Brief Answer: please see below. Detailed Answer: Dear Sir There are two aspects of this situation. First, if you have any symptoms pertaining to these pauses? If you ever had a blackout/ unexplained fall/ transient loss of consciousness/ transient dizziness, particularly in association with pause? If yes, please do see your cardiologist on priority. The second aspect is ascertaining the reason for pauses, or in technical terms, the rhythm at time of pause. Since you have frequent PVC, the pauses may be simply related to them. A PVC is a premature beat, which has an associated lower than normal pulse volume. Thus it may not be felt. The next beat after PVC comes at longer interval, such that the actual interval between the two pulse you feel is double that of normal interval. Hence you feel a pause. There can be other reasons also but will require continuous ECG monitoring like holter recording or loop monitoring. It is not only the duration which is important in determining the danger but also the cause of pause. PVC related pauses are benign. Any pause associated with symptoms is XXXXXXX Pauses arising in sinus node are benign up to 2.5 seconds unless they are associated with symptoms. Pauses due to AV node blockage may be benign or XXXXXXX depending upon type of rhythm. Hope this provides insight into issue. Feel free to discuss further. Sincerely Sukhvinder

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Brief Answer: please upload report Detailed Answer: Dear Sir Sorry. There is no attached report. Please upload it. Sincerely Sukhvinder

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Brief Answer: please see below. Detailed Answer: Dear Sir 1. If there was no symptoms during these runs of VT (if you were asymptomatic at time of these runs), then they do not carry much significance. They (such short runs at this rate) become important only when they are associated with symptoms. They also assume significance if they develop on background of structural heart disease (especially with ejection fraction less than 35%). However, even in these conditions they are more like epiphenomenon ( harbinger of bad prognosis, not because of there own presence but because of underlying heart condition). 2. If you were totally asymptomatic during these 24 hours of holter monitoring, there is nothing XXXXXXX in these findings. More important will be if there is an underlying structural heart disease ? If it is there, then what is the cause? What is the prognosis of that underlying condition. The prognosis of that structural heart disease will govern the future outcomes rather than the findings in this report. I hope I made it clearer to you. Still If there is a doubt please feel free to write. Sincerely Sukhvinder

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Brief Answer: please see below Detailed Answer: Dear Sir 1. It shows Mild LV enlargement with mild LV systolic dysfunction (EF=47%) with Moderate AR. In all probability, most evident reason for this is your morbid obesity (body mass index of ~52). Rest of the causes can be deciphered by further evaluation of bio-chemistry and clinical profile. 2. I do not see any thing alarming for your holter report in view of your ECHO report (provided you did not have any symptoms which you did not mention in repeat query too). However I will be concerned about your weight which is the most XXXXXXX thing for future cardio-vascular events. You must get it down. my second-concern- Any cardiac dilatation and low pumping, even mild, predisposes to future adverse event. However, cardiac enlargement may be an epiphenomenon for obesity (the bigger trouble). Even full fledged heart failure may occur purely because of obesity (OBESITY CARDIOMYOPATHY). Hope this clarifies the scenario. Sincerely Sukhvinder

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Brief Answer: please see details. Detailed Answer: Dear Sir 1. Yes, the LV enlargement will definitely reduce with reduction in weight. Possibly the LV functions will also improve, if obesity is only cause for LV dysfunction. 2. Aortic regurgitation is not directly related to obesity, hence chances of reversal with weight control are relatively less. Only possible related mechanism could be enlargement of aortic root with body large size giving rise to secondary AR (this seem plausible because description of aortic valve is otherwise normal). This may improve with reduction in weight. Sincerely Sukhvinder

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Brief Answer: Please see details. Detailed Answer: Dear Sir 1. One of the Basic causes of VPCs is a mis-match in sympathetic and parasympathetic drive. These two drives excitatory and inhibitory respectively control our heart too. Anything which brings a mis-match between two can induce it in a given individual. Same may be true for postprandial stimulation of nerves in case of hernia. This is only speculative. However, as they are benign phenomenon and do not carry any risk of their own, their aggravation even by hernia is not a matter of concern, unless you have symptoms because of them. 2. Nervousness will increase them by increasing sympathetic drive. It is well known. hope this helps. Sincerely Sukhvinder

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