Results from Holter Monitor and Echocardiogram from last week

[malibu82]

hi everyone

i posted last week about these annoying pvc's or whatever they are that i am having! i have been WAITING since last week for the cardiologist to call me back to give me my test results. i called a few times a day, with no call back. hopefully that is good news?

however i was annoyed about it so i went and picked up the results myself. which means nothing to me because it looks like a bunch of gibberish!

any input from anyone would be appreciated!

my echo cardiogram summary:

1.estimated left ventricular ejection fraction is 55%
2.moderate bio prosthetic aortic valve stenosis (although valve appears to be opening normally)
3. normal aortic dimensions

holter monitor final report:

min bpm: 48 at 8:24:11am Saturday
max bpm: 128 at 11:08:20am Saturday

Total QRS Complexes: 215725
Ventricular Ectopics: 13
Supraventricular Ectopics: 17771


the patients average heart rate was 76 BPM. heart rates greater then 120 BPM were noted less then 1% of the time. heart rates less then 50 BPM were noted less then 1% of the time.

no pauses greater then 2.0 seconds were noted.

13 ventricular ectopics, which represented less then 1% of the total beat count were noted.

the highest ventricular ectopic frequency occured from 12:00 to 13:00 Friday. During this time, 3 VE's occurred. ventricular ectopics were obsereved as 13 isolated beats only. no couplets or runs were noted.

17,771 supraventricular ectopics which represented 8% of the total beat count were noted. the highest supraventricular ectopic frequency occured from 7:00 to 8:00 Sunday. during this time, 796 SVE's ocurred.

in channel 1, a single episode of ST depression occured at 12:17:43 Saturday with a maximum depression of -1.2mm. no episodes noted in chanel 2. no episodes noted in channel 3.


any help in translating this to me would be greatly appreciated! i just want this heart beat problem to go away. i know that has to be causing my constant dizzy/lightheadedness.it seems even with this knowledge, there is nothing i can do to help them. i took the metoprolol again for 1 week and it didn't make any difference except bringing my blood pressure down to 89/50 making me feel super bad.

also has anyone else had moderate stenosis on their tissue valve this soon after surgery? i'm beginning to wonder.................the echocardiogram tech commented on how great my ascending arch looks now with no aneurysm and how they did a great job fixing it, but made no mention on my valve at all............!!

thanks again

 

[Adrienne]

PAC's

PAC's

You are actually having a lot of PAC's (premature atrial contractions), not PVC's (just a few). When it says supraventricular ectopic beats, supraventricular means above the ventricle which, in general, means the atrium. Ectopic beats are beats outside of (or other than) beats started in the sinus node.

Your ejection fraction is on the low side of normal (but still normal).

I'll let other people comment on the other things.

 

[kfay]

Ok, well, you basically only had 13 PVC's, but you had 17,771 PAC's, accounting for 8% of your total beats. No wonder they are driving you crazy!!! Your 13 PVC's are all single beats, no runs (which is good). They don't say what pattern your PAC's are in (for example, if they are singles, couplets, or in a bigeminy (every other beat) or trigeminy (every third beat) etc). If I were in your shoes, I would ask for a referral to an EP at this point to start exploring meds. It's probably too early to start looking at doing an EP study...every EP Dr. I talked to wanted an minimum of 6 months post op but preferred 12 before they would consider doing something else to my heart.

I don't have the problem with the stenosis in my tissue valve (although my gradient did go up this time), but I do have a moderate leak already at two years out. My cardio at the Mayo told me it's not what they like to see at this point in the game, but there isn't anything they will do about now, so not to worry.


Kim

 

[Allisoninoz]

Hi. I don't understand it either but I'm sorry you have to go through this. I hope you get clearer answers soon. Cheers.

 

[Kathy McCain]

Malibu, I would not even begin to try and "read" the test results for you. However, your ejection fraction at 55%, the way I am understanding it, is on the low side of NORMAL.

Take a deep breath, try and relax. If your Caridos office does not get back with you by Thursday in the PM, I would call them back. Tell them you need to talk with the nurse, and you will hold if necessary. If that doesn't work schedule an appt ASAP. It may be better to do that anyway. Have a face to face consultation with the Dr.

In the meantime, although I know it is difficult, please try not to worry. I know, I've been there, done that.

Take care

 

[Michelle D]

That's good you aren't having runs of PVCs. I feel ya though. I have 30000+ PVCs a day and around 1000 PACs a day. It's frustrating beyond belief, like chinese water torture at times. My cardio is sending me to an EP, i don't have the kind of PVCs that can be controlled with meds so ablation is my last hope. I think PACs can be controlled with a-fib meds but whatever you do don't get started on amioderone, you are too young.

 

[malibu82]

thank you all for your comments and help! all of this information is so confusing. are PAC's not as "serious" as PVC's? Are they more likely to go away on their own?

