Palpitations: Insights from a 24-Hour ECG Analysis - Cardiology

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Understanding palpitations can be a complex issue, especially when interpreting the results of a 24-hour ECG (electrocardiogram) analysis. Based on the information you've provided, let's break down the findings and address your concerns.


ECG Findings Overview
1. Sinus Rhythm: The baseline rhythm being sinus indicates that your heart is functioning normally in terms of its electrical activity. This is a good sign, as it means that the heart's natural pacemaker (the sinoatrial node) is controlling the heartbeat.

2. Heart Rate Variability: The maximal heart rate of 107 beats per minute (bpm) suggests that there were periods of sinus tachycardia, which can occur during times of stress, anxiety, or physical activity. Conversely, the minimal heart rate of 34 bpm indicates sinus bradycardia, which is notably low. This could be a result of various factors, including medication effects, sleep state, or even vagal tone (increased activity of the vagus nerve).

3. Atrial Premature Contractions (APCs): The presence of some APCs is not uncommon and can occur in healthy individuals. They are generally benign, especially if infrequent and not associated with other symptoms.

4. Longest R-R Interval: The longest R-R interval of 2.0 seconds indicates a significant pause in the heart's rhythm, which could be concerning if it occurs frequently or is symptomatic. However, isolated incidents may not be alarming.


Addressing Your Concerns
1. Medication Effects: You mentioned taking Entresto (sacubitril/valsartan) before bed. While this medication is primarily used for heart failure and can have various effects on heart rate and rhythm, it typically does not cause bradycardia to the extent of 34 bpm in healthy individuals. However, it can enhance vagal tone, which might contribute to lower heart rates during sleep. If you are experiencing significant bradycardia, it's essential to discuss this with your healthcare provider, as they may need to adjust your medication or monitor you more closely.

2. Perception of Palpitations: It's not uncommon for individuals to feel their heart racing or skipping beats, especially when lying down or trying to sleep. This sensation can sometimes occur even when the ECG does not show any significant arrhythmia. Factors such as anxiety, stress, or even the body's natural response to changes in position can lead to these sensations. The brain can sometimes misinterpret normal heart rhythms as palpitations, especially during periods of heightened awareness or anxiety.


Recommendations
- Follow-Up: It’s crucial to follow up with your healthcare provider regarding these findings. They can provide a more comprehensive interpretation of your ECG in the context of your overall health and symptoms.

- Further Evaluation: If your symptoms persist or worsen, further evaluation may be warranted. This could include additional monitoring, such as an event recorder, or imaging studies to assess heart structure and function.

- Lifestyle Considerations: Pay attention to factors that might exacerbate palpitations, such as caffeine intake, stress levels, and sleep quality. Maintaining a healthy lifestyle can help manage symptoms.

In conclusion, while some findings from your 24-hour ECG may raise questions, many aspects appear to be within a normal range. However, given the bradycardia and your experiences of palpitations, it is essential to have a thorough discussion with your healthcare provider to ensure appropriate management and peace of mind.