I thought I would provide some information about my recent irregular heart rhythms, multiple tests, and scheduled cardiac ablation procedure this week. I have included screenshots from my heart monitor results, as well as video about Texas Cardiac Arrhythmia Institute at the end. Besides telling you what’s going on with me, I thought it might be interesting or helpful to others as well (even though it’s somewhat long).

Sinus Rhythm

Heartbeats normally occur between 60 and 100 per minute; it’s tachycardia when higher, and bradycardia if lower. My regular (sinus) heart rate averaged 57 beats per minutes (bpm), which is slightly below normal, with minimum 39 early morning and maximum 109. I understand it tends to be slower during sleep.

I have frequent premature contractions, or early beats, from both ventricle (PVC) and atria (PAC) that disrupt the regular sinus rhythm. This irregular heart beat is known as an arrhythmia. Also, there are fast heart rate episodes called supra-ventricular tachycardia (SVT) that I’m having with a maximum 156 bpm.

Maximum Sinus

My maximum normal sinus rate was 109 bpm, with PVCs present.

Minimum Sinus

My minimum sinus rhythm was 39 bpm; PVCs occurred when slow or fast.

In some cases, there were both types of early beats (PAC & PVC) even when slower.

Early Beats

I am also definitely having premature heart beats, which are called “ectopic” by cardiologists. There are two types depending on which heart chamber is the source (atrium/upper or ventricle/lower), and I have both.

• PAC (5.8%): premature atrial contractions (SVE in reports).
• PVC (12.5%): premature ventricular contractions (VE in reports)

Premature Ventricular Contractions (PVC)

For a few months now, I have been having heart rhythm issues with frequent premature ventricular contractions (PVCs), which are extra early heart beats between the normal regular rhythm (known as sinus beats). So after a normal beat, another quickly follows and then there’s a long pause before the next regular sinus interval that’s stronger than usual because more blood fills the chamber than normal that must be pushed out. So it’s like “regular (sinus) beat … early (PVC) beat … long pause … Boom (next regular beat – louder and stronger)”.

This shows normal sinus rhythm interrupted by early beats (PAC & PVC) that are followed by a pause (skipping the next regular sinus beat). These early beats are then followed by a longer pause, so they feel like a skipped beat (“palpitations” or “flutter”).

Isolated PVCs

Most occurred as isolated events, and both are frequent, with PVCs twice as often as PACs. Notice the extra beat between the regular sinus beat intervals; there were two different ECG pattern shapes detected, but one was dominant and the other fairly rare.

PVC Couplets

PVCs often occur in repeating patterns. Some occasionally happen in pairs (or “couplets”) as two consecutive PVCs.

PVC Triplets

However, there were a few with three in a row (“triplets”).

Bigeminy

When every other beat is a PVC, it’s known as “bigeminy”, and my longest was 8 minutes.

Trigeminy

It’s “trigeminy” when every third beat is a PVC, and my longest sequence lasted 3 1/2 minutes.

Tachycardia

A fast heart rate is called “tachycardia”. I had 86 intermittent (or “paroxysmal”) supraventricular tachycardia (SVT) episodes with at least 4 in a row that occurred in the atria/upper chamber (“above ventricle”). During those periods, my average heart rate was 124 bpm with a maximum of 156. However, I had no ventricular tachycardia with 4 or more, which can become dangerous.

I knew I had occasional PVCs from when I wore a Holter heart monitor for a week several years ago. At that time, I think they might have detected about 6 PVCs over the entire week that I wore it, whereas now they happened pretty much all the time; now there were 38,166 early PVCs over 84 hours, or almost 8 per minute. That earlier test also showed I have a mitral valve prolapse, where the flaps don’t quite close all the way and there is slight leakage between the ventricle and atria chamber.

Here’s a summary of my frequent PVCs, which occurred both day and night.

Low Thyroid

Initially my endocrinologist found I had low thyroid so they started me on 50 mcg levothyroxine. However when I was tested the next time, it then showed that it was then quite high, so I guess that dose was too much. She had me skip it one day a week, effectively making it about 43 mcg. The following time it was still slightly high, so she switched me to only 25 mcg, which then stabilized my thyroid in the low normal range where I am now.

Shortness of Breath

For a while I noticed shortness of breath, even just taking neighborhood walks, as well as swollen feet, ankles and lower legs. Also was feeling generally jittery too. At first I had thought it might have been due to the higher thyroid level, but those symptoms have disappeared more recently. So I’m not quite sure what caused that, but possibly it might have been associated with the irregular rhythms.

BNP Test

I had been concerned that I might have congestive heart failure (like my mother), so my cardiologist ordered a BNP Pro test to check for fluid overload, electrolytes etc, but they were all great. So I definitely do no have heart failure.

