Holter Report - HR Vrun and SVrun very high but I do not feel it. is it possible?

[rennypuspita]

hello all. I am female, age 27 years, weight 54 and 168 cm. Recently, I've just done a Holter test as having passed out 2 times. holter report are as follows:

HEART RATE
Min HR : 46 bpm
Max HR : 156 bpm
Avg HR 24 hours : 91 bpm
Min HR hourly : 65 bpm
Max HR hourly : 109 
Analyzed beat : 127947

VENTRICULAR ECTOPY
VE total : 91
V-Pair total : 7
V-Run total : 2
Longest V-Run : 3 beats at 23:14
Max HR V-Run : 209 bpm at 23:14
Min HR V-Run : 181 bpm at 00.30
VE's per 1000/per hour : 1/4
Ventricular R on T : 30

SUPRAVENTRICULAR ECTOPY
SVE total : 85
SV-Run Total : 4
Longest SV-Run : 7 beats at 12:46
Max HR SV-Run : 247 bpm at 12:44
SVE's per 1000/ hour : 1/4
Total aberrant beats : 12
Atrial Fib/flutter : N/A

ST SEGMENT ANALYSIS
Total ST Minutes Ch.1 : 196
Total ST Minutes Ch.2: 37
Total ST Minutes Ch.3 : 163
Max delta ST depression : -2,3 at 07.37
Max delta elevation : +2.0 at 0.07
Max ST episode : 31 minutes at 7:18
Max HR in ST episode : 145

there are several questions related to the Holter. I would be very grateful if you could help answer it.

1. There were 2 times Vrun episodes during Holter done. Maximal recorded HR was 209 bpm and 181 bpm lowest. Is this high enough? Does this mean I have vtach?

2. What is the R on T? I heard that this type is very dangerous because it can lead to vtach or VF,  is it true? Recorded in the report has 30 R on T. What this meant for me?

3. Max HR SV-Run I was very high, reaching 247 bpm. I strangely do not feel anything when it happens. Why I can not feel it? Is this normal?

4. What is the use of ST SEGMENT Analysis? The figures listed do not seem normal to me. Can you help interpret it for me?

5. I am currently using coralan 5 mg, 2 times daily for 1 month. So far I feel better after taking it.
Now the average heart rate I was 60 to 85 per minute in a resting state (before 100 to 110 bpm). If this means giving coralan is quite appropriate for me?

Finally, sorry if my english grammar is not good. I come from Indonesia and are less familiar with English. I hope you had no trouble understanding it.

Thanks in advance for your help. I look forward to your answer :)

[rennypuspita]

Hi all,

Tomorrow I am scheduled to do a tilt table test. I wonder a little about it. What is the purpose of this test? Is everyone going to pass out during a test? Since I have several episodes of syncope, so whether it is SHOULD I was going to pass out while undergoing a test? If I did not faint during my test, does this mean that I experienced episodes of syncope is not caused by abnormal heart rhythm?

[grendslori]

You origionally said you do not feel these beats and asked if that is possible. Yes, it is. As your posts are saying, you HAVE felt these beats. SVT is really quite common, but VT isn't and you need to find out the reason for the VT. A three beat run of VT, isn't really too concerning, however, you still want to know the reason behind it, if there even is one.You should be seen by a doctor whose specialty is the electrical system of th heart. (EP Specialist) rather than a regular cardiologist.

[rennypuspita]

It happened so fast I could not position themselves to sit or squat and immediately fell. I often get an additional injuries due to collisions.

[tom_h]

So you say before you fainted, your hear was beating very fast.  Consider the possibility that during the rapid rate, your heart is not filling fast enough to pump any meaningful amount of blood, and consequently, you briefly pass out.

[spade22]

LQTS is rare but your medical history along w/ measuring certain values on the EKG (especially QTc interval) would point the doctor in the right direction.  Some doctors are not aware of this condition but do inquire about your QTc interval.

[rennypuspita]

Most of them had abnormal heart valve or have coronary heart disease. Some had undergone valve replacement surgery and a normal life afterwards.

LQTS? This is something new for me. Thanks for the clue. I will now discuss in more detail to the cardiologist at the next meeting :)

[spade22]

Do you know what the abnormalities are and if a diagnosis of their condition was made?  There are some conditions that are genetic (run in families).

