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Suggest Treatment For Episodes Of Heart Palpitations
Question: Heart palpitations, ECG detected st depression, did a holter for 24 hours, that also reported st episodes. Maximum absolute st change was -4.0. Total st episodes were 379 minutes
Brief Answer:
please see details.
Detailed Answer:
Dear Madam
1. Main aim of getting a holter monitoring done in case of palpitation is to detect the basic rhythm at time of palpitation. However from report it seems that patient never had palpitation during those 24 hours, because patient never pressed the symptoms event button.
2. The maximum heart rate of 159 bpm, which is possibly the sinus tachycardia (as there are no VPCs and APCs during the study) was not felt abnormal by patient. This would have ordinarily caused palpitation provided subject is awake during that time.
3. The ST depression was present at baseline ECG, therefore detection during holter monitoring is expected. Most important factor is if there were any symptoms at time of profound ST depression? What is the cause of ST depression at baseline ECG? What was the QRS morphology at time of ST depression is also important. What is the suspicion of your clinician? Now a days, a few cardiologist use ST segment analysis during holter monitoring to detect ischemia. Hence interpretation of ST changes depends entirely on clinical background.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Madam
1. Main aim of getting a holter monitoring done in case of palpitation is to detect the basic rhythm at time of palpitation. However from report it seems that patient never had palpitation during those 24 hours, because patient never pressed the symptoms event button.
2. The maximum heart rate of 159 bpm, which is possibly the sinus tachycardia (as there are no VPCs and APCs during the study) was not felt abnormal by patient. This would have ordinarily caused palpitation provided subject is awake during that time.
3. The ST depression was present at baseline ECG, therefore detection during holter monitoring is expected. Most important factor is if there were any symptoms at time of profound ST depression? What is the cause of ST depression at baseline ECG? What was the QRS morphology at time of ST depression is also important. What is the suspicion of your clinician? Now a days, a few cardiologist use ST segment analysis during holter monitoring to detect ischemia. Hence interpretation of ST changes depends entirely on clinical background.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear doctor,
I was not asked to press the symptoms button. Holter monitoring was started at 6.00 pm, and i did not feel any palpitations during the night. However, in the morning i went for a walk and did feel the palpitations. This corresponds roughly to the time of the st depression. The start time in the report is wrong and is off by exactly 10 hours.
I need to know why this is happening. If there is not enough information to definitely diagnose, it would be good if i can know probable causes. Also, how serious is this? What are the next steps to be done for a definitive diagnosis. Will this require medication, or affect the quality of life? Can it be cured via lifestyle changes or non invasive therapy
I was not asked to press the symptoms button. Holter monitoring was started at 6.00 pm, and i did not feel any palpitations during the night. However, in the morning i went for a walk and did feel the palpitations. This corresponds roughly to the time of the st depression. The start time in the report is wrong and is off by exactly 10 hours.
I need to know why this is happening. If there is not enough information to definitely diagnose, it would be good if i can know probable causes. Also, how serious is this? What are the next steps to be done for a definitive diagnosis. Will this require medication, or affect the quality of life? Can it be cured via lifestyle changes or non invasive therapy
Brief Answer:
please see details
Detailed Answer:
Dear Madam
1. The ST depression should not correspond to palpitation rather palpitation should correspond to the time when you had a heart rate of 159 bpm which is 10-28 pm as per your report.
2. The report mentions total ST duration to be 379 minutes. If you had symptoms/ trouble/ uneasiness for that much of duration? I hope it is not so. Hence you can understand that why we do not frequently use this parameter these days.
3. Holter monitoring is basically used to ascertain rhythm disorders. As per this report except for the episode when your normal rhythm shoot up to 159 bpm, there is no evidence of abnormal rhythm during those 24 hours.
4. You should ask your cardiologist to specifically look at the areas of holter when you actually had palpitation and give you ECG graphs of that time. They must also mention specifically that what was the rhythm at time of increased heart rate of 159 bpm. I have only presumed it to be sinus as there are no other rhythms during whole monitoring. He should also give the morphology of QRS and rhythm at time of ST depression. We do get cardiac ultrasound (ECHO) of all patients with palpitation. That helps us to rule out any structural heart disease.
5. There are a number of causes of ST depression in ECG, almost, 17 main causes for name sake. Palpitation itself can be best worked out by knowing the rhythm of heart at time of palpitation. Holter is just a part of your work and it is really not possible to answer all the questions about probable diagnosis, prognosis and treatment.
A lot of things are technical in this issue, however, feel free to discuss further.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Madam
1. The ST depression should not correspond to palpitation rather palpitation should correspond to the time when you had a heart rate of 159 bpm which is 10-28 pm as per your report.
2. The report mentions total ST duration to be 379 minutes. If you had symptoms/ trouble/ uneasiness for that much of duration? I hope it is not so. Hence you can understand that why we do not frequently use this parameter these days.
3. Holter monitoring is basically used to ascertain rhythm disorders. As per this report except for the episode when your normal rhythm shoot up to 159 bpm, there is no evidence of abnormal rhythm during those 24 hours.
4. You should ask your cardiologist to specifically look at the areas of holter when you actually had palpitation and give you ECG graphs of that time. They must also mention specifically that what was the rhythm at time of increased heart rate of 159 bpm. I have only presumed it to be sinus as there are no other rhythms during whole monitoring. He should also give the morphology of QRS and rhythm at time of ST depression. We do get cardiac ultrasound (ECHO) of all patients with palpitation. That helps us to rule out any structural heart disease.
5. There are a number of causes of ST depression in ECG, almost, 17 main causes for name sake. Palpitation itself can be best worked out by knowing the rhythm of heart at time of palpitation. Holter is just a part of your work and it is really not possible to answer all the questions about probable diagnosis, prognosis and treatment.
A lot of things are technical in this issue, however, feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
So what should be the next course of action? of the 17 causes are there any that could be serious?
Brief Answer:
please see details
Detailed Answer:
Dear Madam
1. If your main problem was palpitation and you had any such episode during those 24 hours of monitoring, you must discuss with your reporting cardiologist and try to ascertain the rhythm at that time. Rest of things can be planned accordingly.
2. As I told you earlier, We normally get ECHO of all patients with palpitation.
3. Knowing the exact rhythm at time of palpitation and ECHO, are two basic essentials to diagnose the disease and prognosticate.
4. Yes, the list of causes include some serious disorders. It will be too much of imagination to discuss any cause without knowing the exact cause. However if you ever had loss of consciousness, blackout, unexplained fall or dizziness associated with palpitation, it is definitely worth an early opinion by a cardiologist.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Madam
1. If your main problem was palpitation and you had any such episode during those 24 hours of monitoring, you must discuss with your reporting cardiologist and try to ascertain the rhythm at that time. Rest of things can be planned accordingly.
2. As I told you earlier, We normally get ECHO of all patients with palpitation.
3. Knowing the exact rhythm at time of palpitation and ECHO, are two basic essentials to diagnose the disease and prognosticate.
4. Yes, the list of causes include some serious disorders. It will be too much of imagination to discuss any cause without knowing the exact cause. However if you ever had loss of consciousness, blackout, unexplained fall or dizziness associated with palpitation, it is definitely worth an early opinion by a cardiologist.
Sincerely
Sukhvinder
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Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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