Heart Health: Insights on Doppler Ultrasound and Holter Monitoring

Q: Heart Health: Insights on Doppler Ultrasound and Holter Monitoring

Hello, there are moderate to frequent atrial premature contractions (total 299) and occasional ventricular premature contractions (total 216) with multiform, bigeminy, trigeminy, and quadrigeminy patterns. <br>Some arrhythmias have been associated with palpitations and irregular

Could you please explain cardiac Doppler ultrasound and 24-hour Holter monitoring?

Hello, Director.
I am 60 years old, with a cholesterol level of 235 and a glycated hemoglobin (HbA1c) of 6.4.
I am currently taking medication to lower my cholesterol and blood sugar.
Recently, for the past 3-4 days, I have been experiencing palpitations and an irregular heartbeat.
I also stopped drinking coffee for two days, but the palpitations persist.
I found that I visited a cardiologist on July 9, 2022, and the examination results are as follows.
Could you please explain if there are any abnormalities? Thank you very much for your assistance.
Recording from: Duration: Recorder type: FD4 (3 channel) S/N=AR4-0001600 Analysed: Analysed retrospectively S/W version: V4.2(f569.5ale) Analyst: Release: 12.0 Preference: CCH Reasons for recording: Current Therapy: Diagnosis: Recommended Therapy: Comments:
1.
Sinus rhythm with a rate of 49-103/min and a mean of 68/min.

2.
Moderate to frequent atrial premature contractions (APCs) (total 299).

3.
Occasional ventricular premature contractions (VPCs) (total 216) with multiform, bigeminy, trigeminy, and quadrigeminy.

4.
No pauses longer than 2.0 seconds.

5.
No ST segment deviation greater than 2mm.

6.
No entries of symptoms were made in the patient diary.
M-Mode Data:
1.
IVS 11 mm (6-11)
2.
LVPW 10 mm (6-11)
3.
LVEDD 37 mm (36-57)
4.
LVESD 21 mm (20-36)
5.
RVD mm (7-23)
6.
LVEDV ml (76-115)
7.
LVESE ml (39-48)
8.
EF 74% (64-83)
9.
A.O root 35 mm (20-37)
10.
LA 20 mm (19-39)
11.
EPSS mm
Doppler and Color Flow Findings:
1.
MS Mean PG= mmHg; Pt1/2= MSEC; mva = cm2
2.
AS mild (<50), moderate (50-57), severe (>75) Mean PG= mmHg; Peak PG = mmHg
3.
MR ■ mild, □ moderate, □ severe
4.
AR □ mild, □ moderate, □ severe
5.
TR ■ mild, ■ moderate, □ severe, PG= 15 mmHg; PASP = mmHg
6.
PR □ mild, ■ moderate, □ severe
7.
MV flow: E= cm/S; A= cm/S; E/A = <1 in TDI
Interpretation:
1.
Normal four-chamber size, loosening of mitral valve leaflets
2.
Preserved left ventricular (LV) systolic function
3.
Impaired LV diastolic function
4.
No regional wall motion abnormality
5.
Color Doppler: moderate pulmonary regurgitation (PR), mild to moderate tricuspid regurgitation (TR), mild mitral regurgitation (MR)
6.
Estimated systolic pulmonary artery pressure (SPAP): 25 mmHg
Impression: Preserved LV systolic function, diastolic dysfunction, MR/TR/PR.

Mr. Zhou from Pingzhen, 60~69 year old female. Ask Date: 2023/01/02

Dr. He Dongjin reply Cardiology

Hello, there are moderate to frequent atrial premature contractions (total 299) and occasional ventricular premature contractions (total 216) with multiform, bigeminy, trigeminy, and quadrigeminy patterns.
Some arrhythmias have been associated with palpitations and irregular heartbeats over the past 3-4 days, which may be related to the arrhythmias.
It is advisable to consult a cardiologist for medication adjustment.
Changhua Hospital cares about your well-being.

Reply Date: 2023/01/02

More Info

Understanding heart health is crucial, especially as we age and face various health challenges. Based on the information you've provided, it seems you have undergone a comprehensive evaluation of your heart health, including Doppler ultrasound and Holter monitoring. Let's break down the findings and their implications for your heart health.

Doppler Ultrasound Findings
1. Sinus Rhythm with Rate Variability: Your heart rhythm is classified as sinus rhythm, which is normal. However, the rate fluctuates between 49-103 beats per minute, with an average of 68 bpm. This variability can be normal, especially if you are at rest or during sleep. However, if you are experiencing symptoms like palpitations or irregular heartbeats, this could be a point of concern.

2. Atrial Premature Contractions (APCs): The report indicates that you have moderate to frequent APCs (299 total). APCs are early heartbeats originating in the atria and can be benign, especially in the absence of other heart disease. However, they can cause sensations of palpitations or irregular heartbeats.

3. Ventricular Premature Contractions (VPCs): You also have occasional VPCs (216 total), which are early heartbeats originating in the ventricles. The presence of multiform VPCs (different shapes) and patterns like bigeminy (every other beat) and trigeminy (every third beat) can be more concerning, but they are often benign in the absence of structural heart disease.

4. No Significant ST Segment Deviations: The absence of ST segment deviations is a positive sign, indicating that there is no significant ischemia (lack of blood flow) to the heart muscle during the monitoring period.

M-Mode Data Findings
1. Normal Chamber Sizes: The report indicates normal sizes for the heart chambers, which is a good sign.
2. Left Ventricular Systolic Function: Your left ventricular ejection fraction (EF) is reported at 74%, which is well within the normal range (typically >55%). This indicates that your heart is pumping effectively.

3. Diastolic Dysfunction: The report mentions impaired left ventricular diastolic function. This means that while your heart pumps well, it may not fill properly during the relaxation phase. This can lead to symptoms like shortness of breath, especially during exertion.

4. Mild to Moderate Valve Regurgitation: The findings indicate mild mitral regurgitation (MR), moderate tricuspid regurgitation (TR), and moderate pulmonary regurgitation (PR). Regurgitation means that the valves are not closing completely, allowing some blood to flow backward. While mild regurgitation is often not a concern, moderate regurgitation may require monitoring and possibly intervention if symptoms develop.

Holter Monitoring Insights
The Holter monitor results provide a snapshot of your heart's electrical activity over a 24-hour period. The presence of APCs and VPCs, while concerning, is not uncommon, especially in individuals with underlying conditions like elevated cholesterol and blood sugar levels.

Recommendations
1. Lifestyle Modifications: Given your cholesterol and blood sugar levels, continue to focus on a heart-healthy diet, regular exercise, and weight management. Reducing caffeine intake, as you've done, can also help with palpitations.

2. Regular Monitoring: Keep regular follow-up appointments with your cardiologist to monitor your heart health, especially given the diastolic dysfunction and valve regurgitation.

3. Symptom Management: If you continue to experience palpitations or any new symptoms like chest pain, shortness of breath, or dizziness, seek medical attention promptly.

4. Medication Adherence: Ensure you are taking your prescribed medications for cholesterol and blood sugar management as directed.

5. Further Evaluation: If symptoms persist or worsen, further evaluation, such as an echocardiogram or stress test, may be warranted to assess for any underlying coronary artery disease.

In conclusion, while there are some findings that warrant attention, many aspects of your heart health are stable. Regular monitoring and lifestyle adjustments can significantly contribute to maintaining your heart health. Always consult with your healthcare provider for personalized advice and treatment options.

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