Heart Rhythm :: Ischemic Narrative Shows Significant ST Changes
Mar 24, 2016
This problem is a heart electrical issue more than a rhythm one, but I'm guessing some of you might know more about this issue, too, and these changes weren't mentioned in the initial report.
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I had a 24-hour holter, and the report said normal, but when I requested the actual data, I found the ischemic narrative shows significant ST changes, both elevations and depressions, and for longer durations than 1 minute. The ST elevations occurred while I was exercising.
From my understanding, ST depressions or elevations of 1 to 2 mm that last for at least 1 minute can be clinically significant and warrants further patient assessment. Is this not the case? Should I be concerned that no follow up is being done, and that this information wasn't even included in the report?
For background, this cardiologist was a new patient appointment. He did not listen, spent less than 5 minutes with me, the blood pressures and heart rates taken during my appointment are not in my chart, and the two that are in there don't list the correct heart rates, as the heart rates are the same both lying down and sitting -- I have Postural Orthostatic Tachycardia Syndrome (Dysautonomia), hence the high avg HR, and it's impossible my heart rates were the same, my blood pressures rise with sitting and standing (I have orthostatic hypertension, hyperadrenergic POTS), but who knows what the heart rates were. Over half of the notes from my appointment were completely incorrect, my family medical history is missing, and he actually invented past medical history that I've never had and now refuses to change the notes, despite the fact that he essentially diagnosed me with a past disorder that I've never had.
Clearly, I need a new cardiologist, but in finding a new one, in my experience, if this information about the ST segment changes is not in the actual report, no one will see it, & therefore it doesn't exist. Too many things have been missed due to errors like this for me throughout my entire life.
I have Ehlers-Danlos Syndrome, which I had to find myself, after finding POTS, as all my doctors missed both. I'm still waiting to be seen by a geneticist, but I've been diagnosed with "generalized hypermobility of joints" by a Rheumatologist and "whole body pain" and "chronic migraine" by my neurologist. My symptoms overlap with multiple types of EDS, including hypermobile, classic, and vascular. I have both velvety and translucent skin with visible veins. 9/9 Beighton, though my elbows and knees subtly hyperextend, I didn't even know they did.
Age 29, F, 5'3", 120 lb, white, have had chest pain since age 7, Scoliosis, Acrocyanosis, Raynaud's, Livedo Reticularis, Hypersomnia, & many more. Likely have some form of neuropathy, my feet that sometimes fall asleep after I stand and the tingling I feel pretty much constantly all over thinks so, despite the fact that no doctor has yet to pay attention to these symptoms. Grew up in southern US, do take Adderall & Vyvanse for ADD (which likely came from POTS itself), and Chronic Fatigue Syndrome.
Just hoping to get a better understanding of these results, especially since they weren't mentioned at all in the report I received.
Hi, new to MedHelp. I just got my results on a patient portal from a stress test that I just had done a few days ago. I don't see my doctor for 2 weeks, but my anxiety just makes me want to know what is going on. Does anyone know how to interpret these results? Thank you for any input you can give.
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Patient was pharmacologically stressed with adenosine at a
dose of 48 milligrams. No chest pain occurred during stress. A maximal
heart rate of 108 beats per minute was achieved.
Injections of 10 mCi and 30 mCi of technetium 99m Sestamibi were given
for rest and stress imaging, respectively.
SPECT images after each injection show normal size left ventricle. No
fixed or reversible perfusion abnormalities were present. Ejection
fraction was calculated at 72%. No wall motion abnormality.
IMPRESSION: No ischemic changes with pharmacologic stress. Ejection
fraction of 72%. No wall motion abnormality.
I'm a 32 year old female and about a year ago I started with what felt like skipped beats so I went to the doctor who listened to my heart and said it sounded ok so she sent me for a 24 hour heart monitor which showed my heart beating faster than it should at times and also in places there was extra beats which she said would of been what I felt as skipped beats, anyway she said they seemed to be benign but is sending me to a cardiologist to see if there are any mess to control it as it happens daily and just recently I've started to get a feeling a bit like my heart is vibrating but I only notice it when I'm sat down doing nothing. Does anyone else have this problem? I feel like I'm going made and it's taking over my life it's all I seem to think about now.
