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The Nurse Heard A Long Pause....

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hmmmm....so this morning, one of the nurses wanted me to do an ekg on him cuz he'd been having chest pain. the ecg was normal. after i was done doing an ekg on him, i asked him to listen to my heart cuz i had been feeling woozy, moreso than usual, this morning and was questioning whether or not i'd go through another "event" that i've been dealing with for the past couple weeks now....

...he was listening to my heart, while i was standing, and then just gave me this "look"...........he then said "did you just valsalva or something? i just said i did but hadnt really valsalvad and asked him why. he said he heard my heart literally pause for a couple seconds....ironically at that time i started to feel kind of ill, not necessarily feeling my HR drop out like when i passed out, but just a flush over my face and light-headed - the general thing i sense when it's not a "true" pass out..............this is a ER nurse who has been in the field for a good 20 years, so i know he's not just ''hearing things''....

NOW i question if they should put me on an event of some sort....i didnt feel the pause, didnt feel anything in my chest whatsoever, and generally never do, even when my rates are at 180's....the only thing i have really ever felt has been just recently, with my HR drop out, when i passed out once and then the second time when i almost passed out again........



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Wow, that must have been a bit frightening! I'm sure you've worn an event monitor before. In light of your recent new symptoms, I'd say it's time to wear one again. Let your cardio know about this & request a new round of this testing.

I don't know about you, but I always feel "safer" when I'm wearing one. It makes me feel good to push my button & know someone somewhere is recording and reading my arrhythmia. Silly, but true!

Keep us posted on what you find out.



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hi again,

I was not truly diag until i wore a monitor for a few weeks, i felt flutters, but didnt know until actually the last night i had it after 24 days, when the ambulance rolled up 4 hrs later i had the pacer put in. My reg doc call in a elec. card. and he said my heart was pausing for close 2 2 min. the last night, scary!! But with dysautonomia, there are other effects in some of us besides passing out, as i never passed out til the TTT, so i was hard to treat, and was treated for anxiety, etc. But when ur auto. nervous system isnt working as others do, not necc that u have a hrt cond, but the elec signals that go to ur heart are affected in some of us and it can be life threatening, so please get a monitor, if it dont pick up after a wk or two, extend it, i did and they say it saved my life, so dont hesitate please, sounds like u need it checked!E!

Good luck


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Hi Cardiactec,

Wow, that is strange and a bit scary.

I think an event monitor would be a good idea. Hopefully it will give a clear picture of whats going on. Maybe it would also help to explain all of the syncope and near syncope episodes that you've been having lately.

Good luck with everything. Let us know what you find out.


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Hi Angela,

I would not put too much weight on that one "possible" finding of a pause heard by a nurse. I am not trying to say that a nurse would not be competent to hear a pause - experienced nurses, especially in the cardiac units, are very knowledgeable and competent. Rather, because sometimes sinus arrhythmia - where inspiration causes a drop in venous return which can be accompanied by irregularities in the heart rhythm - can be normal. Additionally, you may have been holding your breath and not realizing yourself, which may also cause a small pause. Finally, if you have premature atrial beats - a very benign finding, partly caused by lack of sleep, physical stress and too much caffeine - it can often be associated with a pause. If you're worried, then getting another Holter monitor is reasonable.

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that is what i was thinking too - just a sinus arrhythima or something. not sure though...

i'm not too concerned about it but am, more or less, concerned with the brady. at the time the nurse listened to my heart, he said it was going pretty fast and then just "stopped", completely, for a few seconds and then picked back up at a tachy rate....he then had my lie down and the rate he said dropped to normal but didnt hear any pauses, was just regular.....

..i dont generally listen to hearts with stethescope as it is not part of my job, but i would think a sinus arrhythmia wouldnt result in the complete cessation of all heart beats/heart sound, but more or less hearing the heart beat/rate both slow and increase with respiratory variation....he said this was a complete pause, not a slowing.

who knows...

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Doctorguest, how do you feel about the differences between holters and event monitors? Is it your preference to do a holter or an event? I was a cardiac nurse for a long time and have personally had both, but I often wonder if it's not wiser to do a holter to get 24-48 hours of every single beat and then add the event after that.

For some of us, there is just no guarantee that an arrythmia that is bothering us will show up on the holter, but I also understand the reasoning behind wanting to see everything that goes on without pause for an extended period. Many doctors where I live, are resistant to using an event monitor, if they don't see much on the holter, which makes me resisitant to the holter. It would be great if we could say, I'll have the holter placed next Thursday, because I have all my events on Thursdays, but obviously that's silly. We can't control when we will or won't have them, as a rule.

Do you have any thoughts on this subject? Thanks, justawonderingmorgan

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Hi Morgan,

when I first started to have palpitations (a few years before the syncope started) I was thoroughly checked out. This was because we have a family history of hypertrophic cardiomyopathy. At that point I had a holter monitor for 7 days. After that I had an event recorder to place on my chest to record palpitations (not much use as the palpitations were about 180/min for about 15-20seconds only). Then I had an external loop recorder for 6 weeks - it is like a holter but tapes over itself and only saves an ECG if you press the button - that was awful as it was in the summer and the heat and the sticky electrodes really messed up my skin.

