Patient's Query
Hello doctor,
I have been living with idiopathic RVOT NSVT for over ten years now. I underwent RF ablation 20 days ago, and my ectopic and NSVT episodes have reduced by 90 percent. I am generally feeling healthy. I have had an echo, ECG, Holter, and cardiac MRI. The echo and cardiac MRI, performed post-RF ablation, are normal. The MRI was ordered to rule out any structural abnormalities, ARVD, and cardiomyopathy.
Recently, I have been experiencing back pain, shoulder pain, and mild chest discomfort continuously for a few days. The discomfort feels very much like muscle and back pain that I have experienced before. It is not related to exertion, as I sometimes feel it even while resting or sleeping. I have not been doing any physical exercise for a couple of months and have gained some weight.
Given my normal MRI, echo, and ECG results (except for ectopic beats), can I conclude that the pain is not cardiac-related? I am attaching my reports for reference. Does the MRI report also address ischemic factors, or should I undergo further cardiac tests to rule out any cardiac issues?
If the pain is not cardiac-related, which specialist should I consult for my back pain?
Please advise.
Hello,
Welcome to icliniq.com.
I have reviewed all your reports (attachment removed to protect patient identity). Your Holter monitoring is suggestive of premature ventricular beats that occur occasionally, sometimes in bigeminy, and at other times in couplets or as nonsustained ventricular tachycardia (NSVT). This could contribute to irregular pulse or palpitations. The MRI (magnetic resonance imaging) does not indicate any ischemic areas, and your RVOT (right ventricular outflow tract) is not unduly dilated. There is a very mild defect in the mitral valve, but it is not causing regurgitation or any symptoms, so there is nothing to worry about. Yes, cardiac factors can be excluded, but I recommend some additional investigations, such as an X-ray of the whole spine (cervical, thoracic, and lumbosacral regions).
Regarding your shoulder and back pain, I would like to ask a few questions:
In the meantime, I advise the following:
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
The MRI was done post-RF ablation to investigate the possible causes of arrhythmias. No ARVD or other defects were found, and the doctor has concluded that the condition is idiopathic. I am unsure if ischemic factors were assessed in the MRI, but from your explanation, it seems the MRI did look for ischemic factors, and no ischemic zones were found. Please correct me if I am wrong. I had thought that the test for ischemic factors was different from the MRI I underwent, but I might be mistaken.
To answer some of your questions: I have had this pain for a long time, but it has been more consistent over the past few days. The back pain is mainly in the shoulder area and sometimes extends to the left hand, reaching up to the fingers.
My ectopic NSVT episodes have always been asymptomatic, and since the RF ablation procedure, my ectopic beats have reduced by 90 percent. I no longer feel palpitations, but I do experience some discomfort in the shoulder, the left side of the chest, and occasionally in my hands and fingers.
Which doctor should I consult for the complete X-ray as you suggested? Is there a specific specialist I should see? I will start taking vitamin B12 supplements as per your advice.
Hello,
Welcome back to icliniq.com.
Your observation is very accurate. I would like to clarify that the arrhythmia or irregular pulse in your case is due to PVCs (premature ventricular complexes) or premature beats. In this condition, an abnormal premature beat or heart contraction occurs, and there are many reasons behind this. These beats originate from an irritable area of the ventricle (heart), and such areas are typically ischemic. However, since your PVCs occur occasionally and sometimes alternate with normal heartbeats (bigeminy), your doctor performed an MRI (magnetic resonance imaging) to look for any ischemic zones, but none were detected.
Other possible causes include electrolyte imbalances, excessive tea or coffee consumption, certain medications, or sometimes an idiopathic origin (as in your case). There is no need to worry, as you no longer experience ectopic beats or palpitations. However, I still recommend limiting your intake of tea and coffee.
Your shoulder and back pain are unrelated to the arrhythmia. Since the pain radiates to your hands and fingers, it could be related to your cervical spine. I recommend getting an X-ray of the cervical region. You can visit any diagnostic center to have this done. If the report shows any abnormalities, they can usually be addressed with a cervical collar and some exercises. It is not a major issue.
You can share the X-ray report with us, and I can suggest appropriate medications and exercises. Alternatively, you can consult an orthopedic surgeon. In the meantime, take a vitamin B12 supplement once daily, and you may use painkillers such as Ibuprofen or Paracetamol as needed (after meals).
I hope this helps you.
Thank you.
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Answered byDr. Amit Kumar
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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