Holter Results Back

[EarthMother]

It's so helpful to do a search and read up on other questions about Holter results. Deep bow of thanks to everyone for sharing their insights.

My cardiologist (who diagnosed my POTS years ago) agreed to do a holter test because I was complaining that my heart skips were now often accompanied by hot flushes. He wasn't worried (I'm perimenapausal) and said with hyperadrenic POTS this is not unusual. On the phone yesterday (before I saw the faxed report) he confirmed there was no arrythmias on my holter. He noted normal sinus tachycardia (which is normal for POTS right?)

My summary:

AVG BPM : 85

MAX BPM : 139

MIN BPM : 67

28 min. >120 BPM

Total Ventricular Ectopy Beats 66 (all in isolation that I can see)

Total Supraventricular Ectopy Beats 449

with 40 Atrial Runs, the longest lasting 7 beats

of the 449 SVE, 299 were isolated PACS

All of my tachy episodes corresponded with diary events for standing/walking. I think my question is that I'm familiar with terms like PAC (or PVC) but not VE (ventricular ectopy) or SVE and not sure if a few atrial runs are also fairly common for a POTS person's Holter.

Thanks for your thoughts!

~EM

[cardiactec]

generally people with POTS only have sinus tachycardia (which wouldnt be or shouldnt be classified as "atrial runs" ie: PSVT). "atrial runs" = paroxysmal supraventricular tachycardia (PSVT) which is not POTS.

Paroxysmal means "sudden" onset, which means your rate doesnt slowly increase and decrease as with POTS and a sinus node originating tachycardia. Sinus tachy is a "normal variant" meaning a rhythm that is fast but is coming from the normal electrical pathway in the heart, the sinus node.

PSVT is a rhythm that is coming from somewhere (above the ventricles) outside of the normal electrical pathways in the heart, an "irritable" foci (area) within the heart.

a 7 beat run is very very short in duration, but if you had bits and spurts, especially 40 runs in 24 hours, it may be something to investigate with your EP - maybe to either bump you up on your cardiac meds/ BB's/antiarrhythmics or if very bothersome, look into an EP study/ablation.

are you on cardiac meds right now? did they note how fact the atrial run was? generally the faster the rate, the more symptomatic you are/can be. I noticed that you wrote 139 max for your rate and was wondering if that was your sinus tach (POTSY) rate or if that also was your atrial rate during your atrial run/PSVT. ? generally with PSVT, the rates are a lot higher than 139, more like 160 +, but i have seen "slower" atrial tachs.

Your rates, aside from the above mention, look pretty normal.

[EarthMother]

It's a 21 page report ... but I thin it says in the detail charts the single run of 7 was at 153 BPM. On the summary under SE it lists

Atrial Runs 40

Beats 150

Longest 7

Fastest 96

I'm not on cardiac meds, my Doctor said he's certain for my system they'd make me worse. I've tried BB in the past ... and he's right. He did change my magnesium though.

~EM

p.s. Good luck on your upcoming surgery.

[flop]

All the abbreviations and different names for things to do with ECGs/EKGs gets confusing - the US and the UK can't even agree on how to spell electrocardiogram! I've put together a bit of a glossary trying to explain some of the gobbledegook in the postings:

Atrium = Upper chamber of the heart (left + right)

Ventricle = Lower chamber of the heart (left + right)

Supraventricular = from above the ventricle (ie the atrium or the area just between the atria and ventricles)

PAC = Premature Atrial Contraction (an early heart beat that starts in the atrium) (very very common, normal to have)

PVC = Premature Ventricular Contraction (an early heart beat that starts in the ventricle) (very common, normal to have)

VE = Ventricular Ectopy = early beat from the ventricle

SVE = Supraventricular Ectopy = early beat from above the ventricle

SVT = Supraventricular Tachycardia = a run of fast beats triggered above the ventricles (common)

VT = Ventricular Tachycardia = run of fast beats starting in the ventricles (less common, can be more serious)

PSVT = Paroxysmal SVT = run of fast beats from the atria that starts and stops out of the blue (common)

Atrial Run = several atrial beats one after another (technically an atrial run is a PSVT).

