Hi,

Thanks for your question.

I have not found your blood work in these attachments.

I went through your Holter monitoring, echocardiography, and urine examination reports.

Your echocardiography and urine examination reports are absolutely normal.
Your holter monitoring shows Maximum heart rate of 132 beats /minute, minimum heart rate of 50 beats /minute, average heart rate 77 beats /minutes.

You have in 24 hours rare (6) isolated supraventricular extrasystole and 3 supra ventricular couplets, which means two SVE (SupraVentricular Extrasystoles) have been seen one after another, three times in 24 hours. These do occur in healthy individuals.

Since you are young, 26 years old and have history of one episode of fibrillation, your SVE needs further work up in the form of your thyroid profile, lipid profile, which according to you is having elevated cholesterol and electrophysiological studies of your heart.

Hope I answered your question.
For any further query, do post your follow up.
I will be readily available to answer.
Regards

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Hi XXXXXXX.

Thanks for your follow up.
I can understand your concern.
I went through your blood work.
It gives me pleasure to inform you that your all investigations, including blood work is normal, except lipid profile.
For your satisfaction I am going to explain you, reports of each test;
Complete blood count. Normal.
Fasting blood glucose. Normal
Creatinine Normal
Vitamin B12 level Normal
E GFR Normal
CPK
(Creatinine phosphokinase)Normal

TSH
(Thyroid stimulating hormone).Normal
Your cholesterol and triglycerides are high
You HDL (high density l lipoprotein, which is cardio protective) is low
You have moderate risk for coronary artery disease.
Putting your all investigation together, you have only deranged lipid profile which could be a cause for your rare SVE .
The SVE can give rise to episodic fibrillation.
What I am inferring from your question is your too much tense and tension itself is one of the most important causes of arrhythmias.
Another important factor which you have not mentioned in history is smoking,
Smoking also causes arrhythmias. So, if you’re a smoker, quit smoking altogether.
The bottom line is;
Relax, don’t be tense
Reduce your cholesterol and triglycerides by dietary control and daily exercise.
Quit smoking, if you’re a smoker
Go for serum electrolyte. One of the important investigation left in your bold work up, as
Hyperkalemi a is one of causes of SVE and
Finally go for electro physiological studies of your heart, to rule out any electro physiological cause for your SVC.
Hope I answered your question,
If you have still more concern do write to me I will be readily available to answer.
Get well soon.
Regards.

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Hi thanks for your follow up.

I can understand your concern.

So you yourself discovered the cause of your SVE.

Anxiety disorder is common cause of various types of arrhythmia.

So reduce your anxiety and get it treated from psychiatrist.
Why can’t you go for exercise, you are young only 26 years of age.
Start slowly initially for 10 minutes and then increase the duration slowly day by day.
Serum electrolyte is a blood test, in which blood sodium, potassium and other ions levels are measured
Increased potassium level can also cause arrhythmia. I think it will be also normal in you, as you have anxiety disorder as a cause of arrhythmia.

Yes the electrophysiological tests are done by cardiologist.

Low HDL means you’re not producing enough good cholesterol? Your cholesterol is not too much high, as I have already explained you have moderate risk not high risk for coronary artery disease.

Taking small dose of Aspirin is not bad idea but you’re too young to start aspirin therapy and you don’t have any risk factor other than increased cholesterol which if you will decrease will be better than taking Aspirin. My advice for you is:

Reduce your anxiety
Reduce your cholesterol and triglycerides
Go for daily exercise
Quit smoking if your smoker
Abstain from alcohol intake, if you drink
Reduce caffeine intake, if you take too much of coffee.

Hope I answered your question.
If you don’t any more concern close the discussion, and write the review.

Regards.

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Hi XXXXXXX, thanks for your follow up question.
The first thing I advice you is to relax. Don't be tensed, as tension can increase your problem.

Your chest pain, arm pain and lack of sleep are all due to tension and this tension can aggravate your heart problem.
Yes, there are studies which have depicted that person with ventricular premature contraction on 24 hour holter monitor are at the increased risk of having sudden heart attack, but that doesn’t mean that everybody with premature beat will get heart attack.
I will explain you this with very simple example.
Everybody who drives a vehicle is at the risk of getting an accident, but how any people XXXXXXX an accident daily. Does everybody XXXXXXX accident daily (only a small percentage XXXXXXX with the accident). Similarly you’re at the risk but that doesn't mean you will get it.
Like driving, if you’re careful you can avoid an accident, similarly if you will remain cautious, avoid risk factors which I have mentioned in previous follow up, you can avoid a heart attack.

It is good that your cardiologist has done72 hour holter monitoring and nuclear studies.

My advice to you is;
Take care of risk factor
Keep in touch with your cardiologist
Get a psychiatrist consultation to reduce your anxiety
Keep yourself relaxed
Hope I answered your question
If you don't have more questions close the discussion and review.
You are welcome to write to XXXXXXX in future.
Get well soon

Regards

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