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My 19 yr old son was admitted to the hospital on Friday. His heart afib, His organs were failing as well. He was drinking very high caffeinated soda's as well as energy drinks daily allot of caffeine, Everyone told him to stop drinking so many. All he did was stay in his room playing video games or on the pc from 11 am til 5 am the next day. He ate well, rarely drank any water, then a month ago, he stopped eating, vomited anything he drank or ate. Then he started drinking a gal of water a day, or chewing on gum or candy. Was burping allot, then his heart was beating fast so we took him in. Now I'm told he has an enlarged heart. Where did this come from? He's the healthiest one in the family. He's had maybe three colds since birth. Could all the caffeine and other ingredients do this to him?
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I had PVCs for about ten years before my mechanical aortic valve replacement in 1985 at 41 years of age. My cardiologist told me that the PVCs would probably get worse after surgery, because many times the insertion of a foreign object (i.e., my mechanical valve) fouls up the heart's electrical system even more. To the contrary, my PVCs completely went away after surgery!
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In 2002, I moved to a new location, and my new cardiologist started me out with an ECG. He detected light, occasional PVCs, of which I could feel no effect. I moved again in 2011, and had a 24 hour Holter monitor done in April, 2012. All my cardiologist told me was that my PVC rate was 9.7% of total beats, but all asymptomatic, so not to worry. Again, I only occasionally noticed a PVC.
I went to my primary care physician for my regular four month checkup in mid-November 2015, and my pulse rate while sitting in a chair kept fluctuating between 35-40 (using the finger monitor for pulse and blood oxygenation). I made an appointment with my cardiologist for 10 days hence. The finger monitor again showed a pulse rate of 33-38 sitting (but 98% blood oxygenation), but when laying on the examining table with ECG leads strapped to me, my pulse read at 73. The ECG was abnormal, and I was ordered for another Holter monitor.
This one came back as abnormal with 19% multifocal PVCs, with episodes of ventricular couplets, ventricular bigeminy as well as ventricular trigeminy. Yet, the report stated that all episodes were asymptomatic (which I find hard to believe, since last August of 2015 my yearly echocardiogram indicated that my ejection fraction had decreased over the last few years from 62% to 45%).
At any rate, my cardiologist prescribed one daily Diltiazem CD 120mg Caps. What seems strange to me is that Diltiazem is for angina and high blood pressure, but is only an OFF LABEL use for arrhythmias. Hence, I have noticed no change in my PVCs (perhaps even a little worse for these first 25 days on Diltiazem, and especially heavy PVCs when I first try to go to sleep at night), nor has my blood pressure been lowered.
I am considering making an appointment with a different cardiologist to have him do a new ECG, go over my Holter monitor report, and consider a drug specifically for arrhythmias. Any other suggestions, or should a 72 year-old man like myself just let nature take it's course?
the last couple of days have been much better with the PVCs. I have done nothing differently, just able to relax more because they are much less frequent and bothersome and with the absence of these PVCs, there is less anxiety. it is nice to not be bothered so much by these things, at least for awhile.
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What would this mean? I didn't get one PVC for 4 to 5 hours after the hospital last night. They did blood work and it was good and even chest X-ray and EKG. Saw the PVCs on EKG but the chest X-ray they said they noticed my bronchial tube was enlarged so they gave me antibiotics. What the heck is going on?
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I recently wore a holter monitor that came back with 92 PAC's over a 24 hour period. I have been having the fluttering feeling we all know and fear more often lately. I have been to 4 different cardiologists over the past 3 years and have had every test under the sun. My question is if my heart is structurally fine, why am I having more palpitations? The most PAC's I ever had on a 24 monitor before this was 10 and I've had many monitors.
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Is it factual that stress brings on palpitations? My cardiologist just tells me not to worry and enjoy life. Easy for him to say. Appreciate any feedback or to hear from people having the same problem.