I now have the most definitive event recorder - a reveal device. It is a small box about the size of a USB memory stick implanted under the skin on my chest. The frustrating thing is that between being listed for the reveal and getting it inserted my medications were changed and I have not had the palpitations that I was getting. They were very different to the POTS tachy (I'm not aware of sinus tachy unless I actually count my pulse) but my beta-blockers seem to be suppressing them. I'm glad that they're not happening anymore but it would have been nice to get a print out of one so that we knew what rhythm I was in at the time.

I have also had a holter on for 48 hrs whilst I have the reveal in. This was because I seemed to be quite bradycardic and my cardio wanted to see what my heart rates were doing over a full day.

Sorry that lot is a bit waffly, basically the sort of monitor depends on what you are trying to capture. If is is something that you are not aware of then a holter is probably better, for definite palpitations an event recorder might be better. It is probably best to discuss your symptoms with your cardiologist / ECG department and let them select what type of monitor is most likely to get them useful information.


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not sure if this comment would help put you at ease or not...seems like in general from many of your posts, you are really struggling to pin down exactly what is happening with your heart...so maybe this would help put you at ease or maybe not.

My father-in-law has regular irregular heart beats, and I caught the skip when I first started training as a nursing student. He said it was dealt with long before and determined to be regular irregular...but with his high bp, I take his bp with a stethescope periodically. Last year he had a stroke, and after that his pattern is all over the place, especially in the first few months after the stroke. It skips irregularly, often, for long periods, etc. This is especially true if he fatigues himself. But it got better over the past year. Anyways, with all of that (and by the way, he is about 75 years old), he is still working (he's a scholar in theology and travels around the world giving lectures at conferences and so forth), writing, meeting with people, etc. He's not worried about it, and whenever I tell him to rest or slow down because of his skips increasing, he just laughs at my concern and says, "There must be a price for living this long." And then he ignores all my advice and goes to the next conference in God knows where. How can I hope for him to slow down, he left the hospital after a serious stroke, gave a public lecture to an outdoor gathering of hundreds, then returned to the hospital since he wasn't technically discharged yet (we were all holding our breath that he didn't forget where he was or what he was saying during the address, since he had just come out of a comma). He's a really tough guy. And although I can't relax about health problems the way he does, I do sometimes think of him and it helps. So I think that if we can live with less worry, we will all live longer and happier.

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i'm not a worry wort by any stretch of the imagination.... this is more of a desperate want to sum all this stuff up as something someone can FIX so i can live like a normal 25 year old. that is awesome that your father in law does so much stuff, even with all his health problems. i certainly dont stop myself from much just because of my health struggles - BUT that being said, i DO KNOW where i struggle physically, and because i know my limitations (not my worries), i want to try and target those limitations with a way to remedy what it is that is limiting me - for example, i want so very much to work in a sub-specialized part of cardiology but i cant - not because i'm worried that my heart will explode or go into a strange rhythm, but because physically i am unable to carry out job tasks in the specialized part of cardiology BECAUSE of whatever this is that is going on - tachy, pauses, etc.........it hinders my ability to physically function because it makes me nauseous, fatigued not because i'm worried that if i just "do it", that something bad will happen with my heart.

not a matter of worry at all, more a matter of just wanting to truly pinpoint this problem so the problem can be addressed and taken care of .....actually, to be honest, i have already forgotten about the events of the nurse hearing the pause - i didnt and never have felt anything in particular in my chest when things occur anyway, and was actually surprised that the nurse heard what he referred to as a "long pause" in the first place cuz i never felt anything. actually, i was found to, at the beginning all of this at just a routine docs appt to have a heart rate of 200 when didnt even go to see the doc in the first place for any sensations of my heart beating fast or anything like that - i actually was just being seen for nausea -- SO I THOUGHT!.........and now all this.....i know a lot of people, they may feel the slightest thing that their heart does and are held in fear because of it, but this isnt me at all cuz i am not even aware that my heart is beating at 200 or pausing or whatever everyone says it is doing! the only thing, just recently, that i have been aware of is when i have passed out, with my HR plummeting in my chest - which was definitely freaky -- but once again, still didnt let it get to me cuz i went to work, for a 12 hour shift the next day! lol! call me crazy! haha.

thanks for sharing your story of your father in law though. sounds like a wonderful person, full of life! :)

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I personally would ask for an event monitor. You know my story about the two nasty arrythmias I had ablated. They were only caught after wearing two different event monitors for over a month. The 24-48 hr holter monitor was not long enough because I was going in and out and not on a daily basis. If you are indeed having pauses, I'm an ICU nurse, your pauses may only happen every couple of days, or only during stressful periods, or only at work when your up on your feet a lot, etc. There may be no rhyme or reason to them. Definitely tell your Doc.

Good luck.


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