Dear XXXXXXXX,
Most of these findings have come from your EKG:
AH is a measured interval on your EKG. Address this by complying with your cardiologist on lifestyle changes and medications.
HV interval is also a measurement of the EKG.....prolonged interval with a procainamide drip would be expected.
Abnormal SNRTx1 = one episode of abnormal Sinus Node Recovery Time.....procainamide drip could also be the culprit for abnormal SNRT.
Abnormal AV Function = a problem in the AV node in the heart. There are other nodes that trigger the electrical conduction of the heart. First the SA node (sinoatrial node) fires off impulses through the heart at a rate of 60 to 100 beats per minutes in a normal heart and travels to the AV node (Atrioventricular node) which should be able to initialize its own impulses around 40 to 60 beats per minute. This results in a junctional rhythm where a "P" wave would not be seen on the EKG and the diagnosis would be bradycardia (heart rate below 60.) Having those medications discontinued was a good idea as they were likely contributing to the bradycardia.
Now for the last notes of the EKG...... "No SVT" (Supraventricular Tachycardia) which is a serious arrhythmia where the heart beats at 150 to 200 beats per minute and sometimes as high as 300 beats per minute. "No VT" (Ventricular Tachycardia) another very serious and sometimes fatal arrhythmia where the heart beats at least three ventricular beats in a row with a rate over 100 beats per minute. Sustained VT looks like a bunch of QRS complexes on the EKG without ANY P-waves present also at a rate over 100 beats per minute. "No VA block" = ventricular / atrial block.
Overall, not too bad of an EKG. Problems may resolve on their own in the absense of the ace inhibitor and beta blockers.
Sure Joe,
EP studies is a procedure that evaluates the conduction of the heart.....just a more in depth look (much more) at the electrical conductivity of the heart. As I mentioned in the above reply, the heart has it's own intrinsic pacemakers. Conduction of the heart begins at the SA node (sinoatrial node.) This is where these conductions are initiated. The electrical signal is then sent to the AV node (atrioventrical node.) The AV node then takes over as the pacemaker usually slowing down that intial conduction from the extremely fast conduction of the SA node. From there it travels down then center of the heart called "the bundle of his" which conducts even slower than the AV node. From there it travels down and around the heart to conducted fibers called the perkinje fibers and from there it makes the heart beat. (An awful lot going on to get each beat of the heart, huh?) Depending on where your heart is picking up it's pacemaker will depend on whether or not you'll need an artificial pacemaker. Some patients with extremely slow heart rates are "running" on the right or left bundle to initiate their pacing.....they usually require a pacemaker.
Your symptoms of lightheadedness are likely from the bradycardia....slow heart rate. It seems your cardiolgist wants to take away those cardiac drugs (which slow the heart) and any alcohol to see how well (or not well) your heart is able to conduct on it's own. If your heart is using a slow pacemaker that is not fast enough to sustain a good heart rate for you, then you may require an artificial pacemaker.
Here's a picture of the electrical conduction of the heart. If this still isn't clear, please let me know.
http://www.sfda.gov.sa/NR/rdonlyres/5DF67EC6-A68D-49B2-8B9F-2FA9F9D6C25B/107/heart.JPG
Annlynn RN
One last question. Can you expalin what a slow pacemaker is? I do not have a pacemaker, but this is the recomendation of the cardiologists. I am resisting and currently on an event monitor to see if any symptoms can correlate with heart signals. Assume that by artificial pacemaker, you mean an implantable pacemaker? I was interested based on the findings I forwarded in my original message if those results would lead a specialist to jump to the pacemaker solution. Maybe we should wait and see how the heart reacts to the termination of cardiac medicine and alcohol..
Dear Joe,
Yes, by "artificial pacemaker" I was referring to "implantable pacemaker".....sorry for the confusion.
It's no problem to keep asking for clarification. I certainly wouldn't expect you to pay if you are not satisfied with your answer. Please realize that each of us are online at different times so it may take some time to get back to you.
Sorry if I wasn't clear in the previous posts. I will explain what a slow pacemaker is, but first let me clarify what I meant by your own pacemaker...... You DO in fact have a pacemaker.....we all do. They are "built in" to our heart from birth. Look at the link to the diagram I included in the last post I sent.....it shows the heart's natural pacemakers.
The heart has it's OWN intrinsic (built in) pacemakers as I explained above. (The SA node, the AV node,etc.) You have your own intrinsic (built-in) pacemakers in your heart. (We're born with them and they are a normal part of our heart's anatomy.) As I explained above, when one of those intrinsic (built in) pacemakers do not conduct fast enough to sustain a good heart rate, then an artificial (implanted) pacemaker is needed.
Depending on where your heart is conducting from (which pacemaker is taking over) the faster or slower the heart rate will be. The SA node conducts the fastest. The AV node conducts slower. And the pacemakers beyond the AV node conduct slower and slower down the line (bundle of his, perkinje fibers.)
Usually when the conduction originates beyond the AV node, it's just not fast enough to keep the heart beating at an acceptable rate. So a "slow pacemaker" is a pacemaker (the one built in to your heart) that doesn't conduct fast enough to sustain a good heart rate.
So remember that your heart has it's own pacemakers "built in" so to speak. When the pacemaker that is in control isn't fast enough, you need an artificial pacemaker to "kick in" and make your heart beat faster if yours is not beating fast enough on it's own. The medications you listed that you were taking actually SLOW the heart rate. That is why your doctors took you off of them. This way, the doctor can see if your slow heart rate (bradycardia) was due to the medication, or if there is a problem with your own intrinsic pacemaker in your heart.
The EP studies showed that you had some bradycardia. If in the absense of the cardiac medications and alcohol the heart returns to normal rate, you will likely not need a pacemaker. From this point, it doesn't sound as if the doctor is "jumping" to give you an artificial (implantable) pacemaker. You didn't mention what your heart rate was however, my guess is that it's slow enough to make the cardiologist believe that you will need the artificial (implanted) pacemaker even after you've been off the medications and alcohol.
Artificial (implanted) pacemakers are designed to SENSE and PACE. It SENSES if your heart rate is too slow, and then PACES if it falls below the set parameter given by your cardiologist. Every artificial (implanted) pacemaker can be set according to each patients' individual needs. Your cardiologist will be able to program your artificial pacemaker to "kick in" when your heart reaches a certain rate. (Your cardiologist will decide your artificial pacemaker's settings depending on your individual needs.) The best part is that AFTER you have your pacemaker, your doctor can monitor how frequently your artificial pacemaker is "firing" and adjust it as needed.
Please let me know if you need further clarification. I will try my best to make this as easy to understand as I can. The heart is such a complex organ and it can be overwhelming to think of some artificial object inside controlling our heart. On the other hand, that little artificial object can save your life. Choose wisely, Joe.
Nurse (RN)
RN - 14 years in ICU & Critical Care (Cardiac, Neurology, Trauma, & Medical/Surgical ICU.)