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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Smoker. Chest pain, shortness of breath, lightheaded with skipped heart beats. Any cure?

Answered by
Dr. Prabhakar C Koregol

Cardiologist, Interventional

Practicing since :1998

Answered : 424 Questions

Posted on Mon, 28 Jan 2013 in Hypertension and Heart Disease
Question: I am looking for opinion on Holter Monitor report. I am 57 female smoker, had chest pain last week, short breath and for last few month noticed increase in heart skipping. I had PVCs a long tine and take Toprol, But now I have more skipping, lightheaded.

0000 QRS
123 Ventricular beats (1%)
0000 Supraventricular beats (12%)

51 Minimum at 10:42
77 Average
116 Maximum at 22:38
1624 Beats in Tachycardia >=100 bpm 1% Total
3876 Beats in bracdycardia ,=60 bpm 3% Total
2.09 Seconds XXXXXXX R-R at 13:09

102 Isolated
9 Couplets
0 Bigeminal Cycles
1 Runs totaling 3 Beats
3 Beats longest run 214 bpm 13:31
3 Beats fastest run 214 bpm 13:31

7492 Isolated
2659 Couplets
132 Bigeminal cycles
4 Runs totaling 12 beats
3 Beats longest run 122 bpm 15:51
3 Beats fastest run 122 bpm 15:51
Answered by Dr. Prabhakar C Koregol 4 hours later

Holter shows a significant amount of supra ventricular ectopics which explains your symptoms. But how to tackle these depends on what is causing them, also was the Holter done before or after starting toprol?
Do you have diabetes or hypertension? Also knowing you are a smoker, a component of chronic obstructive airway disease. Please let me know. If you don't have any of these, then are there any anxiety state?

If none of these are there then we need to change your medications, please get back to me with those details.


Above answer was peer-reviewed by : Dr. Shanthi.E
Follow up: Dr. Prabhakar C Koregol 29 minutes later
Holter was done this week, I have been on toprol for about 5 years because I had PVCs. Everything seemed ok up until about a month ago when I started having more feelings like skipping, then lightheaded, once almost fainted, then on Xmas I woke up in the am with burning chest pain that came and gone. So I went to doc and he gave me Holter. Today I had stress test but I know nothing about it yet. I do not have diabetes or hypertension. Before all this I was told to take only 1/2 my metoprolol 25mg (I break it in half) because my blood pressure was running low. Now the doc told me to to take 1/2 in am and 1/2 at night. So that is what I am doing. I also take clonazepham .50 mg for some anixiety that I had last few years off and on but lately I don't feel I need it. I also take Primadone 50mg for essential tremor which has been absent. I have been living very quiet and inactive for some time now. So I doubt it is anixety. Smoking I know is bad and I can feel it. So hard to quit. I had chest xray but it was clear and reported nothing, last week. I do have some congestion in the am, probably from smoking but it clears up quickly. It just has been 'different' for me to suddenly develop so much skipping and an ill feeling in my chest. - Does having so many supra ventricular ectopics mean anything serious? I read online that they are nothing. But I am concerned because it is so many. I can feel my heart sometimes skipping, like every 3-4 beat for long time. New rhythm for me.
Thank you
Answered by Dr. Prabhakar C Koregol 1 hour later
Thanks for the information. Details well appreciated.

I would also like to know what your stress test shows. But other things look good.

Now from seriousness point of view, supra ventricular ectopics are not XXXXXXX but when they are producing symptoms they need to tackled.

Once we know your TMT (Tread Mill Test) report, we can take the discussion further.


Above answer was peer-reviewed by : Dr. Shanthi.E
Follow up: Dr. Prabhakar C Koregol 14 hours later
so, the results are normal? no heart disease?
Answered by Dr. Prabhakar C Koregol 31 hours later
If TMT is normal, then more or less we can conclude that there is no heart disease.
But until we have TMT results, we can take such stand.

Above answer was peer-reviewed by : Dr. Shanthi.E

The User accepted the expert's answer

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