Should individuals worry if there is a family history of HOCM?

Question

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 a 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?

Thank you.

Answer 1

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 an echo yearly. Secondly, if symptomatic or left ventricular dysfunction is shown, then another option is to do ablation. So, find the focus and do an ablation, which will be done by an electrophysiologist. The third thing is if runs of nonsustained ventricular tachycardia, then an ICD - ICD-implantable cardioverter defibrillator is another option, considering your family history. This decision is controversial and needs to be discussed with an electrophysiologist in detail with the risk and benefit ratio. I do not advise you to do vigorous exercise.

I hope this helps.

Please revert so I can assist you further.

Thank you.

Answer 2

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 about. Exercise is safe if there is less discomfort and only bigeminy. So, I will advise you to do 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-blockers? If your arrhythmia and symptoms are less with a beta blocker, then medical management is enough for you.

I hope this helps.

Please revert so I can assist you further.

Thank you.