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Hi I have been experiencing episodes of heart palpitations and

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Posted on Fri, 1 Mar 2019
Question: Hi

I have been experiencing episodes of heart palpitations and extra beats for the past 3 years now. I've done some tests and they have caught the episodes on a holter monitor.

The results from the cardiac surgeon was that he was 99 % sure it is harmless. He says he would guess I have either WPW syndrom (But nothing showed on my echo) or AVNRT I think it was.

He adviced me to get it checked to be certain 100% and possible cure it with ablation. I am fearing the procedure and is highly considering to not do it right now, but I am also unsure if that is the right answer.

Basically my symptoms are associated when I assert myself physically. Wheter it is for weight lifting or a combination of very heavy cardio. My symptoms start when I relax and usually around 1 hour or so after the excercise has finished.

The holter showed that I reach a XXXXXXX of almost 200 bpm when it's ongoing and worst, but they are episodes of NSVT's and are interupted all the time by normal beats too. The episodes are infrequent and can happen with 3-5 months apart when I don't do straining excercises.

The doctor gave me metoprolol to take when I would get episodes but after my results he asked me to take 1 50mg pill a day just to be sure I avoid them.

So to sum it up, I am considering to not do the test and ablation right now but would you say based on my symptoms that this is sounding dangerous if I don't get an ablation?=

Also since I take metoprolol and I read they are through my system already after 6 hours or so, can I just stop taking them or would I need to slow down? I don't feel any different with the metoprolol, but I didn't have frequent episodes without the medicine either, so I can't say if they do anything when I don't excert myself.

Is there any long term issues by taking metoprolol daily? It's mainly not a problem taking 50mg daily but I don't necessarily like the idea of taking medicine regularly but would likely prefer it to the surgery at the current moment because of the fear of it and that I don't experience this so often. If it changes or if I get worse I would do it.

Please also explain me a little more about the possible diagnosis and if they are dangerous. Thank you.
doctor
Answered by Dr. Bhanu Partap (1 hour later)
Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello

After going through the medical details provided by you I can understand your concern for your health and I would like to tell you that before giving any opinion I would personally like to review your ecgs. Kindly upload the images of your ecgs and if possible Holter report summary page also.

If it is PSVT (avrt or avnrt) then these are usually not life threatening however can disturb you symptomatically but if the rhythm is something else then it has be taken care by other means.

Kindly upload the ecg tracing and Holter reports.

Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Bhanu Partap (2 hours later)
I am not sure I can get the actual report and photo. But I have the results:

The holter showed the following:

Sinusrythm: 31-178/min. Many individual uni-focal ventricular extra-systoles (VES), XXXXXXX 910/hour, in avg. 60/hour. Many episodes with non-sustained broad tachycardia, up to 20 seconds and with a frequency of maximum 197/minute. Vectopi is equal to 2.4 % of all beats. NSVT often interupted by just a single small complex, whereas the tachycardia episodes totally has a much longer lasting. No afib. No slim (I don't know the right word) tachycardia, no pauses, no difficult bradycardia. No blockage.

There is a suspected frequent NSVT. Supraventicular tachycardia with aberrans cannot be excluded on the given material.

The echo showed the following:

Nothing wrong all normal.

THe surgeon advised me to get it checked only because he says it seem to affect my quality of life. He didn't seem worried about the condition, but I'd like a second word from another doctor and hence I ask you.
doctor
Answered by Dr. Bhanu Partap (10 hours later)
Brief Answer:
Hello again

Detailed Answer:
Thanks for the feedback.

Without the ecg tracings it’s difficult to analyse, however as per the details provided it’s advisable that you should continue taking the medication provided by your treating doctor for heart rate control.

The morphology of the QRS complex (broad complex) mentioned in the Holter reports along with frequent runs of NSVT is not good and can later on lead to bad arrhythmias.

It advisable that you should personally consult a Cardiologist (Electrophysiologist) for evaluation and proper treatment plans.

I hope this information will guide you properly.

Kind Regards

Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Bhanu Partap

Cardiologist

Practicing since :2010

Answered : 3138 Questions

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Hi I have been experiencing episodes of heart palpitations and

Brief Answer: Please refer to the detailed answer below Detailed Answer: Hello After going through the medical details provided by you I can understand your concern for your health and I would like to tell you that before giving any opinion I would personally like to review your ecgs. Kindly upload the images of your ecgs and if possible Holter report summary page also. If it is PSVT (avrt or avnrt) then these are usually not life threatening however can disturb you symptomatically but if the rhythm is something else then it has be taken care by other means. Kindly upload the ecg tracing and Holter reports. Kind Regards Dr Bhanu Partap