PULSE

Blood Pressure

Low: < 90mmHg systolic over < 60mmHg diastolic (more info)

Normal: 90-120 mmHg systolic over 60-80mmHg diastolic (more info)

High: >120mmHg systolic, >80mmHg diastolic (more info)

Resting Heart Rate

Normal: 60-100 beats per minute (more info)

Recovery Rate

Good: 23-40 beats per minute decrease in heart rate, 1 minute after peak exercise (more info)

Heart Rate During Aerobic Exercise

Normal (suggested): 50-85% of maximum heart rate (more info)

Orthostatic Adaptation or Orthostatic Tolerance

Normal: “Rule of 20-10-20″ (more info)

Pulse Pressure

Normal: 40-59mmHg (more info)

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EKG/ECG - ELECTROCARDIOGRAM

PVCs Per Minute

Normal: less than 6 per minute (more info)

QT Interval

Short QT: .34 seconds and shorter (QTc) (more info)

Normal: .35 - .44 seconds (when corrected for heart rate, or QTc) (more info)

Long QT: .45 seconds and longer (QTc) (more info)

PR Segment

Normal: Along Baseline (more info)

PR Interval

Normal: .12-.20 seconds in duration (more info)

QRSd

Normal: .06 - .10 seconds (more info)

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ECHOCARDIOGRAM

Because the left ventricle has the more difficult task of pumping blood through the entire body, and because the presence of heart disease affects the left ventricle more than it affects the right, most data and studies that are available focus on the left ventricle. We will do the same.

Left Ventricle Mass

Male aged 20-50 - Average: 193 grams (more info)

Female aged 20-50 - Average: 141 grams (more info)

Left Ventricle End Diastolic Volume

Males 20-50- Average: 163 ml (more info)

Females 20-50 - Average: 118 ml (more info)

Left Ventricle End Systolic Volume

Males 20-50 - Average: 65ml (more info)

Females 20-50 - Average: 42ml (more info)

Ejection Fraction

Normal: 50-70% (more info)

Left Ventricle Septum and Wall Thickness

Normal: 10mm (± 1mm) (more info)

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BLOOD

Normal Electrolyte Levels

Sodium (Na⁺): 136-144 mmol/l (more info)
Potassium (K⁺): 3.5-5.0 mmol/l (3.7-5.2mmol/l reported as normal by NIH) (more info)
Magnesium (Mg²⁺): 1.7 - 2.2 mg/dl (more info)
Calcium (Ca²⁺): 8.4-10.2 mg/dl (more info)
Chloride (Cl^-): 96-106 mmol/l (more info)

INR Value

Normal: 0.9 - 1.7 (more info)

eGFR/GFR

Normal: >90 ml/min/1.73m(sq) (more info)

TSH Level

Normal: .40-4.70 uIU/ml (more info)

BNP

Normal: less than 100pg/ml (more info)

PULSE - More Information

Blood Pressure

Normal Blood Pressure: 90-120mmHg (millimeters of mercury) systolic over 60-80mmHg diastolic. The systolic and diastolic values of your blood pressure are simple measures of the amount of pressure in your veins and arteries, not unlike the pressure in the tires on your car (except that your tire’s pressure doesn’t change from moment to moment). The higher number, your systolic pressure, is a measure of the pressure your blood is exerting on your veins just after your heart contracts, which is the highest pressure of the cardiac (heart beat) cycle. The lower number, your diastolic pressure, is a measure of the pressure in your veins just before the next contraction, when pressure is lowest in the cardiac cycle.

The definition of what “normal blood pressure” is has been consistently revised downward over the years in response to lengthy studies showing a connection between what used to be considered mildly high blood pressure and cardiovascular complications. Currently, normal blood pressure is considered to be between 120-80 over 90-60.^[1] (back)

Low Blood Pressure: < 90mmHg (millimeters of mercury) systolic over < 60mmHg diastolic. However, it is possible for a person to have blood pressure of 90/50, for example, and not be hypotensive (the characteristic of having low blood pressure). It all depends on the symptoms that person experiences. If the person normally has 90/50 blood pressure and does not experience any ill effects from that blood pressure, then that person is not considered to have low blood pressure.(back)

High Blood Pressure: >120mmHg (millimeters of mercury) systolic, >80mmHg diastolic. Between 120/80 and 139/89 is considered pre-hypertension and may be treated by your doctor, depending on the doctor’s evaluation of your lifestyle and risk factors. Blood pressure of 140/90 and above is considered high blood pressure.^[2]

