Q:
Hello, I am a 34 year old female 5’6″ 133lbs. Cholesterol is good, I don’t smoke or drink alcohol. I have pvcs and pacs (both caught with EKG and 24 hr holter monitor. I had an echo done that shows MVP with mild regurgitation. I have days that the pvcs/pacs are rarely felt at all. This can last for several days or even a couple of months. Then I’ll have a bad spell of them in which I get 3 to 10 a minute for most of the day and this can last for a day or two, up to a few months. I never know when this round of bad days will be over. I’ve heard other people say that their’s tend to come and go as well. Usually,(there are exceptions) on the bad days, the pvcs/pacs flair up mostly while I’m up moving around but when I sit or lie down they tend to subside almost instantly. Then when I get up or move around again they start right back. As I said, there are exceptions but for the most part this is true. I have no pain or faintness or shortness of breath associated with the pvcs/pacs and can’t seem to find a “trigger” for the them. I can exercise one day and not notice them at all and then the very next day do exactly the same thing and get several a minute. My question is… what would cause such a large variance in how many pvcs/pacs get from one day to the next and even with sitting verses moving around. everyday is different. These things drive me crazy, especially when I can’t seem to find anyone who can give me answers as to why this happens. I’ve heard all the “reduce your caffeine, alcohol, stress etc” but that has no effect on them.
A:
Did your doctor ever tell you about Mitral Valve Prolapse (Floppy mitral valve)? Mitral valve prolapse (MVP) is a relatively frequent valvular abnormality. Various causes have been cited for the occurrence of ventricular arrhythmias, mechanical stimulation (=irritation) of the heart by the mitral valve leaflets, abnormal innervation of floppy mitral valve and so on. You can read more about it here:
http://www.cardiac-risk-assessment.com/heart-information/valve-disease/mitral-va
Treatment is mostly with Beta blockers to reduce the frequency of the PVCs, or with valve repair if the valve leaks badly enough.
From the unpredictable nature of your PVCs, I wonder whether you can relate their occurrence to the position you (and thus your heart) are in when they start? If these PVCs are caused (not at all a proven hypothesis) when a leaflet hits the inside of your heart, I wonder whether you help yourself avoiding that position (such as “don’t stand on your head, if that causes the problem”).
In the meantime, these rhythms can be very uncomfortable!
Hope this helps a little. I am afraid that other than taking Beta blockers and avoiding stress, caffeine etc. there is not much that can be done other than to reassure you are not in danger. To assure you are not alone, there are many support groups for MVP!
Dr T
http://www.cardiac-risk-assessment.com/