As cardiactec said people with POTS get Sinus Tachycardia (fast heart rate but with all the beats starting in the sinus node not elsewhere in the atria). Almost everyone (not just POTSies) will have PACs and PVCs at some time - most of us have them daily and most people are not aware of them, some people get lots of thumps and palpitations from these common early beats (often described as "a missed beat"). Atrial runs are not rare but they aren't strictly normal either - the sort of thing that if it wasn't causing any symptoms would be safe to ignore but can be calmed down with medications or other treatments if needed.

The important issue is whether you had symptoms at the time of the atrial runs - if everytime you have a run you feel ill then it would be worth asking for further evaluation and treatment. There is nothing that you have said from the report that suggests any sort of worrying rhythm problem.

[EarthMother]

Thank you so much Flop your dictionary helps a lot to sort out the jargon.

Since in my case the artrial runs only lasted less than 5 seconds each (only 150 total beats combined with all of them) then I'm pretty sure I can't correlate how I was feeling since when I feel dizzy it's for a lot longer than 5 seconds at a pinch. And my heart rate is usually lower than 100 when it is happening.

I think what I will do however is make sure on the 30th when I see my primary physician that I make sure we re-check my thyroid. I think it was off six weeks ago and we were going to wait a couple months and re-test. I see from my google search that thyroid is one of the things that can cause PSVT.

[valliali]

i don't mean to turn this thread into my issues, but i would like to ask some questions becuase you guys seem more knowledgeable than myself about this.

i experience sudden episodes of severe pounding and rapid heart rates. this almost always occurs after my heart rate has already been increased, whether from anxiety or exercise or excitement, etc. i have IST, so my heart rate usually goes pretty fast under stimulation. however, these episodes i experience are very sudden, and usually dissipate in ten minutes. they are extremely debilitating.

i had one of these episodes during my TTT. it was after the isuprel injection, after i was lowered and my heart rate started to slow down, that it suddenly shot up to 175bpm and was very symptomatic. i became very flushed and started to tremble.

my cardiologist was there and watched the monitors for the four minutes it lasted. he said it was sinus tachycardia but said he had never seen that kind of reaction before.

i find that i have so much doubt about this being a run of inappropriate sinus tachycardia because it comes on so suddenly and is incredibly symptomatic. it sounds more like a pvst to me. but shouldn't i expect that my doctor, who is rated one of the best cardios in my area, should have been able to differentiate between a sinus tachy and a psvt? or other type of abnormal rhythm? or are there svts that are very hard to detect and can be easily confused with a normal rhythm?

i am on toprol, it doesn't help much though i suppose the frequency of these episodes is probably less than it would be not on it. but i still have them.

thanks so much everyone. this is a very informative thread!

[morgan617]

Sometimes it's a bit hard to distinguish exactly what is happening, because on the monitor the beats are so squeezed together. Even for doctors with experience, and the faster the rate, the more squeezed. Atrial flutter is very commonly misdiagnosed as psvt, or sinus tach, because it is sometimes very hard to see the p waves that are in there.

Doctors will sometimes disagree with each other. Unless they have some way of actually slowing your rate and still seeing what's going on, it can just be harder to tell.

The important thing is to remember that even though really fast atrial rates can sure make you feel crummy, they are seldom lethal. Doctors very seldom have any problems diagnosing ventricular problems, they are very different.

The pounding is called a hyperandrenergic response. Mine does that too. It doesn't have to be fast, but it feels like it's going to burst and you can actually see my chesting moving with the beats. This a truly miserable sensation to me and really bothers me a lot. I really don't know why it happens, but am guessing it has to do with a surge of adrenaline or something. Typically my BP is surging upwards too. Atenolol has helped a lot with it, but I still get it with my periodic paralysis (which is another weird little disease not related to POTS, except for some overlapping symptoms) morgan