer time so you can correlate the findings with the symptoms. The good news in your case is that the echo showed your heart function to be normal and the stress test showed no dangerous rhythm, both are very reassuring. If that is the case you can be generally reassured about your symptoms of skipped beats as they would be more anxiety provoking then dangerous.
Hope that was helpful,
Mustafa Ahmed MD