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Had rib/chest tightness. ECG showed sinus arythmia and bradycardia. Unable to sleep. Have palpatations. Suggest?

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I had rib/chest tightness a couple of months ago...low gfr, electrolyte imbalance.
1 ecg showed sinus arythmia, another showed bradycardia...low hr of 37, high of 131, median 65. Admitted to ER with lightheadedness/pale/unable to sleep.

Been feeling better since, esp with less intense workouts. I had a 72 hour Holter monitor and indications showed palpatations, sinus rhythm with a XXXXXXX hr of 131 (workout) and low of 37 (sleeping) avg hr of 65.

Holter also showed 5 asystolic pauses greater than 2 seconds. The longest was 3.1seconds. My specialist is having me wear it again to rule out and 'technical errors', as I indicated holter strips may have fallen off at the time of the 3.1 second pause.

A nuclear medicine cardiac exercise stress test showed no evidence to suggest reversible myocardial ischemia..Gated study shows some hypokinesia inferior wall with ejection fraction 52% stress phase and 54% resting phase. Myocardial perfusion scintiscan shows reduced perfusion to the inferior wall but this is mostly fixed and possibly related to attenuation artifact. Perfusion to the rest of the left ventricle is within normal limits.

A cardio test showed low probability for significant coronary artery disease...I achieved 91% of XXXXXXX age predicted heart rate for 38 yr old. XXXXXXX blood pressure of 180/80 and peak hr of 164 during running.

So, my questions are:
What do these reports mean? My specialist did not explain other than concern over the 3 second stops, and wanting to do another 72 hr holter to rule out technical issues such as strips falling off/false readings. In the event results are confirmed he will be sending me to an "electrical heart specialist' with possibility of a pace maker. Will I live normally?
Posted Sun, 27 Oct 2013 in Heart Rate and Rhythm Disorders
Answered by Dr. Anantharamakrishnan 44 hours later
Brief Answer:
Yes / Repeat Holter / Insert Pacemaker

Detailed Answer:
Hi friend,
Welcome to Health Care Magic

These tests practically exclude Coronary Artery Disease / show normal blood supply; normal function
The problem is with the nerves – conduction system of the heart. It is called Sick Sinus Syndrome

Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. If the episode occurs randomly, one needs Holter or event monitor. Holter records for days; Event monitor for weeks / Holter records continuously / Event monitor only at certain times . A second recording is often necessary to re-affirm…

     The next step is an advanced technique of investigation – Electrophysiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out and so on. Though the test is the gold standard, it is INVASIVE and is not generally done unless there are compelling indications... This super-speciality expert is called ELECTRO-PHYSIOLOGIST.

The treating doctor may suggest them depending on need, based on his assessment of the situation. In all probability, you may need insertion of a pacemaker
Follow up with Nephrologist - regarding the low GFR and electrolytes...

As far as heart is concerned, with a pacemaker, you will have a normal life / It just needs follow up / Prognosis is excellent, if other systems are normal...

Take care     
Wishing all well
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Had rib/chest tightness. ECG showed sinus arythmia and bradycardia. Unable to sleep. Have palpatations. Suggest? 1 hour later
Thank you. The internist I'm seeing said the same...put the 72 hr Holter again to confirm if previous events were true. If they were, I'm being referred to an 'electrical heart' specialist out of town. If Holter shows normal activity, I'll be given a 2 week (forget the name) monitor, and go from there...pacer if needed.

Is it life threatening to have 1-2 second heart stops/pauses and are there vitamins or supplements/foods I can eat to improve the electrical/nerves component?

Also, could dehydration from excess workouts/loss of electrolytes have brought on these episodes; if so, can the heart get back to normal with proper hydration/diet?
Answered by Dr. Anantharamakrishnan 8 hours later
Brief Answer:
Most probably, you will need a pacemaker

Detailed Answer:

Yes, long pauses are ominous

There is no specific vitamin, supplement or food that can change this.

Dehydration or electrolyte disturbances can cause some changes – but not this type, fluctuation or duration

Basically, it is a degenerative disease of the conduction system of the heart

No reason to panic
It is manageable and the procedure is simple.

Above answer was peer-reviewed by
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