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results from 48 hour holter monitor
Hello everyone!
A quick review of what I know so far. I am a 33 year old obese white male, smoker, with hypertension. I was recently diagnosed with hypertensive cardiomyopathy including left ventricular hypertrophy and left atrial enlargement. I am on metoprolol, amlodipine and 81mg aspirin. I take simvastatin for my high sensitivity c-reactive protein number (8.9). I was recently given nitrostat for chest pain. This past week, I was put on a 48 hour holter monitor to see, as my cardiologist put it, why I had so many skipped beats. What follows is the narrative:
"Monitoring started at 2:04 pm and continued for 47 hours 59 minutes. Average heart rate was 73 BPM. The minimum heart rate was 39 BPM at 3:38 AM. The maximum heart rate was 136 BPM occuring at 9:05 PM.
Ventricular ectopic activity consisted of 3 beats, of which, 3 were in single PVCs. Ventricular ectopic beats occurred at a rate of less than one VE per hour.
The patients rhythm included 12hr 34 min 34 sec of bradycardia. The slowest single episode of bradycardia occurred at 3:38:19 AM D1, lasting 3 min 53 sec, with minimum heart rate of 39 BPM.
The patient's rhythm included 2 hr 10 min 43 sec of tachycardia. The fastest single episode of tachycardia occurred at 9:04:02 PM D2 lasting 5 min 21 sec, with maximum heart rate of 136 BPM.
Supraventricular ectopic activity consisted of 1836 beats of which, 39 were in 5 runs, 12 were in atrial couplets, 1545 were single PACs, 7 were in bigeminy, 233 were in trigeminy. There were 2 dropped beats. The longest R-R interval was 2.3 seconds occurring at 6:00:46 AM D1. The longest N-N interval was 2.3 seconds occurring at 6:00:46 AM D1. The longest supraventricular run occurred at 9:49:35 PM D! consisting of 26 beats, with a maximum heart rate of 138 BPM. The fastest supraventricular run occurred at 1:24:33 AM D1, consisting of 3 beats, with a maximum heart rate of 169 BPM. Supraventricular ectopic beats occurred at a rate of 38.2 SVEs per hour
TECH COMMENTS:
Sinus rhythm with episodes of 2nd degree AV block, rates of 39 to 136 BPM.
Rare PVCs without VT.
Occasional PACs with 5 atrial runs, the longest was 26 beats and the fastest was 169 BPM.
No pauses seen.
Patient reported symptoms of palpitations and chest pain, which correlated with sinus rhythm.
My cardiologist wants to run a sleep study. Obviously the 2nd degree AV block is of the greatest concern. The nurses told me it was of the type 2 variety. My question is that I had a sleep study done 4 years ago and it was negative for sleep apnea. Is a new sleep study warranted at this time?
A quick review of what I know so far. I am a 33 year old obese white male, smoker, with hypertension. I was recently diagnosed with hypertensive cardiomyopathy including left ventricular hypertrophy and left atrial enlargement. I am on metoprolol, amlodipine and 81mg aspirin. I take simvastatin for my high sensitivity c-reactive protein number (8.9). I was recently given nitrostat for chest pain. This past week, I was put on a 48 hour holter monitor to see, as my cardiologist put it, why I had so many skipped beats. What follows is the narrative:
"Monitoring started at 2:04 pm and continued for 47 hours 59 minutes. Average heart rate was 73 BPM. The minimum heart rate was 39 BPM at 3:38 AM. The maximum heart rate was 136 BPM occuring at 9:05 PM.
Ventricular ectopic activity consisted of 3 beats, of which, 3 were in single PVCs. Ventricular ectopic beats occurred at a rate of less than one VE per hour.
The patients rhythm included 12hr 34 min 34 sec of bradycardia. The slowest single episode of bradycardia occurred at 3:38:19 AM D1, lasting 3 min 53 sec, with minimum heart rate of 39 BPM.
The patient's rhythm included 2 hr 10 min 43 sec of tachycardia. The fastest single episode of tachycardia occurred at 9:04:02 PM D2 lasting 5 min 21 sec, with maximum heart rate of 136 BPM.
Supraventricular ectopic activity consisted of 1836 beats of which, 39 were in 5 runs, 12 were in atrial couplets, 1545 were single PACs, 7 were in bigeminy, 233 were in trigeminy. There were 2 dropped beats. The longest R-R interval was 2.3 seconds occurring at 6:00:46 AM D1. The longest N-N interval was 2.3 seconds occurring at 6:00:46 AM D1. The longest supraventricular run occurred at 9:49:35 PM D! consisting of 26 beats, with a maximum heart rate of 138 BPM. The fastest supraventricular run occurred at 1:24:33 AM D1, consisting of 3 beats, with a maximum heart rate of 169 BPM. Supraventricular ectopic beats occurred at a rate of 38.2 SVEs per hour
TECH COMMENTS:
Sinus rhythm with episodes of 2nd degree AV block, rates of 39 to 136 BPM.
Rare PVCs without VT.
Occasional PACs with 5 atrial runs, the longest was 26 beats and the fastest was 169 BPM.
No pauses seen.
Patient reported symptoms of palpitations and chest pain, which correlated with sinus rhythm.
My cardiologist wants to run a sleep study. Obviously the 2nd degree AV block is of the greatest concern. The nurses told me it was of the type 2 variety. My question is that I had a sleep study done 4 years ago and it was negative for sleep apnea. Is a new sleep study warranted at this time?
Turns out there is a 4.5 cm tumor behind my heart being fed by arteries from both sides of the heart. WIll know more after meeting with a thoracic surgeon.
I'm not a community leader of this community (just the heart rhythm community) but I agree, no need to make people believe they will die any day if they do not change lifestyle. Of course lifestyle is important, but that's not the only thing that matters.
