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What Does My Electrocardiogram Test Report Indicate?
Question: I have been to ER 4 times over past several months - first time was for palpitations and extremely heaving menses, since then have had normal blood work, normal ekgs at er, chest x-rays also at er and a no XXXXXXX stress test in late sept 2014.
Woke up about 1:50am with racing heart OR I woke up first and freaked myself out and THEN Had racing either heart (got to 145 BPM and I've literally been up ever since). Monitor was done (of course, argh lol) yesterday morning so this episode was NOT recorded - the holter was for 48 hours.
Either way, I got the report back from the Holter Monitor (now being referred to EP Cardiologist) doc said it was normal / negative. Doc thinks it is stress (anxiety) and caffiene related, he wants me to take 12.5 mgs of lopressor in evening.
Says referring me because all else is normal, blood, ekgs, stress test, x-rays, (asked about echo and he said that they could do it, but not warranted because it is a rhythm issue). Not quite sure what an EP Cardiologist is and what he or she will do - so am SCARED.
Can you please review the info from report below and tell what you think? Do I have the atrial fib stuff (he said "it doesn't appear to be")? Is a normal report in your opinion? Any of this stuff dangerous (other than to my sanity)?
IS this upping my risk for a heart attack? Would you mind explaining what the last line means? The "supraventricular ectopic, etc"? Is that bad stuff? He did say some of the fluctuation stuff was from the lead being moved (it was itchy and was scratching around it).
Results say: Interpretation: Patient in NSR. HR ranged from 52 - 150 BPM. HR Fluctuation noted. See strips. Rare Atrial Ectopy with PAC's, A-Couplet x1 and a Atrial run x1. Rare Ventricular Ectopy with PVC's.
Narrartive Summary: Average heart rate was 85 BPM. Min was 52, XXXXXXX was 150. Ventricular ectopic acitivy consisted of 26 beats, of wgucg, 23 were in Single PVC's, 3 were single VE's.
The patients rythym included 24 min 49 sec of bradycardia. The slowest single eopisdoe of bradycardia occurred at 4:28:03 AM, D1, lasting 12 sec, with minimum heart rate of 52 BPM. The patients rhythm included 5 hr 20 min 55 sec of tachycardia. The fastest single episode of tachycardia occured at 12:51:45 PM D1. lasting 2 min 42 sec with XXXXXXX heart rate of 150 BPM.
Supraventricular ectoppic activity consisted of 39 beats, of which, 2 were atrial couplets, 9 were late beats, 28 were single PAC's. The longest R-R interval was 1.4 seconds occurring at 5:03:20 AM D1. The longest N-N interval was 1.4 seconds occuring at 5:03:20Am D1.
Woke up about 1:50am with racing heart OR I woke up first and freaked myself out and THEN Had racing either heart (got to 145 BPM and I've literally been up ever since). Monitor was done (of course, argh lol) yesterday morning so this episode was NOT recorded - the holter was for 48 hours.
Either way, I got the report back from the Holter Monitor (now being referred to EP Cardiologist) doc said it was normal / negative. Doc thinks it is stress (anxiety) and caffiene related, he wants me to take 12.5 mgs of lopressor in evening.
Says referring me because all else is normal, blood, ekgs, stress test, x-rays, (asked about echo and he said that they could do it, but not warranted because it is a rhythm issue). Not quite sure what an EP Cardiologist is and what he or she will do - so am SCARED.
Can you please review the info from report below and tell what you think? Do I have the atrial fib stuff (he said "it doesn't appear to be")? Is a normal report in your opinion? Any of this stuff dangerous (other than to my sanity)?
IS this upping my risk for a heart attack? Would you mind explaining what the last line means? The "supraventricular ectopic, etc"? Is that bad stuff? He did say some of the fluctuation stuff was from the lead being moved (it was itchy and was scratching around it).
Results say: Interpretation: Patient in NSR. HR ranged from 52 - 150 BPM. HR Fluctuation noted. See strips. Rare Atrial Ectopy with PAC's, A-Couplet x1 and a Atrial run x1. Rare Ventricular Ectopy with PVC's.
Narrartive Summary: Average heart rate was 85 BPM. Min was 52, XXXXXXX was 150. Ventricular ectopic acitivy consisted of 26 beats, of wgucg, 23 were in Single PVC's, 3 were single VE's.
The patients rythym included 24 min 49 sec of bradycardia. The slowest single eopisdoe of bradycardia occurred at 4:28:03 AM, D1, lasting 12 sec, with minimum heart rate of 52 BPM. The patients rhythm included 5 hr 20 min 55 sec of tachycardia. The fastest single episode of tachycardia occured at 12:51:45 PM D1. lasting 2 min 42 sec with XXXXXXX heart rate of 150 BPM.
