Re: Inferior infarct/bradycardia

Posted By CCF CARDIO MD-APS on June 18, 1998 at 08:58:19:

In Reply to: Inferior infarct/bradycardia posted by Chris on June 13, 1998 at 06:04:52:






Hello again, remember me?  I posted several days ago re: my 17 year old son who
had done cocaine.  His EKG's that I did showed inferior infarct, 2nd degree
SA block (mobitz I) and ventricular escape complexes.
He recently had a 24 hour holter done and this is what it says:
Predominant Rhythm:  SINUS RHYTHM, SINUS ARRHYTHMIA, WITH SEVERAL EPISODES OF JUNCTIONAL RHYTHM.
Unifocal ventricular ectopic activity:
1 couplet
232 single beats
Ventricular beats at the rate of 9.9/hr
Frequent ventricular escape beats
rare triegeminy noted
4 hrs 15 mins. of tachycardia
6 hrs 59 mins of bradycardia
fastest single episode of tachycardia at 12:21pm lasting 41 beats averaging 165bpm.
slowest single episode of bradycardia at 6:21am lasting 115 beats averaged 37bpm.
Supraventricular ectopic activity consisted of a PAC.  Supraventricular beats occurred at the rate of less than one SVE per hour.

He will be seeing a cardiologist but not until July 20th.  This cardiologist
did look at that EKG and confirmed that he did have inferior infarct.
Could you please comment on the holter report?  Do you suppose he's ok
to wait 5 weeks to see a cardiologist?  
Thank you so much!
Chris


_____


Dear Chris,
This forum has several physicians answering questions, I was not the one who
answered your last question, and this forum intends to answer information seeking
questions meaning that it does not diagnose, evaluate, or treat, not even to comment on it.
The best you could do for your son while awaiting the cardiologist appointment is to help keep
your son from doing cocaine again.  Most instiutions that perform holter monitoring have the reports reviewed by
a cardiologist and a cardiac technician in order not to miss those rhythms that can not wait for an outpatient cardiologist appointment.  It might make
you feel better to call the place where the holter was done to see if it is there policy to have all holters reviewed by a cardiologist.
As for some comments on your son's holter, many of the findings are simply variants of normal and it is very important to know whether the patient was symptomatic (for example short of breath, or dizzi) or simply how active the patient was before you can evaluate a holter monitor.
For example, your son spent a significant amount of time being tachycardic (greater than 100 beats per minute) and this would be normal if he was exercising or the like but abnormal if he was sedentary.  Nothing in medicine is black or white, rather it is like a puzzle where the physician tries to put all the pieces
together to understand and treat any and all potential problems.  This brings me to my last comment.
Until an echocardiogram is performed that shows a malfunctioning inferior wall of the heart you can not be absolutely sure of the inferior heart attack(MI).  Unless of course it is very obvious by the signs and symptoms that your son had at the time as well as the exact appearance of the ECG as read by a cardiologist.
I hope that this has been helpful, and remember that while awaiting the appointment the important things to concentrate on are no more drugs and any new signs or symptoms (palpitations, light-headedness, dizziness,shortness of breath,etc.)should prompt an emergency room visit even if they occur the day before the appointment.
Good Luck.   Information provided in the Heart Forum is intended for general medical informational purposes only, actual diagnosis and treatment can only be made by your physician(s).