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Avatar universal

Holter monitor results - any insights?

Hi everyone,

I wore a Holter monitor  for 24hrs (one month ago), and just received the results, and I am going to a cardiologist tomorrow, however, would like to hear more opinions about the results.

The diagnosis is stated as follows (translated it to English myself but should be quite accurate):

- During monitoring heart rate varied from 47 to 161 bpm. Average rate throughout 24hrs was 84 bpm.
- Minimal average hourly heart rate 61bmp
- Maximal average hourly heart rate 125 bpm
- Episodes of multiple isoline artefacts during which data is inaccurate
- Sinus arrhythmia at night. 2 recorded PVCs.
- Pauses >2.0 sec, no significant ST changes.

I am mainly interested in the bit regarding sinus arrhythmia at night (lowest recorded HR was 47 bpm at 6.30 am), and also the last bit (I'm not clear what the pauses mean). Could it mean that I might have sleep apnea (I often snore, sometimes have pauses followed by loud snores and gasps, as my husband used to tell me, not so much gasping anymore).

About me: 30yrs old female, smoker, used to be very active, now obese (around 290 lbs). My  blood pressure is usually low (100/60 - 110/65).

Reason for Holter monitoring: have episodes of very slow HR when I lie on my stomach for 30mins or more, then my HR falls, start feeling discomfort, feeling shortness of air (unable to take a fullfilling breath) and irregular rhythm (a lot of 'missed beats'). This was not caught on the Holter monitor as I was not allowed to lie on my stomach while wearing it. The sensations increase when I'm on a restrictive diet (around 1200kcal/day), this is the reason I started and quit dieting 3 times in the past 3 months - the symptoms caused me a lot of discomfort and anxiety.

Also usually have many more PVCs during the day, especially those horrible ones where the suddenly start (very fast irregular 'thudding', feeling the actual heart muscle in my chest expand and contract), last up to 5 seconds, and seize suddenly.

I do suffer from anxiety, and used to have panic attacks and severe depression (looks like it's more or less ok now, but the anxiety can still be pretty bad).

Any insight into the results would be very much appreciated!
12 Responses
995271 tn?1463924259
sinus arrhythmia is perfectly normal when it's tied to respiration.  It's the variation in heart rate as you breath.    Nature designed it this way maximize gas exchange during respiration.  The heart will slow down when you exhale, and speed up when you inhale.
1807132 tn?1318743597
We are not doctors here so we can only go by our own limited knowledge when looking at anyone's results.  It's a shame you could not lay in a way that would produce the concerning symptoms.  That was kind of the point of getting the monitor.  The results come back as pretty normal or nothing too concerning.  You only had 2 pvcs which a doctor would not even blink at.  Your heart rate reached 160 which is kind of high but could be explained by a trip up the stairs with your weight.  But even so it isn't a rate that is considered dangerously high.  The only time sinus arrhythmia is really ever concerning is when it is a considerably marked difference in rate.  But otherwise as itdood stated it is a normal part of how the heart works.  Considering they didn't make a reference to the rate change it may not be out of the safe range.  

In any event, unless you have having a crazy high number of the extra beats, in the 20,000 range doctors are not very concerned.  They are more uncomfortable and disconcerting to us then they are a danger so just discuss with your doctor about them and whether or not you should continue to exercise.  Your weight and smoking will take a toll on your heart at some point so stopping your diet and exercises because of the extra beats may not be the best option.  I know for me that my stomach actually plays a bit role in the amount of pvcs I get sometimes.  Watch anything that might cause gas and acid reflux, and address them if they pop up and see if it helps calm down the pvcs.  

Best of luck at the doctors and best of luck getting a handle on your health.  Keep us posted on how you are doing.
Avatar universal
Kind thank you to you both!

The Holter results do make me feel relieved and uneasy at the same time! I have heard that the 24 hr test is rarely representative of the actual situation, unless all of the symptoms occur and are recorded within that period of time.

On the one hand, of course, 2 PVCs is basically nothing. In addition, no recorded PACs, no episodes of bradycardia (under 40 bpm, as specified on the result sheet), several episodes of tachycardia which I take it is normal for me. The high of 161 was during an active time of day where I was walking around quickly, a lot of bending down, carrying, etc., so this was to be expected.