Cardiologist

I had an appointment to see my cardiologist (Dr Michael Grad) in July. I feel confident that he really know what’s he doing; he’s Director of Cardiology at St David’s Round Rock Medical Center. He confirmed that I definitely have frequent PVCs. He heard several just listening on his stethoscope and also on the office EKG. He recommended several tests for me to get:

• CT Calcium Score: Heart scan that calculates a “calcium” score that checks for plaque buildup in arteries around heart for potential blockages that might reduce flow and eventually cause a heart attack.
• Echo Cardiogram: Ultrasound imaging of heart in motion to check heart structure, valves, etc.
• Nuclear Stress Test: Initially he didn’t think I would need that since everything was great 5 years ago. However, he ordered it after my Calcium Score identified that I do in fact have heart disease with significant calcification in 3 coronary arteries. So this would indicate whether I might have any blockages that need intervention (like stents).
• Zio Heart Monitor: Wear for 3 days to see what percentage are early, as well as capture more rhythm details.
• Thyroid test (followup): He thinks my PVCs might possibly be more frequent because of the elevated thyroid earlier, and that might get better as it stabilizes. He wants my thyroid to be on the lower end of the normal range. I might just be a little more sensitive than some people.

Cholesterol

My last cholesterol test was slightly elevated so the cardiologist wants to be more aggressive about getting that down as a preventative measure with my coronary artery disease. So he raised my Crestor statin (generic Rosuvastatin) from 10 to 40 mg.

High Blood Pressure

They had me take my blood pressure at home each day to determine if they might need to increase my Lisinopril BP medication from 20 to 40 mg. However, my readings for about a month indicate that it is really good so there is no need to change the dose. Sometimes my blood pressure monitor indicates a slower pulse; however that might be off because it can’t really be detected properly with the frequent PVCs.

Normal Thyroid

Also my latest thyroid test was back in low normal range, so I will continue the 25 mcg levothyroxine dose.

CT Calcium Score

I have a calcium score of 5,200 that indicates very significant calcification in my coronary arteries (anything over 400 is considered “significant”). There are 3 coronary arteries with plaque build-up on the walls. I don’t know how long it’s been there because I never did one of these tests before. However, it’s not affecting the blood flow yet. My cardiologist said it’s substantial, maybe about 40-50%, but doesn’t require intervention with something like stents (or bypass) until it gets over 70%.

Echo Cardiogram

The echo cardiogram was really good! Ventricle walls were normal and not enlarged or stiff. I still had mild mitral valve leakage, but that’s not really a problem (and fairly typical with older age).

• Normal left ventricular size and function.
• Frequent PVCs appreciated.
• No evidence of left ventricular hypertrophy.
• Mild mitral valve regurgitation.
• Bowing of the mitral valve leaflets, without frank prolapse.

Nuclear Stress Test

This chemically-induced stress test (no treadmill) was normal with NO blockages! My heart had a “good squeeze”, showing a 69% ejection fraction, which indicates that most of the blood was pumped out on each contraction. Since I do have plaque calcification, we just need to focus on preventative risk factors like keeping cholesterol and blood pressure down.

• Satisfactory pharmacologic stress test.
• No evidence of ischemia on myocardial perfusion imaging.
• Preserved left ventricular ejection fraction.
• Estimated ejection fraction is 68%.

Zio Heart Monitor

I wore a Zio heart monitor from iRhythm Technologies for 3 days. This small monitor had electrode wings that was simply applied to my chest above my heart with adhesive backing. I had to shave first, then prep the skin with an abrader to rough the skin a little, and clean with alcohol swab for good contact.

There was a button to click on the monitor, and an iPhone app to log any symptoms (that syncs with the data), like irregular beat, pounding, etc. The entries included date/time, symptom, duration, and activity (what I was doing). For me, it was pretty much all the time so I primarily recorded an entry once a day, rather than every time I noticed something. I mailed it back to San Diego after the 3 days, they analyzed the data, and sent a detailed report to my cardiologist with the results.

This was much better that my previous Holter monitor experience since there were no multiple electrode attachments and wires to a transmitter device hanging from my neck and associated smart phone to transmit data to a central location in Chicago for processing.

The results from about 3 days with the heart monitor were very interesting! My cardiologist provided this summary.

• Underlying rhythm was sinus rhythm, average heart rate of 89 bpm.
• 86 episodes of SVT (fast atrial heart rate), longest lasted 48 seconds.
• Frequent PVCs (early ventricular beats) 12.5%.
• Frequent PACs (early atrial beats) 5.8%.
• No obvious evidence of atrial fibrillation for ablation, ventricular tachycardia, or sinus pause.

