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Avatar universal

Does this look bad?

I've been diagnosed with Lyme Disease recently and had a 48H holter because I'd been having palpitations. That came back OK with 6 isolated ectopic beats. However I have my own ECG (Prince 180B) and I happened to have been using it when I had a real run of palpitations for a few seconds. The graph shows what looks like a run of 7 beats where instead of a normal P-QRS-T it's like a a big T wave, followed by a short R wave and a very deep T wave. This repeats 7 times, no P wave is visible.
2 Responses
Avatar universal
A picture of the ECG trace is in my profile.
20748650 tn?1521032211
COMMUNITY LEADER
Sorry im so late to answer you alex.

What you experienced was an episode of svt.. Superventricular tachycardia.. Im gonna work on getting the picture to a reasonable size where i can maybe give you some more specific information.

However given how fast it started and stopped its very likely that it was an episode on avnrt.

In most cases svt isnt dangerous, but its treatable through an ablation procedure.

The procedures carry very low risks of complications and have very high success rates. They are a very viable option if these episodes really bother you.

If theyre not significantly impacting your life however, not treating svt rarely does any sort of damage physiologically speaking. In other words yes youll live.

This is all very preliminary. I do work with cardiac electrophysiology, however i am not a doctor and can not diagnose ecgs. Further i can only see a thumbnail, and theres still a few things id need to see on a larger image to get a better picture on the TYPE and severity of the svt.
6 Comments
Cant figure out how to make it any larger.. But if i could what id be looking for is (*possibilities for each condition labeled with stars*)..

Are the r-r intervals(timing) in the fast area regular*avnrt* or irregular *afib*? This is important...

Was the first beat in the group of fast beats EARLY or PREMATURE? Specifically what i wanna know is if this happen spontaneously *afib or junctional* or did an early impulse set it off *avnrt*

Do i see any evidence of a p wave buried or hidden in the t waves*sinus tach or avnrt*? Is it upside down*junctional or avnrt*? Is it closer to the r wave before it or the r wave after it *most likely direction of circuit*?


These questions are important to look at just to rule out the small but very real possibility of this being atrial fibrillation (afib), which is a much more serious condition and a potentially ominous sign..
I have posted the image here. The r-r looks regular but the first qrs came before a p-wave:

https://ibb.co/f8TWKb
actually counting the boxed it's not that regular. Should I go to A&E?
So youre in a tough spot.

Unfortunately due to legal and insurance reasons the doctor cant treat you based on the testing you did on yourself/the picture.

However.. If you show someone that photo and request a referral to an electrophysiologist you will get one.

The electrophysiologist will see that photo and know you have a real issue and not an anxiety related issue and will aggressively test you until he can prove its existence on their monitors.

That will give him a legal and insurer payable means to justify an ep study and ablation.

In any case these are primary care type of issues not emergency issues.

Given the variability in r-r afib is still a possibility, but that sort of rhythm looks very re-entrant in nature.

It was started by a very early p wave which points towards avnrt, and you are not preexcited so avrt is unlikely, unless the pathway is  (impossible to know without an ep study).

With all this considered my non doctor opinion is that this is likely avnrt.

Regrettably, despite being 90% certain of this a small possibility of afib or a septal avrt exists. Without any absolutely irrefutable evidence that it can not possibly be afib that is also an option that must be investigated more.

Your pcm can make the referrals you need.
Well I went to a&e anyway, they gave a full blood panel and ecg and found no evidence of Carditis which was my main concern given Lyme. They also found nothing else unusual although couldn't comment on the ECG other than to say it was probably SVT. I will be seeing my GP on Wed.

I had this episode after taking omeprazole for a few days (which can also cause palpitations/tachycardias) and I'm on 400mg Doxycyline/day, 50mg Sertraline and 30mg propranolol. Doxy side effects leaflet also mentions palpitations. I've stopped taking the omeprazole now and I feel a bit better and my heart rate is a bit lower. Hoping it's the medications that have made my heart it bit more irritable. The A&E docs  didn't think there's a reason to be overly worried.

Cheers

Alex
I saw a cardiologist. He says it's AF, most likely due to my 75+ units per week of alcohol I've just realised I've been drinking since my wife's cancer diagnosis and my own Lyme one. I've slipped up badly, and I'm hoping it's reversible...
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