I wanted to have more children so I am hoping I won't have to take medication for this. I just feel them so strongly in my neck and throat it drives me nuts sometimes.

like adrienne said at least my ejection fraction is still in the "normal" range at 55%!

i was looking at past echos and in 2008 my ejection fraction was 60%. then i had two babies and before my surgery the rate was 55%. and now after surgery i am back at 55% again. go figure!

 

[Michelle D]

Runs of PACs could possibly cause atrial flutter at worst, which isn't a big deal and not likely to happen if you haven't had a-flutter or a-fib by now. Runs of PVCs can turn into ventricular tach which can be lead to suuden cardiac death. It is rare to have v-tach but scary just thinking about it. As far as the other stuff like the QRS stuff, I don't know what that means but PACs are truly benign.

 

[kfay]

Malibu, Pac's and Pvc's are both equally considered benign. That doesn't mean they aren't annoying as hell. There certainly is a chance that as your heart continues to remodels, they will go away. It just depends on where they are coming from and what is causing them. They will be able to get an idea from an EKG if they are multi focal (being generated from more than one spot) or not. The number you are having certainly makes an ablation an attractive option if you are open to it. But again, multi-focal ones are harder to track down and ablate than a single one is. I understand your desire to not be on a lot of cardiac drugs, especially if you want to have more children. And take it from me who has first hand experience in trying almost every drug there is trying to stop these things, a lot of them can actually make them worse.

So, my advise to you again, is to find a very good, sympathtic, EP (because some of them may still try and poo-poo you), and start walking down that path. Since you are already 6 months out, they may consider doing a study, but may still prefer to wait another 6 months. If you have to try some drug for that 6 months to get some relief, do it.

My local EP wouldn't touch me, saying it couldn't be done and he was insistant that I be 12 months post op. I saw at least 6 different EP's at the Mayo, who wanted me 12 months out as well, but who were happy to try and ablate me, even though my case was considered extremely complicated due to my type of congenital heart disease and previous heart surgeries. Unfortunately, my first ablation last year wasn't successful, so I returned 3 months later for try number two, and while he could tell he hadn't been able to track down the exact "spot", he was hopeful he had created enough scar tissue around it to considerably decrease them. It took about 4 months for me to see the effects of that ablation, but it took my pac's from around 25,000-30,000 a day to around 3-4,000 which is something I can definitely live with. They are also much "softer" if that makes since. So, there is hope, they can be stopped without drugs. By the way, I was a guinnea pig of the very first cardiac ablations in 1980 done at Duke. They had to do those by heart surgery at the time, so they have come a very, very long way. So, I have had dealt with this stuff for a very long time.


Kim

 

[neil]

think you need to speak with your cardio, just a lot of gibberish to me,time he pulled his finger out and talked to you,getting results without speaking to your cardio must be stressfull,

 

[malibu82]

michelle thanks for your information. i'm not sure what the atrial flutter feels like but i am sure i would know if i had that right? do pac's and pvc's feel the same i wonder?

kim it's great to hear that these darn things are benign and it's just the annoyance factor to worry about.

the idea of ablation still scares me a bit. does it hurt? do they put you to sleep? is there any risk of death like there is with heart surgery? you information is very helpful, thank you so much. you are definitely a veteran of this heart stuff and been through a lot!

thanks neil, i agree! it's stressful. but it makes me realize there is no MAJOR issue that needs immediate attention so i am thankful for that!

 

[ALCapshaw2]

Good Explanation Kim.

You are certainly at or very near the Top of the List of members with complex arrhythmias and may be the leader in terms of number of procedures to alleviate them.

'AL Capshaw'

 

[Luana]

PVCs are usually considered to be benign; however, that's not a blanket statement that applies 100% to everyone. There are some people for whom such rhythms can be quite serious, though I would doubt that would be the case for Jackie; nevertheless, I would not say they're always benign.

 

[Kathy McCain]

My cardio says they are benign. They are however, EXTREMELY ANNOYING. If you have them very frequently they can become NERVE WRACKING. Now that I have been off the Metoprolol for a couple of months. I dont notice them. Maybe every once in a while. Not nearly as much though. Believe me it's not just that I am getting used to it. They are actually VERY MUCH improved!! I had my surgery Feb 2008 too! So for me, it has taken quiet a while to feel almost normal!

Please, don't get too down about this. I agree with Neil. Please make an appt to have a consult with your cardio. Getting face to face with your Dr. instead of playing phone tag with the nurses, is soooo much more reassuring!

