I understand that Mr SUPERSTARDJ01 attended for an ambulatory blood pressure monitor on 7 August 2009. His clinic blood pressure reading was 141/83, pulse rate 39 beats per minute. The ECG showed bradycardia at the rate of 40 beats per minute likely to be junctional rhythm as no P waves were seen on the trace. We have attempted fitting him with an ambulatory blood pressure monitor but the monitor was unable to take his readings in view of the significant bradycardia. I trust that we need to investigate Mr SUPERSTARDJ01’s cardiac rhythm as he may have higher degree heart block and may require cardiac pacing. It is possible that his blood pressure readings may be high due to the bradycardia causing larger stroke volume. We will attempt to make contact with him in the near future for the monitor but he should report any occurrence of dizziness, faints or blackouts. Thank you for your referral.
I am felling hot/hot flushes, getting palpitations and having difficulties breathing so the doc has given me an inhaler for now while I wait for the results of the mobile ECG.
Additional Details
Further to my recent letter regarding Mr SUPERSTARDJ01. He has now had a 24-hour ECG that was done on 17 August 2009. It showed extreme bradycardia with a mean heart rate of 38 beats per minute, maximum heart rate 85 beats per minute around 6:35 a.m., minimum heart rate 28 beats per minute around 8:50 p.m. The trace shows extreme bradycardia with probably no atrial activity seen, probable atrial standstill with junctional rhythm or complete heart block. The heart accelerated to 85 beats per minute only briefly around 6 a.m. We have not detected atrial fibrillation or wide complex tachycardia. The accompanying diary reports occurrence of palpitations, the feeling of missed beats, hot flushing and occasional shortness of breath. This extreme bradycardia may explain raised blood pressure readings in view of the probable increased pulse pressure that is caused by the bradycardia. The maximum heart rate occurred at around 6 a.m., the accompanying diary reports lifting a freezer through the house at that time. The heart does not appear to accelerate during other activities. I will organise to review Mr SUPERSTARDJ01 clinically, discussed the result with him as he may require organising permanent pacemaker insertion
There is a lot of information here to cover. I’ll try to explain the main points but if you need more info just ask. Your 24 hour ECG (Holter monitor) results show extreme bradycardia. Bradycardia refers to a slower than normal heartrate. A normal heartrate is about 60-100 bpm at rest. Of course, your heartrate should increase with exercise and it can slow quite a bit when you are sleeping. In your case, your mean (average) heartrate over a 24 hour period is 38 bpm and this is much too slow (extreme bradycardia). The symptoms you describe can be attributed to this condition. You may also feel very fatiqued.
Your doctor’s interpretation of the recording indicates that he/she saw no atrial activity. The atria are the top chambers of your heart. Normally, a heartbeat originates above the atria and they contract first before the ventricles which are the bottom chambers of your heart. In your case the doctor did not see atrial activity and mentioned that your heart rhythm is probably junctional. This suggests that your heartbeat is originating below the level of the atria, probably at the level of the junction between the top and bottom chambers of your heart. A pacemaker would be the common recommendation for this condition.
This is a problem with the electrical conduction of your heart only. The doctors’ notes you provided do not indicate any other heart problems, such as blocked arteries.
Your cardiologist will discuss the possibility of a pacemaker insertion and should answer all your questions.
Blood pressure: 141/83 mmHg. Pulse pressure 141–83 = 58 mmHg. Optimum pulse pressure is 40 mmHg.
Research suggests that an elevated pulse pressure may be a strong predictor of heart problems, especially for older adults. Generally, a pulse pressure greater than 60 mm Hg is abnormal.
He has got Stage 1 Hypertension and Isolated hypertension.
Isolated systolic hypertension, however, is defined as a systolic pressure that is above 140 mm Hg with a diastolic pressure that still is below 90. This disorder primarily affects older people and is characterized by an increased (wide) pulse pressure.
The resting heart rate of a normal person is 60-100 beats per minute (bpm). A well trained athlete has a pulse rate of 40-60 bpm.
Bradycardia, as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min.
During normal atrial depolarization, the main electrical vector is directed from the SA node towards the AV node, and spreads from the right atrium to the left atrium. This turns into the P wave on the ECG.
P waves are absent in
* Atrial fibrillation
* Sinoatrial block
* Hyperkalemia
* Junctional (AV nodal) rhythm, e.g., in sick sinus syndrome.
Please note that I am not a medical professional.
References :
http://www.mayoclinic.com/health/pulse-pressure/AN00968
http://en.wikipedia.org/wiki/Pulse_pressure
http://www.medicinenet.com/high_blood_pressure/page3.htm#isolated
http://en.wikipedia.org/wiki/Bradycardia
http://en.wikipedia.org/wiki/Junctional_rhythm
http://www.nlm.nih.gov/medlineplus/ency/article/007369.htm
http://www.merck.com/mmpe/sec07/ch075/ch075b.html#sec07-ch075-ch075b-1076
http://www.merck.com/mmpe/sec07/ch075/ch075a.html#sec07-ch075-ch075a-1057
http://www.merck.com/media/mmpe/pdf/Table_075-3.pdf
The ECG in Practice by John R. Hampton.
There is a lot of information here to cover. I’ll try to explain the main points but if you need more info just ask. Your 24 hour ECG (Holter monitor) results show extreme bradycardia. Bradycardia refers to a slower than normal heartrate. A normal heartrate is about 60-100 bpm at rest. Of course, your heartrate should increase with exercise and it can slow quite a bit when you are sleeping. In your case, your mean (average) heartrate over a 24 hour period is 38 bpm and this is much too slow (extreme bradycardia). The symptoms you describe can be attributed to this condition. You may also feel very fatiqued.
Your doctor’s interpretation of the recording indicates that he/she saw no atrial activity. The atria are the top chambers of your heart. Normally, a heartbeat originates above the atria and they contract first before the ventricles which are the bottom chambers of your heart. In your case the doctor did not see atrial activity and mentioned that your heart rhythm is probably junctional. This suggests that your heartbeat is originating below the level of the atria, probably at the level of the junction between the top and bottom chambers of your heart. A pacemaker would be the common recommendation for this condition.
This is a problem with the electrical conduction of your heart only. The doctors’ notes you provided do not indicate any other heart problems, such as blocked arteries.
Your cardiologist will discuss the possibility of a pacemaker insertion and should answer all your questions.
References :
cardio tech