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31,000 pvc's - Holter Results

I haven't been able to find anyone with previous posts similar to mine and I need some help in determing these results.

I am a 33 yo Female experiencing fatigue, dizziness, shortness of breath, memory problems, vision problems and syncope....I generaly have a low heart rate 40-60 and low blood pressure 100/60.

Holter Results...

Minimum HR 39
Max HR 99

VE Total 30,988                          SVE Total 149                SDNN   227
V Pair 48                                     SV Run 5
V Run 8
VE per House  298/1348                        
R on T 36

Atrial Bigeminy events were 1120 and Atrial Trigemeny events were 2171
No Vent. Bigeminy, No Vent. Trigeminy, No Atrial Fib/Flutters

Echo Results....
EF 52%

Are these normal and what can I expect to hear from my Cardiologist?
10 Responses
967168 tn?1477584489
I'm sure others will post also; but I've had pretty much what you posted you have.  A couple of things I notice; while you do have very frequent pvc's no bigeminy or trigeminy is there on that date.  Did you have a stress test or any other tests done?

Your EF is a bit low and it sounds like with your low bp/hr's and other symptoms such as dizziness, fainting etc you have autonomic nervous system issues.

Did they do blood tests that include complete electrolyte panel including potassium, magnesium etc and have they done a thyroid panel with TSH, Free T3, FT4 TPO antibodies.  

Also, have you had a tilt table test to determine the cause of your syncope?

31,000 is quite a bit of pvc's and they need to see if they can find a cause and if meds will help; but with your symptoms they may not and you'll need to see an EP (electrophysiologist) and an ablation may be beneficial.

I've had ans issues and arrhythmia's since I was 9 but didn't find out until I was 42 what was going on for awhile I was in bigeminy and had 50,000+ pvc's...it's been an eventful 2 years =)

def mention a TTT and blood tests to see if they can find a cause and if none found and the pvc's are bothersome; i'd go for an abltion instead of long term meds

if you want to do some reading on the ANS, you can browse through the dysautonomia (autonomic dysfunction)  forum here http://www.medhelp.org/health_pages/Neurological-Disorders/Autonomic-Dysfunction--Dysautonomia-Index-Page/show/857?cid=196
Avatar universal
Wait...what about R on T....I thought that was dangerous?
1124887 tn?1313754891
Well, 31.000 PVCs each day is NOT normal and may easily explain your symptoms. Luckily, most of your PVCs are singles, but you have some more advanced arrhythmias like paired PVCs, runs of PVCs, and a few early PVCs. You definitely need to follow this up with your cardiologist.

If you don't have any heart disease as cause for this, it's not necessarily dangerous but that evaluation must be done by a cardiologist. He should also see the entire test, not just the summary, to evaluate if the PVCs origin the same place. If they do, they can probably be ablated (removed)
Avatar universal
Thanks for the replies, this is pretty similar to what I have found in my own research.  I do not have heart disease and my lab work is normal.  How can they determine if the PVC's origin from the same place?  I have been evaluated from a cardiologist and I'm hoping that he reviewed the entire holter report.  Another concern of mine is that I had a holter 5 years ago that he kept mentioning although those results were 9,000 PVC's in 24 hours.  Still waiting to hear back about my echo which was yesterday....but the tech performing it said everything looked okay other that the "extra beats"  and my ef was 52%.
1124887 tn?1313754891
It's good that your echo is normal, but you can still have a very annoyed spot in your heart that keeps producing those PVCs. They can see if the PVCs origin the same place from looking at the waveforms on EKG, if they look similar, the PVCs origin the same place.

Honestly I don't completely understand how Holters work in the US (so my answer was maybe a bit inaccurate). It seems like you get the results (the computer interpretation) before you see the cardiologist, which I find weird. In this country, we never get to see the interpretation unless we specificly ask for it, the cardiologist will interpret is and provide his results. For example, my Holter report were as follows:

"24 hour EKG monitoring: Sinus rhythm with average heart rate 76, no significant tachycardia, bradycardia, pauses or arrhythmia. Rare premature atrial complexes, otherwise normal findings".

Also, the cardiologist him self does the echo, and you get the results immediately.

It seems your heart rate is slow and that may contribute to more PVCs. That also makes treatment with beta blockers difficult because they may in some cases worsen the problem by further lowering the heart rate and making more "space" for the PVCs.