On the other hand - it was a 'good day' for me as I didn't have the episodes of slow irregular beats (since I could lie down on my stomach), also wasn't one of those days where I constantly feel like I'm short of air (I get sometimes weeks of this, then it goes away for a few weeks and comes back - hopefully this is only anxiety related). Also, didn't have any of the 'scary PVCs' that I described before (sudden onset, fast random beats with heart muscle 'crunching' feeling). The scary ones used to happen very rarely but have recently returned twice or three times in one week. Not a lot, I know, but they leave me so anxious as they are very intense.

Anxiously waiting for my appointment tomorrow. My last heart echo was almost 2yrs ago, which showed a very slight enlargement of the left ventricle. The doctor said it's nothing and probably because of my weight.
Really hope that this hasn't worsened over the years..

I just really want to see if everything is ok enough for me to keep to my diet, even with the slow brady/arrhythmia episodes. I gained all this weight while on Paroxetine which I was taking for 6 years. I stopped taking it completely 5 months ago.

By the way - for the past 4-5 yrs my ordinary ECG showed 1st degree AV block. After quitting Paroxetine - guess what - the AV block disappeared!
995271 tn?1463924259
Was it easy to quit  Paroxetine?  interesting result though.

I just got off Serzone, which works great for my anxiety/panic.  Been off it for about 2 months now.
Avatar universal
Surprisingly - rather easy, though I was quite scared after hearing a lot of 'horror stories'. But I felt it wasn't really having an effect anymore (could that have been due to weight gain? When I started I weighed around 160-170lbs).

So - and THIS IS NOT RECOMMENED (for anyone who's reading) - I started taking it every other day, then every 3-4 days, this was during the 3 summer months. And then quit completely 1st Sept 2014.

Had a little bit of anxiety on and off, as well as the famous brain zaps, but I can't say I feel any significant differences now that I'm 'clean' compared to when I was taking paroxetine (I was on "Seroxat").

Off to my doc in a few hours - dreading it!!!!
Avatar universal
OK so back from my cardiologist now, want to share her findings.

1. Holter monitoring results were evaluated as normal.

2. Echocardiography showed mild enlargement of left ventricle (same as 2 yrs ago) AND then she said that there was a mild abnormality in left ventricle relaxation (this was not present in the last echo).

The doctor did not seem worried about these findings saying that they might probably be the result of weight gain, and in my age shouldbe reversible.

The doctor said the echo should be done again in around 1.5yrs, and also scheduled a veloergometric test in April.

However, here I am, googling "abnormal left ventricle relaxation" and the words "heart failure" come up. I feel like I've been hit with a shovel.
Do I have heart failure???
Avatar universal
"Grade I – The E/A ratio is reversed on the mitral inflow echocardiogram. This is the mildest form of diastolic heart failure and is referred to as an abnormal relaxation pattern. Patients are usually asymptomatic."

So that's it - I have HF?

I am so anxious and depressed at the moment I don't even know how I will have to continue on living with what I heard from the doctor today.

Should my doctor be more concerned? Should I get a second opinion from another cardiologist?
1807132 tn?1318743597
What the doctor said was with your age the things that are going on are reversible at this stage.  Heart failure in the mild form is reversible from what I understand but you do need to take steps to turn your health around if you do not want it to become irreversible.  When in doubt I would always seek a second opinion because it couldn't hurt but I think it sounds like your heart is not damaged beyond repair.  Did you ask the doctor about exercising?

As a side note I also get the crunchy muscle feeling with my pvcs sometimes.  And on days when I am having more than a few they can make me tired and cause some chest discomfort and difficulty breathing/short of breath but it goes away.  It is all par for the course with having ectopic beats.  Try to not let it keep you from a heart healthy lifestyle if your doctor is recommending exercising and diet.
Avatar universal
Michellepetkus - thank you for your reply!

This news has hit me so hard I can think of nothing else from the moment I wake up till I fall asleep, every minute of the day. I am absolutely petrified I might not live to see my birthday in a few months, I'm crying all day long.

Why did the doctor not prescribe me any medication? She only told me to make sure I don't starve myself when I diet, make sure I get enough minerals and vitamins, and also do all possible blood tests (cholesterol, glucose, iron/potassium/calcium etc, thyroid).
I actually said - am I going to die, and she smiled - nooo, of course not.
Could she have been careless??..

