Can You Help Me?

[bellaluna]

If anyone thinks they can educate me, please feel free... Since I am basically fed up with the docs in my area, I obtained copies of my medical records, and am in the process of trying to get a specialist to see me. I was reading through my records, and found the results from 24-hour holter monitor, which my doc told me nothing was found, but here's what it says:

"The underlying rhythm is sinus having an average heart rate of 99 beats per minute. A low heart rate of 46 beats per minute was seen at 07:38:49. Maximum heart rate of 156 was seen at 15:09:28.

The longest R to R interval measured was 1.8 seconds at 07:38:50.

Two supraventricular ectopic beats were recorded. These occurred as isolated atrial premature contractions.

34 ventricular ectopic beats were recorded. All of these occurred as isolated premature ventricular contractions. There was some bigeminy noted.

The patient reported symptoms of dizziness on two occasions and on both occasions the rhythm was sinus, though sinus tachycardia was present with a rate of 102 during the first episode and 124 with the second episode. At the time of maximum heart rate, the patient was without symptoms."

On the day that I wore the holter monitor, I was only mildly symptomatic, and so I am surprised that they found all of this. Can you tell me what it all means?

Thank you in advance.

Mary

[Resting]

Mary,

I don't know a lot about this, but I have read quite a bit on some heart forums. Ectopic beats and PVCs (premature ventricular contractions) and bigemeny are very common and are most likely nothing to worry about at all. My understanding is that sinus rhythm is a good thing. It doesn't look like there was anything sinister or worrisome on the report. My heart rate fluctuates like that as well. In my case it's mostly due to anxiety/panic issues.

Hopefully you'll get more responses from folks who are more knowledgeable. Just wanted to say it doesn't look bad in case that makes you feel any better.

Best wishes,

Cindy

[mrsdavidson8605]

Hi,

My only advice would be to get another opinion. Don't give up because docs aren't listening to you... you will find answers if you keep looking! i'm in the same boat.. i'm just determined not to give up.. If you're really concerend about the results, I would get another opinion of someone who is a specialist in that area and can reassure your concerns.....Hang in there. I literally know how you are feeling!!

Rachel

[JaneEyre9]

Hi Mary,

I'm not a doctor, but I did stay in a Holiday Inn Express last night! Haha. Just kidding.

I did graduate work studying cardiac rhythm and imaging, so this is just my amateur stab at your report.

Sinus rhythm is your normal heart rhythm, where each beat originates from your heart's natural pacing area-- the sinus node. Your low heart rate of 46 appears to be when you were sleeping-- this is measuring the same thing as your long R to R interval. That seems to be during a time when you were sleeping (7:38am), and it's normal to have a lower heart rate while sleeping.

Your high heart rate of 156 may have occurred when you were doing something active at around 3pm. A lot of times if we are walking or doing some chore around the house, our heart rate can shoot up quickly without us realizing it's gotten so high.

Your average heart rate is just that, average for night and day, and though 99 is a high-normal pulse, it is probably not out of the ordinary as an average.

Ectopic beats (supraventricular means above the ventricles, and ventricular) are not harmful as isolated cases and are common even in healthy people. It just means that for whatever reason, a particular beat originated from somewhere other than the sinus node (the natural pacemaker of your heart). These beats can cause problems if there is underlying heart disease or damage, but on their own, they are not harmful. I think bigeminy relates to pairings of ectopic and normal beats.

The fact you reported dizziness two times when your heart rate was above 100 makes sense-- 100 beats per minute is tachycardia (fast heart rate), so it's common to feel symptomatic when your heart rate gets high like that-- especially if you are just standing or sitting still. The fact you didn't feel symptomatic when you were at your peak heart rate suggests to me that you were doing a somewhat strenuous activity at that time and didn't notice your high heart rate at the moment. (But that's just an editorial opinion from my own experience monitoring my own heart rate.)

I know it is frustrating when you are monitored on a mild symptom day. One thing my doctor did was put me on a heart monitor that I could wear for a couple weeks, and so when I felt symptomatic, I would press a button to record my heart rhythm. It's important to know that during your episodes of symptoms you are only having sinus tachycardia because other forms of tachycardia or arrhythmias can be dangerous. It seems from this report that there is nothing extremely dangerous reported, and that's probably what your doctor meant by "nothing" being found. It definitely does NOT mean you are not sick or that you have nothing wrong with you.

Like I said, I'm NOT an MD and not an expert, but from what I know in my past graduate education and research, I wanted to try to explain some of these terms to help put your mind at ease a bit. A good plan might be asking your doctor about your more serious symptom days and/or getting a second opinion from a cardiologist familiar with POTS in your area.

Kristen

[morgan617]

We all have the same type of irregular beats you did, even healthy people. He said it was normal, because normal amount of time for a person to have tachycardia in a 24 hour period is about an hour. Your 24 hours of beats averaged out to under 100, and even with the the few times you went above 100, it didn't stay there very long. For instance, on my first Holter study, my average was 120 and I was tachycardic for 8 hours, therefore mine was considered abnormal.

R-R just means the longest period you went between heart beats. If a person has a heart rate of 60, their R-R interval will be 1 second. Yours was slightly longer, because your your heart rate went under 60 for a moment or however long it was.

Suprventricular is above the ventricles, so that means pac's, which are typically quite harmless. They are beats that pop in early. I have them all day long some days, as do many others, as you probably do on some days.

PVC's are also common, but may be more bothersome. Bigeminal means every other beat was a pvc. That is not usually a problem, pvc's become much more problematic when they run together at a very fast rate. You apparently didn't record anything during your pvc's and so they assume you were non symptomatic with them.

So your test would be considered not worrisome to any doctor reading it. They do not take into consideration that we don't all tolerate everything, just because it's not normal to not tolerate stuff. That has been my biggest problem with doctors and their interpretations of tests. I got one that said I was having runs of pvc's and he recommended a sleep study to check for sleep apnea, but I was told it was completely normal. That was about 3-4 years ago and I am just getting my sleep study next week!

I have a pace maker and told my cardio I was having some pretty symptomatic arrythmias I haven't had before and he said he would worry about them when my pacer recorded something. Well, my pacer is set to record v-tach at 180 or greater and only if sustained. I told him he would be figuring out what to do at my autopsy. Just because some people tolerate these rates, does not mean everyone does, and this is what these guys can't see.

I, personally, find Holter studies to be of little value, unless you are a walking arrythmia. (I know I spell this word wrong, I hate the way it's really spelled) I am much more in favor of event monitors. I would have one Holter just to see a full 24 hours, but then go for event, because it gives you time to have the arrythmias and allows for those days that aren't so bad, not to rule how the doctor perceives your heart to be working.

I have never had a Holter on a really bad day, and it's extremely frustrating. You are at the mercy of your body and it's not like you can say, okay heart, do your thing, and it will. Although doctors seem to think we can do this. An event monitor gives you that opportunity. Hope that helped. He read it and saw nothing to give him any red flags, regardless of how you FEEL, so he didn't mention it.

morgan (Kristen, don't you just feel like some of these doctors DID spend a night at the Holiday Inn???LOL)

[bellaluna]

Thank you all very much- I do feel better now that I know what it all means. Least I feel pretty certain I'm not going to drop over dead anytime soon! I'm going to send the records over to the specialist's office- keep your fingers crossed for me that he will agree to see me without a referral!

Thanks!

Mary