Q. I have a family history of HOCM. Is this something to worry?
Hi doctor,
I am a 25 year old woman. About three months ago, I started having ectopic beats and palpitations. It made me quite worried, because they were definitely something new. I have a family history of sudden death from hypertrophic cardiomyopathy. So, I decided to have an echo and a 24 hour Holter monitor. The echo showed that structurally my heart is fine and according to the Holter monitor results I had dozens of PVCs (some of them were couplets), a few PACs and sinus tachycardia. My blood test results were normal, too. A couple of days later PVCs began to occur not only during rest, but also during exercise, which really scared me. One day while walking home, I had some kind of bigeminy (every other beat was abnormal) that almost took my breath away. Therefore, I wanted to get a stress test on a stationary bicycle just in case. I had some singular PVCs at an intensity level of 120 watts with the heart rate of 164 beats per minute. Is this something to worry about? My cardiologist said that the results do not suggest any heart disease, but I am still afraid to exercise anymore. What about multifocal PVCs, ventricular couplets and bigeminy in a structurally normal heart? Are they dangerous?
Hi,
Welcome to icliniq.com.
As there is a family history of HOCM (hypertrophic obstructive cardiomyopathy) in the family and sudden death, you need to do echo yearly. Secondly, if symptomatic or left ventricular dysfunction is shown, then another option is to do ablation. So, find the focus and do ablation, which will be done by an electrophysiologist. The third thing if runs of nonsustained ventricular tachycardia, then ICD - implantable cardioverter defibrillator is another option considering your family history. This decision is controversial and need to discuss with an electrophysiologist in detail with the risk and benefit ratio. I do not advise you to do vigorous exercise.
Thank you doctor,
But, I have already done echocardiogram and my heart is structurally fine. Is it safe to exercise if I have no structural heart disease or is there still some kind of risk?
Hi,
Welcome back to icliniq.com.
I would like to see your Holter monitor report for the episode of nonsustained ventricular tachycardia. If there is only ventricular bigeminy, then there is nothing to worry. Exercise is safe, if there is less discomfort and only bigeminy. So, I will advise you for a stress test to see your rhythm. In case of nonsustained ventricular tachycardia, exercise is not advised. Do you feel that the symptoms are less with beta blocker? If your arrhythmia and symptoms are less with beta blocker, then medical management is enough for you.
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