Electrophysiologist

My cardiologist had recommended that I see an “electrical” heart doctor known as a cardiac electrophysiologist, who specializes in irregular heart rhythms (or arrhythmias). They receive several additional years of training beyond what a normal cardiologist receives. I saw Dr. David Tschopp, who was outstanding. He’s with a Texas Cardiac Arrythmia group associated with St David’s Medical Center and Austin Heart Hospital.

He reviewed my Zio heart monitor results to investigate any underlying cause for the frequent PVCs that might need fixing, and discussed his recommendations with me. He summarized my condition as follows.

• Sinus Bradycardia
• Frequent PVCs
• Ventricular bigeminy
• RSR(V1) non-diagnostic
• ABNORMAL RHYTHM

He said that I need ablation for the PVC, PAC & SVT, but that I do not have Atrial fibrillation (or A-fib), which actually occurs in the pulmonary vein coming into the heart (atria) with fresh (oxygenated) blood from the lungs. At least my sinus rhythm (regular beat) is good with no “pause”, and no ventricular tachycardia (which is dangerous).

Premature Atrial Contractions (PAC)

The premature ventricular contractions (PVCs) all seem to be coming the same place, and he can fix that with a cardiac ablation. I also discovered that I have premature atrial contractions (PACs) too, so I have extra beats in both chambers.

Isolated PAC

This shows some single early atrial beats (PAC), identified as a supraventricular ectopic (SVE).

PAC Couplet

Sometimes they occur in pairs between regular sinus rhythm intervals like shown here.

Supraventricular Tachycardia (SVT)

I also have supraventricular tachycardia (SVT), or fast heart rate episodes in the upper (atrial) chamber, possibly triggered by the PVCs. He showed me quite a few times where it appeared it might have been triggered following the PVCs, where suddenly it was “off to the races” for a short period.

Here’s a summary of those SVT episodes, which averaged about 124 bpm, and occurred throughout the day.

Fastest SVT (156 bpm)

My maximum heart rate during an SVT run was 156 bpm; it averaged 140 bpm with 63 beats over a 30-second interval. It appears this might have been triggered by the PVC couplet just before.

Longest SVT (48 sec)

This shows my longest SVT sequence lasted about 48 seconds with 99 beats averaging 125 bpm. Here again it looks like a pair of PVCs might have kicked it off.

Intermittent SVT

Here you can see some early beats, and then I’m “off to the races” with an SVT episode sequence of fast heart rate up to 150 bpm for a while, back to normal rhythm, and then more early beats at the end.

Wild Patterns

Several patterns (on different days) were triggered by the monitor that looked rather chaotic, abnormal, and somewhat scary.

I’m not really sure what was going with these, but they included multiple frequent PACs and PVCs and very irregular patterns.

Diary Events

When I noticed symptoms, I pressed a button on the monitor, and recorded the event information in a companion Zio app on my iPhone. These are identified in the report with associated triggered events and details around that time, as shown here with the circled area of the chart.

Here was a time while just watching TV in the evening where I actually had trigeminy, or PVC’s every 3rd beat, along with some PACs too.

Low Glucose

There were several times when my blood glucose was low (70) during the night when I awoke from my CGM alert, and I noticed irregular patterns at those times which I recorded in the Zio app (diary).

This identifies there was PVC bigeminy occurring every other beat during this period because the normal sinus rhythm is suppressed after a premature contraction.

This was another time when I noticed early beats after waking with a low glucose alert.

Cardiac Ablation

I have a cardiac ablation procedure scheduled at 8 am later this week. It’s considered an outpatient procedure. I will arrive 2 hours early, and it takes about 1 1/2 hours usually, with 1-3 hours recovery (and probably an overnight stay). I can have 1 guest so my wife can come, and she will need to drive me home.

After they do an electrophysiology (EP) study to map my heart electrically from inside and identifying the source of the arrhythmias, he will zap those abnormal cell spots with radio frequency energy (“heat”) using catheters guided by robotics and electromagnets to permanently stop the PVC, PAC, and SVT from happening again.

Texas Cardiac Arrhythmia Institute

It will be done in the Electrophysiology Center of the world-class Texas Cardiac Arrhythmia Institute at St. David’s Medical Center main hospital in Austin, where they have a special room with the most advanced technology in the world.

Electrophysiologists are heart rhythm specialists, or cardiologists with extended training as “electrical”  heart doctors. This is an international treatment, training, and research center specializing in heart rhythm disorders – the first of its kind in the US.

Watch this 3-minute video about this new dedicated EP center that opened last year, although TCAI was initially established over 10 years ago. My electrophysiologist (Dr. David Tschopp) is shown at the beginning and end in this video.

Electrophysiology (EP) Center Overview – Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin – 3 min 18 sec

Overall, these tests were all really good news, and quite a relief, even though there are some issues that need to be addressed. I will provide an update after the procedure to let you know how it went, and whether it resolved my irregular heart rhythms.