Heart & Cardiology/holter tracing


I've been having episodes of rapid heart beats while just resting, not that fast maybe 110-120. Been to cardiologists and had many days of holter/event monitoring, and was told the fast heart rates were sinus tach due to anxiety. However to me it seems these events just happen.

anyway I got my own holter monitor to try and capture the fast hesrt rates. I wonder if you could look at the attached tracing and tell me if the sudden speedup looks like atrial beats, and how many atrial beats you think there are?  I've showed this to 2 cardiologists and got different opinions. I know this is not very fast, but the rate goes up to 110 a minute later, and I was just siting at my desk.

Thanks very much for your help.


This is an isolated recording and it would be good to see multiple recordings to see the frequency and length of any irregularities.The differential diagnoses are sinus tachycardia or atrial tachycardia. as you pointed out this is not overly concerning as the rate is not particularly fast in those 4 beats and the conditions mentioned are not particularly dangerous which should be the overwhelming opinion. The sudden starting and stopping may mean you have a form of atrial tachycardia, although its difficult to know the significance of that, something that depends on symptoms and how often it happens. If this keeps hapenning and you are sensitive to it, then it may be worth a trial of a medicine such as a beta blocker prior to other treatment considerations.

Hope that was helpful.

---------- FOLLOW-UP ----------

holter recording
holter recording  
Thanks so much for your reply, but just to be clear are you saying there are only 4 atrial beats in that recording?  The whole thing only last a few minutes and is not that fast, but I find it disturbing. I am now taking a beta blocker (atenolol), but it makes me feel very tired and I am not sure if the cure is worse than the disease.
I've attached a later section of this recording (about 1 minute later). Is it possible to tell if this is atrial or sinus?

Thanks so much for your reply.


It looks like sinus tachycardia. In terms of the beta blocker, you can try a lower dose if necessary or with to another class such as a calcium channel blocker if required however like you say there is some trial and error involved as the treatment should not be worse than the disease!. A normal echocardiogram would be reassuring.

Hope that was helpful.

---------- FOLLOW-UP ----------

QUESTION: Thanks so much again, I have been told my echocardiogram was normal.
Just this last point again, are you saying the initial section had only 4 atrial beats and the rest was sinus? Thanks.


Its honestly difficult to comment definitively, however the way it speeds up suggests possible atrial beats and yes there would be 4. A 12 lead would have been helpful, the reason being we could look at the p wave morphology to see if it differs from the sinus beat. Its always the case with these things that whenever we need to catch them they don't come! The bottom line is though, i would see how your symptoms develop over time. If it becomes too troubling despite medicine, there are lots of good options such as electrophysiology study to help definitively determine a diagnosis.

Hope that was helpful,  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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