Help with severity of Holter Monitor Results

[Lori080869]

First off, I do know I need to see a cardiologist. However, I do not currently have one and I am relocating across country in 8 weeks, so getting into a cardiologist at this point is pretty impossible and will need to wait. Problem is, being a person who already suffers from a panic disorder, waiting 8-10 weeks could make my symptoms worse just from sheer worry. Hoping some of you can help shed some light on what is going on and the results of my 48 hour Holter Monitor I just received.

First some background. I am a 48YO female, overweight, only medical issue is high blood pressure for which I take 5mg of Amlodopine and 40 mg of Benicar. About 18 years ago I started having PVCs. At that time, I would have a few hundred in a day and they would come and go periodically throughout the year. I had a full cardiology work up and found nothing structurally wrong. I was told to avoid triggers like stress and caffeine when they flare up. This past November they came back with a VENGEANCE. They started up after 5 months of intense stress (working full time along side spending 40 hours a week renovating our home to put up for sale because my husband's job was relocating across country). This flare up was the worst I had ever had. I could experience 6-10 skips in a minute. More troubling was that I was also experiencing sudden bursts of racing heart. This lasted from November through December then calmed down for January-March. Then in March it started back up and has been getting worse so I called my doctor and requested a Holter Monitor. He refused to put me on one and sent me to the ER instead. Rather than the ER, I ended up at a walk in clinic where they did a bunch of blood work (everything PERFECT that was tested. Cholesterol 135, everything in optimum ranges; vitamin/mineral panel; thyroid panel, etc, all good). I just got the results back from the monitor and all my General Practitioner will tell me about it is I need to see a cardiologist. Can someone help with some feedback on my results?

Duration: 47:59
256305 QRS complexes
1655 Ventricular ectopics which represent <1% of total QRS complexes
618 Supraventrical ectopics which represent <1% of total QRS complexes
0 Paced QRS complexes which represent <1% of total QRS complexes

Ventriculars (V, F, E, I)
1573 Isolated
0 Bigeminal Cycles
35 Couplets
2 Runs
6 Beats in Runs
3 Beats Longest at 230 BPM at 16:43:16 10-MAY
3 Beats Fastest at 230 BPM at 16:43:16 10-MAY

Supraeventriculars (S,J,A)
402 Isolated
35 Couplets
24 Runs
146 Beats in Runs
16 Beats LONGEST at 131 BPM at 10:26:25 11-MAY
3 Beats FASTEST at 135 BPM at 14:42:02 12-MAY

Heart Rates
62 Min
91 Avg
144 Max at 20:13:00 10-MAY

Interpretation
1. Frequent isolated PVCs (1573), 35 couplets, and a short run of non-sustained ventricular tachycardia of 3 beats at 230/min
2. Short runs of atrial tachycardia, longest 16 beats at 131/min
3. Palpitations correlate with ventricular ectopy
4. No significant pauses or bradycardia

(personal side note)
Interestingly enough, the thing I was MOST excited that they would've caught was I had one of my events of racing heart, where my heart just skipped and then took of racing. Ironically, it happened at around 8 o'clock on the 10th and there is NOTHING mentioned about it on the report other than highest heart rate reported at 144max at around that time... confused about this one, as well.

Thanks everyone for any feedback you can offer my on this. I'm just trying to stay calm until I can see a cardiologist later this summer.

[Stjopa]

Hi, it seems your heart is/was very nervous and jumpy, there were some ectopic beats (pvcs) but there were also lots of other activities. I experienced it once and I wish I had a holter that day, it would have caught plenty of stuff going on in my heart. By far the worst were the couplets and triplets, 2, 3 or 4 pvcs in a row. But, I'm still here, fighting. If your heart is structurally fine, there's nothing to worry about, it's benign. Try to lose some weight, meditate, go to psychotherapy to manage anxiety and panic (god that helps), start not caring for unimportant things, focus on yourself, rest, drink plenty of water and, the most important thing, don't ever escape, fight instead, so if you think that another tach or pvc run will appear in a shopping mall or in a theatre, don't walk away, stay and fight, but that's something you should learn how to with your shrink, it's a process. And remember, what you described are just symptoms, cause is probably inside your head. Take care of the cause. These problems will never vanish, instead you have to learn how to cope and how not to lose your mind. It's very much doable.

[Lori080869]

Thanks so much! Doctor has ordered some follow up testing to be sure everything is structurally ok and put me on a betablocker. You mentioned water, I am TERRIBLE at drinking enough during the day. I need to hydrate more for sure. My doctor told me my heart is very excited. Haha, at least one of us is excited about all of this. He said we have to rule out any issues, but the amount of stress I'm under, coupled with anxiety could be a big culprit. Fight, I am. This is my life and I only have one to live, so I plan to lead it fully. That is one of the reasons we are moving, going to an area that has much more to offer us in all areas... outdoors, activities, etc. Thanks for your reply!

[Stjopa]

And check out some breathing techniques, breathing is priceless.

[MichelleP_3811]

Your heart definitely seems irritated and it is possible it is partly due to the stress you are under.  When we are under stress we produce a hormone that affects the heart.  When the heart is irritated from this hormone it can sort of feed on itself.  You are having about half your beats out of sync.  This is quite a load but you aren't having any sustained runs of either pacs or pvcs.  This is good that your heart isn't getting caught in a fast rhythm but I have to imagine the load of ectopic activity you are having is making you feel unwell.  You say you were glad that the tachycardia was caught.  Can I ask how long you have had boughts of sudden tachycardia?  Is this a newer thing or something you have had most of your life?  If it is newer it could be related to the high blood pressure but if it is all your life it could be a structural issue that can maybe be fixed.  Seeing a cardiologist may help sort that out.  

