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Old 01-29-2011, 10:57 AM   #1
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Question Multitude of problems...

Long story short is this - I've complained of CP, arrythmia's & fainting since I was 9 years old. I've been told nothing was wrong until I turned 42, then found out I had roughly 50,000 [unifocal & multi focal] pvc's. I had an EPS; VFib 3 times due to long runs of polymorphic VT sustained VT D'fibd & testing to find out why; all tests were inconclusive.

I started putting together all of my medical records for a new dr and found this - my ER report says suspicous CP & CHF symptoms; I guess due to my SoB, swelling and CP symptoms? but they did nothing about this and no one has mentioned this to me except in these notes.

I've been to several EP's, even one at a large university, too many Cardio's & no answers. I sent my Ekg's to Dr. Ramon Brugada who said they were negative. Why my dr's didn't do a biopsy when I was in the hospital for 4 days is beyond me; but they did do a cardiac cath, Xrays, Ct's, blood tests, MRI and implant a PM/ICD.

The only thing I can think of is in 1996 I developed Group B Streptococcus during pregnancy, that turned septic and I almost died [I delivered at 22 weeks and he died soon thereafter]. My legs & feet would swell tremendously and I've had that swelling off & on since then. My TSH levels were really high and my dr said my thyroid may have been messed up by the GBS and treated me.

My Ekg's since then have shown: Multiple PVC's [Short R-R, wide QRS] IRBBB [QRS 110ms] QT interval short for rate [QTC, <360 ms] Poor R wave progression; Septal T wave changes are nonspecific; Prolonged QT [398/473]; Sinus Bradycardia with sinus arrhythmia[HR's 51 & 59]; borderline ECG when compared with ECG of 8/27/2009 electronic atrial pacemaker has replaced sinus rhythm [why?]; 4/20/2010 RSR (V1)

I've been through the ringer and told I had no structural heart problems in July 2009, yet in August 2009 I did - how can that be? How can my EF lower so suddenly or my QT intervals be at one end with prolonged intervals on one test yet another test it will be too short QT?

This will be lengthy but any clue if this could possibly be CHF with the following test results, maybe just HF or something else entirely?

7/1/2009 24 hr holter results:
The predominant rhythm is sinus with ventricular bigeminy and trigeminy and an average rate of 89 beats per minute.
Minimum heart rate of 67 and a maximum heart rate of 131 beats per minute.
The longest run was 3 beats long and the fastest run was at 170 beats per minute at 15:51 and 5:44 respectively.
2 premature atrial contractions in 24 hours
very frequent complex ventricular ectopys with bigeminy & trigeminy.
2 runs of NSVT, 2 couplets, 3 triplets, 2 atrial contractions
Rare atrial ectopy

7/6/2009 Stress test: 4:55 min test
Resting - Sinus rhythm with slow R wave progression in the precordial leads
Stress - Frequent pvc's - 2 PVC couplets and 1 PVC triplet in recovery
Sinus Tachycardia with no signifiant ST-T wave changes
QRS segment of PVC's narrowed substantially with exercise, widening again in recovery (180 ms to 80 ms)
BP - 130/70 - 150/90
Heart rate response: resting 74 bpm, peak 154 bpm, 87% age predicted maximum. 1 min into recovery heart rate decreased to 121 bpm
Functional aerobic impairment of 35% 6 mETS achieved
Increasing Dyspnea was noted with exercise stress as well as increasing dizziness. Nausea was noted in recovery.

7/6/2009 Echocardiogram results:
LVEDD 44 (35-57)
LVESD 36 (23 - 40)
Left atrium 39 (19-40)
LVIS 12 (6-11)
LV posterior wall 11 (6-11)
Ascending Aorta 29 (21 - 34)
Mild Tricuspid insufficency
Trace Mitral valve in sufficency
Pulmonic valve was not well visualized due to a technically difficult 2D echo
Mild Concentric left ventricular hypertropy with EF rate of 55 - 60%
Dilated left atrium with normal left atrial pressures
LV diastolic function: E/A 1.0, DT a140 msec, E' 10/cm/sec E/E' 8

7/26/2009 CTA and EKG's shows Degenerative changes in the thoracic spine; Cardiomegaly of the heart; vascular crowding and frequent multifocal pvc's. Compared to 2004 - Xrays & CTA which showed Sclerotic changes seen on both sides of the symphysis pubis and Changes of Osteitis pubis with some sclerosis identified in both side of pubic symphsis (my youngest child was 2 1/2 when these were taken)

8/26/2009 RF Ablation - Post procedure ECG demonstrated NSR and nonspecific T wave abnormality.
dx: Malignant ventricular arrhythmia's w/sudden cardiac death
impressions: PSVT started after ablation

8/26/2009 Head up tilt table test
Classic symptoms of neurocardiogenic syncope with cardioinhibitory and vasodepressor responses.

8/27/2009 Cardiac MRI
LV Mass – [Average: 141 grams] 105g
LV End Diastolic Volume – [Females 20-50 - Average: 118 ml] 100ml
LV End Systolic Volume – [Females 20-50 - Average: 42ml] 30.5ml
Normal LV Wall Thickness - [10mm] 11 on echo; 12 on MRI
Cardiac Output - 4.9 liters/min
Stroke Index - 28.89
Cardiac Index - 2022
LV (5.1cm) and RV (3.7cm) end diastolic midchambers
RV end diastolic midchamber lateral wall (4mm)

Nothing points to ARVD, LV is limited due to wall motion degredation and patient movement since I couldn't complete the test - inconclusive results and it says further testing needed

8/28/2009 Cardiac Catherization
Hemodynamic assessments demonstrates mild systemic hypertension and moderately elevated LVEDP.
The coronary circulation is co-dominant. There was no angiographic evidence for CAD.
EF: 40%
Aortic Pressure (S/D/M) 120/70/90
Left Ventricle (s/edp) 120/34
dx: Non-Ischemic Cardiomyopathy with an ejection fraction of 40%; no kinks, plaque, blocks or clots

Any thoughts or suggestions? Anything I should ask my dr's specifically or any other tests I need to have? I have to find out what's wrong with me, it's eating me alive not knowing.

 
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