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Forum Name: Arrhythmias

Question: Please help, 24h Holter Monitor results and scared


 MHerring-Mitchell - Wed Oct 29, 2008 4:48 pm

Hello,

I am 36 years old and have suffered from anxiety and panic attacks for about 10 years so I am use to feeling an occasional irregular heart beat. Another problem I have suffered from for a little over 2 years now is constant diareah (sorry for that information but it might have something to do with my heart). I thought it was from having anxiety because that was about the time I went back to college for nursing. Well, about 11 months ago my doctor sent me to the hospital and they told me I had crohns disease (even though the only symtom was the diareah that I suffer from). Anyway, The doctor is not sure of that anymore and just took some blood work for absorption in my small bowel. Sorrry, i just wanted to give a little history before I got to my question.

I have been feeling abnormal heart beats for months now and I have been under so much stress that I had to leave school. My primary doctor sent me to get a 24 hr Holter Monitor put on and I just went to pick up the results yesturday and brought them to my doctor who didnt tell me anything but referred me to a cardiologist. Here is what the results said:

The average heart rate was 84, with a minimum of 47 and a maximum of 145. Ventricular ectopic beats totaled 7979, with 6 VE pairs and 0 V-Runs. Supraventricular ectopics totaled 59, with 9 SV-Runs. Pauses in excess of 2.5 seconds totaled 0. The number of minutes of analyzed ECG data was 1396.
ST episode minutes totaled 2. The maximum Delta ST of -1.1 mm occurred at 20:04.

Thats the end of the report and I am so scard. Can someone PLEASE tell me what this means and what I should expect. Do you think this is something very serious? I was also wondering if this could me from all the loose bowel movements I have been suffering from for the last couple of years combined with having anxiety on a daily basis. Thank you any information you can give me.
 John Kenyon, CNA - Thu Oct 30, 2008 8:12 pm

User avatar Hi there -

We need to address two separate issues I think: first, the meaning (if any) of your Holter monitor results, and second, why you've had all this ectopic activity.

First, the test results are fine. In an otherwise healthy (GI problems aside) young person, this number of premature ventricular contractions (PVCs) is not nearly as great as it can be in some subjects, although it probably seems (and felt) like an awful lot. Broken down into per-minute average, it comes to about 5.5 per minute, just enough to be really annoying. However, nothing malignant (scary) showed up. You did, also, have 59 supraventricular beats (usually called premature atrial complexes or PACs), with 9 supraventricular runs (very brief bursts of rapid heartbeat originating up in the atria). While this can feel very disturbing as well, so long as it isn't of concern medically, and even if it were to become sustained, it's almost never truly serious, but more of a major annoyance. That didn't happen.

This is all consistent with the probable causes of what was recorded and you've been feeling. Situational stress, chronic anxiety and, yes, GI upsets, can all contribute to both PVCs and PACs. While we all have some of these once in a while, some have more than others (and believe it or not, some have many more than your test showed up). At other times you may have few to none, but when it's not happening we rarely think about them, except perhaps to anticipate that they might start up again. This causes more anxiety and stress,which releases more adrenaline, which is handy when needed, but otherwise just makes us jumpy and irritates the heart muscle, which reacts by throwing off these premature beats.

The cause of the bouts of diarrhea, whatever it may turn out to be, still has to be in part caused by stimulation of the vagus nerve, which will usually cause premature beats in otherwise healthy people. Just digesting a meal will often cause them (a lot of people complain of this). Eating, digesting, GI upset, drowsing off, laying down to sleep, fatigue, sleep deprivation, caffeine, nicotine, gas (GI again), anxiety, panic attics (in particular), certain medications, and on and on and on -- these all can trigger the really annoying and sometimes unnerving premature beats, but even though they may be relatively frequent, if there is nothing seriously wrong with the heart (usually with the left ventricle specifically), then they actually mean little-to-nothing diagnostically. It does help to know they're happening, as the discomfort can be explained. Unfortunately it rarely is, at least sufficiently.

