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Dr. Andrew Rynne

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What does my ECG report indicate?

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Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1717 Questions

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Posted on Wed, 15 Mar 2017 in Hypertension and Heart Disease
Question: Hi there

I am hoping to get a second opinion on HCM. Over the last 6-8 months I have been experiencing skipped heartbeats. I mainly have PVC but occasionally I do have a PAC too.

I have discussed with my doctor who agreed on sending me for ECG, Echocardiogram. The ECG shows a short PR Interval and occasionally an IRBBB but it is not associated to anything and thought to be “benign”. The results from the Echocardiogram were also normal with no significant findings. I also went for a CT Chest scan with no findings.

I understand that PVCs are mostly bengin however my main concerns are as follows

1)     I get PVCs when lying on my right side at night. For some reason they are more common on left side rather than right side. I attached pictures from a monitor I had at the time.
2)     I get PVCs when sometimes exerting myself such as walking fast. The feeling is a one second squeezing feeling in the chest, which I assume is a PVC.
3)     I get PVCs when having a hot shower or hot bath, what could be the cause for this

I do not get symptoms such as light-headedness, nor do I feel faint. The only feeling is the discomfort from the PVC when it happens and if I feel pulse at the time I feel the skipped beat. I also do sometimes feel a buzzing or vibration feeling from my left chest not sure if it is a nerve or something.

Is it possible to confirm the two concerns specially PVC when walking is not a concern? When I go for a jog or light run I don’t feel many which is odd why it only occurs when walking. If there is any advice you can offer that would be helpful.

Thank you and I look forward to your advice.
doctor
Answered by Dr. Sagar Makode 1 hour later
hello,
Firstly, vpc in your age group and normal investigation is considered as benign condition with normal life expectancy. No need to worry about it. Also, you don't have any syncope fainting etc, that's again good prognostic sign.
Regarding, your doubts. Vpcs are highly variable thing which changes with factors like stress, anxiety, exercise, smoking, drugs, exertion etc and reason for this is catecholamine (like adrenaline) level. VPC are felt more at rest due to increased awareness at rest, more on left side because heart is closer to chest wall in that position. Also, hot water bath increase the sympathetic drive and adrenaline level leading to increased vpc.
With increasing activity as your normal heart rate increases frequency of apc and vpc may decrease and the pause following vpc decreases all of which lead decrease awareness. These are variations and not to be worried about. In some individuals, they may get worse with exercise, has different pathological mechanisms. Get one thyroid test done, if not done.
All your symptoms are due to vpcs. The treatment is to avoid stress if any, for that you can relaxation techniques like yoga, deep breathing etc. Avoid alcohol smoking drugs if any. Also, since you are symptomatic, you should be started on beta blockers class of drugs like metoprolol xr 25 mg once a day which you must be getting. So overall, no matter of worry. Get back if you have any further doubts.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sagar Makode 12 hours later
Hi Doctor

Thanks for the advice. The suggestions are very helpful.

I wanted to confirm that even when I walk and feel a squeeze/PVC this does not matter? Even though echocardiogram was normal walking and feeling this squeeze is fine. Should I do any further follow up for this symptom?
doctor
Answered by Dr. Sagar Makode 9 minutes later
Brief Answer:
Doesn't matter

Detailed Answer:
It doesn't matter, its the way one feels vpcs. During, vpc heart temporarily pauses and contract more strongly and forcefully giving you this feeling. It doesn't affect the prognosis.
The important thing you need to consider is episodes of fainting or syncope, which will change the line of management. If vpcs worssen or symptoms get too frequent then we need evaluate for Change in treatment otherwise routine 6 monthly or yearly follow up.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sagar Makode 9 hours later
Thanks Doctor, I do have a few further questions

1- sometimes I get some left chest pain which cause sweaty hands. It's not crushing or anything like that just a bit of discomfort. I am able to run and jog and go up stairs with no chest pain, but only VPB afterwards, are there any ideas you have from a cardiac view that could cause these sweaty hands or symptoms?

2- any other tests you can suggest I should ask my doctor for?
doctor
Answered by Dr. Sagar Makode 46 minutes later
Brief Answer:
See the description

Detailed Answer:
Any kind of pain and anxiety, more so chest pain as it causes more anxiety can lead to sweat in hand. There are many causes of chest pain, yours doesn't look like a cardiac pain. Cardiac pain typically occurs on exertion and relieves with rest.
Most probable reason is, gastritis and reflux disease. Do you also have upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water feeling in throat or chest burning, these are the other symptoms. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any. You can get prescribed tab Pan DSR 40 mg beforebreakfast once a day for 2 weeks.
Is there a increase in pain on application of pressure or increase with deep breathing or coughing, if yes these suggest some other pains, not to be bothered much.
As far as test is concerned, I don't think need for any test, but you can get treadmill test done just to relieve your anxiety.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Sagar Makode 2 days later
Hi Doctor

I have one more question. On occasion with all these symptoms I get what feels like an electrical shock feeling in the left chest around the heart. Is this cardiac related at all given the echocardiogram and other tests have been negative so far?
doctor
Answered by Dr. Sagar Makode 17 minutes later
Brief Answer:
See the description

Detailed Answer:
As such there is no symptom of electric shock sensation in the Cardiology, however vpc may give such feeling due to forceful contraction and squeezing of heart. So you should worry about this from cardiac point of view. More commonly, patients with reflux disease complaints of such symptoms due to sudden reflux of acid into the esophagus.
Above answer was peer-reviewed by : Dr. Remy Koshy
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