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What Does This EKG Report For Heart Palpitations Indicate?
Posted on
Sun, 21 Jun 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 21 Jun 2015
Answered on
Mon, 13 Jul 2015
Last reviewed on
Question : Hello, I went to the ER today for Palpitations. The EKG showed "SV Bigeminy" as well as a short QT wave, i should mention i've had every cardiac test in the book over the past year, a stress, two echos, and two holters. The only thing to come of them was PVC'S & PAC'S however this abnormal ekg today really scared me, the doctors shrugged it off because i'm in the ER so much but I really need someone to enlighten me more, because i've heard bigeminy is very dangerous. Can someone please help?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand you concern, and would like to explain that facing your resting ECG and prior history of PACs & PVCs, the first thing to rule out/in is short QT syndrome, as it may lead to more complex and life-threatening arrhythmias.
A short QT interval may be also caused by several secondary reasons, like:
hypercalcemia, hyperkalemia, acidosis, hyperthermia, some drug effects, etc.
If all the secondary causes are excluded then a congenital short QT syndrome (SQTS) should be sought:
Coming to this point, I would explain that based on your actual medical data you have a low probability of SQTS (besides QTC<350 ms, no other identifiable SQTS criteria is present, like Jpoint - Tpeak interval < 120 ms, a suggestive clinical history, history of sudden cardiac arrest, unexplained syncope, documented polymorphic VT or VF, atrial fibrillation, family history of SQTS, genotype, etc).
If you have a family history of suspected SQTS (or other additional criteria) then there is a raised suspicion of >/= intermediate probability of SQTS. If such is the case, I recommend to explore further, to study QT response to exercise, and even to perform an electrophysiological study and genotype.
You have to talk with your attending cardiologist about these issues, and probably with an electrophysiologist.
If SQTS is confirmed then there are some options to avoid dangerous arrhythmia, like propafenone, sotalol, dofetilide or flecainide, even hydroquinidine is proven effective to prolong short QT syndrome. When these are not sufficient ICD implantation is an option.
You need to discuss the above opinions with your doctor.
Hope to have been helpful to you!
Feel free to ask me whenever you need. Greetings! Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand you concern, and would like to explain that facing your resting ECG and prior history of PACs & PVCs, the first thing to rule out/in is short QT syndrome, as it may lead to more complex and life-threatening arrhythmias.
A short QT interval may be also caused by several secondary reasons, like:
hypercalcemia, hyperkalemia, acidosis, hyperthermia, some drug effects, etc.
If all the secondary causes are excluded then a congenital short QT syndrome (SQTS) should be sought:
Coming to this point, I would explain that based on your actual medical data you have a low probability of SQTS (besides QTC<350 ms, no other identifiable SQTS criteria is present, like Jpoint - Tpeak interval < 120 ms, a suggestive clinical history, history of sudden cardiac arrest, unexplained syncope, documented polymorphic VT or VF, atrial fibrillation, family history of SQTS, genotype, etc).
If you have a family history of suspected SQTS (or other additional criteria) then there is a raised suspicion of >/= intermediate probability of SQTS. If such is the case, I recommend to explore further, to study QT response to exercise, and even to perform an electrophysiological study and genotype.
You have to talk with your attending cardiologist about these issues, and probably with an electrophysiologist.
If SQTS is confirmed then there are some options to avoid dangerous arrhythmia, like propafenone, sotalol, dofetilide or flecainide, even hydroquinidine is proven effective to prolong short QT syndrome. When these are not sufficient ICD implantation is an option.
You need to discuss the above opinions with your doctor.
Hope to have been helpful to you!
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you dr but I noticed you did not adress my original question of the bigenimy. The dr at the ER was not worried about short QT but I'm very worried about both. Thank you for shedding light on the QT but can you tell me if bigenimy is dangerous? I'm afraid to go to sleep thinking I'll have sudden cardiac r death syndrome
Brief Answer:
Supraventricular bigeminy doesn't impose risk for your life.
Detailed Answer:
Hello again!
Supraventricular bigeminy are not dangerous. They do not represent any risks for life-threatening conditions, including sudden cardiac death. So, relax and don't worry!
You just need to exclude any electrolyte disturbances (a routine blood test), which may frequently trigger ectopic beats.
The only important finding to be taken into consideration on your ECG, is short QT interval (though there exists a QT dispersion accounting different leads).
That's why I tried before to explain in more details.
A short QT syndrome may be a primary source of life threatening cardiac arrhythmia (leading even to cardiac death, if left untreated), not just an isolated bigeminy. That is the important issue that needs further clarifications.
If you have further uncertainties, do not hesitate to ask!
Best regards! Dr. Iliri
Supraventricular bigeminy doesn't impose risk for your life.
Detailed Answer:
Hello again!
Supraventricular bigeminy are not dangerous. They do not represent any risks for life-threatening conditions, including sudden cardiac death. So, relax and don't worry!
You just need to exclude any electrolyte disturbances (a routine blood test), which may frequently trigger ectopic beats.
The only important finding to be taken into consideration on your ECG, is short QT interval (though there exists a QT dispersion accounting different leads).
That's why I tried before to explain in more details.
A short QT syndrome may be a primary source of life threatening cardiac arrhythmia (leading even to cardiac death, if left untreated), not just an isolated bigeminy. That is the important issue that needs further clarifications.
If you have further uncertainties, do not hesitate to ask!
Best regards! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much doctor! One final question, as you said I'm most likely not At risk for short qt syndrome, but the EKG did say it, I have no family history but do have panic disorder, so I guess I'm asking is the short qt related to heart rate? Because I only notice palps while lying down. Also I was quite fatigued due to a disruption in medication schedule, thanks for all your input!
Brief Answer:
You are welcome!
Detailed Answer:
Hello!
Palpitations may be due even to anxiety.
Regarding QT, it is true that it is influenced by heart rate. In fact, normally, faster the heart rate is, shorter the QT interval becomes. That's why we use QTc (corrected for heart rate) to avoid heart rate influence.
My advice is to keep controlling your ECG periodically by your cardiologist.
Wish you a good health! Dr. Iliri
You are welcome!
Detailed Answer:
Hello!
Palpitations may be due even to anxiety.
Regarding QT, it is true that it is influenced by heart rate. In fact, normally, faster the heart rate is, shorter the QT interval becomes. That's why we use QTc (corrected for heart rate) to avoid heart rate influence.
My advice is to keep controlling your ECG periodically by your cardiologist.
Wish you a good health! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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