Worried about holter results - ectopic beats

I've gotten my 24h holter results today and I'm a bit worried due to the ectopics and because each new holter I do the more supraventricular ectopics it registers. It's like a crescendo. This is what it registered:

- 1 ventricular ectopic at 09:20 (I was exercising - walking at a fast pace - and AS ALWAYS when I do that, I was anxious and having all the symptoms associated to anxiety)

- 5 supraventricular ectopics (one of them was at 09:32, I was still exercising as described above. As to the others some occurred while I was sleeping (I didn't feel them), one in the afternoon - I also didn't feel it but was in the hour after I did 30 minutes of bicycle - and one when I went to bed - I felt what seemed to be a very mild extra-beat but it could have been a muscle spasm as well, I'm not sure what it was but the time seems to be coincident with the ectopic)

- 197 bradycardia runs, the longest was 213 beats at 06:16 and the minimum rate was 37 bpm at 05:37 - now, all this is certainly due to the beta-blocker I'm taking (only a half tablet in the morning) because the holters I did before start taking this medication had very few or zero bradycardia runs. Maybe I should talk to the cardiologist to reduce the dose to a quarter tablet?

- Min heart rate: 46 bpm at 05:21
- Max heart rate: 117 bpm at 09:19
- Avg heart rate: 63 bpm
- Sinus rhythm

I had many symptoms during the holter that I took note of and apparently there's no electrocardiographic changes related to them. BUT unfortunately I didn't have any of those almost paralysing "acute" episodes of racing and pounding heart beats, hot flushes and (a sense of) near faint - those ones we think we're going to die. I'd like to know how would those look on the holter. Would they appear as supraventricular or ventricular tachycardias or just a sinus one? So while I am somewhat relieved I am still worried because I'm fearing that potentially dangerous arrhythmias haven't been caught... Have you guys ever had similar holter results and an overall identical experience to mine? I'm seeing the cardiologist next week.

The bradycardia is curious but not too far outside normal for sleep. I get similar numbers.

You obviously need longer monitoring to catch these acute episodes. They could appear as any kind of rhythm. The fact that you have so few ectopics is perhaps reassuring, though, but I'd definitely insist they keep trying to catch it on a monitor. :)

Have you tried taking your pulse during an episode? What did you feel? And do they appear and disappear gradually or suddenly?

You were sleeping and the betablocker I would very much so think contributes to that.

I also get both PVCs and PACs, both caught on a monitor. If you feel the dangerous ones were not caught, I would def ask your cardio if he/she can do a longer one. I had one for 30 days at one point to catch what I was feeling.

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Originally Posted by Aaahhfreakout

Have you tried taking your pulse during an episode? What did you feel? And do they appear and disappear gradually or suddenly?

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When I get them I'm always too frightened to take my pulse, but I still manage to call an ambulance or a taxi to take me to the ER, to clearly describe my symptoms and to tell where I am even though that gets me even more out of control. It has already happened both at home or while doing my exercises outside. As to the symptoms, it feels like my heart is beating faster and stronger in a chaotic manner, I feel like I'm going to faint or to die at any moment and this goes on for several minutes in a row (like 5 minutes or so). There are usually prodromal symptoms that let me know that one of this acute episodes is likely or about to occur: bloated stomach, urgency to evacuate, hyperventilation, dizziness, tight chest (usually the left side), anxiety and fear (of a fatal arrhythmia - specifically ventricular fibrillation). Then, sometimes, the "acute phase" sets in, and there my blood pressure and cardiac frequency go up along with the symptoms I described above. In the aftermath I feel tired, sometimes I get shivers and usually I feel the left part of my chest a bit tightened for half an hour or so. The blood pressure and cardiac frequency stabilize in an hour or two. So I would say that they appear and disappear gradually, but the acute phase sets in all of a sudden. Whenever I start to feel the prodomal symptoms I try to control them (I count to ten, I squeeze a ball, I breathe into a paper bag, I take a tranquilizer, etc.) but sometimes it fails. My cardiologist told me once that the only way to know what this is, is to perform an ECG while I'm having the acute symptoms - which is very unlikely (that's actually when I'm calling the ambulance...). When I finally get the ECG and the blood tests done in the hospital everything is ok: sinus rhythm (sometimes tachycardiac but still sinus), electrolytes OK, cardiac enzymes OK and they end up giving me a tranquilizer and telling me I suffered a panic attack and to see a psychiatrist.

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Originally Posted by Dolphin8808

If you feel the dangerous ones were not caught, I would def ask your cardio if he/she can do a longer one. I had one for 30 days at one point to catch what I was feeling.