1807132 tn?1318743597
No, I promise you she was not careless.  They get in trouble for things like that.  If you were in any danger they would be on top of it.  Anything to do with the heart is very scary for the patient.  Doctors not so much but patients yes, we tend to get super scared.  I lived with svt my whole life being quite blissfully ignorant of what was going on but once they diagnosed me it was a total shock and very very scary but I looked at the whole picture and listened to the doctor and eventually I began to trust that the heart is a very strong resilient muscle that can really handle a lot and still keep going. It can even get a bit damaged and repair itself.  So yes, don't crash diet as that will put stress on the heart and if you start to exercise try to ramp up as opposed to going full out before you are ready but most of all try not to give into the fear of what is going on.  It is more of a wake up call than anything else.  It is good you are catching it now when things can be turned around as opposed to when you hit your 50s and 60s when things tend to take a lot longer to turn around.  So just use this as a way to get determined to be heart healthy.  Some people don't heed the call until after a heart attack.  You can hopefully turn things around and avoid that kind of pain.  But do take a few moments to let this all sink in.  Give yourself some time to process the fear and then put your mind towards improving your health.  One little step at a time if that is what it takes.  You can do it.  We are always around if you need to talk.
Avatar universal
Michellepetkus, really thankful for your words of support.
I agree, anything heart related seems scarier than most other diagnoses.
How are you handling your SVT? I don't know much about it - is it reversible or can you stabilize it?

Both yesterday and today I've been feeling a dull ache/pressure in my chest (mostly middle, slightly above breast area + back (between the blades, around the sides), warm sensation in those areas as well.

Sometimes mild dull pain comes and goes. There's also some burping and yesterday I had slight heartburn.
My BP, as always, is normal/low.

Either it's just my anxiety trying to fool me into thinking I am now having a heart attack, or it's gastro or muscle related. Or maybe I really am having pre-attack symptoms (I've read that people might have them for a week before the actual attack).
I do tend to have tight upper chest/shoulder/back area because of stress and anxiety as well as osteochondrosis in my neck, but muscle pain is a different, I'm quite used to it.

Isn't it funny how the mind and body works... Now that I know about the left ventricle dysfunction I am sure I will die any day now, and I feel all possible symptoms of various diseases.

I just hope they aren't real, as this chest/back ache and discomfort is really unnerving, it's like I can't find a position that would make it better.
1807132 tn?1318743597
SVT stands for supraventricular tachycardia.  I basically had an extra piece of muscle fiber in my heart that allowed it to get caught in a loop around my avnode.  It would run at rates in the 200s.  I had it all my life though it was very rare but because I had it all my life I thought it was normal and everyone did it.  It always stopped on its own so I just never did anything about it until it started to become more frequent in my 30s and by my 40s it was starting to disrupt my life so I had it ablated/correct.  I no longer have episodes of fast heart rate but do still have extra beats called ectopics. I think they were aggravated by the svt because I don't recall having all the jumpiness with my heart except for the last few years I had the svt.  Unfortunately it seems I may be stuck with them.  They feel like skips and jumps and can sometimes hurt but the pain usually only lasts about 10 minutes.  I have also had anxiety and fear pain and that can indeed cause the chest to hurt.  If it is short lived and you can relieve the pain with a bit of relaxation or stretching then it is likely nothing too concerning.  But keep an eye on the pain, maybe keep a diary for your doctor so you can see if there is a pattern.  Try antacids and see if that helps the heartburn and eases any pain.  Also try to do some deep breathing and let go of all the stress if even for just a moment.  If you feel relief from the chest pain it may just be your nerves but if you are at all concerned call the doctor and tell them what you are feeling and let them decide what you should do.  Better to be safe than sorry though I suspect it is mostly fear related.  Very understanding when it comes to heart issues. It is hard to not worry but I would trust the doctor when he said it was reversible.  Doctors really don't make a habit of lying to us, it gets them in trouble.    You are right, the mind can really get us twisted up into a knot but just do your best to try and not allow it to get out of control.  No matter what you are no where near just dropping dead.  The doctor would have been a lot more aggressive about your treatment if that was the case so just try and work on turning your health around and you should be fine.  Hang in there and stay strong.  You are going to be OK.  
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