Married 45 y/o male with 2 small children. I have PAC/PVCs. I have had a 9 beat bout of nonsustained monomorphic VT caught on an event monitor 3 years ago.  It was barely 120 bpm and was deemed benign.

Via a 2nd opinion, I investigated it anyhow which lead to a nuclear stress and an angioplasty and 2 stents(LAD and Left Circumflux). Both were 80% blocked.  I never had pain, dizziness, or lost breath though. I was told that my intervention may or may not solve my PVC issues.

Recently, I have had episodes that seem similar to the past, but worse. I now have a new cardiologist as my old one moved to Florida. I saw the new doc for the first time 3 months ago. I relayed my fears about PVCs and VTach. My PVCs come and go, and may subside for months. VTach was a rare event for me..and that is just me assuming it is VTach because I believe I know what it feels like.

I am starting to think that stress and maybe higher blood pressure causes a "fullness" that can set these off as well. My new cardiologist says that he won't order any new tests or monitors at this time. He also stated that in a structurally normal heart, that what is going on with me is benign. If I have heart disease(I have CAD) can I have a structurally normal heart?? He says that yes I do. Can that be true in your opinion? A recent Echo also showed mild concentric left ventricular hypertrophy. My doctor doesn't seemed concerned with this. My LV EF was 60%. Can another blockage cause the irregular beats?

I don't know what to do anymore or if there is anything else to do except make some lifestyle changes. I have had many monitors, testing, and everything comes back to the same conclusion. I am told that I don't qualify for further intervention from an Electrophysiologist. At times I feel as if I'm doomed to live like this for the rest of my life in fear of just dropping dead at any moment. I can now understand why my original cardiologist basically disowned me when I got the second opinion. He wanted no part in the road I went down. He wanted to avoid invassive treatment at all costs as it could "open a never ending can of worms."

Okay, I've read your posting and concerns. It is not uncommon for persons having underwent cardiovascular intervention to perceive that they now stand at a point of no return. In other words, if any question arises in the mind regarding whether intervention was necessary, then an albatross begins circling overhead which represents the inability to retract the decision and start again from a different approach. Patients often wonder whether they've made a decision which has ironically left them with but one path. Such contemplation is normal, albeit irrational.

It is certainly possible, moreover likely, to demonstrate a structurally normal heart in the presence of CAD and a finding of mild left ventricular hypertrophy is very frankly unremarkable and observed frequently in normal, healthy adults. Based upon your past experience, there appears to be a very natural conclusion being drawn by you that the presence of ectopics is associated with the underlying reason for intervention and I'm constrained to point out that it's very likely not the case at all.

The most common cause for such rhythmic disturbances is vagus nerve-induced palpitations and they do not originate from within the heart. Think of them more along the lines of a muscle twitch similar to what most folks experience with an eyelid from time to time, with the exception that the muscle involved in this instance simply happens to be the heart. Understand that the events do not possess the ability to disrupt or otherwise transform normal sinus rhythm to anything clinically pathological no more than a twitching eyelid can result in blindness.

The understandable concern arises from vigilance to their presence with the notion that the events are interfering or interrupting the normal rhythm of the heart and therefore the implications are very far reaching as to their potential in this regard, up to and including some type of cardiac event. It is simply not the case, so it's important in your instance to maintain the proper separation between these factors and logically understand that although both are heart-related, they are neither synergistic nor compounding in nature.

You also seem to be under the impression that there is something you should be doing to intervene in such a way that your symptoms will abate. Again, be aware that the presence of this type of ectopic is not a defining mechanism with respect to your heart health.

A life of regret can certainly shape your outlook on life in a very negative context and based upon what you're described, I see nothing contradictory with respect to your decision to submit to intervention, for the outcome of failing to do so has equal, if not more, documented evidence in contrast to more conservative measures. With occlusion of the percentage described, you need to realize that intervention was forthcoming regardless and early intervention has been demonstrated to be far preferable than at the 11th hour, if you see my point here.

An EF of 60% is entirely normal and well above the 55% cut-off and it would implicate absolutely no mitigation by way of LVH. In other words, I'm going to call it a healthy heart. Plain and simple.

Fear has a very unique brush style in the ability to paint abstraction far better than reality. Your worries are presently rooted in an abstraction of the actual circumstances and you're in no danger at all. You seem to have the impression that life for you is on the downswing and that it is only a matter of time and advancement of the perceived circumstances which defines your existence. The actual circumstances are far from such a point and I urge you to welcome the insight that you have miles to go before you sleep.

Simply adhere to a healthy diet & lifestyle as your proceed through the coming decades. You're going to be fine.

Best regards,

Rutheford Rane, MD (ret.)

Bumping this in the hopes that RLR can respond.