General Medical issues thread

[Quickstatus]

That's a lot of atrial ectopics - almost even flutter. The 3rd sharp peak is an extra one that you may feel as an extra "beat"

 

[RooFlyer]

That's a lot of atrial ectopics - almost even flutter. The 3rd sharp peak is an extra one that you may feel as an extra "beat"

Not sure why you say a lot - ignoring the very first, 'half' one, there's only one ectopic pair there out of three beats. But yes, I can get a lot of ectopics - every second beat for periods - my Kardia tells me 'possible atrial fibrillation'.

Don't worry, I've done dozens and dozens of these readings and I watch the trace map out and the various peaks appear. Oddly, I think, the 'thump' in my chest occurs when the first of the closely-spaced pair plots (the one right in the middle of the sample). I would have thought it would be the one following the pair (the one on the right), as the heart catches up volume.

 

[trooper]

Don't hesitate to reach out by PM.

Thankyou Sir!

 

[Pushka]

So my latex allergy seems also to have morphed into a surgical tape allergy. Blood test today and have reacted to the tape used, so that I have two bright red rash patches on each side of a white circle which was the cotton swab. One side has quite a significant bruise.

 

[drron]

i spent a fun 1.5 hours in an MRI tunnel this afternoon.

 

[Steamrollersam]

OK, while our sages are thinking about heart issues:

I had 3 episodes of atrial flutter 5 years ago, cured by 2 x atrial reversions, 1 x extra dose of beta blocker. Only occasional bursts lasting seconds since then. None is past 6+ months; I'm not concerned.

I have a 'minor' blockage of one smaller heart artery ('minimal stenosis' CAD RAD score of 1). On stains and Xeralto as precautions.

But I've had issues with ectopic beats since then. Atrial and ventricular; can't say the proportions. I have a 6 channel 'Kardia' ECG device which I can send readings to my cardiologist if necessary or prior to a particular appointment.

I can get a lot of ectopics - every second beat over a few minutes, then various numbers on-and-off over hours; a couple of hours later, more. I call them 'swarms'. They bug me, especially when I am trying to sleep, with the 'thump' of the catch-up beat impossible to ignore.

I was on Sotalol beta blocker after the atrial flutter and increased dosages helped with the ectopics. Eventually they 'broke through' that; tried metoprolol but no help; back to Sotalol, then back they came - talking over a year or two so far here. Changed to amiodarone for about 2 months and that stopped the ectopics, at least the ones I noticed. Checked thyroid - OK. Came off the amiodarone (I know it not great to take) and the ectopics held off for about 3 months, then returned. Cardiologist disappointed. Back on Sotalol, stopped the ectopics again. But after several months, back they came.

So I'm back on amiodarone but it hasn't stopped them this time. Not the 'constant' runs but plenty, and often 'heavy'.

Cardiologist said a while back they they don't now of any particular causative agent for increased ectopics, although I see a positive correlation with being tired (in general, or after a particular bad night's sleep) and/or being hot.

SO: I'm not looking for any particular advice here about what to do, but I'm seeing my cardiologist in the new year and we'll be discussing situation. What are some things I can mention, ask about, explore with him? Other therapies? I've heard about an operation to 'cauterise' the extra beat-initiating locii within the heart - is that just for atrial flutter, or possible for ectopics?

And thank you every one for tuning in

An ablation for non-sustained atrial or ventricular ectopics is an over-kill. I’ve never heard of anyone doing an ablation for premature atrial contractions because they often arise from multiple sites; you would just be chasing atrial ectopics and creating extensive scar—this is simply not done. On very rare occasions (last resort) you can have an ablation for premature ventricular contractions if they’re very frequent and highly symptomatic (>15% of total beats on Holter) or the PVCs are causing weakness of the heart muscle (cardiomyopathy).
Electrophysiology studies +/- ablations are 99.9% done under IV sedation and are day procedures. PVCs have for the past 10-12 years been mapped mostly using 3D software and a multi-point mapping catheter. Ectopics are not induced (you will get rubbish this way); the electrophysiologist will wait for spontaneous ectopics to map.

 

[RooFlyer]

Many thanks @Steamrollersam . A few follow-ups, please.

* What do you mean by 'sustained' - as in number over a particular time (say, hours), or occurring and and off for years?

* You say PVCs are mapped using the software - not atrial ectopics?

* Is it ever done to have an electrophysiology study via catheter just to map, or they sometimes go in and then decide there are too many sites to ablate?

I hear what you are saying re an ablation being overkill. I don't know the proportions of PVCs Vs PAC; like I said, the ectopics took a holiday during my Holter study (I could tell - I wasn't feeling them).

I have a mate in Toronto who has suffered from afib for 20 years and has had 4 ablations since 2008 - the most recent a few weeks ago. In 2008, the procedure was new, so he went to Cleveland Clinic, where it was apparently perfected. His afib/flutter returns after a few years each time. Now routine in Ontario (as I would expect) and for him its like going to the dentist. But that's all for afib.

Thanks all for the input. I'll see what my cardiologist says; I trust him very much but its good to be armed with some concepts to explore, or at least know a bit about if they arise in discussion.