This said, the fact that you have had your heart evaluated to be structurally normal is a good sign that you are not in any imminent danger.  Sometimes these things go out of control and resolve on their own.  And unfortunately the avenues to treat ectopics can create more problems than good. They aren't always successful and sometimes lead to more trouble so cardiologist tend to try to intervene as little as possible unless the heart is in jeopardy.  

The first line of defense is usually beta blockers.  Since you are already on blood pressure medicine the doctor may try to a different kind or different dose.  Is the Benicar the type with a water pill?  The prescription would be Benicar HCT as opposed to just Benicar.  If you are on the HCT type then you  are also on a water pill that may be affecting things.  If you are becoming too dehydrated from a water pill it could be contributing to the erratic beats.    If so would firstly say try and drink plenty of water.  Being on a water pill means we need to be mindful of taking in water so we don't dehydrate.  If you drink caffeine consider cutting it out or cutting back because it will also contribute to dehydration.  This said, drinking extra water and being on a water pill can deplete our sodium levels so make sure to discuss this with your doctor so they can monitor that your levels aren't out of whack.  Either way, even if you aren't on a water pill with your Benicar it may be wise to cut all caffeine at least at this time because it does over stimulate our nervous system and heart and can contribute to dehydration.

I would also watch foods that cause indigestion as issues with the stomach like gas and acid reflux can cause the heart to act up.  And work on your stress and anxiety to lessen the stress hormones coursing through your body.   Anxiety can become chronic if not dealt with so you may want to consider seeing a counselor for a few visits to devise ways to overcome it.  Maybe get a few books on it and see if you can find some practices and exercises to help reduce and deal with it when it flares up.  It will do your nervous system a world of good to get on top of it if you can.  

The long and short of it is you are currently have a high load of ectopic activity.  Odds are your heart is still structurally fine so it may not be much of a worry but it would be good to see a cardiologist to get reevaluated if it has been years and to hopefully get a regimen of blood pressure medicine that helps calm things down.  If you do wind up having a structural issue contributing to the runs of beats you may be able to get that corrected but this needs to be diagnosed first so just try and do your best to put your mind on other things, take steps to reduce the big triggers and work on your anxiety and things may calm down for you on their own.  Best of luck getting it sorted out.  Take care.

      

[Lori080869]

Thank you, thank you, thank you for your thorough response! Quite informative! I do have one question for you, you mention that about half my beats are out of sync. Can you explain that to me? I thought about 1% of my beats were out of sync? I had 2273 ectopic beats out of 256,ooo QRS complexes. Am I missing something one the report that indicates a much higher ratio?

[MichelleP_3811]

Oops, sorry my bad.  I didn't fully look at the QRS complexes and that speaks of 2 days of beats.  I read that you were sent to the er so I made a wrong assumption that you only had a heart monitor on for less than an hour, or 47 minutes and 2,000 extra beats in less than an hour is a lot but 2,000 extra beats in 48 hours is really quite small and not likely to be anything the cardiologist will be concerned about.  Odds are he will not do much but play with your meds.  Though being a new doctor he may order his own tests to evaluate your heart but the amount you are having is probably going to be considered more normal by the cardiologist than severe so just work on the big triggers, caffeine,  stomach issues and stress.  

Though I still want to ask if your tachycardia runs is something new or something you have experienced your whole life?  The answer can possibly lean things towards something you were born with that could possibly be fixed or it all just being short runs of extra beats and not something that can be fixed.  

As a matter of note, I had a type of tachycardia I was born with caused by having extra muscle fibers in my heart that allowed the signal to get caught in a loop.  The tachycardia would start and stop in one beat.  My heart rate would be crazy manic fast in the 200s and happened my whole life.  I thought it was normal so I never had it checked out until I got older and it started to happen a lot.  Because it was happening a lot I also started to get a lot of extra ectopic beats.  I did not know they were two different things but see now that they fed off each other.  The ectopic beats triggering the tachycardia and the tachycardia making my heart irritated triggering more ectopic beats.  I had it fixed but the ectopic beats still happen.  I have them daily but really don't notice them that often.  I do have short runs of the extra beats from time to time that lasts a few seconds but it doesn't feel nearly as fast or manic as the avnrt svt did.  So I am aware of the difference but will say based on that experience a heart rate of 144 isn't super fast so it is probably just a run of extra beats that won't sustain.  Of course I am not a doctor and can't diagnose you and you should still see one when you are settled in your new place but I would say now that you really don't have a lot to worry about.  many people have the amount of extra beats you are having a day and go on to live long lives.  But still get checked out since this is a change to what you were experiencing before.  Take care.

[Lori080869]

Your response is quite reassuring! Thank you ever so much! My GP was concerned enough to manage to get me into a cardiologist this Tuesday, so I'll be sure to report back after. As for the tachy, it's new this year. The ectopics have been present for almost 20 years, though never ever this bad. The ectopics don't stress me much until they start coupleting and tripleting. The tachy stresses me more.

[MichelleP_3811]

Good to be checked out for peace of mind.  I suspect that the cardiologist will not be concerned but please do keep me posted. Best of luck

[Lori080869]

Reporting back on results. Cardiologist is sending me for an echo and a chemical stress test to determine if this is significant or benign (his wording). He also took me off of the amlodipine and put me on metoprolol instead and said it should help with a lot of my symptoms. I'll let you know what comes of it all. Thanks again for your support!

[MichelleP_3811]

Ok, good to hear he is checking you out fully.  Please do keep me posted.  Hugs