ECG results

I am 37, and went for an ECG in December. I have had palpitations on and off for years, ever since thyroid bother in 2004(had graves disease, RAI and now on thyroxine 100mcg). They dont bother me very much, and can go for months without them. GP sent me for an ECG as hadnt had and ECG for years, and was still getting the palpitations. It came back saying normal sinus rhythm, short pr interval. My GP sent this to a cardiologist to look at, and he got back saying it wasnt an av nodal rhythm(or something like that!) as P waves normal and to get a 24 hr tape done and if nothing showed on that an event monitor. I get the 24 hr tape done this week and see my GP again next week. Unfortunately I have googled this short pr interval thing, and am now terrified of what might be wrong! Im wondering: -What does short pr interval mean? Is it serious? Can it be normal? -I read about some things it can indicate, like WPW, and has really scared me. Is this something that my GP, or the cardiologist would have noticed on ECG? -Is the 24 hr tape likely to be to look for reason for short pr interval or reason for palpitations? -Am I still able to exercise and do everything else as normal? Im sure GP said was fine, but now cant remember. As far as I know, there was nothing else abnormal on ECG. I have no other symptoms, no heart racing etc... no other symptoms when have palpitations and they only last for a second or two. My heart did race years ago when my thyroid was overactive, so I know what feels like, but I dont get that at all. I have had bother with low iron/anaemia at times and been on and off iron tablets since birth of 3rd child in 2009. Palpitations have been worse then certainly. Also have had problems with anxiety/panic since thyroid bother, but thats rare for me to be bothered with that now, just when stressed, which I feel just now with all this! I am going to ask my GP all this when see them next week, but really just looking for explanation/reassurance now! Thanks,

Doctor's Response

Date:Jan / 2012

Thank you for your question.

 I am sorry to hear about the problems you are having. You have provided information regarding 'abnormal ECG' which was requested by your GP after you presented to them with a history of intermittent palpitations ('lasting a second or two') with a background of thyroid diesease as described. I assume that your Thyroid profile was recently checked (to ensure that Thyroxine 100microgram is still the appropriate dose for you and does not need adjusting).

You describe 'short pr interval' on the ECG - hopefully the 'printed' autoated ECG reading (which most 12 lead machines now produce) was confirmed by the Cardiologist who would have double-checked that in fact the P-R interval was 'short'. I understand that the Cardiologist communicated with your GP saying that they did not see 'an av nodal rhythm' and the p-wave (morphology / shape) was normal - if this is a fact, it is indeed REASSURING. Just to explain - 'short pr interval' implies that the impulse or 'spark' starting each heart beat (which normally originates in the 'sino-atrial node' located at the top of the Right Upper Chamber of our heart) is actually starting much Lower Down and closer to the middle of the heart where the next node called 'A-V, or atrio-ventricular' node is located' hence the time it takes the spark from the abnormal starting point, possibly lower down, is much shorter and if, another spark starts from a higher or more 'normal' Sino-Atrial (SA) node position, the risk is that both may cause the two lower, 'pumping' chambers (One Pumps fresh blood to Brain and rest of our body-Left Ventricle, and the other pumps de-oxygenated blood to the lung circulation for oxygenation as we breath); may contract very rapidly resulting in a much faster and irregular rate which may cause the chambers not to pump out fully, but due to the fast rate, pump out only partially, sometimes resulting in symptoms such as fainting (syncope), or chest pain etc- which you have NOT described. Here is a link for further informationhttp://medical-dictionary.thefreedictionary.com/Ventricular+pre-excitation+with+arrhythmia andhttp://my.clevelandclinic.org/heart/disorders/electric/wpw.aspx  

As you can gather from the information, these conditions come under a group of cardiac conduction abnormalities also known as 'Ventricular Pre-Excitation Syndroms' - the p-wave (which shows 'electrically' the two upper chambers or, Atria contracting and / or the QRS complex (which is due to the two lower chambers or Ventricles contracting) are usually abnormal in shape or morphology - not suggested by the Cardiologist to your GP; again, a Reassuring fact. 

With regard to exercise and activity, if I had been able to see the ECG myself, I could comment further, but at this time, I am unable to do so hence would suggest you please check back with your GP. However, I can share the fact with you, that Coffee, Chocolate, Tea (any any caffeinated beverages etc.) can increase heart rate and sometimes ' bring out' palpitations. Also in some people who have been on Thyroxine, for various reasons, over time, the dosage may need adjusting downward as even a slight excess of Thyroxine may predispose to faster heart rates, and sometimes, a condition called Atrial Fibrillation or, Paroxysmal Atrial Fibriallation; hence the Cardiologists recommendation to your GP (re. 24 hour cardiac 'tape' etc. as above) is a very good one. There are other conditions that affect heart rates (including anemia, leading to hyperdynamic circulation etc.) but the approach being suggested is the most reasonable and appropriate one.

I do hope the information provided is helpful to you and suggest you proceed with the investigations being suggested by your GP (and the Cardiologist). I wish you good health.

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

Patient's Response

Date:Jan / 2012

Thank you for your reply, was very helpful to understand it a bit more. My GP read out email from cardiologist and that was what he said and no mention of anything else. Im presuming from that there wasnt anything else abnormal on it. I just wondered, when you had mentioned my thyroid, could this cause a change on ECG if wasnt quite right? I havent actually had it checked recently, but will ask if GP can do so next week. Does it always mean there is something wrong if a 'short pr interval' shows up? I will be doing what GP and cardiologist advise with tests etc..., and take it from there, thankyou for your help in the meantime.

Accepted Answer

Date:Jan / 2012

Thank you for your question.

Thanks, I am pleased my reply has been helpful in understanding the clinical scenario.

Thyroid hormone essentially helps 'drive' metabolic process in our body. An underactive thyroid gland would slow us down, casue easy fatigue, constipation, weight gain, feeling colder than usual, slow heart rates or 'bradycardia' and sometimes low mood. On the other hand, an overactive Thyroid gland ('hyperthyroidism', sometimes 'mimicked' by Thyroxine medication if the dosage is a bit more than our body requires), can result in increased metabolic process; resulting in weight loss, diarrhoea, increased sweating or heat intolerance, anxiety, fast heart rates including irregular heart beat known as 'Atrial Fibrillation' which can be persistant or can 'come and go', when it is called 'Paroxysmal Atrial Fibrillation'. Sometimes, very fast heart rates can reduce the conduction time or the time the 'electrical impulse' travels from the starting point of 'SA node' at the top of Right Atrium to the middle point of the conducting tissue- the 'AV node'; hence showing up as possibly reduced p r interval (but the pre-condition is a very fast heart rate !). 

In summary, if you have not had your 'Thyroid profile' (T4, TSH and sometimes,T3) blood test checked in some time; it may be worth your while discussing this with your own GP who may consider checking this. I provide this reference for information:http://heartdisease.about.com/od/lesscommonheartproblems/a/thyroidheart_2.htm

Given all the information, again, I feel that the appropriate steps (investigations as suggested by the Cardiologist to your GP as previously mentioned) have been taken and hope that the additional information I have provided is helpful to you.

Best Wishes,

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

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