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What Do My Holter Monitor Results Indicate?

Posted on Wed, 4 Feb 2015

Question: Hi I have some questions regarding my PACS. I was feeling palpitations several on the ago and was sent to a cardiologist. He ran several tests including an echo, ECG, stress test, holter monitor, and loop monitor for 24 hours. The results of the echo showed a structurally normal heart with some trace regurgitation. Which he said was normal in most hearts. Every function and size of the heart was perfect. The holter monitor picked up 925 PACS over 48 hours. 2 bigamy cycles and 3 couplet cycles very short. It only showed 1 single ventricular beat. I suffer greatly from anxiety and panic especially lately. I have had episodes where my heart will race at 160 BPM through the day but very short 2 minutes or less and slows down when I do deep breathing and drink water. The PACS I feel at night before bed and when I wake up in the morning. I don't know if it's happening when I sleep. I am worried about this but my doctor says they are benign. He didn't explain anything toe which freaks me out more. Is that too many PACS I've heard people can have tens of thousands in a day but I don't know. These tests were 5 months ago. How often do I need a repeat of the tests? My cardiologist told me at least 3 years. I eat very well and have lost 75 lbs over the last 10 months. My resting heart rate is around 56 -60 depending on the time of day. Doctor says this is fine don't know if I should worry.

Here is the results of my 48 hour holter monitor

198000 total beats

26% in bradycardia
12 % in tachycardia

Lowest heart rate was 50 at 5 AM during deep sleep.
925 PACS
915 We're single
3 couplets and 4 bigamy
0 runs totalling 0 beats

1 ventricular beat

Doctor said sinus rythm no arythmia detected

Answered by Dr. Anantharamakrishnan (8 hours later)

Brief Answer:
Benign - not of serious concern

Detailed Answer:
Hi friend
Welcome to Health Care Magic

This is benign – especially with normal ECHOcardiogram
Holter report is normal / No need to repeat the Holter for 2 or 3 years / If you also have symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain along with this, then only, you need urgent work up
The heart rate range too is normal
The arrhythmia – this number is common in most normal people / and especially atrial beats are harmless / Specific treatment may not always be necessary. No need for drugs at all –
The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat.

Good luck
God bless you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (13 minutes later)

Hi Doctor Thank you for your reassuring comments. I just have a couple of more questions to ask. It feels like these PACS happen late at night at rest. Possibly during sleep because I wake up in the morning and they are there for about 15 - 20 minutes. It seems to be triggered at rest when my heart rate is lower. Could this be a link with anxiety? Also do pacs mean I will develop afib?

Answered by Dr. Anantharamakrishnan (33 minutes later)

Brief Answer:
A-fib not likely

Detailed Answer:
Hi

They occur at random / Not that they happen at that time / more likely that we are aware while at rest / our anxiety increases with time and so the awareness of the beat
Theoretically but not practically, A-fib can occur / the chances are meagre
Yes – Anxiety can cause / as also Alcohol, Tobacco (smoking), Caffeine (too much tea, coffee, cola) / There are several others like Fever; Infection; Pain; Thyroid; calcium, magnesium; medicines like Phenylephrine used for ‘cold, Salbutamol used for asthma and so on / Only occasionally, abnormal nerve paths in the heart (bypass tracts) or disease of the conduction system are responsible!

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (8 minutes later)

Are symptoms of a fib and atrial flutter distinguishable. Would I know if I had that? Also would the holter pick it up even if I didn't have an episode while wearing the monitors?

Answered by Dr. Anantharamakrishnan (12 minutes later)

Brief Answer:
Can't distinguish

Detailed Answer:
Hi

One cannot distinguish for certain fibrillation from flutter from the symptoms alone – fast and irregular, irregularly irregular beats, canon waves in the neck are some clues suggesting Fib…

Of course, you will know – if one is aware of Pac, how can this be missed!?

If the episode is rare, one may need an event monitor- Holter records for days; Event Monitor for weeks… Holter records continuously; Event Monitor only at user-activated times / If it was present, Holter would have picked it up for sure

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (5 minutes later)

Thank you doctor. I appreciate everything you have done for me and your detailed descriptions! It was a pleasure speaking with you

Answered by Dr. Anantharamakrishnan (4 minutes later)

Brief Answer:
Thank you

Detailed Answer:
Forget it and enjoy the life
See the doctor - if you have any new symptom
God bless you

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar