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Obese having an enlarged heart, palpitations. Need help in reading a cardiac output monitor report

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
Good Day. Male aged 49 with a BMI of 39 I am obese and I do have an enlarged heart which has never given me any problems, but am otherwise in very good health. BP 121/80. I started getting heart palpitations about 2 years ago for the first time. They come and go, no other symptoms of a heart attack like chest pain etc.

I sell medical equipment, including a non-invasive cardiac output monitor. Out of curiosity I ran a test on myself while on a treadmill. The test results are attached. Nobody has seen them, but I wanted your expert opinion on whether the data reveals irregularities I need be concerned about. Please just consider the data, which I am not informed enough to read or understand, and let me know whether it is "normal" or problematic? (Comparing my ECG trace to others I see some differences which I have marked in red). I don't want to rush off to a doctor to have it checked unless I absolutely have to.

Thank you!
Posted Mon, 21 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 8 hours later
Thank you for your query.

The figure is not exactly an ECG trace. This is actually a depiction of the pulse waveform and its variation during the exercise. A true ECG tracing should need at least 10 electrodes (4 limb and 6 chest) connected to monitor the electrical changes of the heart.

As I understand, the test has monitored the heart rate and the cardiac output changes from rest to exercise and then again recovery after exercise. This shows a normal and sequential increase in the heart rate, cardiac output and other calculated parameters till peak exercise and subsequently, in the recovery phase, this has come back gradually to baseline. This is as expected.

The outlines that you have marked in red appear to be only artefactual changes because of movement on the treadmill.

I would advise you to do a formal treadmill with 12 lead ECG monitoring and BP monitoring if you want to screen for heart disease. Changes in cardiac output occur at a late stage, or in people with already damaged hearts.

I hope this answers your query. Feel free to ask me for any further clarifications.
With regards,
Dr Raja Sekhar Varma, MD, DM,
Consultant Cardiologist

Above answer was peer-reviewed by
Follow-up: Obese having an enlarged heart, palpitations. Need help in reading a cardiac output monitor report 11 minutes later
Thank you for this answer Dr Varma, I am much comforted, even though I did not expect a problem. (Ones never knows though!)

So, just to clarify your answer then, the Cardiac Output that you see in the report is perfectly normal, and the fact that my heart is enlarged is not showing up any abnormal Cardiac Output measurement on that specific test, is that correct?

Have a great weekend,
Answered by Dr. Raja Sekhar Varma 5 hours later
Thank you for the reply.

Yes, the sequence of values for cardiac output is all right. But, as I said before, there is the proviso that fall in cardiac output with exercise occurs only with advanced stages of LV dysfunction or in the presence of very severe disease.

In order to detect coronary heart disease, treadmill test with ECG monitoring is the standard used.

But, as you said, there is no abnormal cardiac output measurement in the test that you did.

I hope this reassures you. Please accept this answer if there are no follow-up questions.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
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