Palpitation Evaluation

[Hiker in Hawaii]

I've had palpitations for years like many on this forum...Had fair amount of tests (countless bloodwork, Echo, chest X ray, Holter, Event Monitor, everything was normal on echo, blood, EM revelaed some brief runs of atrial tachycardia)....Shortly before Thanksgiving, i called my cardiologists office, mentioned to nurse that was having palpitations and can we do another event monitor study....She said she's talk to MD...About half hour later, the doctor himself called and said we really do NOT need to do another EM study...I had, in my usual fearful way, said i was worried about palpitations degenerating into something lethal V-Tach, V-Fib....He laughed, and in a nice way said, paraphrasing "if i thought your palpitations were serious, i wouldn't be monkeying around"...So he reassured me, and again asked if i wanted to start on some beta blockers i think it was, but was strongly against another EM study or doing other tests..

My question for CCF-Cardio MD is when your're evaluating a patients palpitations, when do you determine whether or not that palpitations are benign and harmless or whether they are of a serious/life threatening nature?..What convinces you one way or the other?....Thanks

[Mom2four85]

figures you would get an answer, but not really anything pertaining to your question lol

[CCF HeartMD-2]

Dangerous heart rhyyhms are those that cause either sudden death or cause syncope (passing out).  These heart rhtyhms may be fast or slow.  In general, the dangerous fast heart rhythms come from the bottom chamber of the heart, also known as the venticle.  The rhythm you have (atrial tachycardia) is a fast, organized rhythm coming from the upper chamber of the heart which is not typically considered a dangerous rhythm, and can either be controlled with various medications, or if these are not succesful, then a cardiac ablation.  However, these treatments would only be offered to improve symptoms, not longevity in the case of atrial tachycardia.  

[snarky348]

All I can say is I know how you feel.  I'm going to try to post my story to the doctor here soon.... yesterday morning I had about a 3 minute run of a very chaotic rhythm after being relative symptom free for the better part of 18 months...the reason it scares me so much one reason is that it's just so unpredictable...any time any where, it comes and goes as it pleases...not fun if you're trapped in a car or something.

[Mom2four85]

I'm anxious to see what the dr here at MH or CC says.

I've asked the same questions alot since June 2009 and the answers I get don't add up to me. I don't think dr's know enough about arrhythmia's and sometimes symptoms or cases such as mine get dx as "benign".  I was told since my echo was clear and showed no structural damage I was fine (which I still question) yet 5 weeks later I had some major stuff going on and nothing in my system or life had changed and I was DX with MALIGNANT arrhythmia's where I didn't have them before.

Mine weren't benign even though an echo; which is supposed to be "gold" standard of diagnosis; said I was fine; one of  my ekg's said my pvc's were multifocal and they still didn't think anything was wrong.  When I ask dr's or ask here about echo's and the research I found I get a blank stare and am told they don't know about the standards of echo's LOL

What are the parameters of echo's and where are they listed or regulated and where do doctor's get their 'gold' standard parameters for echo's from? I still haven't found that answer.  I'm sure there's more than out there than even I've found, I just got tired of searching.

read this for more info: One size fits all Echocardiogram? http://www.medhelp.org/user_journals/show/245023/One-size-fits-all-Echocardiogram?personal_page_id=861727

"Even though the labs routinely used the terms "mild," "moderate," and "severe", they admitted that they had no standard guidelines as to what exactly these words meant.  This means that interpreting echo results is partly subjective.  Sources of variability include the patient, the echo tech, the techniques used to obtain the images, the methods used to analyze the images, the equipment, and the reader."

btw, if it's any help, I've read and been told 95-99% of pvc's and arrhythmia's are "benign" and if you've had a full cardiac workup that shows normal there's nothing to worry about, unless you're very symptomatic or pvc's are above 15% of your total 24 hour heartbeats (roughly 15,000+daily)

[tickertock]

I feel your anxiety, but the fact is with a normal cardiac evaluation even complex ventricular ectopy is usually "benign" and carries no adverse prognosis.

An important factor is family history usually sudden cardiac death below 40 years old, if there is none and extensive testing doesn't give a hint of the SCD syndromes such CPVT, LongQt, ARVD/C and Brugada then the doctor can reassure patients they have a benign arrhythmia and no further testing warranted.
Remember nothing is 100% in life besides death and taxes" not trying to sound cold or joke" but the probably of you going into life threatening cardiac arrhythmia is very minute and on par with the general population without palpitations!

I wasted alot of my life worrying about this stuff, I'm 46 years old and still going strong and my palpitations now is the less they ever been in my life! If you've been reassured by your cardiologist that you are ok, just go on living and try not to let the palps get the best of you , I won't say ignore because its impossible to, just don't let fear get the upper hand . Good luck!