Please post a follow up after seeing your cardiologist :)
967168 tn?1477584489
bbxx I completely missed the 36 R on T ones; good catch =) maybe Is_something_wrong or Itdood knows? I think typically RonT can be dangerous in the right circumstances - but I can't say I've ever seen anyone's holter mention this phenomeon here? [racks my brain] but I could be thinking of something else entirely.

They may not find out where the arrhythmia's are originating until you see an EP and have an EP Study, but the tests you've had may point to a certain area and give a clue and then there are times they can't really tell.

Dr's had no clue my pvc's and symptoms were anything dangerous until I went in the hospital - I had a TTT and then followed by an EP Study and ablation my heart stopped during the TTT and then 3 times during the EPS; but this is very very rare.

You've had these tests done and don't have alot of answers from your dr if I'm reading between the lines correctly?  

I would write down everything you noted in your tests that seem out of place and when you see an EP; ask what they are, what he/she thinks is causing each one and how they can correct/treat them.  One thing I would ask about is if the EP thinks your increasing numbers and decreasing EF means that you're developing PVC induced cardiomyopathy; which is reversible if treated. [ducks]

Is_something_wrong that's part of the problem here in the US; the machine reads the results and sometimes the MD never looks at the results - he relies on that reading but what if it's inaccurate and he's missed something or his machine is messed up or say his NP doesn't quite have the skill he does?
Avatar universal
I do have a follow up on Friday regarding the echo that was performed yesterday....My Cardio did mention a TTT test and I was going to disregard it, but now I'm thinking that I should do this test.  Maybe because I am unaware of what the test actually does I know my primary wants to order the EP study so maybe I'll get somewhere else with that.  As of now my cardiologist doesn't seemed concerned other than scheduling me for 3 appointments in 1 week at 60 bucks a pop. Like I said he did mention the TTT and possible cardiomyopthy (spelling?)  and shrugged off my dizzyness and near syncope symptoms as vertigo caused by an earache...thus being said I'm sure you can see my frustrations.
1124887 tn?1313754891
Yes, that's a problem and I think that's why PVCs are "overinterpreted" on your reports. My report told that I had 44 PVCs. I had none, in fact.

My cardiologist told me that he had seen cases where Holter computers told about 15-20.000 PVCs and the result was few or none. Holter computers interpret everything wide complexed as PVCs or other ventricular rhythms. Some people have rate dependent bundle branch blocks, and in some people, almost all PACs are wide complexed because one of the bundle branches have longer recovery time than the other, so a PAC will be conducted with a bundle branch block and is wide complexed.

967168 tn?1477584489
dr's often do that with dizziness; fainting and ANS problems. I've been told mine was everything under the sun since I was 9 years old and didn't find out it was anything to do with the ANS until I was 42 back in 2009.  

For some reason dr's think of the ANS as the last thing to cause problems when they should look at it first with the vagus nerve and sympathetic - parasympathetic system (spelling is wrong ugh my brain is foggy w/meds today)

I know what you mean with $$ and insurance/dr's - I have 17 dr's I see lol whereas before June 2009 I saw 1 doctor per year and had never taken meds before, now my fridge looks like a drugstore shelf.

Do you have good insurance? if it's HMO not PPO they may have to approve the EP Study so you will need to look into that...also check out your yearly and lifetime deductibles - if you're at your yearly one I'd push to have the EPS sooner but if not, I'd see if it's ok to push it to Jan 2012.  Luckily I only had $300 left for my yearly ded because often the hospitals have you pay up front.

Cardiomyopathy is what I was referring to; it's pvc induced cardiomyopathy and shows because of your declining EF%; check out Momto3's profile/posts (Connie) she developed CM from her pvc's but after ablation hers was corrected.

967168 tn?1477584489
I don't think that was my case...I felt them all the time.  

When I went in the ER in July 2009; 10 or 12 doctors came to read my monitors and reports because they didn't believe I wasn't panicking or dying on the spot...the head EP said I had more than my reported 54,100 as he sat there counting...they ALL asked...do you feel those? lol after so long you just get used to the annoying things

there were so many doctors in and out I got tired of it...I told them if one more doctor came in to read my monitor I was going to charge them admission :P
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