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V Fib? arrythmia
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V Fib? arrythmia

Ventricular fib?
i was recently in hospital due to a collapse which resluted in me being shocked twice.i seem to collapse quite a bit but this first time i did not wake up.they have called my previous collapses possible ventricular tachycardias?
Im 19 and have no cardiac problems,normal heart etc.
i have uploaded my ECG in my pictures on my profile
i think in my ecg i can see R waves?but maybe im wrong??because if there are R waves maybe i was not in cardiac arrest?? any healp is much appreciated i am very worried
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1124887_tn?1313758491
You need to keep in close touch with your cardiologist or electrophysiologist.

I'm not a doctor, and this is a serious situation, so it would be wrong if I tried to give you a diagnosis here. The only thing I can say is: Normal hearts don't produce rhythms like this.

It's not possible for me to say for sure if this is ventricular fibrillation or polymorphic ventricular tachycardia. The first rhythm strip looks a bit like polymorphic ventricular tachycardia, I'm not capable of telling you which one of them, a doctor could do that, and it's important for your diagnosis. You may (but impossible for me to say) have some ion-channel defect (LQTS and Brugada syndrome are the most common ones), though they would probably manifest on a resting EKG.

When did you have your syncope events? During exercise/stress or at rest? If you only get them during stress or exercise, and your resting EKG is normal, there is an extremely rare condition that doesn't show on EKG that can cause polymorphic ventricular tachycardia and ventricular fibrillation.

Anyway, what did your doctor say? Are you on any medication for this? Try to post the question on heart disease expert forum if you can. And stay in close touch with your cardiologist. I wish you the best, but you need to get a diagnosis and to get this under control..
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1528249_tn?1291879339
Thank you so much for your reply.I have syncope events quiet a bit but this has been the most serious as i normally wake up. but i never get them when under stress just when i am at rest.I do get palpitations at all times tho. My Ecg is completly normal :) Anyway the doctor put a reveal monitor in me? but i dont see how much good it will be to have the reveal data if there no one to defib me and i dont survive.i have had an EP study but nothing was inducable and my heart is structured fine.
My doctor has me on MEtoprolol (a beta blocker i think) and Dysopyramide which may also be called norpace or rythmodol i think.Thank you for your best wishes.
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967168_tn?1343732745
please please please get another doctor's opinion; also get a copy of your tests/records and look them over and that way you'll have a copy for a 2nd opinion; VFib is not normal and very dangerous so they need to get to the root of the problem and find out what's wrong.

very interesting photo, I tried to get a copy of my Polymorphic VT runs and the hospital didn't send me it so it's cool to see someone with one similar to what I think mine would look like

there has to be a reason for your heart doing this, hopefully you'll find some answers soon - btw I'm shocked the dr didn't implant an ICD (defibrillator) instead of a loop recorder, that's the first thing my dr suggested when I woke up from my ablation.  
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1528249_tn?1291879339
Hi lisa,
They are trying there hardest not to have to put an implantble ICD in cos of my age..i think it was silly they just put a loop recorder in. Am i allowed to ask for another doctors opionon?Im in NZ and health care is free,so i not sure if i can ask someone else??
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995271_tn?1312416925
I'm not an expert in reading ecg.

My initial reaction was that it looks like Coarse Ventricular Fibrillation.  I could be wrong though, it might be what is_something_wrong stated.

The way a heart rhythm can degrade is to go into sustained v-tach, which can degrade into Coarse Ventricular Fibrillation.    Those are the two stages of ventricular arrhythmia in which the heart can be hopefully shocked back into normal rhythm.  If Coarse Ventricular Fibrillation is not corrected it will degrade into Fine Ventricular Fibrillation.    From what I recall reading a heart cannot be shocked into a normal rhythm once it degrades to Fine Ventricular Fibrillation, it's over.

Have you confirmed with your doctor what rhythm he/she feels was recroded on the strip?

If it was coarse v-fib, I would think that an ICD should be implanted on an emergency basis.    I thought anyone with any hint of venturing into v-fib means that an ICD is mandatory, age has nothing to do with it.

Have you been evaluated for Arrhythmogenic Right Ventricular Dysplasia (ARVD)?  If it was v-fib I also think that it would be a logical step to rule this in or out.  If you are being told your heart is structurally normal I think that's enough to basically rule it out which is good.
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995271_tn?1312416925
p.s., another clue on the strip is the shock energy used.  It looks like they started at 200 J, which means 200 joules of electrical energy.

From what I read the protocol for v-fib is to start at 200 J and keep working up until it resolves.  V-tach protocol starts at 100 J, then work up until it resolves.

Could mean nothing but it might be another clue, in other words I'm still thinking it was coarse v-fib.

