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Avatar universal

Identification of this rhythm

I'm a fit 30 year old male, 190lbs., controlled hypertension, moderate/intense cardio daily and have been experiencing skipped/extra beats for almost a decade which for the most part have been identified as PVCs/PACs. For the last few months I've been perceiving a "flutter" sensation occasionally that feels like my heart is just "flopping around" for a second or two. This was why I decided to see my doctor and was evaluated with a two week holter back in December which was mostly uneventful and only showed a relatively small number of PVCs/PACs. Also noted on the report was one case of "Ventricular Escape Beats". I experienced this run of "flutter/flopping" sensation while wearing the monitor and was wondering if this EKG from the report is what I'm feeling and what it is? My cardiologist didn't mention anything about it but even though it's captured on the visualized EKGs here (two separate episodes, days apart), it wasn't noted in the comments of the report. I would just like to make sure nothing is being missed.
4 Responses
995271 tn?1463924259
I know enough about EKGs to be dangerous.

anways,...

Are you sure this graph pertains to the episode of escape beats?  The reason I ask is because I *think* I see P waves right before the ventricular waves, which means it wouldn't be an escape beat.  But then again, if each of those squares is 25mm, that would mean there was about 7 seconds between some of the ventricular beats which would mean that yes they were escape beats.  The spacing between the P and Q waves seems a bit long, which might indicate some AV block, but this is a very amateur guess.

Also, the very bottom strip, that looks like NSVT to me but it would depend on the model of EKG you were wearing.

If I were told I had escape beats I'd be wondering why, either is was blocked (AV block) or the SA node didn't generate it.

The NSVT portion is something I'd ask more about too.
995271 tn?1463924259
p.s., If I had to go out on a limb and detail what escape rhythm feels like (which I've never experienced), I would tell someone it would be a very slow heart rate.  4-7 seconds between each beat, which is a rate of 40-60 bpm, which is what an escape rhythm generates.  You see, you can't live without your ventricles beating at that minimum rate.  The ventricles have a backup built in just in case the SA beat doesn't signal it to go.  This back  up paces automatically at a slower rate than the SA node to achieve that sort of backup.  It's always there, but because its rate is a bit slower than the SA node, the SA node usually leads the whole thing.  The ability for ventricular cells to pace is what causes PVCs, BTW.  When a ventricular cell paces faster than this 4-7 second propensity it's called "enhanced automaticity" and this what causes PVCs, but I digress.

Since you are describing a lot of quiver, flip flop, I'm inclined to think that would more match the NSVT profile which is what I see in the bottom strip.  

I usually tell people to ask their docs and take their advice but you might want to get a second opinion on that test.  Not that NSVT is bad, it's usually benign, but at least get the right answers.
995271 tn?1463924259
pp.s, dangit I wish I could edit posts, I end up doing this ps thing.   Anyways, I'm guessing that each of those squares is about 5mm.  If that's the case, than I really doubt this strip shows escape rhythm because at most there is only about 1.5 seconds between v-systoles which doesn't fit escape timing (as I understand it).  If you can, measure the distance between those squares and post it back, knowing that is needed to interpret the EKG.
Avatar universal
Thanks itdood, I showed this to my EP and he thought it was an artifact and not NSVT. In any case, I have a followup stress echo to rule out any structural disease.
1 Comments
Hi, did you ever find out more about this? I am currently in the same boat as you.
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