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Is Quick Recovery Evidence That Cardiomyopathy Was Caused By PVCs Alone?
Posted on
Wed, 29 Jul 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Wed, 29 Jul 2015
Answered on
Mon, 24 Aug 2015
Last reviewed on
Question : Hello-
I have consulted cardiologists here before so if I have spoken to you before- hello again and thank you. I am back because I need constant reassurance that I am ok.
I had PVC-induced cardiomyopathy, diagnosed in October 2014, after holter showed 65,000 PVCs/24 hrs. I had an ablation in December and by January, Heart function was normal again and heart size back to normal. Lisinopril 5 mg was stopped in March, and carvedilol 6.25 being tapered down and discontinued too.
My doctors have had different opinions on everything so I am very confused and afraid and always think that I am sick again. Originally I was told I had idiopathic DCM and would not live long. I was so scared that even though I'm told I'm cured, I am haunted by my thoughts of dying young and leaving behind my young son.
Questions-
1. Is quick recovery good evidence that cardiomyopathy was caused by PVCs only? Is it safe to discontinue carvedilol?
2. Am I in danger of immediate recurrence of CHF and cardiomyopathy? One doctor told me I would never be cured or safe and that I would have to weigh myself all the time and if weight changed even one pound, I would be in CHF. Another dr grabbed a water bottle out of my hand when I was sick and said my body could not process fluid. Because of those two doctors I am very very scared when I drink water, terrified that I will retain the water. Is this impossible with normal heart, kidney, and liver function? I obsessively monitor intake and output of fluid and always fear that I am drinking much more than I am urinating. I am obsessive about this.
3. Does EF fluctuate? I've had serial echoes and EF is generally about 60 but echo one month ago was 55-60 and then 5 days ago it was 68-70. Is this normal? Is EF going up and down this much? Could it not go down very quickly as well then back to lowered EF? Even just 5 days after normal echo, I fear my heart has become weak again.
Thank you so much for your help. I know anxiety is my main issue and I am seeking help for that but I feel like if I have more clinical reassurance that I am ok, that I will stop being so afraid. I spend my days worrying about drinking and urinating and think all the time that I am dying. I want to feel normal again and believe that I am cured.
I have consulted cardiologists here before so if I have spoken to you before- hello again and thank you. I am back because I need constant reassurance that I am ok.
I had PVC-induced cardiomyopathy, diagnosed in October 2014, after holter showed 65,000 PVCs/24 hrs. I had an ablation in December and by January, Heart function was normal again and heart size back to normal. Lisinopril 5 mg was stopped in March, and carvedilol 6.25 being tapered down and discontinued too.
My doctors have had different opinions on everything so I am very confused and afraid and always think that I am sick again. Originally I was told I had idiopathic DCM and would not live long. I was so scared that even though I'm told I'm cured, I am haunted by my thoughts of dying young and leaving behind my young son.
Questions-
1. Is quick recovery good evidence that cardiomyopathy was caused by PVCs only? Is it safe to discontinue carvedilol?
2. Am I in danger of immediate recurrence of CHF and cardiomyopathy? One doctor told me I would never be cured or safe and that I would have to weigh myself all the time and if weight changed even one pound, I would be in CHF. Another dr grabbed a water bottle out of my hand when I was sick and said my body could not process fluid. Because of those two doctors I am very very scared when I drink water, terrified that I will retain the water. Is this impossible with normal heart, kidney, and liver function? I obsessively monitor intake and output of fluid and always fear that I am drinking much more than I am urinating. I am obsessive about this.
3. Does EF fluctuate? I've had serial echoes and EF is generally about 60 but echo one month ago was 55-60 and then 5 days ago it was 68-70. Is this normal? Is EF going up and down this much? Could it not go down very quickly as well then back to lowered EF? Even just 5 days after normal echo, I fear my heart has become weak again.
Thank you so much for your help. I know anxiety is my main issue and I am seeking help for that but I feel like if I have more clinical reassurance that I am ok, that I will stop being so afraid. I spend my days worrying about drinking and urinating and think all the time that I am dying. I want to feel normal again and believe that I am cured.
Brief Answer:
You are in perfectly normal cardiac conditions.
Detailed Answer:
I would like to thank you for being with us on HCM, and giving the opportunity to be helpful to you!