Where, when, did this happen?  How long were you out before someone with an EKG and defib got to you?
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1528249_tn?1291879339
hey thank you so much for your response. the first ever time i passed out i was in thailand on holiday. and defib was placed on me and i was in monomophic VT? does that sound right?
anywho i live in new zealand and my cardiologist wants to capture some vt in nz b4 implanting an ICD. My crdiologist thinks that it was Vfib,but my nurse put the question into my head about the possible R waves .I was out for a minute or two before i recieved treatment,i was outside a mall and just passed out. again thank you for your reply!!!
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995271_tn?1312416925
R waves are a normal part of ventricular contractions.   There's not a single normal variant R wave on that strip, I don't think.

If your cardiologist thinks he sees v-fib he should have implanted the ICD I think.  Waiting to see what happens next when you know a patient went into v-fib for no particular reason (idiopathic) is just plain dangerous.  Perhaps I'm  being flippant, I know from experience that when I only have 1 side of the story I shouldn't jump to conclusions.  

Try searching on "idiopathic v-fib", that might give you more options to think about.  

There's a lot that can be going on here too  Another idea I had was that the meds you are on can be making it worse.  I don't know off hand and it's getting close to my bed time here, but I think norpace can cause abnormal rhythms when used in a healthy heart?  I could be wrong.

On the monomorphic VT, yes that sounds right.  My first thought when I hear that is it's ablatable if they can reproduce it in the lab and find the focus that is misbehaving.  The catheter can buzz those trouble makers out of there.

I'm hoping you can get to see a different cardiologist.  Whenever troubleshooting a complex problem it's always wise to get a second set of eyes on it.
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1124887_tn?1313758491
This is a mystery.

Like I told you, I can't interpret the rhythm strips because 1) I'm not a medical doctor, and 2) they are confusing. It can be ventricular fibrillation (especially the second strip) and it can be polymorphic ventricular tachycardia. Some define polymorphic ventricular tachycardia as a variant of ventricular fibrillation, but it's not completely correct.

What makes me doubt, is that I can't believe a doctor would not treat someone who survived ventricular fibrillation with an ICD. As Lisa said, you should definitely see another cardiologist. Make sure to bring the rhythm strips you have.

What is important, is what's happening before the tachycardia/fibrillation, what's triggering it. If an EP study didn't find any triggers (they will probably even try to induce it by pacing the ventricles during the so-called "vulnerable phase" at the end of the repolarization, as some people will get arrhythmias in that case), it's possible the problem is in the heart cells, and their ion channels. Some people have a "hidden" LQTS but this is rare. the condition I referred to in my last answer would not show an abnormal resting EKG but it would only be triggered by adrenaline.

Are you bothered with PVCs all the time? Some PVCs can induce ventricular arrhythmias but they are usually only present in the setting of heart disease, and an EP study would probably have found them. There are conditions like abnormal coronary arteries (not angina) but again, it would probably have given symptoms only with exercise.

My only advice is: See another cardiologist as soon as you can. Don't accept "don't know" as an answer. Bring all your test results.

I really hope you find out what this is. Take care :)

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967168_tn?1343732745
IMO either way...VF should be treated with an ICD in case of another episode - not wait and see if you have another episode and guess what...the nearest defibrillator is miles away - this is just my opinion and what I've gone through and lived with as a patient with VT & VFib

btw when I got my shocks they were 360J; and 17J to test my ICD; I think it's 200–360 J typically used to bring about normal sinus rhythm.

yes I think with monomorphic vt it can be ablated; but it's very tricky - if it were like mine with polymorphic then probably not -  here's some info I have on VT/Vtach - http://www.medhelp.org/user_journals/show/228899/VTACH---VT-?personal_page_id=861727

You may want to read and ask here: http://www.icdsupportgroup.org/  the ICD support group is a great bunch and can answer alot more questions about the need for one. There are all age groups in the forum - I know one young woman is 19 and has had an ICD for many years and I think you'll find quite a few from NZ & Austrailia in the group as well =)

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1528249_tn?1291879339
thank you all for your answers,my cardiologist put the reveal in to see what happens before i went into this rhythm, but i think its sill as i dont want this to happen again like you said and there be no defib to save me. i will go and see another cardiologist for a second opinion. or maybe even my GP? ill definatly check out those websites thank you so much :D
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995271_tn?1312416925
I think getting a GP involved would be a great idea.  I'm a firm believer that GPs should be managing the specialists.  If you do nothing but go to specialists your care knowledge becomes isolated on islands.  The specialists will not communicate, they generally just don't.

A GP should act as your care "manager".  They will get the reports from the specialists and tie it all together.    It's another set of eyes too.

I was getting no where with my condition.  I was on my 3rd GP before I found someone that would take a proactive role in managing the cardiologist.  I value my GP not for his knowledge but for his ability to take the findings, step back to see the big picture, and strategize our next moves.    This has worked wonderfully.  
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