Abnormal ECG

[Mizzou]

The ECG I had done for my SFAS physical says the following:
Marked sinus brachycardia with sinus arrhythmia
Incomplete right bundle branch block
Abnormal ECG
PR: 48, BP 140/80

Occasionally I experience "fluttering" (I've been told they are palpitations) in what feels like the lower half of my heart. It lasts for a few seconds, never more, and goes away. While at SFAS, it began happening every few minutes or so, and I began to feel occasional faintness and pressure in my throat. I alerted my tent leader and ended up in the TMC, where they told me I couldn't continue the course but could return once cleared by a cardiologist, which is reflected on my Med Drop paperwork. I have practiced my google-fu, and I have a general understanding of what is going on. Does anyone have any experience with this type of situation? Should I be concerned? Am I doomed to be sober and caffeine/Copenhagen free for the rest of my life?

[Heretic]

The only advise I can say is to be PROACTIVE in your care. Ask these questions to your cardiologist! Be up front and HONEST with him/her. Make sure he/she knows your intent and goals (SFAS & QCOURSE).

Further information is needed: What where you doing when you had this "occasional faintness and pressure in my throat"? Be very specific in what your body was going through! What made it worse, what made it better have you ever felt this before. Have you ever fainted before? Have you ever had airway problems before. When you were training for SFAS (you did that right?) did you notice any similar symptoms? Does anyone in your family have this condition?

These are questions your doc should ask you and you should be prepared to answer. Stay on top of this and dont just sit back and wait for shit to happen.

[Mizzou]

In answer to those questions: I usually experience the palpitations every few weeks or so, and never while exercising. I have never had any airway problems or fainting. Stress makes it more frequent, but generally mental stress, not physical stress. It only happened at SFAS while standing in formation, and the worst of it happened while sitting on my bunk packing my ruck. My father has atrial fibrillation, but I have not been checked for that. Unfortunately, the TMC never saw anything significant in my ECG, so it should be an uphill battle to get a referral to cardiology.

[reservetech]

I have a heart flutter just about the same as you describe. I never knew I had it until a couple years ago, my GF at the time had her head to my chest and told me my heart stopped briefly. That freaked me out a bit, but it didnt effect me until just last year. It was the end of the semester and was smoking alot and drinking coffee like it was going out of style to keep me awake for my all nighters. One day, I was walking back from class and I nearly fainted, it seemed like my heart was going to beat out of my chest. So I went to the Dr. He proceded to outline a fairly easy fix. Hate to tell you bud, but the elimination of nicotine and limiting my caffein intake helped alot. Now i'm not saying quit drinking coffee altogether, but keep it to a cup in the morning. Moderation is the key. I say quite the nicotine not only for health reasons but also because the constant chemicaly induced elevated HR just isnt good for the condition. I have not had a problem since Just remember, keep up the excersize to keep your heart strong too!!

[CSB]

brachycardia = slow heartbeat, usually defined as under 60 beats per minute. Years ago I had a physical (when I was running 20 - 30 miles a week, including a five kilometer in 18:18). I was taking the ECG in a cool, air conditioned room, flat on my back, almost dozing, when the machine went "brat-brat-brat" and spit out a paper tape. On the tape it said "MARKED BRACHYCARDIA."
So when the lab guy came back in I asked his what that was all about. He looked at the tape, said "pulse 44, you're a runner, aren't you?" I said yeah. He tore up the tape (he had apparently seen a lot of them in the 101st Airborne)

So the slow heartbeat alone, for a distance runner/swimmer, etc. is good. If you are a tall thin skinny runner with rubber-band legs ... great.

It just means your heart is healthy and fit. --- BUT ---

Now for the second part, a sinus block. The heart doesn't beat "all at once", it actually "rolls" from one quadrant around to the next, each quadrant compressing for a split second and then relaxing. The electrical signals travel, much like demolition time fuse, through nerves that start on one side of the heart and travel in sequence, causing the muscle to compress when they arrive. A block is exactly what the name implies: the electrical signal coming down the bundle of nerves slows or stops, causing the next chamber in the sequence to either compress out of sequence, or not compress at all.

The expression "arrhythmia" simply means "not in rhythm" and describes any of a number of "out of sequence" compressions of the heart.

You are going to need a lot of tests to determine how much of a blockage there is, how much efficiency you are getting out of your heart (what are your times on the runs?) and if there is a risk of the heart getting totally out of sequence. That's "fibrillation."

Oh, and you shouldn't be doing the Copenhagen thing anyway.

[Heretic]

Ah CSB, you take away my Copenhagen then I am going to get really pissed off

Mizzou, best of luck!

[Doczilla]

Right bundle branch block is a normal variant in approximately 10% of the population. This by itself is nothing to be concerned about.

Marked sinus bradycardia, with a heart rate of 40, would be expected in someone of the physical condition that you are in to successfully pass SFAS. It is typical of athletes in good shape.

The only worrisome things here are the palpitations, particularly if associated with a feeling of faintness. I would get a cardiac echo, treadmill stress test, holter monitor, and baseline labs to include a thyroid workup. If these were all normal, then you could return to SFAS. Most of the time, palpitations are not indicative of any particular cardiac event, and the cause is never truly found. They can be caused by any number of things, the worrisome things being arrhythmias of the heart.

I agree with CSB. Skip the caffeine and nicotine. These will precipitate palpitations from several causes.

'zilla

[Mizzou]

I got an echo done today, nothing remarkable was found. I have the monitor strapped on for the next two weeks, and my stress test is Monday. Resting heart rate today was a 36, which the cardiologist chalked up to my fitness level.

Copenhagen and coffee are gone but they can take my beer from my cold dead hand.

[bluenote]

Since we are talking about ECGs and physicals...

When I went in for my airborne physical my ECG said: Left ventricular hypertrophy with QRS widening. Abnormal ECG. When I asked the PA about it he said "I can schedule an echo or stamp you qualified, that's the most common abnormality". Well I said stamp it and have had no problems before or since, but, here is my point...Am I going to keel over anytime now?

60 BPM. 136 over 80. No nicotine, tons of caffeine. BN.