Heart Palpitations: Causes and Concerns for Patients - Cardiology

Arrhythmia with tachycardia?

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I'm sorry to disturb you, Director.
Recently, when I lie down, my heart rate is around 70-80 bpm, but when I get up, it increases to 100-110 bpm.
Walking raises it to 105-120 bpm, and when I sit back down, it drops to 80-90 bpm.
Could this be a type of arrhythmia? I have a bit of an anxious constitution.
Is this heart rate normal, or could it be a positional heart rate issue? Currently, I only have antiarrhythmic medication and Xanax available for use when needed.
Below are the reports from last year and this year.

This is the Holter EKG from February of this year:
- Code No.:
- Clinical diagnosis:
- Technical quality of record: Good
- Dominant rhythm: Sinus
- Total Beats: 107,704
- Min HR: 43 BPM at 06:33:46 (sinoatrial bradycardia)
- Avg HR: 75 BPM
- Max HR: 154 BPM at 13:25:47 (sinoatrial tachycardia)
- PVCs/couplets/triplets/VT: 76/0/0/0
- PACs/couplets/AT: 33/0/0
- Drop (delay > 2.0 sec)/Late: 0/0
- Longest N-N: 1.6 sec at 08:09:51
Conclusion
- Sinus rhythm with a rate ranging from 43 to 154 bpm and a mean of 75 bpm.

- Rare isolated PACs.

- Rare isolated PVCs.

- No significant long pause.
This is the Holter EKG from a year ago:
- DATE OF 24-HOUR RECORDING:
- Study for: ARRHYTHMIA ANALYSIS
- RESULT
1) Quality of recording: GOOD
2) Dominant rhythm: SINUS
3) Total Beats: 112,778 beats
4) Minimum heart rate: 45 beats/minute at 01:56:23 (sinoatrial bradycardia)
5) Average heart rate: 80 beats/minute
6) Maximum heart rate: 158 beats/minute at 13:28:21 (sinoatrial tachycardia)
7) VPC/couplet/triplet/bigeminy: 236/0/0/0
8) APC/couplet/AT: 54/0/0
9) VT/idioventricular rhythm: 0/0
10) Ventricular pause > 2 seconds: 0
COMMENTS
- Sinus rhythm with mean HR 80 BPM (min: 45 BPM; Max: 158 BPM)
- Rare isolated APCs
- Few isolated VPCs (0.2%)
- No significant long pause.
This is the echocardiogram report from February of this year:
- Indications:
- Echo machine: Philips IE33
- Patient source: OPD
- [Atrium and Aortic Root]
- AO (mm) = 29
- LA (mm) = 36
- [Left Ventricle]
- IVS (mm) = 10
- PW (mm) = 10
- EDD (mm) = 48
- ESD (mm) = 29
- EDV (ml) = 106
- ESV (ml) = 32
- LV mass (g) = 176
- LVEF: by M-mode measurement: 69.6%
- LV Wall motion: Normal wall motion
- [Right Ventricle]
- TAPSE = 30 mm
- [Diastolic function]
- Mitral inflow E/A: 81/54 (E/A ratio = 1.5)
- Septal E/e: 5.9; Lateral E/e: 5.0;
- [Valve]
- MS: nil; MR: Mild; AS: nil; AR: nil; TS: nil; TR: Mild; Vmax = 2.29 m/s = 21 mmHg
- PS: nil; PR: nil;
- [Other findings]
- IVC diameter: mm with sniff collapse > 50%
- Pericardial effusion: None
- Intracardiac thrombus: No
- Congenital lesions: None
Abbreviations
- LA: Left Atrium, LV: Left Ventricle, RV: Right Ventricle.

- Ao: Aortic Root, IVS: Interventricular Septum, PW: Posterior Wall,
- MS: Mitral Stenosis, MR: Mitral Regurgitation.

- AS: Aortic Stenosis, AR: Aortic Regurgitation.

- TR: Tricuspid Regurgitation, TS: Tricuspid Stenosis.

- PR: Pulmonary Regurgitation, PS: Pulmonary Stenosis
Conclusion
1.
No cardiac chamber dilation
2.
No LV thickness
3.
Normal LV systolic function with normal wall motion
4.
Normal RV systolic function with normal wall motion
5.
Normal diastolic function.

6.
Trivial MR and TR.
This is the treadmill exercise test report from February of this year:
- Treadmill Bruce Protocol
1) Resting EKG: Sinus arrhythmia.

2) Exercise duration: 13 min 11 sec, Max.
METs: 17.4
3) Stress tension: Resting HR initially 59 bpm, rose to a max.
HR of 160 bpm, which represents 102% of the maximal age-predicted HR.

4) Exercise provoked ST-T change: Nil
5) Exercise provoked arrhythmia: Nil
6) BP change: 136/83 to 216/72 mmHg
Interpretation
1.
Adequate exercise loading.

2.
Negative for ischemia.

3.
Isolated PVCs and ventricular couplets noted during recovery stages.
This is the echocardiogram report from 2020:
- IVS: 9 mm, LVEDD: 47 mm, LVESD: 31 mm; PW: 8 mm, EF by Linear method: 63%, Sinus of Valsalva: 26 mm, Left Atrium: 23 mm
1.
Heart size: dilation of: nil
2.
Pericardial effusion: nil
3.
Valvular measurement: MS: nil, MR: nil, AS: nil, AR: nil, TS: nil, TR: nil, Vmax: _ m/s; Max.
gradient: _ mmHg, PS: nil, PR: nil
5.
Mitral E/A: _ / _ cm/s, E/E’’: med _, lat _, aver _.

6.
Others: IVC diameter 10 mm with inspiratory collapse >50 %, Doppler & ECHOCARDIOGRAPHIC REPORT: Rhythm and Appearance: Sinus tachycardia
Left ventricle: Systolic function: Normal
Wall motion: Normal
Diastolic function: Normal
Right ventricle: Systolic function: Normal
This is the echocardiogram report from 2021:
- M-Mode Data:
1.
IVS 11 mm (6-11)
2.
LVPW 10 mm (6-11)
3.
LVEDD 49 mm (36-57)
4.
LVESD 30 mm (20-36)
5.
RVD mm (7-23)
6.
A.O root 30 mm (20-37)
7.
LVEDV ml (76-115)
8.
LVESE ml (39-48)
9.
EPSS mm
10.
EF 70% (64-83)
Doppler and Color flow Findings:
1.
MS Mean PG= mmHg; Pt1/2= MSEC; mva = cm2
2.
AS mild (<50), mod (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= = mmHg; PASP = mmHg
6.
PR □ mild, □ moderate, □ severe
7.
MV flow: E= 87 cm/S; A= 56 cm/S; E/A = 1.5
Interpretation:
1.
Normal LV and LA size
2.
Normal LV wall thickness
3.
Preserved LV gross systolic function, the estimated EF=70%
4.
No regional wall motion abnormality
5.
Trivial MR
I apologize for the lengthy report, but I am really worried about my heart.
My daily life has become a bit bleak due to my concerns.
I am either experiencing a fast heartbeat or some missed beats, which leads to anxiety and panic.
I would appreciate your professional guidance to help ease my worries.
Is there anything else I need to check? Thank you, Director.
I really appreciate your help and wish you peace.

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Niming, 20~29 year old female. Ask Date: 2023/05/09