心律不整與心臟狀況：從Holter EKG、心臟超音波及運動心電圖檢測-心臟血管專科

心律不整 心律快？

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主任對不起打擾您，最近躺著心律70-80一起來就會變到100-110，走一走就會105-120，坐回床上就會降回80-90 這是有可能是什麼心律不整嗎？本身有點焦慮體質，還是我這樣的心跳是正常的，還是有可能是姿勢式的心律問題，目前備用藥只有心律錠跟贊安諾需要時吃，以下有去年跟今年的報告這是今年二月的HOLTER EKG: Code No.: Clinical diagnosis: Technical quality of record: Good Dominant rhythm: Sinus Total Beats: 107704 Min HR : 43 BPM at 06:33:46 sinsu bradcyardia Avg HR : 75 BPM Max HR : 154 BPM at 13:25:47 sinsu tachcyardia PVCs/couplets/Triplets/VT: 76/0/0/0 PACs/couplets/AT : 33/0/0 Drop(delay＞2.0sec)/Late : 0/0 Longest N-N : 1.6 sec at 08:09:51 【Conclusion】 * Sinus rhythm with a rate ranging 43~154 bpm and a mean of 75 bpm. * Rare isolated PACs. * Rare isolated PVCs. * No significant long pause.

這是一年前的HOLTER EKG: DATE OF 24-HOUR RECORDING: Study for: ARRHYTHMIA ANALYSIS RESULT 1) Quality of recording: GOOD 2) Dominant rhythm: SINUS 3) Total Beats: 112778 beats 4) Minimum heart rate: 45 beats/minute 01:56:23 sinus bradycardia 5) Average heart rate: 80 beats/minute 6) Maximum heart rate: 158 beats/minute 13:28:21 sinus tachycardia 7) VPC/ couplet/ triplet/ bigeminy: 236/0/0/0 8) APC/ couplet/ AT: 54/0/0 (longest beats, bpm, at ) 9) VT/ idioventricular rhythm: 0/0 10) Ventricular pause ＞ 2 seconds: 0 COMMENTS * sinus rhythm with mean HR 80 BPM (min: 45BPM;Max 158 BPM) * Rare isolated APCs * few isolated VPCs (0.2%) * No significant long pause.

今年二月的心臟超音波Report: Indications： Echo machine：Philips IE33 Patient source：OPD 【Atrium and Aortic Root】 AO (mm) = 29 LA (mm) = 36 【Left Ventricle】 IVS (mm) = 10 PW (mm) = 10 EDD (mm) = 48 ESD (mm) = 29 EDV (ml) = 106 ESV (ml) = 32 LV mass (g) = 176 LVEF： by M-mode measurement：69.6 % LV Wall motion: Normal wall motion 【Right Ventricle】 TAPSE＝30mm 【Diastolic function】 Mitral inflow　E/A：81/54 (E/A ratio＝1.5) Septal E/e：5.9； Lateral E/e：5.0； 【Valve】 MS: nil; MR: Mild; AS: nil; AR: nil; TS: nil; TR: Mild; Vmax＝ 2.29m/s＝ 21mmHg PS: nil; PR: nil; 【Other findings】 IVC diameter：mm with sniff collapse ＞ 50% Pericardial effusion：None Intracardiac thrombus：No Congenital lesions：None Abbreviations LA: Left Atrium, LV: Left Ventricle, RV: Right Ventricle.Ao: Aortic Root IVS: Interventricular Septum, PW: Posterior Wall, MS: Mitral Stenosis, MR: Mitral Regurgitation. AS: Aortic Stenosis, AR: Aortic Regurgitation. TR: Tricuspid Regurgitation, TS: Tricuspid Stenosis. PR: Pulmonary Regurgitation, PS: Pulmonary Stenosis 【Conclusion】 1. No cardiac chamber dilatation No LV thickness 2. Normal LV systolic function with normal wall motion 3. Normal RV systolic function with normal wall motion 4. Normal diastolic function. 5. Trivial MR and TR.

今年二月的運動心電圖Treadmill Exercise Test Report: Treadmill Bruce Protocol 1) Resting EKG：Sinus arrhythmia. 2) Exercise duration：13 min 11 sec, Max. METs: 17.4 3) Stress tension：Resting HR initially 59 bpm, rose to a max. HR of 160 bpm, which represents 102% of the maximal age-predicted HR. 4) Exercise provoked ST-T change：Nil 5) Exercise provoked arrhythmia：Nil 6) BP change：136/83 to 216/72 mmHg 【Interpretation】 1. Adequate exercise loading. 2. Negative for ischemia. 3. Isolated PVCs and ventricular couplet noted during recovery stages.

這是109年的心臟超音波Report: IVS: 9 mm, LVEDD: 47 mm, LVESD: 31 mm; PW: 8 mm, EF by Linear method: 63 %, Sinus of Valsalva: 26 mm, Left Atrium: 23 mm 1.Heart size: dilatation of : nil 2.Pericardial effusion: nil 3.Valvular measurement: MS : nil, MR : nil, AS : nil, AR : nil, TS : nil, TR : nil, Vmax: _ m/s; Max. gradient: _ mmHg, PS : nil, PR : nil, 5.Mitral E/A: _ / _ cm/s, E/E’’: med _, lat _, aver _. 6.Others: IVC diameter 10 mm with inspiratory collapse ＞50 %, Doppler ＆ ECHOCARDIOGRAPHIC REPORT: Rhythm and Appearance: . Sinus tachycardia Left ventricle: . Systolic function: Normal . Wall motion: Normal . Diastolic function: Normal Right ventricle: . Systolic function: Normal

這是110年的心臟超音波M-Mode Data: 1.IVS 11 mm(6-11) 5.RVD mm(7-23) 9.A.O root 30 mm(20-37) 2.LVPW 10 mm(6-11) 6.LVEDV ml(76-115) 10.LA 32 mm(19-39) 3.LVEDD 49 mm(36-57) 7.LVESE ml(39-48) 11.EPSS mm 4.LVESD 30 Mm(20-36) 8.EF 70 %(64-83) Doppler and Color flow Findings: 1.MS Mean PG= mmHg; Pt1/2= MSEC; mva = cm2 2.AS mild (＜50), mod (50-57), severe (＞75) Mean PG= mmHg;Peak PG = mmHg 3.MR ■ mild, □ moderate, □ severe 4.AR □ mild, □ moderate, □ severe 5.TR □ mild, □ moderate, □ severe, PG= = mmHg;PASP = mmHg 6.PR □ mild, □ moderate, □ severe 7.MV flow: E= 87 cm/S; A= 56 cm/S; E/A = 1.5 Interpretation: 1.Normal LV and LA size 2.Normal LV wall thickness 3.Preserved LV gross systolic function, the estimated EF=70% 4.No regional wall motion abnormality 5.Trivial MR
再麻煩主任我的心臟這樣會有問題嗎？我真的每天都在擔心心臟生活已經有點灰暗了…已經影響我的生活了，不是心跳快就是有點漏拍，再來就焦慮恐慌了…麻煩主任您了…對不起報告有點多，給主任的專業開導我真的會比較放心，再麻煩主任幫我看看有何問題，還需要做什麼檢查嗎？謝謝何主任真的謝謝您平安

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匿名，20~29歲男性，詢問日期：2023/05/09