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Forum Name: Arrhythmias

Question: Inherited Multifocal VPC's/Bidrectional VT


 Viper - Sat Nov 08, 2008 9:09 pm

Last month my elder brother(22yrs) passed away while he was sleeping. He never had any kind of disease or physical abnormality in his life. He was perfectly fit and was an athlete.
On receiving this devastating news i was very sad and under a lot of stress. After two days of receiving the news i felt some uneasiness in my chest along with shortness of breath.On consulting the doctor he advised me to have a ECG.
On having the ECG the doctor got very tensed and said that I had a very CHAOTIC heart rhythm( my vent rate 107bpm) and quickly advised me to get admitted in an ICCU in a hospital.
Later I found that my mother along with all her family had this arrhythmia problem All the members are living to their old age and never had any prominent symptoms nor were there any instances of SCDs till my brother. In their ECG they had a missing P-wave.
The doctors said that my ECG was different from them.
As far as I remember i knew that I had an abnormal heart rhythm but never took it seriously as i had never had any symptoms such as palpitations or dizziness etc.
I was perfectly fine and did some strenuous cardiovascular exercise daily, same as my brother.
In the hospital Angiography and Cartography was done on me.
No physical defect, scars or any muscle problem was found, my hear was perfectly fine. The doctor said that extra pulses were being generated from nodes spread over a large area of my heart. Ablation was also done on a few nodes but had no effect and the doc said that he wasn't sure whether more ablation would harm or do good to the heart. He said he didn't know why these nodes had created.
The report says: 1) Multifocal VPC's/Bidirectional VT
2)Ventricular bigemini suppressed with atrial overdrive pacing
3)focal ablation done in RV, unsuccessful.
The doctor said that medical science still doesn't understand this properly and such cases are very rare. Considering the fact that my brother had expired in such a way he considered not taking chances and implanted within me a dual chamber ICD. After all this and being under medications ( amiodarone and metoprolol succinate), i now sometimes feel palpitations with increasing pulse rate along with uneasiness in chest but no therapies have yet been done by the ICD.
My questions : 1)Is this problem completely unheard of or there are a few cases?
2)Is the ICD really needed?
3)What is the possibility my brother expired due to this problem?
His postmortem report shows nothing.
4)Possibility of something like this happening to me(19 yrs) and
my mother (49 yrs) who like me never had any symptoms.
Her ECG is also quite scary but no EP studies have been done on
her as yet.
5)If my brother expired due to this what could have been the
triggering factors.He only did some occasional drinking and
smoking from past one year but I do none of these.
I would be greatly obliged if you could answer my questions because I'm in a very miserable and confused state after this great tragedy.
Thank you.
 Parks P, RN - Mon Nov 10, 2008 5:00 pm

User avatar Hello Viper, I am sorry to hear about your brother. The same thing happened to my best friend when he was 24. To answer your first question, no it is more common than you would think. VT may occasionally come and go in young people without any evidence of heart disease. The person may have no symptoms, except for maybe a funny fluttering feeling in the chest. In your case you are not asymptomatic and have a family history of cardiac arrhythmia's, if left untreated could lead to a very serious arrhythmia one called TORSADE DE POINTES a type of VT that comes from around a central point with bidirectional forms of the tachycardia, the twisting around the central point gives it the funny name, french for curling or twisting. Without knowing all of your history that's why the ICD was implanted so yes you really need it. The possibility that your brother passed away from a life threatening arrhythmia is pretty high especially if his post mortem exam was normal I am sorry to say. The possibility of this happening in your case now is greatly reduced since you have had a full cardiac workup and the ICD. There is no reason at all why you can't live a long normal life as long as you stick to what your cardiologist says and cutting normal risk factors ie. smoking, weight etc. As for your mother please have her get a full cardiac workup and EP study. Again I am sorry for your loss.

Good luck to you and your mother,

Paul
 Viper - Mon Nov 10, 2008 6:26 pm

Thank you very much doctor for giving such a prompt reply.
I did not used to have any symptoms of arrhythmia before but as far as I remember my pulse was very irregular from childhood itself.I know this because I had an automated blood pressure monitor which also beeped whenever there was a pulse.
After what happened with my brother, it was the first time I had the feeling of chest discomfort and shortness of breath i.e. the first time I showed any symptoms.
Also after all these EP studies and implantation of ICD I now have palpitations with increasing pulse rate 'along' with the earlier chest discomfort and shortness of breath.
Not only that, after having these palpitations some times during the night, I feel slight pain in my chest(to be precise in the center of the chest) the next whole day along with some twitching sensations in the heart.
So even though I'm on medication I still have all these symptoms.
Actually I'm feeling as if all these EP studies, medications and surgery have worsened my symptoms, although my ECG is now quite stable and better than it was before, due to the medicines.
Is it possible to have all these symptoms even when you are on medication and have an ICD implanted? Could all this treatment have worsened my symptoms?
What is the percentage of people among the many having arrhythmia like me, have a sudden cardiac death?
Also how much is the probability that this problem may appear worsened in my future generation or it may even occur in them.I'm asking this because my ECG is much worse compared to the ECG's of my mothers side relatives( mine is so bad that the peaks in one section are crossing the graph of another section below it!).

