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What Does The Following ECG Report Indicate?
Question: I would very much if someone could cast an eye over a small snapshot recording from a cardiac event monitor for me. The recording was taken during the time I was symptomatic with a 'sinking feeling' and awareness of palpitations. However, there is no chest pains with these episodes. I had a stress test some years ago, which was fine, and many ECG's over time which have also been normal. Would an echocardiogram be worthwhile, or not necessary?
Brief Answer:
See the description
Detailed Answer:
Hello, I've reviewed the images,
Your tracing is showing multiple Ventricular premature complexes or VPCs and also probably episodes of atrial fibrillation which is causing your symptoms. It's not a heart attack so there will not be a chest pain, but if heart rate increases too much then it may cause chest heaviness, shortness of breath, fainting etc. There is also lot of artefact as well.
If possible try to upload more tracing of symptomatic period. This can cause your all symptoms. Usually cause for this anxiety, stress, drugs, caffeine, structural heart disease, thyroid, smoking and sometimes without any detectable cause then called as idiopathic.
So we need to evaluate for the cause. Usually ECG is normal as it is usually done in between the episodes. ECG done during episodes will show abnormality as it has shown here. So you'll need to get Echocardiography done to rule out structural heart disease.
Also, hemoglobin and thyroid test should be done.
And yes, you should receive beta blockers which will stop these VPCs and keep your heart rate and thereby symptoms under control.
Please get back if you have any further doubts.
Regards
See the description
Detailed Answer:
Hello, I've reviewed the images,
Your tracing is showing multiple Ventricular premature complexes or VPCs and also probably episodes of atrial fibrillation which is causing your symptoms. It's not a heart attack so there will not be a chest pain, but if heart rate increases too much then it may cause chest heaviness, shortness of breath, fainting etc. There is also lot of artefact as well.
If possible try to upload more tracing of symptomatic period. This can cause your all symptoms. Usually cause for this anxiety, stress, drugs, caffeine, structural heart disease, thyroid, smoking and sometimes without any detectable cause then called as idiopathic.
So we need to evaluate for the cause. Usually ECG is normal as it is usually done in between the episodes. ECG done during episodes will show abnormality as it has shown here. So you'll need to get Echocardiography done to rule out structural heart disease.
Also, hemoglobin and thyroid test should be done.
And yes, you should receive beta blockers which will stop these VPCs and keep your heart rate and thereby symptoms under control.
Please get back if you have any further doubts.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dr Makode,
Thank you very much for your reply. I'm so glad to know that I'm not going mad! I have uploaded some more images from the event monitor. Sorry that there is a lot of noise - I assume that's the limitations of the monitor used by my GP surgery.
I do get symptoms during these episodes (mostly a feeling of 'sinking') but then I go for weeks, sometime months, without getting episodes at all. I have been very reticent to take beta blockers as my resting heart rate can be in the 50's and I worry about them slowing my heart rate even more, which might make me feel poorly? I can certainly cope with the episodes, as long as know that there is nothing to worry about.
I have had a thyroid check, which is normal, and although I have had anaemia in the past, I haven't been so for quite a few years. Caffeine doesn't seem to play a part, neither does alcohol, although I am careful to avoid these. I do believe that anxiety makes them worse, but ironically the anxiety is also caused by them! I've never taken drugs and have never smoked either.
I will definitely pester my doctor for an echo. Thank you for the confirmation about that. I did think I should have one, but it's not been offered.
If an echo is normal and I can cope with the episodes, are the beta blockers a definite must? Or can I do without them?
Thank you very much for your help.
Thank you very much for your reply. I'm so glad to know that I'm not going mad! I have uploaded some more images from the event monitor. Sorry that there is a lot of noise - I assume that's the limitations of the monitor used by my GP surgery.
I do get symptoms during these episodes (mostly a feeling of 'sinking') but then I go for weeks, sometime months, without getting episodes at all. I have been very reticent to take beta blockers as my resting heart rate can be in the 50's and I worry about them slowing my heart rate even more, which might make me feel poorly? I can certainly cope with the episodes, as long as know that there is nothing to worry about.
I have had a thyroid check, which is normal, and although I have had anaemia in the past, I haven't been so for quite a few years. Caffeine doesn't seem to play a part, neither does alcohol, although I am careful to avoid these. I do believe that anxiety makes them worse, but ironically the anxiety is also caused by them! I've never taken drugs and have never smoked either.
I will definitely pester my doctor for an echo. Thank you for the confirmation about that. I did think I should have one, but it's not been offered.
If an echo is normal and I can cope with the episodes, are the beta blockers a definite must? Or can I do without them?
Thank you very much for your help.
Brief Answer:
Beta blockers are not absolutely necessary, but echo should be done
Detailed Answer:
Hi again,
Beta blockers are basically for symptomatic benefit, not absolutely necessary if you are able to cope up with symptoms.
In most individuals, especially at your age, it's very unlikely that these are life threatening. So I think there is no need to worry.
These report looks same.
Were the episodes sudden onset and sudden offset or more of a gradual nature ? If yes, it also raises a possibility of PSVT, which is again a benign condition and not life threatening, but this condition is permanently treatable with ablation. Try to have one normal EKG during episodes of tachycardia if possible which will clear the picture. In order to abort these episodes, you can cough hard or pour some cold water over face.
Echo should be done as a part of diagnostic work up and to rule out any structural heart disease which can be associated with this. If Normal, we can be rest assured. If anxiety is too much then you can get some anti-anxiety medicine like Clonazepam or Escitalopram etc.
Overall, it's a benign and no need to worry.
Regards
Beta blockers are not absolutely necessary, but echo should be done
Detailed Answer:
Hi again,
Beta blockers are basically for symptomatic benefit, not absolutely necessary if you are able to cope up with symptoms.
In most individuals, especially at your age, it's very unlikely that these are life threatening. So I think there is no need to worry.
These report looks same.
Were the episodes sudden onset and sudden offset or more of a gradual nature ? If yes, it also raises a possibility of PSVT, which is again a benign condition and not life threatening, but this condition is permanently treatable with ablation. Try to have one normal EKG during episodes of tachycardia if possible which will clear the picture. In order to abort these episodes, you can cough hard or pour some cold water over face.
Echo should be done as a part of diagnostic work up and to rule out any structural heart disease which can be associated with this. If Normal, we can be rest assured. If anxiety is too much then you can get some anti-anxiety medicine like Clonazepam or Escitalopram etc.
Overall, it's a benign and no need to worry.
Regards
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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