As far as the palpitations go, what you can expect is that they will come and go, sometimes act up for long periods, then for no obvious reason will go away for a while. It's normal. Some people actually have a PVC as every other beat, which would mean, given an average heart rate of only 60 beats per minute, somewhere around 43000 PVCs in 24 hours, with nothing serious going on. Hard to believe, but it happens. Since some of these people don't feel them at all (for whatever lucky reason), they are surprised to find out they're even having them. Others feel every single misfire. This can produce terrible anxiety -- and, ironically, it can be caused by anxiety as well.

Your doctor, after reviewing the report, and considering your problem with PD and generalized anxiety (GAD), may well prescribe something to reduce the frequency of the premature beats, but only to give you a little break and some peace of mind. It's preferable to not treat them in general, but for those who are seriously troubled by associated anxiety will often be prescribed a beta blocking drug which slows the heart rate and reduces the threshold for PVCs, PACs, etc., and this often helps reduce the anxiety. You may also be offered (if you don't already take one), something to address the anxiety and panic attacks directly. In some cases this is a good approach and can really be a life-changer for some people.

In short, managing your anxiety ranks right up there with diagnosing what's going on with your GI tract. Either or both may lead to relief or reduction of the frequency of palpitations, which are actually not a medical concern. The other things are, and once they're resolved, it's very likely you'll feel a whole lot better. If the doctor chooses to treat the palpitations and/or anxiety medically together, that's fine too. Something else to consider (assuming you haven't already tried it) is cognitive behavioral therapy, a self-limited form of psychotherapy which is interactive and helps the patient learn how to manage stress, anxiety and even some physical symptoms. It works for a lot of people to some degree.

I hope this helps ease your mind. Your heart appears to be fine, just in a cranky mood. This sort of symptom is almost never a true problem and yours is no exception. It does take time for this to sink in sometimes, though, once it's been explained. Get that stomach issue figured out. That's medically a lot more important.

Best of luck to you and please follow up with us as needed.
 MHerring-Mitchell - Fri Oct 31, 2008 7:14 am

Thank You so Much for replying so fast and all the information. I have to go to the cardiologist today at 2:00 and I will definatly let you know what they tell me. I do go to counceling for the anxiety and panic attacks. I have been going for a very long time now and learned about cognitive behavioral theropy (it's just a little hard when you have 5 kids running around). I have also tried a lot of different medications to help with the anxiety (SSRI and others) but my body is so sensitive to medication they had to keep taking me off of them. They basically just have me on xanax 1mg. 2-3 times a day. I only take it in the morning and at night right before I go to sleep unless I start having a severe panic attack which actually has been under controll compared to years ago when I couldn't even leave the house (then I will take that 3rd one but I really try not to). I have been on xanax for so many years now and I do know that it is very addictive and thats why I will only let myself take the 2 I mentioned.

I am more worried about the diarrhea now because I do feel that it is causing the heart problems. I will see the doctor next week regarding that because she ran a blood test and I'm going back for the results. You have really put my mind at ease regarding my heart and I thank you so much for that, you have a graet day and I will write back after seing the cadiologist.

Thank you So very Much
 John Kenyon, CNA - Fri Oct 31, 2008 12:40 pm

User avatar Thanks for the follow-up and we'll be looking for the update as well.

Regarding the anxiety problem, you've done a lot of work toward managing that, and it can be really difficult sometimes. Medication can play a role for sure, but SSRIs often have the unfortunate result of increasing agitation and anxiety in certain people, so they don't always work. While Xanax is a great "rescue" drug (for aborting a panic attack), it's not long-acting, so you're very wise to use it as you have so far. Another, related medication, clonazepam (brand name Klonopin) sometimes works far better as a maintainance medication and can make the Xanax a fall-back in case of symptom breakthrough. It would be worth discussing this with your doctor unless it's already been tried and found not to work for you. Most people who respond well to Xanax do very well with clonazepam. Just a thought.