I have reviewed again all your previous medical history and I am glad to confirm you as follows:
1. Arrhythmia-induced cardiomyopathy is a well-known cardiac disorder, demonstrating a direct relationship between the level of arrhythmia presence and severity of cardiac dysfunction. The best evidence of such a causative factor is the fast recovery after the successful procedure of cardiac ablation.. Improvement of LVEF was clearly noticed after eliminating arrhythmogenic focus.
So, once definitely avoiding the persisting etiological factor (arrhythmia) of cardiomyopathy, and consequently returning cardiac structure and function to normal, there is no medical evidence for drugs therapy (CHF or arrhythmia). The same hold true for Carvedilol.
2. It’s true that a favorable water balance should be always aimed in the presence of CHF. At the same time, I am happy to confirm you that your overall cardiac performance is quite normal. You are not in danger of recurrent heart failure, as long as the structural focus of arrhythmia is permanently destroyed, so there are no more chances for such a PVC-induced cardiomyopathy.
Your recent BNP levels completely clarify this point of uncertainty (actually you have no scientific proven basis for CHF).
Regarding your obsession of drinking much more than urinating, I would explain that we should account even those invisible water losses (with sweating and respiration) when checking daily water balance. Remember that invisible losses may reach up to around 1 liter/day. So relax! As far as your cardiac, renal and liver function is OK, there is nothing to worry about.
3. As I have explained you before, your LVEF is steadily perfectly normal. Those EF fluctuations noticed be ECHO, are in fact mainly inter-observers variations (which is normally seen during echo-derived measurements). After that successful cardiac ablation, there will be a continuing improving trend of cardiac performance until it reaches its normal previous condition. So, no fast up and down fluctuations could be practically possible (within 5. 15, 25, etc days). You should relieve your increased anxiety. Nothing dangerous is going to happen.
You are in perfectly normal cardiac conditions.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
You are in perfectly normal cardiac conditions.
Detailed Answer:
I would like to thank you for being with us on HCM, and giving the opportunity to be helpful to you!
I have reviewed again all your previous medical history and I am glad to confirm you as follows:
1. Arrhythmia-induced cardiomyopathy is a well-known cardiac disorder, demonstrating a direct relationship between the level of arrhythmia presence and severity of cardiac dysfunction. The best evidence of such a causative factor is the fast recovery after the successful procedure of cardiac ablation.. Improvement of LVEF was clearly noticed after eliminating arrhythmogenic focus.
So, once definitely avoiding the persisting etiological factor (arrhythmia) of cardiomyopathy, and consequently returning cardiac structure and function to normal, there is no medical evidence for drugs therapy (CHF or arrhythmia). The same hold true for Carvedilol.
2. It’s true that a favorable water balance should be always aimed in the presence of CHF. At the same time, I am happy to confirm you that your overall cardiac performance is quite normal. You are not in danger of recurrent heart failure, as long as the structural focus of arrhythmia is permanently destroyed, so there are no more chances for such a PVC-induced cardiomyopathy.
Your recent BNP levels completely clarify this point of uncertainty (actually you have no scientific proven basis for CHF).
Regarding your obsession of drinking much more than urinating, I would explain that we should account even those invisible water losses (with sweating and respiration) when checking daily water balance. Remember that invisible losses may reach up to around 1 liter/day. So relax! As far as your cardiac, renal and liver function is OK, there is nothing to worry about.
3. As I have explained you before, your LVEF is steadily perfectly normal. Those EF fluctuations noticed be ECHO, are in fact mainly inter-observers variations (which is normally seen during echo-derived measurements). After that successful cardiac ablation, there will be a continuing improving trend of cardiac performance until it reaches its normal previous condition. So, no fast up and down fluctuations could be practically possible (within 5. 15, 25, etc days). You should relieve your increased anxiety. Nothing dangerous is going to happen.
You are in perfectly normal cardiac conditions.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Dr. Iliri! Again I am both pleased to talk to you again, and embarassed that I have been asking the same questions so much. You are so knowledgeable and helpful, and yet the doubts and fears come back and I feel the need to ask again.
One more question about fluid- is it only a concern for those with heart/kidney/liver issues? Do I need to weigh myself regularly and be concerned about small changes in weight? My doctors do not agree on this point. They say I am cured but one dr says I should still weigh and be vigilant and go to the hospital if there is any weight change. It has caused many unnecessary visits to the hospital.
