Can anyone help me understand this holter monitor report

[pedro157]

Hi !! Just got these results back from the hospital and I'm not sure what they mean.So maybe somebody can help me out here? It would be much appreciated.
1. exercise test. upsloping in Stage 3. what does that mean?
2.Holter Monitor showed sinus rhythm throughout with sinus tachycardia at 11.27,120bpm.There was isolated PVC's and APC's. There were 80 episodes of tachycardia the longest being 24 beats at 16.45, the slowest 38 beats at 3.1.There were no pauses ongoing.The mean was 61bpm.

Thanks a lot !! I haven't  a clue about the figures 16.45 and 3.1. Are they referring to the time of the recording ?

[pedro157]

Hi ! just been checking out the R test you mentioned and it seems to be the test I need to have done as the very fast beats haven't appeared on my BP monitor recently nor the Holter monitor which I had done fairly recently as well. I hadn't heard of this test before, and I'll discuss it with my doctor the next time I see him. Sorry I confused you by referring to my blood pressure. It was greatly increased in the A and E, but my ECG was Ok.  However, just two days later I had a pharmacy 24 hr bp test done and again my heart beat at 198 bpm just for one of the readings during the 24 hr period. So, its hard to track down, but its there nevertheless and ... Or, could it be possible that these episodes of very fast beating might have been just a once off occurrence, or is that wishful thinking?  

[is_something_wrong]

Hello,

No, you will not die from a rapid heart rate causing no symptoms, but of course, if it doesn't go away in a couple of minutes (one minute is the rule in Norway), you should seek medical attention. If the blood pressure monitor indicated a rapid, irregular heart rhythm, atrial fibrillation should be suspected. Other arrhythmias usually produce a rapid, but completely regular rhythm (except a special variant of atrial tachycardia known as multifocal atrial tachycardia, but this condition is extremely uncommon).

The fact that you may have an increased blood pressure could contribute to atrial fibrillation.

I didn't quite understand; did your EKG reveal signs of high blood pressure, or did you get your blood pressure measured in the emergency room?

You don't bother me at all! But if you do have atrial fibrillation, treatment is available (and usually necessary). Maybe you could ask your doctor for a so-called R-test (1 week monitoring) instead of Holter, to make sure you capture something?

[pedro157]

thanks  for your answer. The problem is I don't know myself when my heart is beating really fast up to 198. I became aware of the problem through the three different BP Monitors I used, two of which belonged to the pharmacy. Otherwise I have no real symptoms like dizziness or chest pain. Originally, these three separate monitors indicated heart beats using the special symbol for irregular heart beats. Then I noticed the heart rate and the unusually low blood pressure readings. I double checked with the pharmacy thinking perhaps my own monitor was faulty, but it wasn't. Next, I went to the A and E and my ecg/ekg was ok not showing any irregularity but very increased blood pressure. Nevertheless, they ordered a Holter Monitor but the consultant decided my case wasn't urgent unlike the first doctor so.. I saw him nine months later. He got me more tests 1.stress test2. echo 3. holter monitor 4. 24 BP. So far none have indicated the original 200 bpm which concerns me, but they happened and I have given the written results to the hospital. Unfortunately the last holter test for 48 hours stopped after 24 and I'm asking for another test, even longer this time. As I see it 200 beats per minute is crazy and needs to be explained. If this rate was to be sustained for any length of time I could die as I see it. So....I'm not too happy about that!! In any event I'm making my presence felt in the hospital and the docs are ok. But, it takes forever in this country and its not getting any better to be frank. Sorry to bother you with all my troubles. Thanks a lot!  

[is_something_wrong]

The numbers would be somewhat interesting (not necessarily exact, but was it 90 systolic or 170?)

You can't compare your blood pressure when you are sitting still with high heart rate to the numbers you have during exercise. It's very common that your blood pressure drop during an arrhythmia, but if it is so low that you faint, it's dangerous. While a blood pressure of 190/80 can be normal and expected with high heart rate during exercise, far lower is normal with an arrhythmia. It's also common that the difference between systolic and diastolic is low.

The questions are; how often do you have those arrhythmias? Is it something that trigger them? Do they terminate instantly or slow down to normal? Do you have symptoms like chest pain, shortness of breath or dizziness during the arrhythmia?

[pedro157]

Hi again! Yes the 200 bpm has bothered me a bit and the doctor got me another holter test as you suggested; but I haven't got the results yet. It was intended for 48 hours, but the battery went flat somewhere after the first 24 hours! I think it should be repeated. The original very high rates were compared to two other BP monitors and they all revealed much the same result.The blood pressure readings were not normal as I recall. They were very low in fact for the corresponding high heart rates. I'm an Irish public patient which means I wait for months between tests, even years in fact! I'm not too happy about it. So, its good to get as much information as possible and this site looks like a good one. Many thanks again.  

[is_something_wrong]

You're welcome!

But if you had an episode of heart rate above 200 bpm, I think you should repeat the Holter (or a longer event monitoring) until you have symptoms. A Holter test without symptoms is not of very much help (except insuring you that your heart rhythm usually is normal).

It is, however, possible that your blood pressure monitor picked up muscle tremor or other errors and interpret them as your heart rate. What was your blood pressure when this happened, by the way?

A heart rate above 200 usually produce symptoms...

[pedro157]

Hi !! thanks a lot for your detailed and very helpful answer. Yes you were right i had a stress test and no chest pain and the holter was basically to see what was going on as my BP monitor indicated a very high rate of 200 bpm initially but which wasn't repeated on the holter. Thanks again for your help.

[is_something_wrong]

This is a bit unclear and maybe there are errors in the report. When I try to answer, I assume the following:

- You had a stress test done in addition to the Holter
- You did not have symptoms of chest pain during the stress test.

1. Exercise test: Upsloping (probably ST segment depression): During the stress test, you (possibly) had upsloping ST segment depression, which most of the times mean nothing regarding coronary artery disease. It depends on the slope and you may ask your doctor about this, but it's horizontal or downsloping ST depression that usually are markers for angina.

2. Your Holter did reveal normal heart rhythm with occational rapid normal rhythm (sinus tachycardia is a normal heart rhythm with rate above 100 bpm, which usually happens in the setting of stress, exercise, when standing up, climbing stairs, etc.). Isolated PVCs and APCs means that you did have single premature heartbeats that origin both high and low in the heart. They may be experienced as palpitations but everyone have them, some of us many,  some of us few.

Your longest run of heart rate above 100 bpm did happen at 16.45 (4.45 PM). It was only 24 beats long. Your fastest run had a rate of 120 bpm (this is not very fast) and it did happen at 11.27 (AM).

Your slowest heart rate was 38 bpm (this is normal during deep sleep) and did probably happen 03.01 (at night, AM). You had no pauses in the heart rhythm (good) and your average heart rate was 61 bpm (good).