I'll be watching for your next post. Good luck to you!
 MHerring-Mitchell - Sat Nov 01, 2008 8:47 am

Hello,

Well, I just saw the cadiologist yesturday and he put me through a bunch of test. When I first arrived the nurse brought me in to do a EKG (which she did twice after seeing so many palpatations the first time). She brought the results to the doctor and he came in the room and spoke with me about my family history and some other stuff. He listened to my heart and at that point he decided to have a sonogram done on my heart and sent me into another room. The person doing the sono let the doctor know that I did have a small heart murmur (but nothing for me to worry about). I heard them say something about MVP's (I hope that is right or is it MPV?) but again, nothing that was a big concern. He basically told me everything you explained to me about the PVC's and PAC's (hope i am putting the right initials). They decided it was safe enough for me to do the srtess test and I was so scared I would die but I trusted the doctor. Well, I did great on the stress test from what the doctor said. Actually, the palpitations stopped when I started getting a work out. My blood presure first started off at 130/100 then when the machine speeded up it went up to 160/100, but the strange thing is when we went to the next level and it went faster it was 168/90. The doctor told me all the palpitations stopped which I knew because i didn't feel them at all anymore (plus I know when my heart speeds up when I'm having an anxiety attack at home they always stop). He told me that a little exercising (even if its just taking long walks each day) will help me a lot. He definatly said my doctor had to find out what going on as far as the diarrhea beause that can put a strain on the heart with the amount that I go. (In Jan. 2008 I weighed 152 and yesturday I was 126 lbs.). I know that might sound good to some people but I am losing weight in a very unhealthy way and I keep losing weight each week, last week at the doctors office I was 132 and the week before I was 136.
So basically, I need to start walking each day to get some excercise and I don't have to see him again for 1 year regading the small heart murmur that I never knew about so they can just follow up and make sure everything is o,k,. Of course he told me that if I felt anything that was bothering me I could see him before that. He also told me when i first came in and he saw the results from the Holter Monitor and then the 2 EKG's they did he was going to put me on Beta Blokers but he feels I don't have to take them now after doing the stress test which was such good news to me because I am so scared to take medication.

I would like to Thank You So very much because when you explained everything to me before seeing the doctor it made me less anxious when I went to the cadiologist and I already knew everything he was explaining to me because you already broke everything down to me in a way that I could understand so when he was telling me the same thing you explained I already understood. You are doing a GREAT job on here explaining things to everyone and i hope I am speaking for everyone when I say that "We really appreciate You".

Thank You So Very Much,
Mia
 John Kenyon, CNA - Sat Nov 01, 2008 10:54 am

User avatar Hi Mia,

I'm so glad you had such a positive experience with the cardiologist! It's always really reasurring to be able to see the evidence that everything's OK even when it seems something must be wrong. Oh, and you got the initials of the premature beats right. :)

In most people exercise will reduce of eliminate PVCs, especially if they occur at rest. In a few people it works the opposite way (they come on with exertion and seem to go away at rest), so this has become part of the conventional wisdom, and you got to see just how that works with the stress test. Also, during a stress test we like to see the blood pressure go up just as yours did. Not through the roof, but appropriate to the amount of stress being placed on the heart by the test (which is exactly why it's called a "stress" test). You did great!

I'm glad you won't be having to take a beta blocker, mainly because of your aversion to medication. And you can still know that's there as a fallback plan if the palpitations ever really start driving you crazy.

You're very welcome by the way, and thank you for bringing your concerns to the site here. We all do our very best to help clarify and reassure. I'm very happy things turned out as they did. (You're right about the weight loss, too, and the GI issue can now be addressed with less anxiety, which may actually help that part).

Best of luck to you. Don't hesitate to bring any further questions to us.

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