A useful blood pressure reference can be found at Vaughns 1 Pagers.(back)

Normal Resting Heart Rate: 60-100 beats per minute. It’s important to note a few things about your resting heart rate. While it’s practical for the general population to have defined parameters for what is considered a “normal” resting heart rate, it’s also possible that the “normal”, healthy rate for you falls outside of this range. Doctors just use that rate as a guide in determining overall cardiac health. For example, Lance Armstrong, seven time Tour de France winner, has been reported as having a resting heart rate as low as 32 beats per minute. And even resting heart rates over 100 can be considered normal, or at least not something that requires treatment (so long as that resting rate is of shorter duration, such as during a period of anxiety, stress or physical pain). If you are experiencing symptoms that accompany your resting heart rate, such as lightheadedness, dizziness, nausea or vomiting, reporting your symptoms to your physician would be a reasonable precaution. ^[3][4] (back)

Exercise Recovery Rate - Good: 23-40 beats per minute decrease in heart rate, 1 minute after peak exercise. This value was difficult to quantify because 1) several studies defined “normal” heart rate recovery (HRR) differently, and 2) we did not have access to the raw data from each study, making comparison between studies impossible. Therefore we are unable to define a “normal” heart recovery rate. The range we propose (23-40) seems to accommodate the defined normal ranges of most relevant studies. ^[5][6][7][8] (back)

Normal or Suggested Heart Rate During Aerobic Exercise: 50-85% of maximum heart rate. This range is calculated by first finding your theoretical maximum heart rate by subtracting your age from 220, then multiplying that number by .50 and .85, giving you a BPM range to maintain in order to receive cardiovascular benefits from the exercise.

For example, a 30 year old would have a theoretical max heart rate of (220-30) 190bpm, and her target heart rate should be (190 x .50) 95bpm to (190 x .85) 162bpm. A heart rate that is higher or lower than this range may still be healthy, but you should discuss it with your physician.^[9] (back)

Normal Orthostatic Adaptation or Orthostatic Tolerance: “Rule of 20-10-20.” Defined as your body’s adaptation of heart rate and blood pressure to meet changes in cardiovascular demands when changing position (from laying to sitting, sitting to standing, for example). It’s expected that when you go from a supine (laying down) position to standing, there should be a decrease in systolic (higher number) blood pressure of up to 20mmHg (millimeters of mercury), an increase in diastolic pressure of 10mmHg and an increase in heart rate of 20 bpm. ^[10][11][12] (back)

Normal Pulse Pressure: 40-59mmHg (millimeters of mercury)Pulse pressure is the difference between your systolic (higher, first number) and diastolic (lower, second number) pressures. In mechanical terms, if you were to connect a fire hose to a hydrant and turn the water on and off, pulse pressure measures how much more pressure is in the hose when the water is on compared to when it’s off. It’s calculated by simply subtracting your diastolic pressure from your systolic pressure. Pulse pressure less than 40 can be a sign of blood loss (such as with a serious injury), or possibly congestive heart failure, where the volume of blood pumped with each contraction is diminished. Pulse pressure that is 60 or greater is considered abnormal and research suggests that it is a predictor of future heart problems. The most common cause of high pulse pressure is loss of elasticity or stiffness in the aorta, the largest artery in your body. Long-term high blood pressure and fatty deposits on artery walls can make the aorta less elastic, as can hyperthyroidism and severe anemia.

Treatments for high pulse pressure are the same for that of high blood pressure, and the reduction of blood pressure usually results in lower pulse pressure, too.^[13][14] (back)

EKG/ECG - ELECTROCARDIOGRAM - More Information

Normal PVCs Per Minute: less than 6 per minute. Technically PVCs are not called normal, but are called rare, isolated or occasional when they occur at a rate of less than 6 per minute. Some authors consider anything less than 10 PVCs per minute to be occasional or rare. In general, further testing of your PVCs is warranted if

• You recently had a myocardial infarction (heart attack) and are experiencing an increase in PVCs
• You are experiencing additional symptoms during your PVC episodes, including light-headedness, dizzyness, blurry vision, confusion or syncope.
• You are experiencing 6 or more PVCs per minute and this represents an increase in PVC frequency for you.