Supraventricular ectoppic activity consisted of 39 beats, of which, 2 were atrial couplets, 9 were late beats, 28 were single PAC's. The longest R-R interval was 1.4 seconds occurring at 5:03:20 AM D1. The longest N-N interval was 1.4 seconds occuring at 5:03:20Am D1.
Brief Answer:
This is a normal holter, nothing to worry. Do ECHO, follow my suggestions..
Detailed Answer:
Hi XXXX!
I read your query and understood your concerns.
I read carefully your holter monitoring reports. Your principal rhythm was sinusal (normal).
There were recorded ~25 min of bradycardia with the minimal HR during sleep 04:30 AM (which is normal). Also were recorded 5 hours and ~20 hours of tachycardia with maximal HR of 150 during the day (which is normal too).
During heart monitoring were recorded only 39 supraventricular ectopic beats, which are extra cardiac beats originating in the atrium and if 39 should be considered normal.
There were not recorded any atrial fibrillation episode or ventricular pauses longer than 2,5 seconds.
This is why I also consider this a normal Holter monitoring. Moreover as long as ECG, stress test and other analysis were normal you should be relaxed because there's nothing dangerous for the moment.
You should be relaxed you aren't in any danger for the moment and your examinations lower the risk of heart attack.
However if you were my patient I would suggest:
- Cardiac ECHO (this will ease your concerns and would erve as a corner stone for future examinations and followups)
- Complete cardiac follow up every year (ECG, ECHO, stress test and Holter).
- Avoid drinking cafe, black tea, chocolate, energy drink because they may increase the number and severity of palpitations episodes.
- Reduce alcohol intake.
- Avoid unnecessary stress. Stress also increase the number and severity of palpitations episodes.
- Increase recreational activities (like sport dancing, swiming etc.) this will help to reduce stress.
Hope this information will be of help!
Wish you health!
Dr. Benard
This is a normal holter, nothing to worry. Do ECHO, follow my suggestions..
Detailed Answer:
Hi XXXX!
I read your query and understood your concerns.
I read carefully your holter monitoring reports. Your principal rhythm was sinusal (normal).
There were recorded ~25 min of bradycardia with the minimal HR during sleep 04:30 AM (which is normal). Also were recorded 5 hours and ~20 hours of tachycardia with maximal HR of 150 during the day (which is normal too).
During heart monitoring were recorded only 39 supraventricular ectopic beats, which are extra cardiac beats originating in the atrium and if 39 should be considered normal.
There were not recorded any atrial fibrillation episode or ventricular pauses longer than 2,5 seconds.
This is why I also consider this a normal Holter monitoring. Moreover as long as ECG, stress test and other analysis were normal you should be relaxed because there's nothing dangerous for the moment.
You should be relaxed you aren't in any danger for the moment and your examinations lower the risk of heart attack.
However if you were my patient I would suggest:
- Cardiac ECHO (this will ease your concerns and would erve as a corner stone for future examinations and followups)
- Complete cardiac follow up every year (ECG, ECHO, stress test and Holter).
- Avoid drinking cafe, black tea, chocolate, energy drink because they may increase the number and severity of palpitations episodes.
- Reduce alcohol intake.
- Avoid unnecessary stress. Stress also increase the number and severity of palpitations episodes.
- Increase recreational activities (like sport dancing, swiming etc.) this will help to reduce stress.
Hope this information will be of help!
Wish you health!
Dr. Benard
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
THANK YOU so much for getting back to me so quickly.
Follow up question (I will try to be brief) for clarification...
Will the EP Cardiologist do the ECHO? Not exactly sure what that is.
Main doc office is making that appt for me. Also, would you take the 12.5 of lopressor as recommended by doc? I have normal BP and my usual HR is anywhere from 78 - 85. He said I could take it during an episode if I wanted to try cutting back caffiene, getting back to working out etc (used to work out daily until the first er vist in Sept), first.
I am afraid to take meds for fear of becoming dependent on it / having some crazy reaction, etc. Not sure of what Lopressor will do to me.
Since I am having (hope I never do again) these bursts of tachycardia, is that an arthymia (Doc called it a "sinus tachycardia") that is going to give me a heart attack or something? Or could it REALLY be my nerves (am anxiety prone and have been under tremendous stress lately) causing this?
Finally, do all arthymias need to be treated? Meaning am I a candidate for surgery or something? I am shaking as I write this but my HR is normal.
THANK YOU again for taking the time to get back to me...I appreciate your detailed answer very much.
:-)
THANK YOU so much for getting back to me so quickly.
Follow up question (I will try to be brief) for clarification...
