Can you help me interpret these holter results?

[bondieluv]

Hello - I'm brand new here, this is a really reassuring place to read over!  I am a 44 year old mum of two, slightly overweight (not a lot), physically active, and have had PVC's for about  5 years.  They got "worse" lately so I had a holter monitor on, andI got my holter monitor results today, and the reading Cardiologist has recommended a referral to an arythmia specialist - so I guess that is who will read these results to me, my regular doctor just said to me to not worry.  I tend to be anxious and I'm an introvert, people tell me I appear very calm but inside I take life pretty seriously...I am on metroprolol 25 mg for my 3rd day (2x a day) and that has seemed to calm down things quite a lot.

Anyhow, here's what's written...I have left out what there's no information about...

General
109769 QRS complexes
2823 Ventricular beats (3%)
4 Supraventricular beats (<1%)
100 bpm) 12% total
22099 beats in bradycardia (<60 bpm) 20% total
1.36 seconds max r-r at 5:33 a.m.

Supraventriculars
4 isolated
0 couplets
0 bigeminal cycles
0 runs totalling 0 beats

Okay just typing all that made me scared again.  Thanks for any help...

~Karen

[Momto3]

Hi Karen!

Welcome to the Heart Rhythm Forums!  This is a wonderful place for learning, listening, sharing and venting : )

I am not a doctor, but have had my share of Holters.  Here's what I can gather from what you have written:

During the entire recording period, you had 109769 QRS complexes (heartbeats).  Of those, 2823 (3% of the total) were ventricular beats.  These are extra beats that originate in the heart's ventricles (also known as PVCs, or premature ventriular contractions).  You had 4 (less than 1% of the total) supraventricular beats, or extra heartbeats that original above (supra) the ventricles in the atria. (PACs, or premature atrial contractions).

I'm not sure about the reference to "100 bpm) 12% total"

22099 (20%) of the beats were considered bradycardia (<60 bpm). Depending on how low the HR was, you may or may not have been symptomatic.  Many people have HRs below 60 and are healthy.  That's something your doctor will be able to tell you more about based on the rest of your exam.

Not sure about "1.36 seconds max r-r at 5:33 a.m."

Supraventriculars
4 isolated - these are the PACs noted above

You had no couplets, bigeminal cycles or runs.  Couplets are two ectopic (extra) beats in a row with no normal beat in between.  Runs are 3 beats or longer with no extra beats in between.  Bigeminy is when every other beat is an ectopic.

Hope that helps.  When is your appointment?  That's great that the beta blocker is helping to calm things down : )

Connie

[bondieluv]

Hi, Connie!

Thank you for all that information!  The trouble is that I don't have any idea when my appointment is, my GP refers me to the specialist who then will interpret my results (as listed above) - and I'm also scheduled for an echocardiogram, again I have no date yet - both the specialist and the echo people will call me when they have a date/time for me. In the meantime my GP who is one of the most lovely doctors you'll ever meet, tells me not to worry, which I am trying very hard not to do but then the fear sets in - because of course this isn't my knee or elbow or earlobe we're talking about here...and then I have a panic or a few tears and I'm good to go for a few hours...

I kind of rest on the hopes that if this situation were urgent, I wouldn't be sat at home typing to you...?  The not knowing whether I should worry, well, it worries me!!

~Karen

[bondieluv]

That line I missed, under "Heart Rates", reads

13251 beats in tachycardia (>100 bpm) 12% total
22099 beats in bradycardia (<60 bpm), 20% total

~Karen

[Momto3]

Karen,

Your reaction is completely normal!!  We hear "cardiologist" and we're running out the door....MY HEART?  HOLY COW!!!  But, I feel fine!!  The fact that your GP is reassuring is great!!

OK, so on the report.....

You had 13,251 beats where your heart rate was over 100 (anything over 100 is considered tachycardia)
You had 22,099 beats where your herat rate was under 60 (considered bradycardia).

Do you remember exercising or something stressful when the HR was above 100?  Sometimes, our HR goes up because we are active.

Also, HR below 60 while we are sleeping is not really a problem.  Any idea from the printout the times of these occurences?  

I think you're gonna be fine.  But, if I were you, I'd worry until the cardiologist told me that....LOL.  Seriously, if your GP was worried, you're right, you would not be typing on the net.  Take care and post whenever you like.  We're all here to help one another learn and to support one another.

Connie

[bondieluv]

Hi there Connie

...so here's an update to this holter and referral-to-an-arythhmia-specialist thread...I called the specialist's office today and the secretary told me that the specialist has reviewed the holter report, and they will be mailing me my appointment date for in the fall of this year.  My husband said I have reason to be relieved because if it was urgent, they wouldn't have decided to wait til fall to see me.  