^[15][16][17] (back)

QT Interval

Normal QT Interval: .35 - .44 seconds (when corrected for heart rate, or QTc). The QT interval can vary with an individual depending on the person’s heart rate at the time of the ECG. To more accurately measure QT interval then, formulas were created to account for the variance in heart rate, so that a “normal” range could be defined for the general population. Bazett’s Formula, named for physiologist Henry Cuthbert Bazett, is the most often used of the formulae. It states that the corrected QT interval (QTc) is equal to the mean of the measured QT intervals (more than one QT interval should be measured) divided by the square root of the RR interval (which is the interval between the onset of one QRS complex and the onset of the next QRS complex). ^[18] (back)

Short QT Interval: .34 seconds and shorter (when corrected for heart rate, or QTc). Though there are respected websites that indicate that this is a potentially dangerous condition, a substantial study (10,822 patients) was conducted by Finland’s Department of Medicine over the span of 29 years, and found no difference in mortality between those with a short QT interval (”Short QT Syndrome”) and those with a normal QT interval. Short QT Syndrome is inherited and is autosomal dominant. ^[19][20][21] (back)

Long QT Interval: .45 seconds and longer (when corrected for heart rate, or QTc). Long QT Syndrome, like Short QT Syndrome, can be dangerous and causes approximately 4,000 deaths in the United States each year. (To understand the relative risks, more than 40,000 people have died each year in motor vehicle accidents in the United States since 1975. [a]) Having a long QT interval is considered more dangerous than a short one and is genetic (passed from parents to children), but can also be acquired. If you have unexplained episodes of loss of consciousness during physical exertion, emotional excitement or after taking a new medication, you should see your physician. ^{[22][23][24][25]} (back)

Normal PR Segment: Along Baseline. The PR segment is the portion of the cardiac cycle seen between the end of the P wave and start of the QRS complex. This segment is typically straight and horizontal, along the baseline of the ECG. Abnormalities seen in the PR segment include segment elevation, where the horizontal tracing of the PR segment is above the ECG baseline, or segment depression, where the tracing falls below the baseline. PR segment depression greater than .8mm on an ECG can be a sign of a cardiovascular problem, while PR segment elevation is usually a sign of a poor baseline related to ECG equipment issues and not heart health. ^[26] (back)

Normal PR Interval: .12-.20 seconds. Though their names are similar, the PR interval and the PR segment are different and provide different diagnostic information. The PR interval is the measure from the start of the P wave to the start of the QRS complex, where the PR segment measures the flatline/baseline space between the P wave and the QRS complex. PR intervals that are less than .12 seconds mean that the electrical signal from the SA node is being transmitted extremely quickly to the ventricles, which may be caused by the presence of an alternate or extra electrical pathway from the atria to the ventricles, such as with Wolff-Parkinson-White (WPW) syndrome. PR intervals that are longer than .20 seconds indicate a delay in electrical conduction and are a sign of AV block. ^[27][28] (back)

Normal QRSd: .06 - .10 seconds in duration. QRSd is the measure of the duration of the QRS complex, which is the depolarization (electrical activation) of the ventricles, initiating their contraction. A QRSd that is .10 - .12 seconds indicates slower progression through the ventricles than is expected, and a QRSd greater than .12 seconds is a sign of complete bundle branch block. “Poor R wave progression” is often a notation on ECGs showing a longer than normal QRSd.^[29] (back)

ECHOCARDIOGRAM - More Information

Left Ventricle Mass, Male aged 20-50 - Average: 193 grams, Female aged 20-50 - Average: 141 grams. Left ventricle mass estimations can be useful in helping determine if ventricular hypertrophy (abnormal enlargement of ventricle) is present.^[30] (back)

Left Ventricle End Diastolic Volume, Males 20-50 - Average: 163 ml, Females 20-50 - Average: 118 ml. End diastolic volume is the measure of the size of the ventricular cavity when it is completely filled with blood, just before the initiation of contraction. An end diastolic volume that is far above the average can be a sign of dilated cardiomyopathy, an abnormal increase in the cavity size of the left ventricle. When the diastolic volume is far below the average, it can be a sign of hypertrophic cardiomyopathy, where the increased muscle mass of the left ventricle makes the ventricular cavity smaller, reducing the amount of blood pumped per cardiac cycle (heartbeat). (see image comparing normal left ventricle (above) to hypertrophied left ventricle (below)) Both types of cardiomyopathy can lead to heart failure and arrhythmias.^[31][32] (back)