Will the EP Cardiologist do the ECHO? Not exactly sure what that is.
Main doc office is making that appt for me. Also, would you take the 12.5 of lopressor as recommended by doc? I have normal BP and my usual HR is anywhere from 78 - 85. He said I could take it during an episode if I wanted to try cutting back caffiene, getting back to working out etc (used to work out daily until the first er vist in Sept), first.
I am afraid to take meds for fear of becoming dependent on it / having some crazy reaction, etc. Not sure of what Lopressor will do to me.
Since I am having (hope I never do again) these bursts of tachycardia, is that an arthymia (Doc called it a "sinus tachycardia") that is going to give me a heart attack or something? Or could it REALLY be my nerves (am anxiety prone and have been under tremendous stress lately) causing this?
Finally, do all arthymias need to be treated? Meaning am I a candidate for surgery or something? I am shaking as I write this but my HR is normal.
THANK YOU again for taking the time to get back to me...I appreciate your detailed answer very much.
:-)
Brief Answer:
Your EP cardiologist can do the ECHO and you shouldn't start Lopresor...
Detailed Answer:
Hi back,
An EP cardiologist (Electro Physiologist) is a general cardiologist subspecialized on rhythm disorders. All cardiologist can do cardiac ECHO but in the states it is done by technicians and is interpreted by your cardiologist. So your cardiologist can interpret the ECHO so you shouldn't look for another cardiologist for that.
Based on the Holter reports you are having only sinusal tachycardia (i.e. a HR above 100 per minutes) it's not an arrhythmia.
My opinion is that you shouldn't start Lopresor (metoprolol) for the moment but you should follow the above suggestion. If you stop caffeine and control stress you will not need medications.
Only if the problem persist or your symptoms worsen than you should start treatment. The dose recommended by your doctor is a low dose and will not cause you any major side effect, especially it will not lower BP but will control your HR.
Wish you health!
Dr. Benard
Your EP cardiologist can do the ECHO and you shouldn't start Lopresor...
Detailed Answer:
Hi back,
An EP cardiologist (Electro Physiologist) is a general cardiologist subspecialized on rhythm disorders. All cardiologist can do cardiac ECHO but in the states it is done by technicians and is interpreted by your cardiologist. So your cardiologist can interpret the ECHO so you shouldn't look for another cardiologist for that.
Based on the Holter reports you are having only sinusal tachycardia (i.e. a HR above 100 per minutes) it's not an arrhythmia.
My opinion is that you shouldn't start Lopresor (metoprolol) for the moment but you should follow the above suggestion. If you stop caffeine and control stress you will not need medications.
Only if the problem persist or your symptoms worsen than you should start treatment. The dose recommended by your doctor is a low dose and will not cause you any major side effect, especially it will not lower BP but will control your HR.
Wish you health!
Dr. Benard
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last question to clarify your advice.
Why wouldn't you start it? I agree with your advice but wondering your thoughts, as my reason is I don't want to be dependent on any drugs and don't want crazy side effects...but if needed to get through an episode am hoping it will be safe.
Would taking it affect the ECHO? I would really like to try to not use meds if possible but last night was beyond horrible for me, I just shook and had a racing heart and have been awake since then.
THANK YOU for your wonderful advice and will close out after your next answer, I know you are busy and do not want to take up much of your time.
:-)
Why wouldn't you start it? I agree with your advice but wondering your thoughts, as my reason is I don't want to be dependent on any drugs and don't want crazy side effects...but if needed to get through an episode am hoping it will be safe.
Would taking it affect the ECHO? I would really like to try to not use meds if possible but last night was beyond horrible for me, I just shook and had a racing heart and have been awake since then.
THANK YOU for your wonderful advice and will close out after your next answer, I know you are busy and do not want to take up much of your time.
:-)
Brief Answer:
I think you shouldn't start medications without trying first my suggestions
Detailed Answer:
Hi back again,
As i said to you you can take safely lopressor in cases like that to ease your symptoms, but this will not cause any drug dependence.
Taking Lopressor will not affect Echo results.
Please again I suggest follow my advice because will help you to control your heart rate without medications. This is why i think you shouldn't start medications without trying first lifestyle modifications (my suggestions).
Wish you health!
Dr. Benard
I think you shouldn't start medications without trying first my suggestions
Detailed Answer:
Hi back again,
As i said to you you can take safely lopressor in cases like that to ease your symptoms, but this will not cause any drug dependence.
Taking Lopressor will not affect Echo results.
Please again I suggest follow my advice because will help you to control your heart rate without medications. This is why i think you shouldn't start medications without trying first lifestyle modifications (my suggestions).
Wish you health!
Dr. Benard
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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