ST-Segment Changes on Holter

[veronicabell]

http://i.imgur.com/ktOa4h5.png

I had a 24-hour holter, and the report said normal, but when I requested the actual data, I found the ischemic narrative shows significant ST changes, both elevations and depressions, and for longer durations than 1 minute. The ST elevations occurred while I was exercising.

From my understanding, ST depressions or elevations of 1 to 2 mm that lasts for at least 1 minute can be clinically significant and warrants further patient assessment. Is this not the case? Should I be concerned that no follow up is being done, and that this information wasn't even included in the report?

For background, this cardiologist was a new patient appointment. He did not listen, spent less than 5 minutes with me, the blood pressures and heart rates taken during my appointment are not in my chart, and the two that are in there don't list the correct heart rates, as the heart rates are the same both lying down and sitting -- I have POTS, and it's impossible my heart rates were the same, my blood pressures rise with sitting and standing (I have orthostatic hypertension), but who knows what the heart rates were. Over half of the notes from my appointment were completely incorrect, my family medical history is missing, and he actually invented past medical history that I've never had and now refuses to change the notes, despite the fact that he essentially diagnosed me with a past disorder that I've never had.

Clearly, I need a new cardiologist, but in finding a new one, in my experience, if this information about the ST segment changes is not in the actual report, no one will see it, & therefore it doesn't exist. Too many things have been missed due to errors like this for me throughout my entire life.

I have Ehlers-Danlos Syndrome, which I had to find myself, as all my doctors missed it. I'm still waiting to be seen by a geneticist, but I've been diagnosed with "generalized hypermobility of joints" by a Rheumatologist and "whole body pain" by my neurologist. I also have Postural Orthostatic Tachycardia Syndrome (Dysautonomia).

Age 29, F, 5'3", 120 lb, white, have had chest pain since age 7, Scoliosis, Acrocyanosis, Raynaud's, Livedo Reticularis, Hypersomnia, & many more; grew up in southern US, do take Adderall & Vyvanse for ADD (which likely came from POTS itself) and Chronic Fatigue Syndrome.

Just hoping to get a better understanding of these results, especially since they weren't mentioned at all in the report I received. Thank you.

[erica1991]

I cannot stress this enough, take the report and GET A SECOND OPINION!!!!! and TELL the doctor that the information was not in the report. It took me a full year to have my arrythmia diagnosed because all EKGS were normal, echos, ect. were all normal, so they ordered a holter monitor. I was in florida during the time that I was wearing it, so admittedly I didn't wear it as often as I should, but it picked up ONE episode of my SVT, and the cardiologist who read my report said that the machine had a "glitch" and there was nothing wrong. A little background history, I was 20 at the time, and I had become so inactive because I could not walk to class, couldn't walk up and down the stairs, couldn't do simple tasks because my heart would start pounding and I would feel like I was about to pass out. I was told that it was all just anxiety but I was PERSISTANT that something was wrong, you know your own body and you know when something isn't right. My mom had just had open heart surgery and was at a follow up with her cardiologist and mentioned it to her doctor and he said that it was a bunch of BOGUS, so he sent me to an electrophysiologist (I highly recommend you see that type of heart doctor because they deal with arrythmias) who told me to come in for an appointment. I flew home from college, had my appointment and was scheduled to have a cardiac ablation. During this ablation they found that I had very severe SVT, my highest rate was 250 and they cauterized until they couldn't anymore or they would kill my SA node and I would need a pacemaker. It was a miracle and a lifesaver for me, I became a normal 20 year old again and I remained symptom free up until this year (four years later) and I am having a problem from the first surgery and I will eventually need a pacemaker, but the surgery was so worth it and I have zero regrets.

BE PERSISTANT! I was told I was crazy for a year and I spent thousands of dollars on exams I didn't need. The only other test that was abnormal was a cardiac stress test.