Help Understanding Holter Monitor Report

Our family doctor had a 24 hour monitor done on my husband after about 4 weeks of resting heart rates in the 90's and sometimes as high as 110-115.  After the results came in they called him in a beta blocker (Metoprolol 25mg), but no one really explained the results to us and they aren't referring him to cardiology.  I work in medicine and know enough to know that SVT can be dangerous even if it's just a few of them so I'm not sure I'm comfortable with it all.  What does all this below mean???  And do you think he should be followed by cardiology???

24 Hour Holter Results are:

Sinus rhythm with periods of sinus tachycardia.
Rare Premature Atrial Complexes and Premature Ventricular Complexes

QRS Complexes 122,603
Ventricular Ectopics - 9
Ventricular Isolated - 9
Ventricular Bigeminal - 0
Ventricular Couplets - 0
Ventricular Runs - 0
Ventricular Beats in Runs - 0
Supraventricular Ectopics - 3
Supraventricular Isolated 3
Supraventriuclar Couplets - 0
Supraventricular Runs - 0
Supraventricular Beats - 0

Average Heart Rate 85
Max Heart Rate 147
Min Heart Rate 50

[tom_h]

Actually, most SVT's are not dangerous.  I had 54 years of it.  I'd say for a 24 hr. monitoring period, this isn't bad at all.  It appears that he experienced 9 ventricular ectopic, most likely premature beats.  If this is the case, this is nothing to worry about.  I'd say the same about the supraventricular ectopics as well; PAC's.  Interpret the term "rare" as very seldom.  His max heart rate could have been from walking up a flight of steps, or walking to get the mail.  It's really not that bad.  Average rate 85 could be a little high, but certainly within the average.

Metoprolol (Lopressor) is a very common, very cheap beta blocker.  25mg is a very low dose.  I'm on 75mg, and experimented with dosages up to 200mg. back in the days before my EP study.  My cardiologist has prescribed dosages as high as 400mg. per day, so his dose is very small, and there's a lot of room to play with without feeling its effects.  I actively skate and coach today on75mg. with minimal effects other than taking a longer time for my heart to come up to "operational speed".  75mg. also has no effect on my libido, a common side effect.  

A yearly cardiology check would be prudent just to monitor what's goin on.

[is_something_wrong]

Hello.

I don't understand why you mention SVT here (and as Tom said, most SVT runs are not dangerous). A "normal" heart rhythm with a heart rate above 100 is pr definition also SVT, but the expression SVT is usually reserved for those having abnormal electrical pathways in the upper heart chambers. It's causing sudden extreme increases in heart rate (usually in the 160-200s but may be as high as 250).

There are no runs of abnormal heart rhythm in the report. He has a few premature beats, we all have those. They have nothing to do with SVT or other arrhythmias.

The heart rate is supposed to vary through 24 hours. To compare, at my Holter test, my lowest heart rate was 39 and my highest was 186. Even that was considered normal. I had a heart rate of 186 when running to the bus, and 39 once at night. My average was in the low 70s (I don't remember exactly), and as Tom said, 85 is slightly above average but not a dangerous number. We all have different hearts, some of us have a slow resting heart rate and a low max heart rate, some of us are opposite. It's not a "right" and "wrong" there. A truck engine works different from a motorcycle engine. But they both work.

It's not easy to say if visiting a cardiologist is reasonable. In my country, only cardiologists do Holter tests, and they interpret the rhythm strips, not just the summary. I guess it depends on the symptoms. If he has discomfort with his heart rate, it sounds reasonable to see a cardiologist. If he is experiencing lightheadedness, chest pain, shortness of breath, etc., it sounds very necessary.

Also, to visit a cardiologist can provide a lot of reassurance.

[michellepetkus]

I believe there may be a misunderstanding of acronyms.   SVT is Supraventricular Tachycardia or a fast beat originating from the atria and is generally attributed to an extra fiber/pathway in the heart or other structural abnormality as the previous poster described.  It is not the same as Sinus Tachycardia which is a normal heart rate albeit faster than normal.  This is sometimes caused by a problem in the heart but more often than not it is caused by something outside the heart like, thyroid issues, electrolyte imbalances, lung issues to name just a few.  A resting rate of over 100 iis a bit high but not a dangerous rate though if this is a new symptom that isn't resolving it is good to try and find out why the heart rate has become elevated but in general if the heart is healthy the rate will not put your husband in more danger.  This all said, I do believe your main concern may be the Ectopic beats your husband is having.  Pacs are extra beats in the atria and Pvcs are extra beats in the ventricles.  In a healthy heart these are also not considered a danger.  It is believed that most people will have them at some point in their life some getting them every day but most people won't even feel them.  But again, if your husband's heart is healthy they really are not a concern unless they are causing troubling symptoms.  To some extent they are a nature way for the heart to ensure it keeps beating if something goes amiss but the medical community doesn't really know why the occur in an otherwise healthy heart.  Who knows, maybe after a flu or something a few developed and once they flare off they have the ability to continue to do so but the bottom line being they really aren't a threat.  So all in all your husband's holter report looks pretty normal which may be why you were not referred to a cardiologist though if your husband's resting heart rate continues to stay above 100 you may want to pursue having other possible reasons investigated.  Take care.

[rmlyonsfamily]

Thank you, all, for your input.  

I should have probably started with the fact that he has always had heart rates in the 60's and sometimes 70's.  He had brain surgery August 1st and even still continued in the 60's and 70's.  All of the sudden, 4 weeks after surgery, he started getting short of breath even just getting up moving around the house and felt his heart beating hard.  We started tracking it and it was consistently in the high 90's low 100's at rest and even just standing was 130+, going up and down steps even harder.  After a few weeks of it they did the holter monitor and this was the report.  

That all being said, the Metoprolol 25mg is working and he's back down in the 70's and his energy is returning.  So glad for that!!!