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Abnormal Holter monitor help understanding
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Abnormal Holter monitor help understanding

I have just had the results from a 48hour holter monitor test which came back abnormal and I need someone's help understanding the results before I give myself a heart attack panicking about it.

Heart rate average 75. Min 45 (mostly at night) max 173 ( I admit I went for a run when the monitor records the highest reading.

"Episodes of sinus tachycardia and sinus bradycardia noted. Very frequent ventricular ectopics (14%) seen as isolated beats and prolonged episodes of bigeminy and trudge money. Very occasional supra ventricular ectopics seen as isolated beats, couplets and episodes of bigeminy and trygeminy. No pauses.

I am 31 year old-female. My mother died at 45 of a heart attack and I'm quite worried. I have an appointment with a cardiologist for further tests. Any help you can give me in understanding how worried I should be is greatly appreciated.  
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1423357_tn?1373023915
There are a number of people (none of us are professionals) who are more experienced in this field, but I'll give you a couple of things to consider.

First, was this a written report from a physician or a computer generated report.... or possibly a combination of both?
"Episodes of sinus tachycardia and sinus bradycardia noted."
If you are running, and have an elevated heart rate as you should, you're experiencing "sinus tachycardia".  It's there, so it was noted.  Likewise with the episode of bradycardia.  This could be verified by looking at the times of these event and comparing them.

So with an average heart rate of 75bpm, that would be 108,000 per 24 hr. period. 14% of that figure would be around 15,000 ectopics per day or roughly 10 per minute or roughly one every 5 seconds. I'm assuming these are PVC's?  That's sounds like a lot, but I would imagine it's near the threshold of where a cardiologist sits up and notices.  We've had lots of people on here with at least that many and way more, so it's not like you're sitting out there alone.

There must have been a reason why you were wearing the monitor in the first place. Were you feeling these ectopics?  I think it's wise to consult with a cardiologist, but don't be surprised if he isn't as alarmed as you are.  There's a lot of people in the boat with you!  Hope it works out fine.

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Avatar_f_tn
Thank you for your (very) quick reply Tom.  It was a 48 hour (not 24h) monitor  done because I get palpitations quite often and had palpitations after a 20 min run - that being said I am quite an anxious person.

It's unclear if the report was written by a person or whether  it was computer generated.  

There's other info on the report's cover page:

22734 ventr beats (14%)
1350 supraventricular beats (<1%)
30% of total time classified as noise

Ventriculars:
22734 isolated
0 couplets
14160 bigem cycles
0 runs


Hr
11079 Beats in tachycardia (all happening during my run)
8935 beats in bradycardia
1.42 secs max rr

Supraventriculars
1234 isolated
58 couplets
785 bigeminal

All done over a total of 45 hours.
That's probably more info that anyone would want.

Is that relatively unconcerning?
Thanks again!
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257552_tn?1404606154
As the other commenter said, who informed you the results were abnormal, the Doctor or a readout supplied with the results that may have been electronically interpreted?

Heart rates below 60 are referred to as Bradycardia, a rate below 60 is not significant in itself, it has to be compared to the patient. Athletes may have resting rates below 60 normally, so may people taking Beta Blockers, Calcium Channel Blockers, and other medications. Rates below 60 while sleeping are not uncommon.

Tachycardia is heart rates above 100, sinus means a regular heart rate (no PVCs, PACs, and variants) so that is normal from my perspective, just regular above 100 beats/min  (Tachycardia) and below 60 beats/min (Bradycardia) at times.

Isolated beats means no runs, they worry about runs, which would be fast consecutive PVCs or PACs, which would be Tachycardia limited to either the Ventricles (PVC) or Atria (PAC). These cause concern when seen. Couplets are two rapid PVCs limited to just 2, at three or more they worry about them, based on different factors.

Read the question and response at the following link.

http://www.*****************/cardiology/forums/backup/topic-15389.html

In contrast, Sinus Tachycardia is a functioning of the heart at an elevated rate but electrically synchronized. It could be from exercise, fear, medicines, and some people have hearts that go into a rapid but synchronized beat spontaneously. Though not comfortable, it usually is not a big concern to doctors.

I get bigeminy, trigeminy, quadregiminy, yet the doctors are unconcerned. My last Holter for 24 hours I had 6000 PVCs. My cardiologist and family doctor are unconcerned.

My Holter was electronically screened then interpreted by an independent cardiologist before my cardiologist received the results. We were told by the technical center where the Holter was put on me that when they receive the monitor back, after I wear it, that the results are uploaded to a computer and screened for urgent problems. Most likely you would have received notification if anything urgent was noted.

Do follow thru with seeing the Cardiologist, but relax, read the link I sent. It's very similar to what you and I are going through.
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1423357_tn?1373023915
I think so..  You definitely have something going on, but I don't know to what degree it will impress a cardiologist.  I also don't know how the "30% of total time classified as noise" plays into this.  Does this mean that 30% of the recording was "illegible" in nature?  Does it mean there are 30% more event that could have taken place that were included in the report?  Hopefully someone else can add input on it.
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257552_tn?1404606154
When I had my Holter, being the usual American, I never read the instructions, and the technician never took the time to tell me something I guessed on my own, namely I held my tablet far away from the leads and monitor for the duration of the test. With the prevalence of electronics, the center that places the Holter should warn everyone. Phones, tablets, other devices can be a problem. Poor connections as well, so I periodically would assure the electrode pads weren't coming off. When I wore an event monitor for 10 days, I was given replacement pads to place as the originals became loose.
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257552_tn?1404606154
They keep stripping my link. Just search Google for the material contained in what remains. Interesting and reassuring article.

Please keep us updated on your progress.
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Avatar_f_tn
Thanks for your reply! My family doctor saw the results and referred me to the cardiologist, which I guess is the safest way of dealing with this from their point of view.

It's interesting what Tom is saying about electronic devices; my mobile phone and tablet may be the cause of the "noise", they should definetely mention that! Also, at some point one of the electrodes disconnected itself, I am not sure for how long.
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Avatar_f_tn
I'm guessing that 'trudge money' which appeared in your report is Autocorrect's version of 'trigeminy.'

And, yes, Artaud, medhelp doesn't like links very much, *especially* not the one you tried, which might be seen as a direct competitor.  As you note, the link will work if you just copy and paste the portion beginning with 'cardiology' and ending with html
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257552_tn?1404606154
Thanks for the update. I can understand why they would limit certain sites, I'm good with that. Someone needs to pay the bills. The particular link was to a gentlemen that seemed to have a way of explaining things in a humane way, but he seems to have disappeared from the internet (the article is several years old) as has a neurologist that someone on Medhelp provided a link to that has an interesting perspective on Vagus Nerve issues and Arrhythmias.

Thanks again.
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1807132_tn?1318747197
You have isolated and patterns of ectopic beats in a rather high number but generally not a number that is too alarming for doctors.  There doesn't appear to be any mention of runs which is good.  This said, with a history of heart disease and the early death of your mother you should have your heart evaluated to be structurally normal.  An echo is definitely called for.  If your heart is structurally fine then none of what you are experiencing is considered a danger to you from what I have read.  At that point it will be a matter of trying to find your triggers to help alleviate the amount you are having, stress is the biggest as well stomach issues.  If you run you may want to ease up on your routine a bit if you push yourself to extremes.  Easing up a bit may give the heart a chance to settle down and be less irritated.  Sometimes people go on meds like beta blockers to help lessen the symptoms. For some it helps for others it makes it worse so you would have to do trial and error to see if it would help you.  Best of luck with the cardiologist and keep us posted on how you are.
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