Can you please interpret my ecg?

[XTA22]

So I´m a 23yo male and had this thing happen to me that I think was atrial fibrillation, when I felt sudden fluttering in my chest and when I felt my pulse, it was very fast and irregular. First time it happened it lasted only 10 seconds or so but after a few months it happened again and this time it lasted about 5 minutes. The second time I called an ambulance, but by the time they got there, it had already gone back to normal rhythm. It went back to normal just like it started, like someone flicking a switch. I've been lightheaded at random times and last time my fingers started tingling and it felt like I was gonna pass out. I had a stress test that apparently was normal and holter monitor that recorded 4 SVES and 3 VES in 22 hours. Since my cardiologist puts it all on my anxiety and doesn't listen to what I say cause the fluttering has never been caught on paper, I thought I would get another opinion. I've been looking at ecg interpretations and what I found is that the S waves in some of the precordial leads are too high and suggest left ventricular hypertrophy going by the Cornell voltage criteria S in V3 + R in aVL > 28 mm. If the ecg calibration mark was the normal 10mm then the S wave would not be high enough but since the mark is 5mm, you have to multiply the heights 2x, if I got it right? Also the 0.5mm of ST depression in V5 is should be about 2mm if the 2.5mm/mV calibration mark is correct. If there's anybody out there who knows this stuff I would really appreciate if you would take a look at my ecg and share your opinion as to what this might be.
ECG picture: http://oi58.tinypic.com/opzfc6.jpg

[XTA22]

Ok it's been a while and my heart has been out of rhythm 2 times for maybe 10 seconds each time during this period. My echo was completely normal.
The problem I've had is my heart gets real fast about 10-15 minutes after I eat, up to 130bpm or so, not so high every time but still over 100bpm at least.
And when it's this high I also seem to get skipped beats more often, I've noticed this lifting weights and resting between sets, I sometimes get missed beats. Usually didn't get them when I was exercising.
Anyway, I wanted your opinion about what is going on with the latest ecg I got done, the fastest time I got to a cardiologist is months away and maybe someone knows what this is.
http://oi63.tinypic.com/1448a2q.jpg
http://oi65.tinypic.com/2irk7z8.jpg
What are those spikes and random deviations in the middle of the 2 pictures, those can't be caused by me moving a muscle, can they? Or is the machine they're using causing these weird abnormalities?

[XTA22]

The smartphone thing would be the best bet cause I always have my phone with me and I could get it documented when it happens.
I also have beta blockers but I don't take them regularly.
It happened about 3 months apart, the first time it was at a random time but the second time it was triggered by emotion (discovered someone had broken into my car)
I'm having an echo done in 10 days so that should show if anything is wrong or not.

[is_something_wrong]

I'm not sure if another Holter would help you. If you have the arrhythmia twice a year, the chance of having it while wearing the Holter monitor is 2:365 or slightly above 0,5%.

I also have some runs of rapid heart rate, but they are regular. They typically last for 5-10 seconds or so, and happen a couple of times a year. I don't have any symptoms except palpitations, so my doctor doesn't care. As I have PACs (SVES) on Holter, he assumes it's benign SVT and doesn't want to investigate it further. I'm taking beta blockers to calm the heart somewhat, and Zoloft for anxiety. It helps, but doesn't eliminate the problem completely.

A normal heart is very unlikely to stay in atrial fibrillation for a long time. Brief episodes may happen, but for the arrhythmia to persist, it needs a dilated left atrium (often a result of decades of hypertension or extreme aerobic exercise). Professional cyclists often end up with atrial fibrillation after their career is over.

[XTA22]

You didn't scare me any more than I already was. Yeah it would be good to get it on EKG, but here, you usually gotta wait for the holter monitor to free up, so I doubt they would have anything like that for patients like me.
I'll look into the smartphone EKG thing.
I don't know if she has calculated anything but I don't smoke, don't have diabetes, not overweight, don't have high blood pressure and nobody in my family has had heart problems.
Greetings from Tallinn, btw too bad Lilyhammer got cancelled, I hope some other company picks it up and makes some more episodes :)

[is_something_wrong]

Sounds like short runs of atrial fibrillation. I hope I didn't scare you, short runs are perfectly benign but if it persists or happens often, treatment is available. Often a beta blocker is enough, but as you are so young, ablation is an option to permanently get rid of the problem.

It would clearly be a good idea to get the arrhythmia documented and diagnosed on EKG. But if you only have it a couple of times a year, it will be difficult. I doubt you will get an implantable rhythm monitor, you might of course ask your doctor, but they are usually reserved for severe arrhythmias which are causing symptoms other than palpitations. That's the disadvantage of European health care.

You could buy EKG equipment for iPhone or other smartphones which works as an one lead EKG, to document the arrhythmia.

Regarding your ST depression, I would assume that your doctor has calculated your cardiovascular risk (smoking? diabetes? overweight? high blood pressure? blood lipids? family history? symptoms like chest pain? breathlessness with exercise?). Coronary artery disease is EXTREMELY rare at age 23. Some people have ST depression as a normal finding (my mom does, if she is going to register an EKG, I always have to tell the her doctor about this so he doesn't freak out - her cardiologist told us it was normal for her), and as mentioned, it often happens with moderately increased heart rates. If your cardiologist didn't say anything and you are feeling healthy and you don't have any severe risk factors, I would try not to think about it.

Greetings from Oslo :)

[XTA22]

Thanks for your answer. Highest ST depression on the stress test was -168uV at 143hr but that was 15 seconds into the test, after that it was -105uV at 150hr and -141uV at 167hr, then after the test stopped it went down to about half of that.
Heart rate was "irregularily irregular" as you say, I couldn't detect any rhythm in it, completely random. I don't pass out or feel pain during it though.
My cardiologist doesn't seem to look into the matter too much, when I handed her (not a he, hehe) the ambulance ECG, she looked at it for like 2 seconds and said everything was fine, I don't think you can really diagnose someone that fast.
Close, not quite Scandinavian but Estonian :)

[is_something_wrong]

I also notice that you are saying "SVES" and "VES" instead of PACs and PVCs. Are you Scandinavian?

[is_something_wrong]

I don't like interpreting EKG because I'm not a physican or healthcare professional.

However, since you ask your question on a patient community, knowing there are no doctors here, I can share some thoughts.

At age 23, ischemic heart disease is very unlikely. I would assume that your cardiologist has considered this and ruled it out. ST depression can have other causes too. It's fairly normal at "medium high" heart rates, especially in the setting of anxiety or hyperventilation. If so, it tends to disappear at higher heart rates (like >140-150). The same with inferior T wave changes.

Honestly I don't know what the chest fluttering is. It could of course be atrial fibrillation (even though this is very rare in young men), but it could also be sinus tachycardia with PACs or PVCs. Whatever it is, as long as you are hemodynamically stable (no blackening or fainting or intense chest pain during the event) it is probably not dangerous. To figure out if it was atrial fibrillation or not, you can try to remember if the heart rate was "regularily irregular" or "irregularily irregular". In atrial fibrillation, there is no baseline rhythm. It's completely random when the next beat occur. With PACs or PVCs, you usually have a regular baseline rhythm which is interrupted by double or skipped beats / pauses.

An EKG with sinus tachycardia will usually meet the voltage criteria for LVH. Adrenaline will make the QRS complexes spike. LVH cannot be diagnosed by an EKG during sinus tachycardia. So this is fairly inconclusive. If you are in doubt, ask for an echo.

Otherwise try to trust your cardiologist. If he told you that your heart is fine, it usually is :-)