This has been going on for about 2 years now, I was 26 then, now 28 (male) I went to the cardio when it started and nothing was ever picked up on the ekg so i had a stress (ekg) test and a echocardiogram, cardiac said I had a strong healthy heart with no blockages but did have a small murmur caused by a very mild mitral valve leak but it was nothing at all to worry about and that I needed to relax and exercise... fast forward another year and I start having a lot of pacs, or what feels like a lot, like 20 a day that I feel... so it gets my anxiety going and I go back to the cardio, still nothing picked up on the ekg, so for my peace of mind he's says we'll do another echocardiogram just to make sure the valve leak wasn't getting worse. Everything come back good on that and he said no need for another echo for 3-5 years... so he give me a 10 day event monitor where we finally figured out that I'm having pacs, he says they are harmless and no need to worry about them. My resting heart rate avgs between 50-60 which he said was good but with it being low it could be allowing the extra beats to fire off occasionally. I had blood work like 3 different times and everything come back good. So to this day I still have no idea what's causing the pacs, the only thing i can relate it to is it seems to happen more after eating so i got back on acid reflux meds when that spell started and it seemed to help, now I may go a week or longer without a single pac but then I might 2-3 a day for a few days and then they go away again as suddenly as they came... it really makes me think something I'm eating is triggering them. The reason I'm here today is because the devil makes sure to throw everything in front of me that will get me to worrying, latest example being the mma guy dying from heart trouble... so I go straight back to reading about my pacs and start reading stuff where they may cause afib, so now I'm literally a wreck scared I'm going to end up with afib. They say in a normal heart pacs are completely harmless but I worry that mines not normal bcuz of the valve leak, he said I didn't have mitral prolapse just that the valve wasn't closing as tight so it was slightly leaky but of no concern. Someone please give me some reassurance.
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Does anyone have any suggestions for getting over feeling like every PVC is going to kill you? I have had countless tests and ALL of them have come back saying that my heart is healthy.
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I don't get a ton of PVCs all the time anymore. Once I started magnesium, that helped that. I do get a few REALLY noticeable ones every few days. When they happen, sometimes they take my breath away and then the panic sets in. Sometimes, it will ruin my whole day. I will sit there and think about it all day. Waiting, worrying, not able to let go of it. I'm afraid to exercise, although I've been told countless times that there is no reason I shouldn't. I just don't know what to do anymore. I wish I could go back to a time when this didn't happen.
I have this problem of breathing normally which occurs sometimes a few weeks or as prevalent as 2 times a week. I will often feel better when lying down. Some of the symptoms include increase saliva and nausea. My appetite will also be gone. However I will not have this problem the next day.
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I realized that this problem occurs when there is a great change in the temperature. For example when i am travelling from a country with a tropical climate to a colder country (around 10 degrees). This problem also occur sometimes after food (Etc. Eating hot and cold food). This problem strangely do not occur during the morning.
I went to the doctor a few months ago for a routine physical and mentioned that I had been feeling an occasional (0-10 times a day) thump in my chest (which I thought to be some sort of ectopic beat after looking it up online). They did bloodwork and an EKG and said my blood pressure was a little high but the bloodwork and EKG did not show anything to be worrisome. My doctor said it could be stress related (because this was right after Christmas) but I am still having them. She also told me that if they get worse to let her know, but they haven't got worse and I am just worried that I should be having them checked more in depth than what was done during my physical.
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I've been experiencing a flare-up in my ectopics recently.
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My heart is healthy (I had an EKG and an echo done two months ago when my ectopics started to bother me again). I don't know if what I'm experiencing now is PACs or PVCs (none were found on my EKG) but earlier I had only PACs. I would assume that most of my ectopics are PACs.
I know that stress and anxiety is a major trigger, and what often happens is that I'm having one ectopic, I'm trying not to worry about it, then I have another one and I get a major rush of adrenaline, which makes the ectopics go wild and I'm having 5-15 a minute for a while (15-20 minutes) and suddenly they just go away.
The sensation is quite variable from event to event, sometimes I get the throat fullness sensation followed by a thump, sometimes it feels like my heart stops and then a thump, sometimes I just feel some fluttering in my chest for a second or two. I'm worrying about the latter as I fear it's a run of ectopics.
The problem is, I KNOW that premature beats are benign but still I can't stop worrying. It's like a fear of fear, because I fear that the ectopics will ruin my life.
I'm taking 100 mg Metoprolol (and some Propranolol as needed) and it takes the edge off my ectopics, but it's not a cure. Also, I'm on Zoloft for my anxiety.
