Hello -
Here's the deal with ectopic heartbeats (and especially in the setting of
MVP): while the conventional wisdom (and most common scenario) is that
PVCs occur at rest and disappear with exercise, there is no hard and fast rule about that. With
MVP there are more
PVCs and PACs than there would likely be otherwise in many patients. It is extremely difficult to tell, subjectively, when we are feeling
PVCs, PACs or a combo. Sometimes, if one is way too somatically oriented, it can be done, but even then half the time one would be wrong.
Further: those 256
PVCs on your Holter monitor recording are really unremarkable. Truly.
PVCs, in the absence of structural or organic heart disease (with marked left ventricular dysfunction) are of no significance whatsoever. Neither are PACs unless you start getting runs of them lasting for minutes to hours, in which case you have a whole different (and still not terrible, but much more disturbing) problem. That doesn't appear to be the case.
Many people, especially when stressed, will develop premature beats (
PVCs and/or PACs) or even accellerated idioventricular rhythm (which tends to be regular but feels like something's not right) during exercise, which seems wrong and can quite often interrupt exercise due to the unpleasantness of the sensation. It still doesn't mean anything, however.
So far, so good. It seems unlikely your
PVCs and PACs are due to CAD, since they will occur in the average subject whether or not there is any CAD present, and even if there is, again, they are of no prognostic significance. So you can't really use those as any kind of indicator of anything except, perhaps, the level of stress in your life at any given moment.
The only thing I would fault is the choice of your doctor to not perform a stress test (and, in fact, a nuclear scan with stress test would be the ideal). You're at the right age to warrant this, and with the nuclear scan any elevated BP artifact would be irrelevant. The test would ease your mind considerably, most likely, even if it did uncover some unlikely CAD (which would be what we call "occult", since it is quite hidden, having no symptoms -- the ectopic beats do not count as a possible symptom). I personally feel you -- and your cardiologist -- would benefit from a nuclear scan/stress test, because it would ease the pressure on both of you. If your cardiologist refuses to yield on this one you might want to consider a second opinion or change of specialist, as there are many out there who would be more than happy to spend the time to lay this to rest once and for all.
All that said, the ectopy, when it is perceptible, can be pretty disturbing, but it is harmless -- and meaningless. I hope this is helpful to you and please do follow up with us as needed, especially if you have any further questions or would like to add any information. Good luck to you.
