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Sinus arrythmia with frequent ectopics.
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Sinus arrythmia with frequent ectopics.

I brought my 21 y/o daughter (beautiful violinist) in to clinic due to sudden onset frequent ectopics.  12 lead EKG and rhythm strip showed marked sinus arrhythmia (SA) but she did not have ectopics @ the time of the EKG or rhythm strip.  (go figure!)  Later in the evening she was having up to 20 ectopics/min.  Don't know origin (atrial vs. ventricular).  She had a run of ectopics with some lt. upper chest pressure.  Computer reads EKG as normal except for SA.  I am a critical care RN and have written and taught 12 lead EKG courses.  Family Doc gave me the rhythm strip and EKG and I took a little time tonight  to look at them and discovered that she had flattening of T wave in lead III and inverted T waves in V1 (consistently).  QRS is biphasic (pos. and neg in lead III and AVF and she has notching of her QRS in lead AVL and V3)  P wave inverted in AVL.This all started last Tuesday after playing Badminton at college.  (She is a music major due to graduate.)  She has a Holter moitor on for 48 hours so I'm sure it will record plenty of ectopics to evaluate.  She has been healthy and a dancer and violinist since age 7.  Does not take caffeine except a little tea, no drugs except vitamin and Ferrous sulfate for iron def. anemia.  This just came so "out of the blue"..  I just hope they take the time to really read the subtleties when they read the EKG and look at the rhythm strip.  I know enough to just get me in trouble:)  Any opinion on this?  We trust in the Lord here and are not panicking.  My attitude generally is "if you're upright and off the vent you are doing well!"  She is not enjoying this experience but she trying to relax about it.  It may be benign but I'd just like a little reassurance.  Mighty precious daughter!  
Tags: Sinus arrhythmia and ectopics
1687176_tn?1321401609
Unfortunately it is difficult/impossible to be able to say exactly what is going on here just by description of an ECG alone (without being able to see it).  There are a number of findings that can be benign, non-specific, and artifactual depending on the underlying rhythm, lead placement, and patient history.  Given that she is only 21 - it would be rare that this is representative of coronary ischemia.  However, a holter monitor (as you have mentioned) would be the most appropriate test to determine how often and what type of ectopy she is experiencing to guide treatment.
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