EKG: Normal sinus rhythm, 64/min, normal.
Echo: All normal.
BP: 115/75 at doctor's office.
At what point should I worry about ectopics (how many)? Is it common to have a fluttering sensation even with a single PAC or PVC? Is it normal to get those flare-ups where you feel ectopics several times a minute?
I've been experiencing PACs for the last 5 months, they seem to happen a lot when I am standing up, bending down or when I'm concentrating on something.
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Does anyone have any tips or can recommend a supplement that helps reduce them? They seem to happen everyday and are driving me insane. They sometimes can make me feel dizzy and lightheaded.
I went through a 30 day holter study due to what I thought were skipped heart beats. Luckily I had a couple of episodes caught on the holter and they were determined to be PACs. I've lived with them for a year and always just dealt with them. No biggie. But I fainted and had a seizure back in September so it prompted me to have everything checked out... anyway what I want to ask is does anyone else have severe runs of PACs? I'll get them for several minutes at times, and they'll come in irregular intervals... Like I'll get one on top of another, and then it'll switch to every 3rd beat, then every 4th beat, then back to every other beat... This usually only happens when my heart rate increases to above 120 and it stops when my pulse settles back down. I especially get them in a hot shower, or sometimes after a big meal. And I get them when I exercise and really bad during exercise recovery. I'm concerned about Afib.
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Does anyone know if Sotalol causes rebound tachycardia when weaning off of it (or if you miss a dose). The last few days my resting rate when I woke was 84. That's not normal for me. My rate is low 60's or High 50's most of the time.I am a 38 year old male (very athletic and in shape) and I work out vigorously 6 days a week. I don't know what could be causing this. I had an Aortic Valve replacement in 1992 and has been stable ever since. I am 6'0" tall 197 lbs 11% body fat. Low cholesterol LDL 61, HDL 52, Triglycerides 82. It seems like my normal day rate is elevated about 12-13 beats. I am very confused by this and a little worried.
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My husband has been on Lisinopril for approximately 3 years after being diagnosed with Heart Failure, High Blood Pressure and Cholesterol. He was admitted to hospital in January 2007 as his condition had worsened. They prescribed Warfarin, increased his diuretic but left Lisinopril the same. They confirmed he also suffered with an irregular heart rhythm and that they would like to carry out a Cardio Version Procedure once his INR levels were between 2.0 - 3.0. This finally went ahead last week and his rhythm has returned to normal (for the time being). I am somewhat concerned though that the side effects shown within the packaging states that Lisinopril can cause an irregular heart rhythm. I have spoken to various pharmacists and they cannot comment. We are due to see the GP in 10 days for his opinion. Can anyone shed any light on this area please?
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I am Nico, I am a 26 year old male who has been suffering from an array of symptoms since I was 17 years old. I am 5ft 8" and I weigh 235 lbs ( I've gained over 60lbs in the last year and a half) I have had a Panic Disorder, Generalized Anxiety Disorder, and dizziness (not vertigo) problem since 17 (nearly 8 years now). In 2009 I got into a car accident and fractured my frontal right sinus cavity and had to do a reconstructive surgery. In this accident I also got a concussion and was in shock and also unconscious for about an hour. The last few years my health has gradually been declining and my quality of life has gotten so low. I have seen a TBI specialist, a Neurologist, a Cardiac Electrophysiologist, a Psychologist, and a Psychiatrist for Psychotropic medication management
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****(Since Wednesday Morning 10/7/15 I noticed whenever I am Sitting or Standing that My Heart Rate Is Super Erratic and Jumping around a lot, it goes into the 120s-140s when I stand "from a sitting 60-70 bpm" and then bounces all over the place, 40s to low 100s to 80s to 50s, etc. Also since this has started I have noticed an extreme shortness of breath made worse sitting or standing, made better by laying down on my side, my blood pressure since wednesday had also been very low for my normal average when standing, other symptoms with this are blurred vision and off balance/dizzy... I fainted for about 5 seconds friday 10/9/15 night after climbing my flight of stairs, earlier that friday morning I went to the Emergency Department to be evaluated and they said my chest xray was okay as well as my CBC and CMP blood tests.... I explained that most of my symptoms were POSTURAL and or ORTHOSTATIC but they kept me lying down till discharge and didn't let me show them, but on the monitor I was having 100s! of PVCs and PACs which is not normal for me to have that many, also the PACs were making my shortness of breath worse.... They discharged me even though I said I don't feel safe because these are new symptoms and they said well we need your room because we are busy and your cardiologist said all the Arrhythmias are from your Sinus Node so your fine and were discharging you.