I don't know how to thank you enough doctor, for helping me in such a difficult time.
 Parks P, RN - Tue Nov 11, 2008 3:21 pm

User avatar Hello, That was very smart of you to notice the alarm on the b.p. monitor was due to your irregular heart rhythm. I couldn't even imagine the stress you are under with your brother and then dealing with your own condition. That would be tough for a person without cardiac problems let alone someone with. It would be normal for you to have an increase in all your stress hormones, one called catecholamine in particular. Increased levels of catecholamines increase heart rate, blood pressure and increase likelihood of cardiac arrhythmia. I don't see in your history if you are on any anti-anxiety medication, if not you might want to discuss taking them with your doctor. Stress, worry, lack of sleep increase catecholamine levels a good anti-anxiety med will decrease catecholamine levels and allow you sleep and may even reduce some of your uncomfortable side effects by lowering the stress hormones. It is possible to have all of these symptoms with the ICD and meds. Remember the important thing is you are asymptomatic and your ECG is normal. The ICD is ready in case you were to have an event so that is good. It may be that over time you may have to adjust to these unwanted side effects, but that''s all they are, you are asymptomatic at this time and hopefully always. I am wondering if maybe the shortness of breath and increase HR may be some anxiety added to the situation that's why I mentioned anxiety meds. The treatment could have worsened the symptoms but you are hemodynamically stable, no fainting or passing out so I doubt very much in your case this is the cause and your ECG is stable with medication. The data indicates that sudden cardiac death( SCD) rarley occurs "suddenly out of the blue" which suggests that it is important to give at risk patients and families detailed information about signs so they can recognize warning signs (like your ICD going off so you can react accordingly. It appears you have a strong family history of this VT so chances would be high you would pass this gene on, but with gene therapy evolving virtually day to day there is much to be optimistic about.

Best Wishes,

Paul
 Viper - Tue Nov 11, 2008 7:46 pm

OK doctor that explains a lot.
Thank your very much Doctor Paul for helping me so much.
I'll try my best to reduce the stress that I take. As for the anti anxiety drugs I will try without them because I am not used to taking so many drugs and this is the first time that I am on medication. Never had any problems before.
If I still find that I'm not able to cope with the stress I think I will have to take them I suppose.
As you said as long as the machine is there, there is nothing to worry about.
As for my mother, she has undergone Holter test and we should be getting the reports by today. Lets see how they are.
She has never had any symptoms till now and lets hope it remains that way.

Viper
 Viper - Wed Nov 12, 2008 4:19 am

Thank you very much Doctor Paul. You helped a lot.
I will try not to take too much stress.
As for my mother , she will get her Holter test reports by today.
She has never had any symptoms and lets hope she never has any.

Thank You.
 Viper - Mon Nov 17, 2008 1:43 am

Doctor,
I had not told you this before because you may think as if I'm losing my mind.
It has happened two times now during the night.
I have gotten up with the feeling of my heart beating very strongly along with very strong palpitations. The beating is so strong that I can hear my own heart beat when this happened. The pulse becomes random and some times drastically increases its pace and then it becomes kind of normal( the palpitation and the strong beat still persisting). But then it finally picks up the pace steadily until it becomes so fast that there is no gap between the pulses and its extremely fast.
Then I don't feel my heartbeat any more and then after that I don't feel my body and finally I think I lose consciousness. After not much time, I don't know exactly how much, suddenly I regain consciousness along with my body getting very warm specially in my arms. I also can now hear and feel my body properly. But I still feel the palpitations for a few minutes, though not as strongly as before and having a normal pace. I then feel chest discomfort and breathing difficulty along with a slight pain in the center of my chest for the whole day.
The first time this happened I didnt open my eyes but instead tried to control my heartbeat but to no avail.Also although I could feel my body lying on the bed I was unable to move.
The second time this happened I tried to open my eyes but could only do so for a few seconds as It was very difficult and exhausting to do so. Also when i opened my eyes i could see but with darkness surrounding the border of my vision just like before you faint. I also tried to call for help but the sound that left me was very weak. I could also feel my throat vibrating when i spoke. I also tried to move but could move only very little. So in short the second time this happened I was sure I was hundred percent awake.
I thought that the ICD was used both the times but when the doctor checked it, when i went to his clinic, he said that there had been no episodes and the machine was also working fine, which was a very shocking along with a slightly good news to me. Also my ecg was coming fine when i met.
But im now very confused as to what is happening with me. Is this my mind or is something really happening. I'm unable to accept that I had been imagining or dreaming all this because i can swear and say i was perfectly awake both the times.
Is there any explanation for all this or am I really losing it. Also I am not that kind of a person who takes pleasure in creating trouble. With all the suffering I have had to bear lately , this heart problem is now driving me insane.

Your help will be gratefully appreciated.
 Parks P, RN - Sun Dec 28, 2008 3:44 pm

User avatar Sorry for the absence, but I have been doing huge amounts of studying as I am taking university courses. To answer your question, you aren't crazy. What has and is happening to you is a traumatic event not unlike PTSD (post traumatic stress disorder). I am not a psychiatrist, but your episodes could have a psychological component to them. I would suggest some counseling so you can talk with someone about what is going on. Psychiatrist can prescribe medications while a psychologist can not. I would start out with a psychologist or counselor since medications have side effects and you don't want that. I believe in your case cognitive therapy, i.e. talking, expressing your feelings etc..should be considered first.

Good luck, Paul
 Viper - Sun Feb 01, 2009 2:28 am

I read a bit about PTSD and found that it may be the answer to some of the experiences i had while sleeping.
Now that there is some explanation to those events, I feel much better now.
I don't know how to put it in words but your replies have really helped me a lot.
Thank you!!
Viper
 Viper - Sun Feb 22, 2009 11:57 pm

Hello doctor,
Recently I received my brothers death certificate.
It states the cause of death as follows:
a) immediate cause: Probable cardiac dysrhythmia in a person with
cardiomegaly(Etiology unknown)

So what does this mean? Did my brother have cardiomegaly?
If so could it have worsened his problem or is it normal to have it in a postmortem report?
I'm a bit confused now as to what was it that caused this to happen, arrhythmia or cardiomegaly?
Can you please explain in detail what this means?
Thank you
VIper

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