Help for my mother-in-law

Hi all - As I have a heart issue my family ask me advice from time-to-time on things. I am conscious that although I know more than them I do not know on some heart terms, having only suffered one type of heart issue I do not want them to get bad information from me to take back to the GP.

My mother-in-law has palpatations and has recently received the following results from a 72 hour holter monitor.

Sinus Rythm

Frequent ventricular ectopics (1%) with rare bigeminy, occaisonal trigenimy and one couplet.

Rare supraventricular ectopics with one couplet and two triplets

No pauses greater than 2.0 seconds

four patient triggered events, sinus rhythm, rates 55-99bpm.

She has high blood pressure and is taking medication.

The GP has said she needs to start taking beta blockers.

Is there anything here that suggests she should be seen in more detail by a cardioligist or is this expected with someone with high blood pressure and not good fitness or lifestyle?






Nothing too worrisome, but I would still seek a cardiology opinion

by Gemita - 2022-03-29 12:16:02

John, it is good to hear from you and I hope you are making some progress yourself.

Firstly I am not suggesting anything that you have posted is a cause for concern, but I would recommend, as your mother-in-law appears symptomatic, that she is seen by a cardiologist for review of all her symptoms (like any breathlessness, palpitations, chest pain etc.)   A cardiologist would order a range of tests, including an echocardiogram to have a closer look at her heart.  The cardiologist might also do other tests to look for electrolyte imbalances, a thyroid problem or other conditions. Stress, excess caffeine, high blood pressure, effects of medication may all trigger ectopics. Since she has high blood pressure they might also want to rule out coronary artery disease which can be a cause for arrhythmias like ectopics.

Her holter monitor was for 72 hours.  She might benefit from longer term monitoring, 14 days to 28 days to pick up something more significant.  Arrhythmias can be very difficult to detect because of their intermittent nature, so the longer the monitoring the better.  My GP missed Atrial Fibrillation with short term monitoring.

Going back to the Holter report, they say frequent ventricular ectopics (1% of the time) with the following also seen:

Bigeminy = every other beat is a PVC

Trigeminy = every third beat is a PVC

Couplet = two consecutive PVCs

Supra Ventricular Ectopics (SVEs) - (originating in the atria) with one couplet and two triplets seen:

Couplet = two consecutive SVEs

Triplets = three consecutive SVEs

Your mother-in-law was in Sinus rhythm with ectopic beats seen originating in both the top and bottom chambers of her heart during monitoring.  Although these are benign atrial/ventricular ectopics, atrial ectopics in particular may develop into Atrial Fibrillation unless they are controlled.  Similarly, ventricular ectopics need controlling, especially if your mother-in-law has any hint of coronary heart disease.   I see nothing on her report though that would concern my doctors, especially since her heart rate is well controlled and pausing is minimal. However, as we always say here, go by her symptoms.  Any pause that is producing symptoms could be significant.

Ectopic heartbeats are extra heartbeats that occur just before a regular beat. Ectopic beats are usually not a cause for concern. We may feel like our heart is skipping a beat or producing an extra beat and they can cause symptoms for some of us.  My initial arrhythmia presentation was not too dissimilar to your mother-in-law's.  

I wish you and the family well John

Best wishes to your mother-in-law

by Julros - 2022-03-29 14:50:40

Palpitations are a very non-specific symptom, and can be hard to pinpoint a cause. And holter monitors are rather brief, but it looks like she is have a few extra beats, which can be normal. A beta blocker could be useful, and not unusual to use in the setting of high blood pressure. A GP can manage this, and can order blood tests to check metabolic levels. He/she can also order an echocardiogram, which would be interpreted by a cardiologist, who also likely read the holter monitor. 

I don't see that a cardiology consult is necessary here, unless M-I-L is having pain, shortness of breath, unexplained fatigue or weight gain. 

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