questions about PVCs and mitral regurgitation

augigi, CNS · Aug 4, 2006

(Not sure what level you are at, so forgive me if this is too basic)

Many people have occasional PVCs. Basically when it happens, the electrical system does not energize the heart correctly, so it does not eject a full beat properly. If this happens frequently, or the heart is not ejecting fully because of cardiac failure, then the left ventricle can get overfilled. If it gets overfilled and the pressure rises to a certain level, you can get some backflow through the mitral valve into the left atrium - mitral regurgitation.

The ways to improve this include reducing the heart rate and increasing contractility (eg. beta blockers like metoprolol) - this allows the heart to fill correctly and eject a full stroke volume more strongly. The more blood ejected, the less in the heart to backflow. Beta blockers have a good effect over time, so give it a bit longer.

Hope this helps a bit.

LanaBanana · Aug 5, 2006

Thanks. I'm a beginning student, so I appreciate this explanation. So this isn't something to be concerned with right now? I was wondering if I should push her to get another opinion because she seems satisfied with what she was told.

Trauma · Aug 5, 2006

Premature ventricular contractions become more common the older we get. They can occur because of stress(both mental and physiological), pathology and sometimes without an explanation. The most important question is are these PVCs unifocal or multifocal. Unifocal meaning the morphology of each PVC is the same originating from just one place in the ventricle. They are multifocal if the morphology changes from one PVC to the next usually indicating a diseased heart.

The reduction of cardiac output due to improper filling time from the regurgitating valve can lead to decreased blood flow to the coronaries leading to chest pain and ischemia producing the PVCs. The Toprol is a beta blocker thereby decreasing the contractility of the heart and decreasing the workload. Because of its negative chronotrope effect, the heart stays in diastole allowing for greater filling pressure to achieve an optimal cardiac output. In addition, the coronary arteries are filled in diastole as blood is pushed back toward the closed aortic valve so a slower heart rate>>>>longer diastole>>>>better perfusion of the coronary arteries.

It may be time to evaluate the degree of mitral regurge and begin to interview CV surgeons for either tissue or mechanical valve replacement.

Hope this helps.

Peace,

Troy

Lisa CCU RN, RN · Aug 5, 2006

bump

Dinith88 · Aug 5, 2006

My mom was called and told me her results from cardiology tests today and I'm curious about them. I am a nursing student, so I don't completely understand. If someone can help I would appreciate it.
She was having chest pains last month and had an EKG run, which showed PVCs and her dr referred to cardiologist, which she saw last week. Holter monitor and ECHO were ordered. They still showed PVCs and also mitral regurgitation. The nurse she talked to today told her it was not really a big deal and since she's already on toprol, that was all she needed. She's been on the toprol for about a month and half, so was on it when the holter was done. So my concern is that it hasn't really helped, although her bp is down and staying around 125/83. She wasn't schedule for any follow-up with the cardiologist, but she did request that her records be sent to her family doc.
Can someone please explain these conditions to me and tell me if they really aren't a big deal, or is there something to be concerned with? *I'm not asking for medical advice, just clarification and information.* Thanks!

As the other posters have said,PVC's are normal and happen in perfectly healthy people with perfectly healthy hearts. The nurse who told your mom 'it's no big deal' is mostly correct.

Your mom should watch her caffeine intake, etc.

I disagree with troy-trauma that it's time for an evaluation for a valve replacement. There're 'degrees' of mitral regurgitation, and unless it's severe or causing symptoms, it can be managed with medications... but again, if it's minimal/trace/minor or asymptomatic regurgitation it's no big deal and no medications may be needed...and a fairly common finding even in healthy people. She should ask Dr. how 'severe' here mitral valve regurgitation is...(as far as severe 'symptoms' are concerned, when a mitral valve goes bad enough for a valve-replacement, the symptoms are more from pulmonary edema/congestive heart failure...not,as mentioned, pvc's or rhythm problems...)

The toprol (or any other beta-blocker) is a good drug for treating pvc's because (to put it simply) it will help to 'sooth' or 'cool down' an irritable myocardium...which is the primary 'cause' of pvc's.

and if i were you i would disregard the posts about hemodynamic jargon-mumbo-jumbo-jabber as it'll only confuse you and is actually a little(alot) out-of-place in this thread.

Trauma · Aug 5, 2006

LanaBanana,

Just to clarify to avoid confusion, the degree of regurge should be known. If it is insignificant such as trace, +1 or +2 then ususally there is no concern. However, if the regurge is +3 causing dyspnea on exertion then you may consider a surgical consult. The main thing is to prevent futher hypertrophy and demand on the heart. Chest pain is a very serious issue and should be thouroughly elvaluated. The MR could be causing the chest pain itself. Not trying to worry you, just offering my opinions from my experience.

Peace,

Troy