Left Ventricle End Systolic Volume, Males 20-50 - Average: 65ml, Females 20-50 - Average: 42ml. End systolic volume is the measure of the size of the ventricular cavity when it has just completed a full contraction (not when it’s empty - your ventricles will never be completely emptied). The end systolic and end diastolic volumes are used to calculate the stroke volume, or volume of blood pumped with each heartbeat. ^[32] (back)

Normal Ejection Fraction: 50-70%. This number, reported as a percentage, is the amount of blood ejected from the ventricle during contraction compared to the amount of blood in the ventricle when it’s full. Left ventricle ejection fraction (LVEF) is what’s most often reported, and is calculated as follows:

Ejection Fraction = 100 * (1-(Left Ventricle End Systolic Volume / Left Ventricle End Diastolic Volume))

Ejection fractions below 50% can indicate heart failure. Thankfully, many forms of heart failure can be treated and ejection fractions improved. (See Shelby’s story)^[33][34][32] (back)

Normal Left Ventricle Wall Thickness: 10mm (± 1mm). Along with ejection fraction data, being able to measure the thickness of the septum that separates the ventricles, as well as the free wall of the left ventricle help doctors to recognize heart disease processes that are underway. Left ventricle hypertrophy (LVH) is a condition where the muscle walls have thickened. This can occur because of long-standing high blood pressure; the left ventricle has to work against the added pressure in the arteries and veins in order to pump blood throughout your body, and just like any other muscle, when it works harder, it gets larger. The problem with hypertrophy of your heart muscle is that the muscle almost never grows outward. Instead it grows inward, filling the space the blood is supposed to occupy before it gets pumped out. As you can imagine, this reduces the amount of blood that can be pumped with each cardiac cycle (heartbeat), which means the heart now has to beat faster to do the same job. This cycle results in the heart muscle actually getting weaker, not stronger, and can lead to heart failure.^[35][36] (back)

BLOOD - More Information

Normal Electrolyte Levels

Normal Sodium (Na⁺): 136-144 mmol/l (millimoles per liter) While sodium plays an important part in the transmission of electrical signals in the heart, given the salty diets of most people in developed countries it would appear at the surface that it is unlikely your diet would suffer from lack of sodium. ^[37] (back)

Normal Potassium (K⁺): 3.5-5.0 mmol/l (3.7-5.2mmol/l reported as normal by NIH) Low levels of potassium cause an increase in heart muscle activity which can result in an irregular heartbeat; high levels cause a decrease in heart muscle activity, which also has the potential to be dangerous.^[38] (back)

Normal Magnesium (Mg²⁺): 1.7 - 2.2 mg/dl (milligrams per deciliter) Magnesium helps control muscle function, including your heart muscle. ^[39] (back)

Normal Calcium (Ca²⁺): 8.4-10.2 mg/dl (milligrams per deciliter). Like sodium, calcium also plays a large role in the transmission of electrical signals in the heart. When sodium ions enter a cell, calcium ions are released which cause another electrochemical reaction to occur that results in your heart muscle contracting. ^[40][41] (back)

Normal Chloride (Cl^-): 96-106 mmol/l (millimoles per liter). Chloride helps your body maintain the appropriate fluid levels.^[42] (back)

Normal INR Value: 0.9 - 1.7INR stands for International Normalized Ratio and is a measure of the time it takes for your blood to clot. While the lower end of this range does represent a normal result, most often those interested in measuring INR levels are those who are receiving some sort of anticoagulation therapy. Specific to this site, it’s going to be people who may be receiving prophylactic treatment for an arrhythmia that has the potential to cause blood clots, such as atrial fibrillation. In that case, the target INR is more likely to be 2.0-3.0.

That being said, your physician should be the one to give you your target INR values, as only your physician is familiar enough with your medical history to make informed decisions about your treatments.^[43][44] (back)

Normal eGFR: >90 ml/min/1.73m(sq). eGFR or GFR is your Glomular Filtration Rate, and is a measure of how effectively your kidneys are functioning. For this test, the larger the number, the better. A larger number means your kidneys are filtering out contaminants at a faster rate. While the overall filtration rate is important, the rate of decline in kidney function is also important. For example, a person with a slightly low but unchanging eGFR (as measured by multiple blood tests over a year or more) may be in less jeopardy of kidney failure than someone who has a normal eGFR that has been declining rapidly.

