Help Please - Event Monitor Issue

This evening, I called to transmit my event monitor recordings.  After the transmission, the operator tells me to take a current recording and send it over.  I asked him why, since this was not normal protocol.  He said something showed up in my recording and they needed a current recording to "see what my heart's doing right now."  Needless to say, this scares me.  I asked him if it was anything serious.  He said it was just something they saw that they're supposed to fax right away instead of waiting the normal 24 hours.  Of course, he couldn't tell me what it was.  I've been having many PVCs and have sent many recordings over the last week.  The last couple of days, thank God, have been pretty quiet with the PVCs, but last night, after just falling asleep, I woke up with my heart beating fast.  I've had episodes like this in the past.  My heart will beat anywhere from 100-150 bpm  and I feel really pannicky.  It usually just lasts a couple/few minutes.  Does anyone have any input as to what they could have seen that they would have to report right away?  I swear, it's always something!!!!!!!!

[bbxx]

My guess is perhaps they saw what they thought was a run. Before you freak out any further, when I went through this I was also FREAKED out. For me it ended up that they saw a (possible) 3 beat run. My EP told me he does not believe it was that and there was static in the way and the ones reading it assumed it was a run and he says it was not. Remember, no matter what it was, you said you have had it before and you are still here--so dont think death ok? If there is an emergency--they will call you in. Keep us posted.

[tom_h]

Here's what happens with the typical 30 day event monitor.  They can be setup differently, but are often set like this: When it begins to record, it jumps back 30 seconds to hopefully catch the beginning of the event.  It will then record a preset amount of time; let's say 2 minutes.  If the recorder stop while the event is still in progress, the lab reading your telemetry, has no way of knowing if the cardiac anomaly was terminated or if it's still in progress.  They are responsible for your safety for the period of time that you wear the recorder.  So they may insist that you record a fresh one, and immediately transmit it to them to insure that you are in NSR.  If you refuse they WILL call local rescue to your house.  This happened once to me during my 30 day, and there was no way that I could talk my way out of a fresh recording even though I obviously knew my SVT had been terminated.

[ireneo]

I've worn Holter monitors and event monitors many times over the years. Only during this last time with the event monitor did they ask me to do a recording while I was on the phone after sending some tachy times. I just figured it was some new procedure like doing a baseline x-ray or MRI on a body part. They like to have something to compare against the irregular times. I don't think it means anything ominous because I'm still here and doing fine.

[AbnormalHR]

Thank you all for your responses.  I called my doctor's office today and they told me that what they saw was trigeminy.  I asked him if it was anything to worry about, and he said "well it's not life threatening."  It was like, well it's not life threatening but it's something to worry about.  At least that was the impression I got.  I guess I was relieved that it wasn't something really serious.  He said they'll just keep watching it.  I don't really know what to think.  I haven't really felt anything like 2 normal beats and 1 skipped beat, unless that's what was happening when I woke up to a fast heartbeat the other night.  Does anyone know what trigeminy feels like?

[bbxx]

Well, yes. I dont know how to explain it. I get tri and bi and couplets. It just feels -gross.
Instead of occasionaly feeling a skip, you feel flopping. (at least for me).

[jimbeau]

I have tri's and quad's sometimes. they feel like a strong beat followed by a longer than normal gap before the next normal beat.
Never had a couplet, don't want any!!!

[twinbee]

I would not be too concerned. I have been on several event monitors throughout the years, and if it was anything serious, your doctor would have called you. I have had that happen to me a couple of times when I went into V-tach,. The monitoring place called me and asked me to resend a recording, then about 20 minutes later, my doctor called me and told me to go to the hospital. So, my guess is, that if you have not heard from your doctor, it really wasn't anything serious to him. Good Luck! Wishing you well, and wishing you enough..

[cardiactech22]

I can tell you are a cardiac sales person. Most patients do not know what NSR is. I work at JH and baltimore shock trauma, as well as a local monitoring center, and I can tell you that needing a follow up recording while on the phone with a patient means one of two things: either an arrhythmia needing triage was seen (in which case they compare the previous heart conduction recording to how the heart is conducting now) or the technician sees "artifact" (electrical noise caused by a bad electrode hook up, faulty wires, or in need of a fresh set of electrodes) and needs the follow up to see if the monitor is able to record an EKG. If the tech sees a three-beat run of PVCs, this is a ventricular triplet and is not noteworthy by cardiologists. If they see four or more in a row, this is considered ventricular tachycardia (VT), and the cardiologist must be notified immediately per ACC and AMA medical protocols. However, these protocols can be altered per patient diagnosis; patients with persistent or recurrent episodes can have their triage limits increased, so a patient with many four or five beat runs of VT can have his/her traige limit increased to 6 beats or more, etc.

PS. Refusing to comply with a follow is NOT evidence to send the local fire and rescue to a patient's house and can constitute medical negligence, as you have just unneccessarily put the patient in harm's way by scaring them. The cardiologist must be notified by the technician, and the CARDIOLOGIST makes the call to the patient or local fire/rescue, not the technician! Technicians aren't even allowed to tell you take aspirin for a headache, do you really think they are qualified to make this type of medical alert? This is reserved for an RN, EMT, or MD, not a CCT.

[cardiactech22]

Ventricular Trigeminy is where you have a PVC or ventricular contraction every third beat, so it goes: normal............. normal..... PVC...(compensatory pause)................... normal........... normal... PVC...(compensatory pause)..........
This is something to keep watch of but not get worried about because:
1). It occurs more frequently than most people think
2). It is still a regular rhythm (they call it regular-irregular, as the main rate and rhythm is normal with the exception of the PVC.)
3). It is something to watch because in later years it could develop into Bigeminy which is a PVC every other beat: normal.... PVC..(compensatory pause)........ normal.... PVC..(compensatory pause).......... normal.... PVC..(compensatory pause)..............
4). If not medically managed, it could lead to ventricular couplets (two PVCs in a row which is still okay), then triplets (three PVCs in a row which is still okay), then Ventricular runs (which is four or more PVCs in a row which is something the cardiologist must address immediately).

[cardiactech22]

That "gap" is called a compensatory pause, and it happens because your heart will pause slightly in order to go back to it's normal rhythm. Say you have normal beats, about 60 beats per minute (bpm), which is one beat every second. Then a premature atrial contraction (PAC) or premature ventricular contraction (PVC) occurs before the full second has occured; the pause is the rest of the time need for the next beat to occur at the 2nd second mark.

Imagine three beats, each one second apart. Now take the middle beat and move it closer to the first beat. The middle beat occurred prematurely (hence "premature") less than a second, and the time between the middle and 3rd beat is longer than a second. The time between the middle and third beat is the compensatory pause, because your rhythm compensates by waiting a little longer and then going back to it's normal 60 bpm, one beat per second, rhythm.
Here's what it look like:

Normal Sinus Rhythm (NSR):
(Beat)--------------------------(Beat)---------------------------(Beat)---------------------------

Premature beat with compensatory pause
(Beat)---------(Early Beat)------------------------------------(Beat)---------------------------

The period after the Early Beat is the compensatory pause, or the "gap" that you are feeling.