Results of Holter (heart) monitor ? (help deciphering)

[medianewbie]

Had a 48 hour Holter monitor last Oct. After which the Consultant said: 'nothing to note'. Since then, have been symptomatic but told 'no further monitoring needed'. We have had other issues with this Consultant and are thinking of asking for 2nd opinion. Applied for notes which have arrived.

As I cant ask the Consultant (hard to get hold of & not interested anyway)
I thought I'd ask here. I appreciate this is NOT medical advice, more of a 'would you expect to be told about these results and given a chance to discuss them'.
The results show issues with (no idea how 'bad' as can't read the details)

ST segment change, ectopic beats, marked sinus braccycardia, short cycle Wenkebach, sinus arrrithymia, and rare slight change in P wave and T wave.

I appreciate that this might all sound like 'something' and not be (this is post Myocarditis) but if anyone can give any thoughts I'd appreciate it.

If they said nothing to note I expect the results of your holter are not concerning or requiring follow up given your situation. I had a 24hr monitor, all they said was every other best was ectopic beats but they weren't concerned. Maybe if the findings are not concerning they just can't be arsed. I had no follow up or anything else after mine though I understand your situation maybe different. Ring your GP and ask yo go in and have them go through it with you. They will have the reports.

Sinus arrhythmia is normal - healthy, in fact. Ectopic beats can be totally benign but depends a bit on the context. Sinus bradycardia could also be completely benign - often found in physically fit people. Not sure about the other observations, but interpreting ECGs is a real art and needs a lot of experience. Isolated observations like 'sinus bradycardia' don't mean much without the context of the whole ECG and the context of the patient, so it's impossible to say whether those findings in isolation were things that should have been discussed.

Is this your son who had myocarditis not long before he was supposed to be going to university?

Wenkebach is a type of heart block. Only treated if symptomatic (tiredness, shortness of breath, dizzy, fainting). Can be caused by medication like beta blockers, usually just monitored incase the heart block progresses.

@Gottheick25 thank you. we are moving GP practice (they refuse to acknowledge Ds Autism & have been generally appalling) so no dice there.

@reesewithoutaspoon thank you this is helpful to know.

@SpecduckularlyQuackers Yes. Ds has not got better. Told 'anxiety' last Oct but 2nd MRI showed scarring increased & ejection fraction falling & small regurgigant fraction. Consultant didn't speak to us but orderd a 3rd MRI which Radiologist reports as: 'scarring across 4 sections, oedeam in T2 and stable current Myocarditis'. Consultant then writes to GP saying: 'previous Myo, current symptoms anxiety have referred to Psychaitrist'. Consultant has not seen Ds since last Oct. We wrote and asked for an appt & he said: 'no need'. Ds can barely get out of bed but as Troponin & inflammation low they are not interested. I appreciate that someone qualified would need to look at the tracings & details. If we had confidence in the local Consultant we'd not be 2nd guessing like this (I'm not telling Ds that I am) but we don't.

sp. should be: 'oedema in T2'

Sorry to hear he's not feeling better. Do you happen to remember what his ejection fraction was on the most recent MRI? Is he still on the beta blockers (because they can make you feel pretty crap)?

Ultimately I think if you don't trust the consultant you need to request a second opinion. Hopefully it is the case that there isn't anything cardiac to worry about and the ECG/MRI findings are a normal part of recovery from myocarditis. If that's the case then hopefully they'll be able to explain to you more clearly why they believe it to be so.

@SpecduckularlyQuackers Left EF was 68% on discharge, then 60% now 55%, Right EF is 48%. Regurgigant of 2%. Scarring spread from 2 areas to 4. Oedema in T2. We saw a private Consultant who also dx PoTS and said the betablocker would not be helping and to try a different medicine. GP refused the script & wrote to NHS Consultant who said 'if I thought it was only Pots it would be okay but I suggest doubling the current betablocker instead' (odd as he is so insistent it is 'only' anxiety?) Anyway, Ds feels worse not better and I think, given it's been 7 months, should be able to get up without chest pain & giddiness and heart rate going up to 148 (and drops to 48 overnight) & still having nightmares.

I can see why you feel the original consultant is giving mixed messages there. It sounds like there are several possible causes for what he's experiencing, or even a combination of them. What was the specialism of the private consultant you saw?

@SpecduckularlyQuackers a Cardiac Consultant who specialises in electrophysiology. Might be a good perti go back to but don't have scan copies from NHS, just paper notes (on which I see query MI? on his notes from inpatient week. No one told us)

My guess would be the query MI was an early possible diagnosis based on the high troponin but then superseded by the myocarditis diagnosis. I seem to remember there was a family history of something possibly relevant on his Dad's side too?

@SpecduckularlyQuackers yes that makes sense. I'm glad they gave him the correct meds for an MI anyway. They didn't decide on Myo for two days (in fact it's still down as 'suspected Myo' on his current paperwork) On his Discharge it says: very high cholesterol, history familial hypercholesterolaemia, GP to refer lipid clinc. Despite 2 further fasting blood tests both showing high breakdowns we are still waiting. GP refused to refer, suggested appt with Consultant but told unavailable (haven't seen since Oct). No one has taken time to explain anything to him (or me). Yet here's a 3 page handwritten disclaimer in the notes of the time he was held down when they tried to first cannulate him. It notes that the HCP 'approached Mum with a hot chocolate and thus apologised. Mum suggested we move on'. Not so, I reiterated that Ds ASD should be on his notes and that the HCP would be better apologising to him (to help restore his trust in HCPs).
Sorry, none of this is relevant to the Holter test deciphering, just cathartic!

This really sounds baffling, I can't understand why they won't refer him to test for the FH in the circumstances. There's so much going on with him, you must feel really at sea. It would hardly be surprising in the circumstances if he did have anxiety but it's also understandable that you're concerned that might not be the full story. Re the FH, is there anything helpful in the NICE guidelines that might move things forward? https://www.nice.org.uk/guidance/cg71/chapter/Recommendations

@SpecduckularlyQuackers sorry for the delay replying. The NICE guideline is useful thanks. His C is 7.4 so .1 under the 'refer' guideline. But all the breakdown figures are abnormal (for 3rd time in 6m) & his Dad has been on statins since his 40's (history of heart failure in my family of origin too I discover, although people generally much older than Ds).
I think he will write to the NHS Consultant with all these Qu's. If we get nowhere (as he has been vague from the get go) we will ask for 2nd opinion outwith area. I spoke to PALS and they explained that I have no right to an out of area NHS 2nd opinion (it's tricky as our current guy is Head of Dept). Rec that I make a formal complaint and go to Ombudsman if necessary (this has the advantage that they seek an out of area 2nd opinion apparantly). But, Ds can't wait the 4/5 months that would take. He is ill now. Really stumped.

@SpecduckularlyQuackers well, Ds emailed the NHS Consultant who has now replied. He says: 'Troponin & CRP normal, no increase to scarring. 'possible' oedema of heart wall is, I think, probably just a consequence of what has previously happened certainly no reason to put you on steriods. Sorry you are finding it hard to get on with your day to day activities. You will be deconditioned so you must be more activie or it will get worse. I am very keen you take up the offer of help from the Psychiatric Dept'.
No mention of the 148 bpm, no mention of the graded exercise rehab which was suggested in Oct (never heard any more of it). No mention of Cholesterol. No reference to the pain Ds says he is in.
Interestingly though he does then bring up the POTS / private Cardiolgist.Says he still thinks Bisopralol better but if Ds wishes he can try Ivabradine 'this would be your choice' (via NHS or not, not clear?) Finishes off with general POTS advice. Rather odd.