Ask a doctor on the topic of Internal medicine

Heart palpitations and clarification of the findings with a long-term ECG.

September 21, 2017 | 20,00 EUR | answered by Dr. med Ralf von Seckendorff

Hello,

I (38 years old) have the following problem: For about a year now, I have noticed irregularities in my heart (while feeling my pulse). Therefore, I went to a cardiologist who did a long-term ECG. The results were as follows:
"Average heart rate 70/min, max 106/min, min. 41/min (at 4:37 am)
Ventricular ectopic activity was present, consisting of frequent polymorphic VEs. There were no couplet episodes, no bigeminy or trigeminy, no salvos, and no episodes of ventricular tachycardia. The supraventricular rhythm disorder consisted of moderately frequent isolated SVEs. Two pauses up to 2.1 seconds in duration caused by an AV block II type Wenckebach. The ECG now shows frequent polymorphic ventricular extrasystoles in the patient. In addition, there are two instances of AV block II Wenckebach type with a 2.1-second pause. There are also frequent supraventricular extrasystoles with postextrasystolic pauses. All these findings are of no significance in a patient without complaints."

My question now is: For a layperson, this multitude of findings during a single 24-hour ECG sounds more than alarming, even if the cardiologist assigns little significance to these findings. Should I seek a second opinion, or is such an accumulation normal in an otherwise healthy individual? I also enjoy sports (especially jogging). Do I need to restrict myself in any way? I am particularly concerned about the polymorphic VEs. One reads the worst things about them on the internet. I have no significant complaints except for feeling the irregularities in my pulse. I also do not experience any issues while jogging. Sometimes I feel slightly dizzy after strength training, but it could also be psychological or panic-related. It would be appreciated if a doctor in this forum could advise me on whether I should pursue further investigation or if I should not pay too much attention to this finding. (I find the amount of findings in the report particularly concerning)

Thank you in advance

Kind regards
Flämig

Dr. med Ralf von Seckendorff

Good day,

You have described 3 things:

1. frequent supraventricular extrasystoles, which are extra beats of the so-called atria. These are harmless in otherwise healthy young individuals.
2. AV block type 2 Wenckebach, which is a partial delay in the electrical conduction of heart impulses from the atria to the ventricles. This also has a favorable prognosis.
3. frequent polymorphic ventricular extrasystoles. These can theoretically become more dangerous, particularly in patients with other more severe heart conditions such as Coronary Heart Disease, etc. However, in otherwise healthy and mostly asymptomatic patients, there is usually no immediate need for intervention.

Discuss with your treating cardiologist the possibility of regular follow-up examinations to monitor the findings. Additionally, a supplementary echocardiogram (if not already done) can be performed to assess the overall pumping and ejection function of your heart (which should be assumed to be normal if you can jog without symptoms).

In summary, you do not need to worry about 1 and 2, and for 3, occasional cardiological check-ups should be done as a precaution.

Yours sincerely,