Heart & Cardiology/Frequent pvcs
Thank you for taking the time to answer reader's questions. I am aged 50, female, non smoker, 190lbs. I was diagnosed with frequent PVCs after an operation 10 years ago. I took a while to come round from the op and had low blood calcium at the same time but this corrected itself. I often have hundreds of PVCs a day, with occasional spells of bigeminy. I have had several ekgs and a 24hr holter. My GP is not concerned, and even after an A and E visit with bigeminy last July the cardiologist sent me home saying they were benign.
Sometimes they seem connected with gas or anxiety, at other times come from nowhere.
1. Could the general anaesthetic or low blood calcium have caused them? Could this have caused heart damage or just a benign irritability of the cardiac system?
2. I have no other symptoms. All my doctors say they are benign and I am familiar with the HL Kennedy research about PVCs not affecting life expectancy (I wish the sample was bigger!) However, they continue to cause me huge anxiety. Can thousands a day really be benign and not lead to serious heart issues?
Your blog was very informative and thanks for taking my question. I live in Manchester, UK, by the way - not raining for once, in fact having a heat wave.
It's highly unlikely that the PVC's are caused by the general anesthetic or the associated hypocalcemia at the time. If that were the case the effects would almost certainly have been transient. I suspect that was the first time you had likely been monitored with a heart tracing and hence the PVC's were diagnosed.
Occasional PVC's are extremely common, in fact seen in almost everyone. In some they are more frequent. When determining if more frequent PVC's are benign, the following is a decent approach. Firstly to look for triggers and rule out underlying causes. An echocardiogram can rule out underlying structural heart disease or heart muscle damage. in some patients exercise stress testing may be performed to characterize the PVC's further. Blood tests can rule out common chemical imbalances. And triggers such as alcohol, caffeine, illicit drugs and stress can be modified to see if they are the problem.
If there is no underlying heart disease and no symptoms then the PVC's are generally not treated as there is no compelling reason to do so. In some patients despite no underlying disease the PVC's are symptomatic and medications or occasionally an ablation procedure may be used to see if they can suppress the PVC's and the symptoms. In a small minority of patients the PVC's are so common (nearly every 2nd or third beat over a prolonged period of time) and there is underlying evidence of heart muscle damage that is thought to be associated. There is some evidence that treating the PVC's may reverse the damage and those patients typically have thousands and thousands of PVC's per day and at that point electrophysiologists should be involved to characterize the PVC's further and discuss treatment options.
In most people such as yourself, with relatively low burden of PVC's and no evidence of structural or associated heart disease the PVC's are considered generally benign and treatment would only be directed towards symptoms.
Hope that was helpful,