Your ECG Results: What Do They Mean for Your Heart Health?

I have questions regarding an electrocardiogram and would like to consult with other doctors?

I have chronic conditions related to hypertension, hyperlipidemia, and diabetes, and I regularly see my doctor and take medication.
Recently, I experienced unexplained episodes of rapid heartbeat and cold sweats, so I consulted a cardiologist.
The doctor arranged for a stress electrocardiogram (ECG) and a 24-hour Holter monitor.
After reviewing the reports, the doctor only mentioned that my condition was very serious and scheduled two additional tests: a myocardial perfusion scan with stress and a left ventricular ejection fraction assessment (which I have not yet undergone).
However, I have no understanding of how serious my condition is, so I decided to look at the reports myself, but I find the medical terminology difficult to comprehend.
Since my follow-up appointment is still some time away, I would like to consult other doctors regarding the ECG reports.
The stress ECG report indicates:
- I ST change: upslope - 3.75 mV
- aVL ST change: horizontal - 3.25 mV
- V2 change: horizontal - 1.45 mV
- V3 change: horizontal - 2.25 mV
- V4 change: horizontal - 2.2 mV
- V5 change: horizontal - 1.65 mV
The 24-hour Holter monitor report states:
1.
Sinus rhythm with a rate of 51-131/min and a mean of 88/min; the maximum heart rate was 131 bpm at 9:32 am due to sinus tachycardia.
2.
Rare ventricular premature contractions (VPCs) total: 5 beats with pairs.
3.
Rare atrial premature contractions (APCs) total: 5 beats.
4.
The longest R-R interval was 1.81 seconds at 6:46 am due to second-degree AV block, Mobitz type 2.
5.
There were suspected intermittent second-degree AV block, Mobitz type 2.
6.
There were intermittent first-degree AV block.
7.
No ST segment changes.
8.
Chest discomfort recorded in the patient diary was associated with normal tracings.
Note: Monitored for a total of 23:59 hours.
Start time was 9:57 am.
There were a total of 123,654 beats.
Note: Three channels (MV5, MV1, Lead III).
I hope the doctor can provide a detailed explanation.
Thank you.
Ever since I heard the outpatient doctor say it was very serious, I have been very afraid of suddenly experiencing a myocardial infarction.

Mr. Pan, 30~39 year old female. Ask Date: 2021/01/12

Dr. Wu Xueming reply Cardiology

Based on your history of chronic illness and the results of the exercise electrocardiogram, there is a possibility of cardiovascular disease.
It is recommended that you wait for the results of the myocardial perfusion scan and then consult your physician for the report findings.

Reply Date: 2021/01/12

More Info

Understanding your ECG results is crucial, especially when you have chronic conditions like hypertension, diabetes, and hyperlipidemia. These conditions can significantly increase your risk for cardiovascular diseases, including coronary artery disease (CAD) and heart failure. Given your recent symptoms of rapid heartbeat and cold sweats, it's understandable that you are concerned about your heart health.

Exercise ECG Report Interpretation
Your exercise ECG report indicates some notable findings, particularly with ST segment changes. The ST segment is a crucial part of the ECG that reflects the heart's electrical activity during and after contraction. In your case, the report shows:
- I ST change: upslope - 3.75 mV
- aVL ST change: horizontal - 3.25 mV
- V2, V3, V4, V5 changes: horizontal with varying degrees of depression
These ST segment changes can indicate myocardial ischemia, which occurs when blood flow to the heart muscle is reduced, often due to blockages in the coronary arteries. The presence of horizontal ST segment depression, especially during exercise, is often more concerning than upsloping changes, as it can suggest that the heart is not receiving enough oxygen during physical stress.

24-Hour Holter ECG Report Interpretation
The 24-hour Holter ECG provides a comprehensive view of your heart's rhythm over a full day. Here are the key points from your report:
1. Sinus Rhythm: Your heart rhythm is predominantly sinus, which is normal.

2. Heart Rate Variability: The heart rate ranged from 51 to 131 beats per minute, with an average of 88 bpm. The maximum heart rate of 131 bpm was noted during sinus tachycardia, which can be a normal response to stress or activity.

3. Premature Contractions: You had rare occurrences of both ventricular (VPCs) and atrial (APCs) premature contractions, which are generally benign but can sometimes indicate underlying issues, especially if they are frequent.

4. AV Blocks: The report mentions intermittent second-degree AV block (Mobitz type II) and first-degree AV block. AV blocks can affect how electrical signals travel through the heart, potentially leading to slower heart rates or even pauses in heartbeats. Mobitz type II is particularly concerning because it can progress to complete heart block.

5. No Significant ST-T Changes: This is a positive finding, indicating that there were no significant ischemic changes during the monitoring period.

Implications for Your Heart Health
Given your chronic conditions and the findings from both the exercise ECG and Holter monitor, it is essential to take these results seriously. The presence of ST segment changes during exercise suggests that there may be areas of your heart that are not receiving adequate blood flow, especially under stress. The intermittent AV blocks could also pose a risk, particularly if they lead to significant bradycardia or other complications.

Next Steps
1. Follow-Up Testing: You mentioned that your doctor has scheduled a myocardial perfusion scan and a wall motion study. These tests will provide further insight into how well blood is flowing to your heart muscle and how well your heart is contracting. They are critical for assessing the severity of any ischemia and determining the best course of action.

2. Medication Management: Ensure that you are adhering to your prescribed medication regimen for your chronic conditions. Medications such as beta-blockers, ACE inhibitors, or statins can help manage your heart health and reduce the risk of complications.

3. Lifestyle Modifications: Consider making lifestyle changes that can improve your heart health. This includes a heart-healthy diet, regular physical activity (as advised by your doctor), stress management techniques, and avoiding smoking and excessive alcohol consumption.

4. Regular Monitoring: Keep regular appointments with your healthcare provider to monitor your heart health and adjust your treatment plan as necessary.
5. Education and Awareness: Understanding your condition and being aware of the symptoms of heart problems (such as chest pain, shortness of breath, or severe fatigue) can help you respond quickly if issues arise.

In conclusion, while the findings from your ECG reports are concerning, they also provide an opportunity for proactive management of your heart health. Engaging with your healthcare team and following through with the recommended tests and lifestyle changes will be essential in managing your risk and maintaining your overall well-being.

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