Can I truly just forget about fluid and trust that my body is now working normally and will balance my fluids without me paying such close attention? Would lowered urine output be quite an advanced symptom of heart failure, something I am not in danger of? I don't know why this obsession is holding me so tightly. I think it's because of how much I was told to fear water in the brief time I was sick.
Many thanks to you, good doctor. You have been so kind and knowledgeable.
One more question about fluid- is it only a concern for those with heart/kidney/liver issues? Do I need to weigh myself regularly and be concerned about small changes in weight? My doctors do not agree on this point. They say I am cured but one dr says I should still weigh and be vigilant and go to the hospital if there is any weight change. It has caused many unnecessary visits to the hospital.
Can I truly just forget about fluid and trust that my body is now working normally and will balance my fluids without me paying such close attention? Would lowered urine output be quite an advanced symptom of heart failure, something I am not in danger of? I don't know why this obsession is holding me so tightly. I think it's because of how much I was told to fear water in the brief time I was sick.
Many thanks to you, good doctor. You have been so kind and knowledgeable.
Brief Answer:
You are advised to follow a normal fluid regimen (without any restrictions)
Detailed Answer:
Hello dear XXXX!
Controlling fluids intake is an integral part of a favorable body hydric balance. But this would be a relevant in-hospital intensive management component of advanced heart failure patients (especially acutely decompensated ones).
In such a case, it would be beneficial in improving loading conditions of an insufficient heart. In hospital settings, it is quite accurately feasible, as fluid intakes, as well as fluid elimination (urine output, invisible losses) are scrupulously controlled by a dedicated professional team.
But, it is not the case, when it comes to your excellent clinical conditions.
It would be non-sense talking of a strictly fluid control on perfectly normal cardiac conditions (LV Ef >/= 60), especially in the absence of a chronic renal disease. It is quite useless and furthermore poses a worthless restriction on ambulatory settings.
I would highly recommend not being such over-reactive on this issue.
You are advised to follow a normal fluid regimen without any special restriction.
You are in perfectly normal heart conditions. Just enjoy your life!
Wish you good health!
Best regards,
Dr. Iliri
You are advised to follow a normal fluid regimen (without any restrictions)
Detailed Answer:
Hello dear XXXX!
Controlling fluids intake is an integral part of a favorable body hydric balance. But this would be a relevant in-hospital intensive management component of advanced heart failure patients (especially acutely decompensated ones).
In such a case, it would be beneficial in improving loading conditions of an insufficient heart. In hospital settings, it is quite accurately feasible, as fluid intakes, as well as fluid elimination (urine output, invisible losses) are scrupulously controlled by a dedicated professional team.
But, it is not the case, when it comes to your excellent clinical conditions.
It would be non-sense talking of a strictly fluid control on perfectly normal cardiac conditions (LV Ef >/= 60), especially in the absence of a chronic renal disease. It is quite useless and furthermore poses a worthless restriction on ambulatory settings.
I would highly recommend not being such over-reactive on this issue.
You are advised to follow a normal fluid regimen without any special restriction.
You are in perfectly normal heart conditions. Just enjoy your life!
Wish you good health!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Have you never had a patient who had totally normal echo and then was in CHF just a week later? I know I am letting my anxiety control me but I have these irrational thoughts that if my EF can seemingly go up 10-15 points to 70 in 3 weeks, that it is also possible for it to go down that much in same quick time frame. Is this not possible?
Thank you for your patience. I know I am being controlled by my anxiety but even with EF of 25 and CHF, I felt fine and was not having symptoms so I am so scared I could get sick again and not know. I feel like fluid intake/output is the only way I may be able to monitor my heart function. So you are sure I can just forget about fluid? I can honestly just relax? I don't know why it is so hard for me to believe I am cured.
Thank you so much. You are so knowledgable and kind and patient.
Have you never had a patient who had totally normal echo and then was in CHF just a week later? I know I am letting my anxiety control me but I have these irrational thoughts that if my EF can seemingly go up 10-15 points to 70 in 3 weeks, that it is also possible for it to go down that much in same quick time frame. Is this not possible?
Thank you for your patience. I know I am being controlled by my anxiety but even with EF of 25 and CHF, I felt fine and was not having symptoms so I am so scared I could get sick again and not know. I feel like fluid intake/output is the only way I may be able to monitor my heart function. So you are sure I can just forget about fluid? I can honestly just relax? I don't know why it is so hard for me to believe I am cured.
