Increasing Incidence of PVCs
44 years old, 5'10", 295 pounds. Ten years ago, I experienced a singular episode of atrial fibrillation, which was effectively treated with cardiac ablation. Since then, I haven’t relived an AFib event, but I’ve been facing persistent premature ventricular contractions (PVCs). Initially, the PVCs were quite frequent, occurring multiple times each hour. However, with a treatment plan that included 50 mg of Metoprolol and 150 mg of Flecainide, both taken twice daily, I managed to reduce the frequency to just one or two occurrences each month. As I continued under this medication regimen, my dosage was adjusted upward when I sensed an increase in symptoms. Regrettably, over the last few months, the situation has deteriorated. I'm now experiencing multiple PVCs again, sometimes as often as one or two times every hour. About six weeks ago, I increased the Flecainide dosage to 150 mg, but this change has not yielded any significant improvement, and I find myself having several noticeable episodes throughout the hour. My healthcare providers don’t seem overly concerned since these events aren’t perceived as life-threatening; however, they certainly disrupt my daily routine. I was on the cusp of a healthier lifestyle, able to walk between one to three miles several times a week and bike up to ten miles, but now I struggle to remain seated without my heart misbehaving. It's challenging to motivate myself to engage in intentional cardiovascular exercise under these circumstances. I have a follow-up consultation with my electrophysiologist next week, and I’m reaching out for insights, suggestions, or strategies that I might discuss with them to regain control over my health and lifestyle.
Answers (1)
9/13/2025, 2:30:53 PM
OpenHealth AI
It's understandable to feel concerned about the return of your PVCs, especially when they disrupt your daily activities and motivation to exercise. Managing PVCs can be challenging, but several strategies can help improve your situation. Here’s a summary of key points and practical steps to consider before your consultation with your electrophysiologist.
Summary of Key Points:
- Current Situation: You are experiencing an increase in PVCs after a successful period of control with medication.
- Impact on Lifestyle: These episodes are affecting your daily routine and motivation for exercise.
- Upcoming Consultation: You have a follow-up appointment with your electrophysiologist.
Explanation:
Premature ventricular contractions (PVCs) can be bothersome but are typically not life-threatening. It's great to hear you've found ways to manage them before, and your efforts to engage in physical activity are commendable. However, if medication adjustments haven’t provided relief, it's important to explore other avenues to address your symptoms and support your overall health.
Next Steps:
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Lifestyle Adjustments:
- Limit Stimulants: Reduce or eliminate caffeine, nicotine, and alcohol, as these can trigger PVCs.
- Hydration & Nutrition: Ensure you stay well-hydrated and maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support heart health.
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Monitor Triggers:
- Keep a Journal: Track the frequency of your PVCs, associated activities, meals, and stress levels. This may help identify any specific triggers linked to your episodes.
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Stress Management:
- Relaxation Techniques: Practice stress-reduction techniques such as deep breathing, meditation, or yoga, which may help manage your heart rhythm and overall stress levels.
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Exercise Safely:
- Gentle Activity: Consider engaging in low-impact activities, like walking or cycling at a comfortable pace, even if it’s just for short periods. Start gradually, and stop if you experience discomfort.
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Discuss Medication Options:
- Talk About Alternatives: During your follow-up, inquire about the possibility of adjusting your medication regimen. Ask your electrophysiologist about other antiarrhythmic drugs or treatments that might help.
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Consider a Holter Monitor:
- Further Evaluation: If PVCs are persistent, ask if a Holter monitor (a portable device that records your heart’s rhythms over 24-48 hours) could be helpful to provide more data on your heart’s activity.
Your follow-up with your electrophysiologist is a crucial opportunity to review your current situation and adjust your treatment plan. Express your concerns and the impact these PVCs have on your life, and don’t hesitate to ask questions about potential strategies. Remember, you're not alone in this journey, and there are ways to regain control over your health and lifestyle.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.