I seem to be getting a lot of questions about rhythm problems. As a heart surgeon, my perspective of this condition is very different from others doctors.
I often dealt with acute rhythm problems during or immediately after surgery, and was also one of the early surgeons in the US involved with the treatment of survivors of Sudden Cardiac Death Syndrome (more about this later). As such I did a number of procedures where the inside of the left ventricle was “mapped”, identifying abnormal electrical pathways than I then treated with stripping and freezing those areas (cryo-ablation and resection). Although very successful in my hands, this operation was later eclipsed by the Implantable Defibrillator, a procedure I pioneered in my region of the country. So here it goes:
Causes of PVCs include:
- A variety of underlying cardiac conditions, including coronary artery disease, cardiomyopathy, mitral valve prolapse, etc.
- Abnormal levels of “electrolytes” (minerals) in the blood. Decreased potassium and/or magnesium are the most common associated abnormalities of electrolytes. Both may be caused by the use of diuretics (water pills), among other reasons.
- There are unusual congenital (familial) causes of ventricular arrhythmias.
- Abnormal conditions such as increased thyroid hormones, and others.
- Toxins, including alcohol.
- Stimulants including Caffeine, Nicotine, Cocaine and some over-the-counter medications and herbal/natural formulations contain important stimulants.
- Infection, inflammation or degeneration of the heart muscle.
- Infections at other sites in the body.
- They are often worse with lack of sleep, or stress.
A number of these conditions occasionally played a role in my patients, and the first thing to do was to control the rhythm if it affected blood pressure etc. while simultaneously correct abnormalities found, especially in electrolytes, pH and ventilation. It also depended to a degree whether the underlying condition was corrected by the surgery (not always possible), and often required working closely with cardiologists. Heart surgery includes a lot more than just operating!