Thank you so much. You are so knowledgable and kind and patient.
Brief Answer:
No reasonable evidence to support recurrent cardiac function deterioration.
Detailed Answer:
Hi XXXX!
As I have explained you before, it is not possible to have such high EF fluctuations for a relatively short periods of time, especially in the absence of an obvious pathological process. The same holds also true (regarding a hypothetical LV EF decreasing).
Returning to your concrete question (Have you never had a patient who had totally normal echo and then was in CHF just a week later?), my answer is YES!
BUT, the clinical background and pathological process was totally different (acute myocardial infarction, acute inflammatory disease, etc), and would hardly be implemented as a reasonable explanation in your case.
So, it is quite impossible a return of your arrhythmia induced cardiomyopathy and a subsequent CHF syndrome.
I am not discouraging you from being alert on your body fluids traffic, as it is part of the important attention on health care issues.
But, what I am trying to explain is the fact that fluid intake/output could not be part of a recommended strategy for monitoring heart function or current treatment (facing your actual cardiac performance, your ambulatory settings and your perfectly normal clinical conditions - without any ongoing medical therapy).
So, from a practical point of view, a strict fluid balance would be useless (besides from being an important source of increased anxiety).
My best wishes,
Dr. Iliri
No reasonable evidence to support recurrent cardiac function deterioration.
Detailed Answer:
Hi XXXX!
As I have explained you before, it is not possible to have such high EF fluctuations for a relatively short periods of time, especially in the absence of an obvious pathological process. The same holds also true (regarding a hypothetical LV EF decreasing).
Returning to your concrete question (Have you never had a patient who had totally normal echo and then was in CHF just a week later?), my answer is YES!
BUT, the clinical background and pathological process was totally different (acute myocardial infarction, acute inflammatory disease, etc), and would hardly be implemented as a reasonable explanation in your case.
So, it is quite impossible a return of your arrhythmia induced cardiomyopathy and a subsequent CHF syndrome.
I am not discouraging you from being alert on your body fluids traffic, as it is part of the important attention on health care issues.
But, what I am trying to explain is the fact that fluid intake/output could not be part of a recommended strategy for monitoring heart function or current treatment (facing your actual cardiac performance, your ambulatory settings and your perfectly normal clinical conditions - without any ongoing medical therapy).
So, from a practical point of view, a strict fluid balance would be useless (besides from being an important source of increased anxiety).
My best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Iliri,
You are wonderful and so wise and patient. I am so grateful to you and apologize for my anxious state which makes me ask these questions again and again! As a doctor who sees so many critical patients, I am humbled that you are being so kind. I wish I could turn the alarms in my brain off that keep telling me I am in great danger. As I had told you, one doctor told me I always would be in great danger. Thank you for sharing story of your declining patient who had such a different profile. as I had almost no symptoms other than PVCs, I have become so focused on water retention. I will keep trying to listen to everything you have told me. I want badly to appreciate my recovery and live my life. So you are sure I can simply forget about water? I will try to forget about it completely, and tell myself my healthy heart and kidneys will be able to take care of my body. Thank you so very very much.
You are wonderful and so wise and patient. I am so grateful to you and apologize for my anxious state which makes me ask these questions again and again! As a doctor who sees so many critical patients, I am humbled that you are being so kind. I wish I could turn the alarms in my brain off that keep telling me I am in great danger. As I had told you, one doctor told me I always would be in great danger. Thank you for sharing story of your declining patient who had such a different profile. as I had almost no symptoms other than PVCs, I have become so focused on water retention. I will keep trying to listen to everything you have told me. I want badly to appreciate my recovery and live my life. So you are sure I can simply forget about water? I will try to forget about it completely, and tell myself my healthy heart and kidneys will be able to take care of my body. Thank you so very very much.
Brief Answer:
You don't need to look so closely after fluid balance.
Detailed Answer:
For sure XXXX!
Your cardiac conditions are optimal, and you don't need to look so closely after water balance (your body is quite efficient in doing that process).
So try to avoid overreacting on such an issue.
Regards,
Dr. Iliri
You don't need to look so closely after fluid balance.
Detailed Answer:
For sure XXXX!
Your cardiac conditions are optimal, and you don't need to look so closely after water balance (your body is quite efficient in doing that process).
So try to avoid overreacting on such an issue.
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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