If your kidney function is impaired it can’t adequately filter out potassium, one of the electrolytes important in the electrochemical processes of your heart. The electrolytic balance in your body is very delicate and complex, and the condition of having too much potassium, hyperkalemia, can cause arrhythmias.^[45][46] (back)

Normal TSH Levels: 0.40-4.70 uIU/ml (1 millionth of an International Unit per milliliter). TSH is an acronym for Thyroid-Stimulating Hormone, which is probably the more common name used for thyrotropin. The function of thyrotropin/TSH is to stimulate the thyroid to create and secrete two other hormones, T₃ (triiodothyronine) and T₄ (thyroxine).

In the case of hyperthyroidism, too much TSH is being created by the pituitary gland. This overabundance of TSH can result in excess thyroid hormones (T₃ and T₄) acting on the cardiac and nervous systems, causing palpitations and other arrhythmia (as well as other symptoms). ^[47][48][49] (back)

Normal BNP: < 100pg/ml (picograms per milliliter). BNP stands for Brain Natriuretic Peptide. It’s name is a misnomer because it has little to do with the brain, but because it was discovered in the brain and presumably scientists didn’t know why it was manufactured or what it’s function was, it’s name was forever tied to the brain. But BNP is very specific in it’s origin - it’s created and stored in the heart’s ventricles, and released when the ventricles have experienced ongoing diastolic pressure increase. In other words, when the ventricles are consistently stretched more than they should be by blood volume overload in between contractions (possibly because of congestive heart failure) over an extended period of time, the ventricles release BNP. A simple blood test can determine whether your BNP levels are elevated. Because congestive heart failure (CHF) can cause palpitations and arrhythmia, if your physician thinks you may be suffering from CHF, a BNP test may be in order.^[50][51][52] (back)

References

Images of cross-sections of left ventricles courtesy of Echo in Context
Image of echocardiogram of ejection fraction courtesy of Heart and Metabolism

What is a Tilt Table Test?

Simply put, it’s a test where you lay on a table that’s a lot like a gurney, strapped to that table (for your own safety), and then periodically tilted nearly vertical (head up), and then back down. During the test all of your vital signs are closely monitored, including blood pressure and heart rate and rhythm.

Why Do I Need a Tilt Table Test?

If you’ve been experiencing dizziness, lightheadedness or syncope (loss of consciousness), and the reasons for your symptoms are not obvious to your doctor, your doctor may order this test to help assess the severity of your symptoms as well as finding a potential cause. The purpose of the test is to see if changes in body position produce symptoms such as an arrhythmia, syncope or near-syncope due to a change in blood pressure, all signs of orthostatic intolerance.

Normally, when a person stands up from a supine (laying) position, there is a small drop in blood pressure, which the body compensates for by increasing heart rate and constricting the blood vessels in the legs. Certain conditions prevent the body from making these kinds of adjustments, occasionally resulting in loss of consciousness.

Is a Tilt Table Test Dangerous?

It should be understood that uncontrolled loss of consciousness can be extremely dangerous. Driving a car, using stairs, lifting a small child and operating heavy machinery (among other things) can all be dangerous to you and those around you if you are susceptible to unexpected losses of consciousness. Being in a hospital with a trained medical professional constantly monitoring your vital signs is about the safest place you can be if you lose consciousness. Some arrhythmias that have occurred during tilt table tests can also be dangerous, but again, inside a hospital is the safest place to be if they’re going to occur, where treatment can be initiated immediately upon experiencing symptoms.

While experiencing a dangerous arrhythmia is unlikely, pre-existing ischemia makes that event more likely.^[1]

How Do I Prepare for a Tilt Table Test?

Most commonly a patient is asked to fast before a tilt table test. Your doctor may instruct you to stop taking certain medications prior to the test. To be prepared you may also want to bring along a list of any medications you are taking.^[2]

One of your arms will have a blood pressure cuff placed around it for the duration of the test and you may also have an IV line inserted for the administration of isoproterenol, a drug designed to make you more susceptible to the test. The IV line may also be used to quickly administer other medications in the case of an adverse reaction.

You may also be instructed to have someone drive you to and from the hospital for the test.

I Had a Positive Tilt Table Test. Now What?

