Brief Answer:
Ecg is in sinus rythm with frequent premature ventricular contractions.

Detailed Answer:
Hi XXXXXXX
Firstly thanks for choosing health care magic to ask your query!

I have seen the ecg attached ,

Frequent Premature ventricular contractions are seen in ecg.
Premature ventricular contractions (PVCs) are extra, abnormal heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a skipped beat in your chest.

Before explaining the significance of PVC'S lets first understand the normal physiology of heart .
Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by the sinoatrial node (SA node) — or sinus node — an area of specialized cells located in the right atrium which generates the heart beat;also termed as pacemaker of the heart.This natural pacemaker produces the electrical impulses that trigger the normal heartbeat. From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood out to your lungs and body.

Now i will explain to you how PVC's disrupts normal pumping action of ventricles;
As we already know Premature ventricular contractions are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat. And they often interrupt the normal order of pumping, which is atria first, then ventricles. As a result, the extra, out-of-sync beats are usually less effective in pumping blood throughout the body.

Though there are a number of causes for PVC'S, yet cardiac ischemia is the most important and common cause of observing Pvc's in ecg.

However,the following stimulants, conditions and triggers may increase your risk of premature ventricular contractions:
Caffeine, tobacco and alcohol,Heavy Exercise,High blood pressure(hypertension),Anxiety.


Initially i would recommend you few base line tests of cardiology to rule out ischemia-

Tread mill test- This diagnostic test uses electrocardiography to record your heart's electrical activity while you walk on a treadmill, if exercise provokes extra beats, it may indicate higher risk of serious heart rhythm problems due to underlying ischemia.

Holter monitor- This portable device is carried in your pocket. It automatically records your heart's activity for an entire 24-hour period, number of PVC'S in a period of 24 hours will be observed .Its very important test for ruling out underlying arrythmia.

2d echo-An Echocardiogram (Echo) is a non-invasive test that uses sound waves to make pictures that look at the structure and function of your heart, it would help to rule out ischemia to the heart muscles.

Combined together the sensitivity of all these test to rule out cardiac ischemia is more then 90%, to rule out cardiac ischemia.
Advice
24 hour holter monitor
2D echo
Tread mill test
Serum electrolye level.
In case you have any other query i would be happy to help!

Thanks,
Dr Rishu Saxena
Cardiologist XXXXXXX Hospital ,New XXXXXXX

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