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Dr. Andrew Rynne
Dr. Andrew Rynne

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What do these ECG findings indicate?

Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 7126 Questions

Posted on Tue, 12 Sep 2017 in General Health
Question: Hi Doc. XXXX here again. I have now uploaded some results for you. These are 24 hr with several wires, and a week of Holter with I believe it was one wire.
I saw the cardiologist yesterday, which was a immense dissapointment. First of, it cost me 500 euro. Second, all I got out of the appointment, was an ultrasound which was good - the heart was structurally good. He also stated that the output (not sure the correct term) was good.
However regarding the rythm, he said all was fine. He seen nothing on it, and goodbye.
I said I am amazed by both the time 500 euro bought me, AND that nothing was seen on the recordings. Specifically I was so happy to be wearing the 24 hr recorder when I provoced an episode of irregular heartbets which I never seem to be lucky enough to catch otherwise.
On the scans, you can see on the HOLTER (not the 24 hr) on datum 03.08.2017 where I drew a red circle, there is something registered. This was due to me having a little "adrenaline" or beeing active. NOT overly active, just getting in and out of car, during a time where I had to hurry a bit. This was a very short burst. But they feel EXACTLY the same as the ones I get when I am scared, get adrenaline from driving fast, or as we spoke of earlier- during certain times of sexual activity/orgasm/masturbation.
I ALSO had this burst of irregular beats during the 24 HOUR ECG, but while just that; sexual activity. This went on for much longer than the one I circled out on the HOLTER. My girlfriend actually felt this on my pulse that it was totally irregular.
Now, I cant seem to find anything on the 24 HOUR my self. But I have outlined a episode that occured at 15.15 oclock on the 24 HOUR. However I have not taken notes of that in my papers/diary. I have put down the episode at 16:15 in my diary, and the 24 HOUR has a tachy episode at 15:15. So either I have missed by an hour, or the 24 HOUR machine has everything one hour early as a preset fault, and the tachy beeing a result of me "panicking a bit" after getting the irreguular beats. Now, if you look at the other incident taking place at 15:12:49, there is a "trigemi". Which just makes my suspicions that this is all about a timer fault, either by me or the machine. Becuase it would sound right that the trigemi incident at that time is what I had when feeling the chaos, and its followed by the tachy.
However, when I asked for the results to bring, he said- Okay, i will cross out the things that are artifacts and wrong in case you are showing it to some internet amateur. So he has crossed over the incident called trigemi at 15:12:49 as a wrong/artifact etc. I think he is actually wrong, and the reading was correct.
All the other ectopics etc is all provoced by movement on my part. i.e I get them when I turn my upper body, breath deep, sing, or bend over. All was in my notes for the cardiologist, which just laughed and said wow must be boring to have so much problems.
I tried explaining I am not scared to die, just scared to continue living like this. But he was rushing me out the door with the message that what I had felt (where I have dran with red) was not the heart. Could be something else, but not the heart. Even had my girlfriend saying she could feel it on the pulse while having it. But no.
Sorry for a looooong post, dear IIir.
Answered by Dr. Ilir Sharka 8 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXX,

Welcome back on HCM!

I reviewed carefully your uploaded ECG strips and would like to explain as follows:

1. Uploaded photo of 3 ECG strips showing Maximum Heart Rate (time 23:17), Minimum Heart Rate (time 9:33) and Pause (time 9:33) contain noises during registration or the so called artifacts. You shouldn’t worry about it as it doesn’t show the real XXXXXXX and min heart rate and the pause is not true.

2. Uploaded photo of 3 ECG strips, the first showing Idio-Ventricular Rhythm (time 23:18) is artifact; the second showing Triplet (time 15:14) is artifact; the third showing Polymorphic Couplet (time 14:02) is artifact.

3. Uploaded photo of 3 ECG strips, the first showing Monomorphic Couplet (time 13:27) is artifact; the second showing Bigemini (15:15) in fact is true: there are some episodes of bigemini inside the registration even though there are a few artifacts too. But the conclusion is exact: it is Bigemini; the third ECG strip showing Trigemini (time 15:12) in fact is artifact, so your doctor is right at this point.

4. Uploaded photo of 3 ECG strips, the first showing Ventricular Ectopic Beat (17:48) is in fact artifact; the second strip showing Isolated Ventricular Beat (time 13:22) is artifact; the third strip showing Supraventricular Tachycardia (time 15:15) is in fact ectopic beats: Bigemini (one extrasystole interpolated with one normal heart beat).

5. Uploaded photo of 4 strips, showing Paroxysmal SVT (the first with time 17:16 up to the fourth with time 18:54) are in fact all artifacts.

6. Uploaded photo the same as number 4.

7. Uploaded photo of 3 ECG strips, the first showing SV Couplet (time 20:38) is artifact; the second strip showing SV Triplet (time 9:26) is artifact; the third showing Supraventricular Ectopic Beat (time 18:58) is artifact (your doctor has checked correctly the third strip).

8. Uploaded photo of 4 ECG strips showing Atrial Fibrillation (time 17:15; 23:34; 17:48; 00:21) are in fact normal sinus rhythm without any episodes of atrial fibrillation. So they are pure artifacts.

9. The first and the last uploaded photos are the same and represent summaries of Heart Rate Trend, PR Trend and Arrhythmia Trend. They are not completely exact as they are based on the machine interpretation and as I showed there are a lot of artifacts and false conclusions inside.

In conclusion, I could say that except episodes of some extrasystoles (ectopic beats) expressed as short periods of bigemini or isolated, there are no complex cardiac arrhythmias.

These extrasystoles seem to be the reason why your feel palpitations and irregular heartbeats (even when checking the wrist pulse). Besides of the unpleasant feeling they produce, they are not dangerous or life-threatening.

It remains to be totally examined strip by strip in order to exactly conclude on the exact number of these extrasystoles.

This conclusion is encouraging, because ectopic beats may be present even in the presence of “increased adrenaline” such as excessive physical and psychological stress.
For the moment, my recommendation go in favor of concentrating on body weight control and increasing your physical endurance by performing a well-tailored physical training program (escalating physical activity under the supervision of a certified training expert).

That’s my personal professional opinion.

I apologize for the delayed response due to my professional commitments!

Hope to have clarified your ECG uncertainties!

You may ask me again in case of any further questions.

Wishing you all the best!

Kind regards,

Dr. Iliri

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

The User accepted the expert's answer

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