The good news is, now your doctor has more information from which to base a diagnosis and begin treatment. Some of the reasons you may have had a positive tilt table test result include:

• vasovagal or neurocardiogenic syncope - a benign condition that is not life threatening except for the injuries you may sustain when unconscious.^[3]
• diabetic autonomic neuropathy - an autonomic nervous system disorder that causes orthostatic hypotension (positionally mediated low blood pressure). ^[4]
• Shy-Drager syndrome - also an autonomic nervous system disorder ^[4]

Beta blockers are often prescribed to treat patients after a positive tilt table test; the beta blocker prevents the heart rate from climbing too quickly and the parasympathetic nervous system from responding to that heart rate increase by slowing the heart down so much that the patient passes out.^[5][6]

Celebrity note: Greg Page, better known as the Yellow Wiggle of The Wiggles, had to stop performing due to his orthostatic intolerance.^[7]

References

Tilt table test image courtesy of Columbia University Medical Center, Division of Cardiology

Back in January I was having some unusual heart rhythms, skipped beats, racing pulse, and I wanted to have it checked out. However, having had Holter monitors before, I knew that wasn’t going to work for me this time. The problems I was having didn’t reliably happen every day, and when they did they were of very short duration. So going through a Holter monitoring was risking not catching the arrhythmia at all, and I’d be no further along than I was when this all started.

So my doctor prescribed a 30-day event monitor. The model I had was the King of Hearts. And I have to admit, I’d read posts from other people that had had it, and for some reason I thought this was going to be a large device that would be difficult to hide from curious gawkers. Thankfully, it wasn’t (you can see a picture of me holding the recording device - it wasn’t much bigger than a pager).

The experience is one I won’t soon forget. Walking out of the Appleton Heart Institute with electrode leads attached, I was both relived and a little nervous. Relieved because a trained eye was going to be able to look at every skip, blip and anomaly I felt with my heart. Like I had a small cardiological team to just to me. But I also felt nervous. I was afraid of what might be found in those recordings. Maybe some kind of deadly arrhythmia that would force me into emergency surgery to treat it. Maybe I got my doctor involved too late, and I my final recording would be of my heart stopping completely.

As my 30 days progressed, I began to really appreciate having trained nurses on the other end of the line to provide assurance that what they were seeing in my data transmissions wasn’t dangerous. (Sort of. More on that later.) My instructions throughout the monitoring were pretty simple and straightforward - change the electronic leads each day, press the big gray button when I feel something, and when I’ve recorded five somethings, call the heart institute to transmit the ECG strips. But oh how I hated the transmissions. That data is recorded and then transmitted via phone line, and it uses musical notes to correspond to each position along the ECG strip. Higher note equals higher position on the strip. And while that sounds pretty pleasant, listening to musical notes when you transmit your ECG data, it was very unpleasant. The sickly tonal fluctuations the unit made during transmission made every beat sound like my heart was a leaky bagpipe. I was a wreck every time I called in my recordings. It was a lot like if you were a kid again and had to show your parents 10 bad report cards all in a row. There was bad news coming, you just knew it; it was only a matter of how bad.

As my 30 days drew to a close I was ready to tear the sticky, gooey leads from my chest for good. I had had one good scare, where when I asked the nurse receiving the transmission what she saw, she replied “Oh…yeah. I see a little V-tach in there.” I almost threw up right then. A person with even cursory knowledge of heart rhythms knows that ventricular tachycardias are the “bad” ones, the ones you don’t ever want associated with your ECGs. But there it was. I had a deadly arrhythmia. Or so I thought.

My last day of monitoring finally came, and while I was happy to be rid of the thing (as was the skin on my chest), I was again nervous. My cardiology team wasn’t going to be following me around wherever I went anymore. I was on my own with my skipping palpitations, and I wasn’t sure I liked that.

A few days went by and I got a call from my cardiologist’s physician assistant; the only thing they found of note was a short burst of paroxysmal atrial tachycardia (PAT). I asked about the recording that shows ventricular tachycardia. The PA explained that they had noticed it and reviewed it, but that it was not v-tach, and the error in it being reported to me was likely due to the computer software that analyzes the transmissions.

Each transmission is fed directly into a computer which makes a determination as to what kind of arrhythmia was transmitted. In cases where the computer is unsure, it takes a guess. In my case, it guessed v-tach. But the (human) cardiological review of that rhythm showed that there were artifacts in the transmission that masked just about every wave except the QRS complex, and the nurse on the other end of the phone didn’t know any better than to just repeat what she saw on the computer. Which of course scared the hell out of me. I think this is why some of the nurses were very tight-lipped about providing information about the rhythms they see - it’s too easy to really scare a patient. Don’t be surprised if they aren’t forthcoming with you when you transmit. That being said, know that they are trained to alert a cardiologist immediately if they find a dangerous rhythm, and will direct you to the ER if the arrhythmia is considered dangerous.

Jeff