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Yes, I will ask him this time. Usually while I'm on antidepressants I can go for months without experiencing any of this, but that's not the case this time so it might be the right time to try to catch this once and for all.

Well, I managed to change my next week cardiology appointment to today thanks to a patient who has postponed his. The cardiologist said that all the arrhythmias caught on the holter were benign and not to worry about. However, we wants to know whether exertion might cause them or not (since some of them occurred while I was exercising) so he wants me to do a cardiac stress test to rule that out. I will do it next week (along with an echocardiogram, a standard ECG and blood tests). I told him that unfortunately I didn't experience any of those sustained episodes of fast, hard and seemingly irregular heart beats along with a sensation of near faint during the holter monitoring, and I asked him what could it be. He told me that it is most likely several atrial extrasystoles in a row. He didn't make any remarks on the bradycardia runs (I suppose he didn't because they're due to the beta-blocker he gave me) and he told me to increase the dose from a half to an entire tablet!!! I told him right away that sometimes I get blood pressures around 90-100/60-70 mmHg (in an attempt to make him change his mind), but he just replied "don't worry about that now". I'm afraid to take the entire 5 mg pill though. If my average heart rate is of 63 bpm now, with a 5 mg daily dose I guess it will be almost permanently bradycardiac, and as to my blood pressure, I'm afraid that I'll be most of the time in a state of hypotension (below 90/60 mmHg). I'm wondering whether I should take those 5 mg or not. I'm really confused. As to a longer holter monitoring they only do 24 hours ones, I'll have to search for longer ones elsewhere.

Beta blockers aren't linear in the way the effect your heart, so double the dose doesn't mean double the effects...

They also don't physically slow your heart, they just help compete with adrenaline in the heart receptors and act as an inert plug that plugs up the receptors that adrenaline likes to stimulate, so your natural heart rate isn't being slightly overdriven by anxiety and stress.

So don't worry, these pills aren't affecting your sinus node, they're just helping curb the unnecessary hyperactivity caused by adrenaline. They're classed as a cardio protective and given to people with severe structural heart failure, so you with a seemingly fine heart are in a much better state than those guys.

As for the PVC/PAC/Ectopics... The doctors aren't worried because they are common in ALL hearts, they have no clinical significance at all - but a lot of people with anxiety and panic disorder have managed to tune their nerves into their chest to such a degree that their body feels the need to exaggerate the sensation of every ectopic to bring it to the conscious minds attention as you feel they are a danger.

An innocent ectopic or run if ectopics happens, your nerves have been anticipating it for hours and diligentally amplify the sensation to sound the alarm, you immediately dump adrenaline into your system and boom, you have a minor panic episode that sets you on edge and ramps up the anxiety.

As for the flutters that turn into a racing heart, that is exactly how severe panic attacks start, your body ramps up, dumps a ton of adrenaline, you get a horrible discomfort in your chest, you go faint, not in a genuine passing out way but in a severe woozy hyper aware hyper tense way, your heart has a few ectopics as it snaps itself into gear to get you to safety :p

The key is the rate, if this racing heart episode is less than 180bpm it'll be due to your sInus node which is normal and means the issue is outside of the heart, I.E. the heart is being told to go that fast by intense fear or exercise etc

If it's over 200bpm, which you couldn't even count, it might be something else like a PSVT which is harmless.

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Basically, if they where my results - I'd be pretty damn happy :p

Thanks for the description. That you know it's going to happen is very interesting. The chaotic feeling might only be ectopic beats from anxiety or it might be ectopic beats from anxiety triggering something else like short runs of atrial fibrillation.

I also know from my own heart monitoring that anxiety can make it feel like my heart is trembling when in fact it's my stomach.

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Originally Posted by Junot

As to a longer holter monitoring they only do 24 hours ones, I'll have to search for longer ones elsewhere.

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There are event monitors to use for a month or more. Hopefully you can find someone to give you one.

sputnikmoon, thank you so much for your detailed and explanatory post. All this panic/anxiety thing throws me into such a mental disarray that I quit thinking rationally.

Aaaahhfreakout, sometimes I also get some odd feelings in the chest and in the end I realize that it was only my stomach. I tend to overreact to the slightest symptom in the chest and my first thought is: heart! I wish it were always the stomach though.

I just wanted to say I have recently been diagnosed with supra ventricular tachycardia and ventricular ectopy following a 7 day holter monitor. My average day I have up to around 7,000 ectopic beats which actually relates to only 4% of my daily heart beats, and this is classed as non dangerous and completely benign, they on,y start to get concerned she you have 15-20% of your daily beats as ectopic.

Hope this helps x