To answer your questions, the report doesn't specify when my heartrate went fast, but at about hour 22 of the 24 hour monitor, I started stressing that after waiting for so long to get the holter monitor test done, the thing wasn't going to record anything, and then whamo, all my symptoms came in full blast once I was good and anxious.  I believe that's when the tachycardia was recorded, I saw the strips/pages that showed the tachycardia and remember noticing they were towards the end of the test (I didn't ask for a copy of those).  The letter with the report states that I will need an echocardiogram "to determine her left ventricular function" as well as the referral.

In your experience, if there was something urgent going on, with this many doctors involved, someone would have pushed the panic button?  I am SO trying not to worry, but I'm not doing that well at it...and funny thing is with the 25 mg metroprolol, my heart is really calmed down, not to say there are NO palps becuase they are still there somewhat, but they are so much calmer and less frequent, that if I didn't have the prognosis to worry about, I would probably be feeling pretty good about the medication helping!

Thank God for this site and these people, I feel much less alone now!  Thank you for your help, Connie...

~Karen

[upbeat633]

Well, if sharing my story helps you to not worry about your situation until you can see the electrophysiologist in the fall...then here goes:

Connie, as you know my E.P visit was today, after wearing the event monitor for 3 weeks. I suspect he is a nice, patient fellow, he seems so.

He smiles, "so you have a lot of pvcs". Yes, I know I reply. It could have ended right there. Nothing new.

I'm almost constantly in bigeminy, lots of couplets, triplets, doesn't matter. He says people can exist indefinetly in bigeminy no problem. He says pvcs are mostly annoying. And I said, well if you will allow me to turn the light on and off 20 or more times a minute while we sit here, I can assure you they are more than annoying. He looked startled, as if I would actually do it. Then he said, well, we'll have to work on getting the rate down. He thinks I should increase the beta-blocker. That's it.

He believes my pvcs are unifocal, but again, he highly recommends against ablation, he wouldn't do it, because of the risk of stroke or other serious side effects. And he nixed anti-arryhthmics again because he believes it's more likely to cause a life threatening arryhthmia.

PVCs are benign, bigeminy, couplets etc. etc. benign, benign, benign. I'ved lived with them 27 years, he thinks my heart is healthy, I'll live another 27 easily (I better).

So my chin is up. The estimate is 30,000pvc/day, lucky me. Guess I'm not in the record book yet though.

[bondieluv]

30,000 PVC's a day??? Holy crow you have my sympathy, that would be exhausting and more than a little distracting.  By the way, I had to chuckle about the light thing - too funny (and also completely accurate).  Sharing your story definitely helps, it's reassuring knowing others are getting on with their lives in spite of these things, and that you have been able to do so for the last 27 years.  I pray for you 27 more at the very least, attitude and humour inact!

Up until last week I didn't even know what a beta blocker was.  Can you believe that.  Thank you for sharing and for your positive attitude.
~Karen

[Momto3]

OMYGOSH, what a story!!  I know exactly what it feels like to be sitting there with 20-30k PVC/day and to hear, "benign, not a problem, learn to live with 'em......"  Heard it from a number of cardios....You know how things turned out for me, but I think as long as you remain vigilent to any changes, you're just gonna have to change the lightbulbs more often.  Sorry, but you know I LOVE that analogy!  

I heard the same advice on anti-arrythmics and on ablaiton for years.  When I learned to live with 'em, they snuck up and wreaked havoc on me : )  

It does seem as though the doctor has a good feel for what's going on.  I'm not sure I'd up the ante (BB) since you seem to manage them....something to think about.

I hope Upbeat's story has been helpful.  She is a great contributor on the forum and she has "been there, done that" a LOT!!  She and I have joked that not being in bigeminy feels weird because we're so used to it.  Now, that's weird in and of itself : )

The reason the doctor mentioned the LV function is because sometimes (rarely) having a lot of PVCs can lead to a change in the heart's pumping action.  There can also be structural reasons, but I think you're in good hands.  I do believe the doctors would have jumped if they thought something needed attention now.  Stick around and we'll help you along the way.  In the meantime, you're gonna have a great summer!

connie

[bondieluv]

Thank you ladies...you make me smile!   :)

[upbeat633]

Now it's my turn to laugh, change the lightbulbs more often?! Hilarious.

I think I will stick with my current dose of acebutolol because I'm getting the sense of icy feet now, and while the EP thinks the dose is the smallest possible and couldn't possibly cause poor circulation, I think I know my body.

I think it's also caused some mid back pain, and I have an urge to cough now, like I have to clear something stuck in my throat. I didn't have those before taking it, but which of course could be caused by a million other things. If the acebutolol doesn't keep the multiple pvcs at bay, I may decide to go back to the inderal as needed.

I wish everyone a terrific weekend.