PVC’s darren peress md fhrs Tucson Medical Center Cardiac symposium

2. PVC’s • darren peress md fhrs • Tucson Medical Center Cardiac symposium

3. PREMATURE VENTRICULAR CONTRACTIONS (PVC’S) VENTRICULAR PREMATURE BEATS (VPB’S) VENTRICULAR ECTOPIC BEAT’S

4. TEXT

5. SYMPTOMS SKIPPED BEATS EXTRA BEATS MISSING BEATS THUMPING FORCEFUL BEATS CHEST +/- THROAT CHEST PAIN DIZZINESS EFFECTIVE BRADYCARDIA RACING

6. HOW COMMON MULTIPLE RISK FACTOR INTERVENTION TRIAL (MR FIT) PVC’S ON A TWO MINUTE RHYTHM STRIP ... 4.4% OF APPARENTLY HEALTHY WHITE MEN 24 H HOLTER MONITORING OF MALE MEDICAL STUDENTS ... 50 % HAD AT LEAST ONE PVC, 2 % HAD MORE THAN 50. BY EXERCISE STRESS TESTING ... 7 - 20 %

7. STATISTICAL IMPLICATIONS IN MR FIT 3 FOLD INCREASE IN SCD AT 7 YR FOLLOW UP IN A STUDY OF 45K VETERANS 3.8 % HAD PVC’S ON A RESTING EKG AND A SIGNIFICANTLY HIGHER MORTALITY (39 VS 22 %) SIMILAR FINDINGS ELSEWHERE

8. HOW USEFUL IS THIS... NOT PARTICULARLY... POPULATION BASED BUT WE’RE DEALING WITH INDIVIDUALS

9. HOW DO PEOPLE PRACTICE

10. ELECTROPHYSIOLOGISTS PRACTICE WITH THE FOLLOWING PRINCIPLES

11. ELECTROPHYSIOLOGISTS PRACTICE WITH THE FOLLOWING PRINCIPLES 1. EXCLUDE STRUCTURAL HEART DISEASE (LV DYSFUNCTION ETC)

12. ELECTROPHYSIOLOGISTS PRACTICE WITH THE FOLLOWING PRINCIPLES 1. EXCLUDE STRUCTURAL HEART DISEASE (LV DYSFUNCTION ETC) 2. EXCLUDE CAD AND LOOK FOR VT WITH EXERCISE

13. ELECTROPHYSIOLOGISTS PRACTICE WITH THE FOLLOWING PRINCIPLES 1. EXCLUDE STRUCTURAL HEART DISEASE (LV DYSFUNCTION ETC) 2. EXCLUDE CAD AND LOOK FOR VT WITH EXERCISE 3. IS IT A TYPICAL BENIGN PVC? (REALIZING THAT A SMALL PROPORTION OF THESE ARE LIFE THREATENING)

14. ELECTROPHYSIOLOGISTS PRACTICE WITH THE FOLLOWING PRINCIPLES 1. EXCLUDE STRUCTURAL HEART DISEASE (LV DYSFUNCTION ETC) 2. EXCLUDE CAD AND LOOK FOR VT WITH EXERCISE 3. IS IT A TYPICAL BENIGN PVC? (REALIZING THAT A SMALL PROPORTION OF THESE ARE LIFE THREATENING) 4. IS THERE ANYTHINNG ELSE OBVIOUSLY WRONG ( QT PROLONGATION ETC...)

17. WHO IS AT RISK? LV DYSFUNCTION CAD CMP QT PROLONGATION SYNCOPE SHORT COUPLED/FAST NSVT HIGH PVC BURDEN FHX SCD

18. ONCE YOU’VE ASSESSED RISK, ASSESS SYMPTOMS

19. CASE ONE 23 YEAR OLD WOMAN WITH INCIDENTALLY DISCOVERED PVC’S. NO SYMPTOMS. OTHERWISE NORMAL EKG.

20. AVAILABLE TESTS EKG EXERCISE STRESS TEST HOLTER ECHO MRI

21. CASE TWO 23 YEAR OLD WOMAN WITH PALPITATIONS DUE TO UNIFOCAL PVC’S. MODERATELY BOTHERSOME.

22. HER HISTORY.... SKIPPED BEATS NO RACING NO SYNCOPE NO FAMILY HX SCD NORMAL EKG RVOT MORPHOLOGY PVC’S NO VT NORMAL ECHO AT REST/MORE SO WITH ACTIVITY 3 CUPS OF COFFEE A DAY NO MEDS

23. COFFEE OVERRATED

24. ADENOSINE FOR SUSTAINED VT BETA BLOCKERS EFFECTIVE IN 25 - 50 % CALCIUM CHANNEL BLOCKERS EFFECTIVE 25 - 30 % COMBINATION OF BB AND CACB SYNERGISTIC DILT AND VERAPAMIL EQUALLY EFFECTIVE 1C RX EFFECTIVE 25 - 50 % SOTALOL AND AMIO MORE EFFECTIVE

25. ABLATION

32. CLOSELY RELATED 41 YO WITH NEAR SYNCOPE AND MMVT.....

39. CASE THREE 72 YO MAN WITH NO PALPITATIONS BUT A 20 Y H/O PVC’S. 25 K PVC’S A DAY. EF 35 %. FAILED BB AND AA DRUGS. FAILED 8 HOUR ABLATION IN CHICAGO.

48. egg