Hugs

 

[Marguerite53]

Good for you for going down and picking up your test results. And good for you for keeping a sensible head while we NON-professionals try to help you weed through the lingo.
Tomorrow is Friday. Call that cardio BACK. Let him/her know that you have your results in hand and you are concerned to know what the stenosis remark is all about. And you want to know what is the next step for you in alleviating your OBVIOUSLY abnormal heart rhythms. Keep that doctor on the phone for as long as you need to until you get the answers or instructions that you want to hear. If they balk at sending you to an EP (and for heaven's sake, what is an EP? Electro Physiologist??) I think you need them to tell you why they won't put you through to one. What exactly are they waiting for? Does the cardio think this may all calm down with time? HOW MUCH TIME? I want you to have your pencil ready and I want you to ask that doctor very specific questions. I think it was extremely insensitive for you to have been made to wait that long. A Physician's Assistant, another doctor in the office, a nurse.... someone could have called you!

Now, I don't want you to alienate the cardio. You can be patient and sweet. But you have every right to be firm and demanding, okay??

Go get 'em. Let us know!

Marguerite

 

[malibu82]

thanks again ladies! i have been sitting here today thinking, why wouldn't they automatically call with the results. why do i have to keep calling over and over leaving messages? it's getting ridiculous. thanks for all of the ideas about questions for the doctor marguerite! so helpful. i will try to call again tomorrow and make an appointment to go down there. it's just a bit of a hassle going downtown chicago when i live 35 minutes away...i was hoping they would call me back. but it's my health so whatever it takes!

weird thing is, the report was actually read and signed by my cardiologist locally here, since i went to my hometown hospital for the tests. don't you think he would have at least called and said hey, why did you get these tests done, and wow, i see you do have a problem going on here!

what are the chances two cardiologists wouldn't be calling back after seeing these results on a 5 month post op heart patient? so strange. maybe it really isn't that big of a deal then? i'll hope so!

ill keep you all posted thank you so much for your comments and concern. i dont know what i would do without you all nobody else understands!

 

[Michelle D]

If you didn't have atrial fibrillation or flutter on your holter then I wouldn't worry about it. I think most people that get afib after surgery do within a few weeks of surgery.

I hate when they don't get back with you. I just had a talk with my pcp about this, and now I have two primary care doctors, so if one doesn't get back to me then I have a back up. But I did ditch a cardiologist out right after not calling me back when I was having a PVC crisis. He never called me back, not even a nurse and I left two messages, one with his receptionist and one on his nurse's voice mail.

 

[kfay]

thanks again ladies! i have been sitting here today thinking, why wouldn't they automatically call with the results. why do i have to keep calling over and over leaving messages? it's getting ridiculous. thanks for all of the ideas about questions for the doctor marguerite! so helpful. i will try to call again tomorrow and make an appointment to go down there. it's just a bit of a hassle going downtown chicago when i live 35 minutes away...i was hoping they would call me back. but it's my health so whatever it takes!

weird thing is, the report was actually read and signed by my cardiologist locally here, since i went to my hometown hospital for the tests. don't you think he would have at least called and said hey, why did you get these tests done, and wow, i see you do have a problem going on here!

what are the chances two cardiologists wouldn't be calling back after seeing these results on a 5 month post op heart patient? so strange. maybe it really isn't that big of a deal then? i'll hope so!

ill keep you all posted thank you so much for your comments and concern. i dont know what i would do without you all nobody else understands!

The thing is, they really aren't going to see this as a problem. Even with these numbers. They are still considered benign. That's why you haven't seen anybody running to the phone to call you. It's not some emergent situation. I realize that to you, it's important, but it isn't to them. You are going to have to be the one who is going to tell them that it's just not something you are willing to live with. Period. Trust me on this. So, make that appt., and go in there and ask for help and make sure that they know how serious you are about it. I wish you luck!


Kim

 

[malibu82]

thanks for your help again kim! it seems you are right about the holter.

after calling the doctor again today the nurse finally called me back but of course i wasnt home so she left a message saying:


first, she wanted to tell me that the doctor is not able to call me today but she will call me next week.

she said the holter monitor results were FINE

she said about the echo, the doctor wants to see the actual film. so of course it makes me think oh great there goes my valve already.........but we will see

now its going to take another week to find out her thoughts on my valve but oh well maybe finally some answers!

 

[Lynlw]

thanks for your help again kim! it seems you are right about the holter.

after calling the doctor again today the nurse finally called me back but of course i wasnt home so she left a message saying:


first, she wanted to tell me that the doctor is not able to call me today but she will call me next week.

she said the holter monitor results were FINE

she said about the echo, the doctor wants to see the actual film. so of course it makes me think oh great there goes my valve already.........but we will see

now its going to take another week to find out her thoughts on my valve but oh well maybe finally some answers!

I wouldn't worry about there being a problem with your valve, since the cardiologist wants to see the actual echo themselves and not just go by what someone else writes in a report. I think it is pretty common for the doctor to want to see the test themselves, especially something like an echo that each person can measure slightly different ect.