I'm pretty sure that 2nd degree AV block type II can NOT be fixed by quitting smoking, by the way. 2nd degree AV block type I is perfectly normal during sleep (20-30% of us have that during sleep) but type II is considered somewhat more serious, though this may also appear normal in some people. If you want to read what is normal and not during sleep, you can read a chapter of the book "Noninvasive electrocardiology in clinical practice" (you can find it on Google Scholar if interested).
Otherwise the Holter didn't reveal so much "exciting" things in my opinion. You have some PACs, slightly below 1000 a day, which are usually normal, but in your case, you should watch out for Afib given the runs and the left atrial enlargement, which you probably are aware of. The PVCs are nothing. Most young men have a 24 hour low in the high 30s or low 40s, so that's pretty normal too. Yes, beta blockers and to a certain degree calcium channel blockers can/will slow AV conduction, but I assume your doctor know what's safe for you. Never change this yourself.
The hypertensive cardiomyopathy sounds concerning, what has happened, at your young age? How high is your blood pressure now? Do you have any improvement of the condition?
Sorry, your diagnosis is a bit complicated and none of us are doctors, so you should stay in close touch with your doctor..
Take care and good luck :-)
I'm pretty sure that 2nd degree AV block type II can NOT be fixed by quitting smoking, by the way. 2nd degree AV block type I is perfectly normal during sleep (20-30% of us have that during sleep) but type II is considered somewhat more serious, though this may also appear normal in some people. If you want to read what is normal and not during sleep, you can read a chapter of the book "Noninvasive electrocardiology in clinical practice" (you can find it on Google Scholar if interested).
Otherwise the Holter didn't reveal so much "exciting" things in my opinion. You have some PACs, slightly below 1000 a day, which are usually normal, but in your case, you should watch out for Afib given the runs and the left atrial enlargement, which you probably are aware of. The PVCs are nothing. Most young men have a 24 hour low in the high 30s or low 40s, so that's pretty normal too. Yes, beta blockers and to a certain degree calcium channel blockers can/will slow AV conduction, but I assume your doctor know what's safe for you. Never change this yourself.
The hypertensive cardiomyopathy sounds concerning, what has happened, at your young age? How high is your blood pressure now? Do you have any improvement of the condition?
Sorry, your diagnosis is a bit complicated and none of us are doctors, so you should stay in close touch with your doctor..
Take care and good luck :-)
Vienna13, people come to this site and others like it to seek guidance and support in their health issues, not to be talked down to and not to be criticized. Please feel free to post comments on someone else's issues, but not mine. Obviously I have not made the right lifestyle choices over the years but I doubt many of us have. Saying things in your broken English like "go on strich diet and exercise every day or ...not... after all is your life, you can have it short or long in your choice" does no one any good and allows you to feel superior to others. Knock it off.
Going in this afternoon to consult with the cardiologist and discuss "options". Will let everyone know what we decide.
More lifestyle changes!! Throw away your cigarettes go on strich diet and exercise every day or ...not... after all is your life, you can have it short or long in your choice.
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Just got the results back from the sleep study. Everything normal...no sleep apnea. So with 2nd degree AV block type II (which showed up again in the sleep study), what's next? More medicine or pacemaker?
I will be going in tomorrow to do a split sleep study due to the apparent urgency of the AV block. I will post results when I get them.
Congratulation on losing weight .25-30 pounds is something, but near not enough. You called yourself obese, so you have lot to do. Your High blood pr. is very high. Do you know it doesn’t matter if we take the maximum amount of BP medications,if we get under high level of stress and that can happen to all of us shorter or longer time ,our BP can jump up, like if we haven’t even take Beta blockers etc. and unfortunately even if goes up for a short period, it can be fatal. If the body more fit, it has more chance to stay alive by getting a BP just moderately up and not over 180/120. By losing weight, the high will be less high. Your high numbers are warning you, if you will be fit you won’t get stroke that suddenly as obese people can. You not just should consider, you MUST lose weight and a lot.
Don’t let me start on your habit of smoking. Flycaster said it well!
Taking big issue about the details of your tests just useless if you don’t concentrate these two most important things mentioned: these often kill people without considering if a person old or young.
So my only advice is: More lifestyle changes!!
Don’t let me start on your habit of smoking. Flycaster said it well!
Taking big issue about the details of your tests just useless if you don’t concentrate these two most important things mentioned: these often kill people without considering if a person old or young.
So my only advice is: More lifestyle changes!!
My weight has actually gone down since then by about 25-30 pounds. If sleep apnea is causing the AV block, will a CPAP machine make the block go away? The beta blocker and calcium blocker I am on can cause the AV block as well but without those meds, my BP spikes to about 235/135.
I'm sure you know you should quit smoking. I'm a former smoker but when confronted with similar heart issues, I was able to quit. Millions of us have done so. In my opinion, that should be your number one focus. If you are obese, you have great risk for cardiac arrest. The fact that I've lost three good friends died at an early age who had sleep apnea and Brady/Tachy symptoms like you and were obese proves that to me.
I wouldn't look at the results so much as I'd suggest you follow your doctor's suggestions, and make lifestyle changes. I wish you well, and please, keep us informed.
I wouldn't look at the results so much as I'd suggest you follow your doctor's suggestions, and make lifestyle changes. I wish you well, and please, keep us informed.
It's been 4 years, your monitor shows some pretty slow rhythms and you've had a few dropped beats. If they feel there's been a change since then, you should go through another study. You mention your weight. Has it gone up since 4 years ago? That may be contributing to the breathing problems at night which will also affect your heart. I understand the sleep studies aren't that fun with all the gear hooked up to your body and face but for the sake of your health, you might want to get it done.
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