Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM! Thank you for your question!

I passed carefully through your girlfriend medical history and also reviewed all your uploaded reports.

From two ECG recordings, it may be concluded that her heart rate reveals some abnormal variations, which are not considered sinus phasic arrhythmia (a common finding in normal, young adults), which seems to be related to an increased abnormal automaticity in the atria.

This explains why the heart rate abruptly increases from a basal 50-55bpm to 75-80-90 bpm. Also the preceding P waves (atrial depolarization) seem different. This explains that the underlying impulse, responsible for those episodes of faster heart rate is not generated in sinus not (as normally happens), but somewhere below in the atria.

It is necessary the review of more and longer ECG strips, to differentiate between a wandering pacemaker, an abnormal automaticity, etc..

Whichever could be the conclusion, I would like to assure you that we have only to do with a supraventricular phenomenon, which is harmless on its own. So nothing to worry about!

In such case, for a thorough investigation of this issue, it is necessary to review the whole day-night heart rhythm trends. If you have any available Holter monitoring, please upload it here for a direct review.

You have to relax, as these phenomena are commonly found in young adults.

An investigation for some secondary problems is necessary:

- Pulmonary function
- Cardiac ultrasound
- Renal function and blood electrolytes levels
- Thyroid function tests
- Gastro-intestinal function (hiatal hernia, spastic colitis, gastro-esophageal reflux, etc.)


Regarding your concern about a possible POTS, I would like to explain that it doesn’t seem to be so, based on her ECG recordings: short periods (a few seconds) of abrupt heart increase, interchangeable with lower heart rate.

When diagnosing POTS, it is important the presence of chronic symptoms of orthostatic intolerance (at least 6 months) accompanied by an increased HR ≥30 bpm within 10 minutes of assuming an upright posture and in the absence of orthostatic hypotension (a decrease in BP >20/10 mm Hg).

The orthostatic tachycardia must occur in the absence of other overt causes of orthostatic tachycardia such as prolonged bed rest, medications that impair autonomic regulation (such as vasodilators, diuretics, antidepressants, or anxiolytic agents), or chronic debilitating disorders that might cause tachycardia (such as dehydration, anemia, or hyperthyroidism).

The standard test for diagnosing POTS is Head up Tilt Test.

Hope to have been helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion as follows:

Detailed Answer:
Hi again,

I passed through all your Referred ECG slides, and would say that the presence of differing P wave morphology, irregular heart rhythm, slight variation of PR intervals and heart rate generally less than 100 bpm are in favor of a Wandering Atrial Pacemaker.

ECG strip calibration is not shown during registration and also there is no presence of multi-channel simultaneous ECG registration.

Nevertheless, the differential diagnosis should be done at some isolated strips (suspicious!!) with multifocal atrial tachycardia (MAT) (the heart rate seems transiently greater than 100 bpm in certain strips, though the average HR shown at the beginning of the rows refers less than 100 bpm).

Wandering pacemaker may be seen in individual with increased modulation of vagal tone to the sino-atrial node (SA); it may be normally seen during sleep; also in certain SA node dysfunction or atrial abnormalities, while MAT is usually present in individual with exacerbated pulmonary disorders.

In such case a differential diagnosis should be done.

opinion is to repeat the heart rate monitoring in a second time by using a professional (medical) ECG recorder: performing a standard Holter monitoring.

At the end, I would like to conclude that these ECG phenomena are harmless; they are not dangerous at all. No special treatment is necessary.

In the case of MAT presence, management of possible lung disorders may be useful.

So, nothing to worry about.

Just a periodic medical checkup would be sufficient.

Hope to have been helpful to you!

In case of further uncertainties, feel free to ask me again.

Regards,

Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful!

I will be happy to review your uploaded recordings as soon as you have them!

You can ask me directly at any time at the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Best wishes,

Dr. Iliri

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