. Here are the symptoms I have experienced daily or within this time frame:
*Constant Fear/Adrenaline Rushes
*No Sex Drive
*Easily Overstimulated (sensory Overload)
*Heart Arrhythmia (PVC's, and Sinus and or Paroxysmal Tachycardia)
*Sensitive to Sounds (Always have to wear earplugs)
*Sensitivity to Light (always wear sunglasses)
*Slight body tremors
*Chronic Neck and Muscle tension in Occipital and Trapezius Muscles
*Startled by normal everyday sounds (occasionally)
*Frequent muscle twitching (Eyelids, Stomach and Diaphragm, temple, legs)
*I can't climb a flight of stairs without feeling exhausted (2 years ago I used to hit the gym a lot)
*Always Feel Like I Am Dying or That I Have Some Serious Terminal Illness
*Elevated Blood Pressure
**Obstructive Sleep Apnea (Not using CPAP)
*Brain Fog Always
*Shortness of Breath
*Lump In Throat
* Every few months a random mouth and tongue become paralyzed for less than a minute when I eat then I get
Confused afterwards or Panic attack.
Here are the Medications I take everyday:
Clonazepam (Klonopin) .75 Mg
Diazepam (Valium) 5MG as or if needed
Here are TESTS performed in the last 7 years I will put a number next to it to indicate how many times I've had it done
* Head/Brain CT Scan 3-4 Times
* Brain MRI 4-5 Times
* Neck/Throat MRI 2 Times
*Chest X-Ray 10+ Times
*EKG 20+ Times
*Implanted Cardiac Monitor 4/01/2014(Still Implanted)
*EEG 3-4 Times
*Basic Neurological Function Test 10+Times
*Echocardiogram Stress Test 2 Times
*Echocardiogram 1 Time
*Stress Test 2 Times
*Transcranial Doppler Ultrasound (testing for artery compression or insufficiency) 1 Time
*Neuropsych Testing (TBI and cognitive function) 2 Times
*Blood Tests/Urinalysis >CBC>CMP>CRP>Troponin>Metanephrines>Cortisol>Lipid Panel>Heavy Metal Compounds>Catecholamines>Thyroid Levels> and some others I can't remember.
*Pulmonary Lung Function Test (shortness of Breath) 1 Time
*Overnight Sleep Studies (In Lab) 9 Times
*Cervical Trigger Point Injections (Marcaine/Lidocaine) Done Monthly
I have small pimples all over my face. But the problem is you only see them on strong lights or sunny place s. They are kinda under the skin. And when I wear makeup they tend to look so ugly. I don't know how to get rid of them. And I really wanna what causes them. They appeared almost a year ago.
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1. I had a HIV test done that came back negative. Not sure which one but I had blood drawn and found out my results around an hour or so. Any clue what gen that is?
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2. With that test is it safe to assume anything I did 8 weeks previously to have gotten HIV May not show up but anything 8 weeks and on would be conclusive?
3. My only exposure in the past 8 weeks was unprotected oral, 25 days before the test in the window period, with a woman (both ways) whom I had done this act with multiple times before in the past year. Is this a concern?
4. Do I need to re-test based on this information?
Uterus normal in length 10.8cm. Combined endometrial thickness 8mm which is normal. there is 10mm heterogeneous focus involving the fundal endometrium. the myometrium shows multiple fibroids including 30x30mm fundal mural fibroid, 30x26mm posterior mural fibroid, 23x22mm anterior mural fibroid. Some fibroids are partially calcified.
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Normal right ovary. Left ovary shows 3 fairly simple appearing cysts which measure up to 23mm. In addition there is 39x30mm tubular complex cystic structure in the left adnexa which may represent complex separated cyst or hydrosalpinx.