Its important that you see an electrophysiologist (EP) - this is a cardiac specialist who deals with electrical issues of the heart (rather than plumbing issues, which is what a traditional cardiologist does).

Do you know if your QTc interval has been measured?  From what I understand of your post, you are having runs of VT and have had unexplained incidents of passing out since you were young.  These symptoms are suspicious of LQTS.  I am by no means suggesting that you have this, but it is something that your dr should look into "if" they havent already.

[rennypuspita]

Hi Spade22,

Yes, both families from the father or my mother had a history of cardiac abnormalities. My father also people with coronary heart disease. But my mother seems fine.

I've had fainted since I was in elementary school. but the symptoms are more obvious such as palpitations, dizziness and skip beat increasingly frequent since 9 years ago.

I have never checked out extensively up to this time. This reinforces the notion that if I have heart problems?

Thank you,

[spade22]

Do you have any history of other family members fainting or any other heart problems?

[tom_h]

The reason I mentioned SVT is because those results were listed in your report under "SUPRAVENTRICULAR ECTOPY".  SVT can vary in duration.  Some convert to normal rhythm spontaneously while some, like mine, were self sustaining meaning once started, it would run on and on requiring intervention in the way of physical manuvers to slow it.  It's not uncommon for SVT episodes to last for hours.  It is extremely uncomfortable when it lasts for more than a few minutes.

Good luck with your tilt table test.

[rennypuspita]

hello there,

I remember a while before I passed out when my heart beat so fast (probably about 30 seconds or more) and then stop just before I fainted. But it does not take long till I regain consciousness. Is this serious?

Doctors are still learning my condition and that is why he sent me to do TTT next week. Hope that my results are good because my job requires me as the event organizer is very active in the outdoors.

Thanks for the answer :)

[is_something_wrong]

The important question is: Why did you faint? If you fainted when standing up, etc. it's probably caused by low blood pressure and not serious. If you faint without any reason, or during activity, or you feel palpitations before fainting, the link to your cardiac test results can be clear and a cardiologist should evaluate you without delay.

Your questions (I'm not a doctor but I'll give it a try):

1. According to the textbook yes, VT is a run of 3 or more PVCs. However, VT is usually not serious if not prolonged. The question is if you also have prolonged runs, which may cause the fainting?

2. This question is extremely difficult to answer. There's a lot of debate about this phenomenon, even among electrophysiologists. R on T is a PVC that occur before the previous beat is finished, triggered by a special mechanism known as an early afterdepolarization. They are dangerous in unhealthy hearts and in hearts with repolarization abnormalities, where they can trigger VF/polymorphic VT. They can also trigger VT in hearts with an affinity for having VT, but it is not necessarily so.

3. Great answer by Tom :)

4. ST-segment is an EKG interval, a depressed or elevated ST segment may be a marker for various heart diseases, but again, it may happen in healthy hearts.

You should be evaluated by a cardiologist based on the findings, but they are not necessarily dangerous. The fainting is important..

[rennypuspita]

Hi Tom, I really appreciate the answers you give :)

So you think I already undergo an episode of SVT? How long commonly SVT attack occurred in most people? Whether SVT can cause fainting?

Next week I had an appointment with my electrophysiologist to perform tilt table test. Will update as soon as the results came out.

Thank you for your time and attention, Tom :)

[tom_h]

Your English grammer and writing is excellent!

I'll take a try at #3.

247 bpm is pretty typical for SVT.  We have to assume that the times of the events are accurate time-of-day, and that you were not sleeping at these times and consequently unaware of the event.  You had a 7 beat run at 12:46, but that's the longest run, and it doesn't state how fast it was.  That's pretty short duration.  I still have these short runs occasionally even after my ablation nearly a year and half ago.  Two minutes before this event (at 12:44), you had the fastest run of 247, but it doesn't say how long this event lasted.  It could have only been 2 or 3 beats long.  Some people may feel it while others may not.  I know from experience that I felt every single run of SVT as well as the skips.

I'm sorry I can't address the other issues, but I am not qualified to venture even a guess.  Perhaps others can add more.