Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on - Ask a Doctor - service!

After reviewing your Holter monitoring results let me explain as follows:

-1. The underlying heart rhythm is OK: normal sinus rhythm with normal heart rate ranges.

-2. The presence of occasional premature atrial contractions even when a 4-bear run i present is not considered an issue of concern. It will not harm you anyway and no specific measures are recommended. There are frequently several extra-cardiac problems that may lead to premature atrial contraction appearance (a pulmonary, digestive, anxiety , etc. disorder, as well as an electrolyte imbalance, certain drugs like psychotropics and antidepressants, etc. Other endocrine (like thyroid, adrenal, etc.) or metabolic issues should be sought as potential causes of extrasystoles.

What is more concerning seems to appear the presence of ventricular extrasystoles; they appear more frequent and at this point it is necessary to first exclude a cardiac substrate generating them (whether an ischemic, metabolic, inflammatory, metabolic, etc. reason) in the setting of a certain cardiomyopathy.

Nevertheless, before concluding on the clinical importance of ventricular extrasystoles it is necessary to know the exact number of the whole amount. Could you upload a copy of the report containing the numbers and prescription about each of them?

- 3. The presence of ST depressions is suspicious, but not conclusive about cardiac ischemia; first because it is very transient, related to increasing heart rate and also difficult to correlate in adjacent ECG leads (as Holter monitoring usually doesn't monitor concomitantly the 12-lead ECG).

Coming to this point, in case you have also coronary risk factors like hypertension, diabetes, close smoking contacts, strong heredity or dyslipidemia it would be advisable a provocative cardiac test like exercise cardiac stress test, cardiac stress echo or even a coronary angio CT. In this case, you should discuss with your doctor on the above mentioned issues.

- 4. & - 5. The presence of unpleasant symptoms is quite expected in the settings of extrasystoles occurrence and the most important part would be the effort to explore the exact generating cause lying behind them.

I recommend you discussing with your attending physician on the possibility of performing the above mentioned tests.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

I agree with your that Mirtazapine could trigger some of these Holter findings. You should know that all antidepressants may lead to QT prolongation and thus increase the risk for extrasystoles. As you have not tolerated this drug well, I find it reasonable to discontinue it.

Regarding non-significant pauses, it means that there no pauses longer than 3 seconds, which can suggest a cardiac disorder. There are just some compensatory pauses, following the ectopic heart beats. So, there is nothing to worry about!

Regarding coupletes, you should know that they refer to two consecutive premanture ventricular contractions.

While Bigeminy refers to two heart beats close together with a pause following each pair of beats.

Anyway, this number of coupletes and occasional bigeminy and trigeminy does not indicate any serious cardiac arrhythmia.

Hope you will find this information helpful!

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr. Iliri

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