 

[Quickstatus]

Not sure why you say a lot

The one you saw was not an atrial ectopic - that was a ventricular response to an atrial ectopic - which is how you felt it. You don't feel atrial ectopics unless there is a ventricular response (an extra heart beat = PVC)
What I'm seeing is a ECG that looks like atrial flutter. An atrial ectopic is a very small wave along the baseline. The ones before the QRS is called P wave. Sometimes these are ectopics. The larger wave after the QRS is the T wave and is normal. It looks a bit like flutter though not the classic sawtooth appearance.

) you can have an ablation for premature ventricular surgery contractions if they’re very frequent and highly symptomatic (>15% of total beats on Holter) or the PVCs are causing weakness of the heart muscle (cardiomyopathy).

Correct - EPS/RFA only offered if the ectopics are symptomatic and not controlled by the usual meds. Generally, single ectopics are not considered for EPS/RFA - it's mainly if you are getting runs of them (=sustained). Such a run of 3 consecutive PVC.

The ones who have a general anaesthetic are for example the ones who have a complex EPS like a complex AF /VT where it will take several hours and / or if cardioversion is planned.

@RooFlyer have your holster ever showed AF (atrial fibrillation) ?

 

[RooFlyer]

What I'm seeing is a ECG that looks like atrial flutter.

How can you say with just 3-4 beats on it?

 

[Quickstatus]

How can you say with just 3-4 beats on it?

Which is why I'm not saying it is - just looks like one. It may well be normal. Here is a real one

Here are what I think are atrial ectopics in lead II

 

[RooFlyer]

OK ... found that web site too . Not to worry, the one I posted was old and I just chose it at random.

 

[Bundy Bear]

Another day off work back to the doctor again today, parts of me feel better, I don’t have that overall feeling of being sick and tired but I do have the feelings of what a head cold usually feels like, going through tissues, but I have another pain under my lower ribs left side which I get checked, didn’t get much sleep but some was better than none.

last weeks random pain in my shoulder, doctor suggested it was a muscle spasm of some sort, its cleared itself.

 

[drron]

Which is why I'm not saying it is - just looks like one. It may well be normal. Here is a real one
View attachment 355112
Here are what I think are atrial ectopics in lead II
View attachment 355113

The atrial rate at 150 is too slow for atrial flutter. The first wave you have marked looks like a U wave to me. It’s slightly different to the second wave. The second wave doesn’t appear in the lead 111 trace either so maybe not an atrial wave. Needs a proper ECG,

 

[Quickstatus]

The Robot

One of the 4 arms will carry the camera module.



The surgeons controls
The big thing is the screen projector
All fly by wire (blue fibre optic)

Surgeon scrubs up for initial placement of the arms, scrubs up at the end for closing the holes. But in between with at the terminal - can be unscrubbed

Controls are feet pedals and articulating arms under the projector - to the left of the circular bit just above the black and white rail in the last photo

 

[JohnM]

The Robot

One of the 4 arms will carry the camera module.

View attachment 355154

The surgeons controls
The big thing is the screen projector
All fly by wire (blue fibre optic)

Surgeon scrubs up for initial placement of the arms, scrubs up at the end for closing the holes. But in between with at the terminal - can be unscrubbed

Controls are feet pedals and articulating arms under the projector - to the left of the circular bit just above the black and white rail in the last photo
View attachment 355156View attachment 355155

Apart from prostatectomy, does the Da Vinci unit have other uses?

 

[TheRealTMA]

Apart from prostatectomy, does the Da Vinci unit have other uses?

da Vinci Surgical System - Wikipedia

en.wikipedia.org

 

[drron]

And the Australian College of Surgeons is increasing training in Robotic surgery so it should become more common.

Robots to shake up surgery, but early training for surgeons 'is key' - InSight+

The surgical field is on the cusp of reinvention but whether robots will take over all operating theatres in the next decade is up for debate. Robotic surgery has been around in Australia since 2003 and has primarily been performed in the private sector in the specialties of urology and...

insightplus.mja.com.au

 

[Steamrollersam]

Many thanks @Steamrollersam . A few follow-ups, please.

* What do you mean by 'sustained' - as in number over a particular time (say, hours), or occurring and and off for years?

* You say PVCs are mapped using the software - not atrial ectopics?

* Is it ever done to have an electrophysiology study via catheter just to map, or they sometimes go in and then decide there are too many sites to ablate?

I hear what you are saying re an ablation being overkill. I don't know the proportions of PVCs Vs PAC; like I said, the ectopics took a holiday during my Holter study (I could tell - I wasn't feeling them).

I have a mate in Toronto who has suffered from afib for 20 years and has had 4 ablations since 2008 - the most recent a few weeks ago. In 2008, the procedure was new, so he went to Cleveland Clinic, where it was apparently perfected. His afib/flutter returns after a few years each time. Now routine in Ontario (as I would expect) and for him its like going to the dentist. But that's all for afib.

Thanks all for the input. I'll see what my cardiologist says; I trust him very much but its good to be armed with some concepts to explore, or at least know a bit about if they arise in discussion.

Many thanks @Steamrollersam . A few follow-ups, please.

* What do you mean by 'sustained' - as in number over a particular time (say, hours), or occurring and and off for years?

* You say PVCs are mapped using the software - not atrial ectopics?

* Is it ever done to have an electrophysiology study via catheter just to map, or they sometimes go in and then decide there are too many sites to ablate?

I hear what you are saying re an ablation being overkill. I don't know the proportions of PVCs Vs PAC; like I said, the ectopics took a holiday during my Holter study (I could tell - I wasn't feeling them).

I have a mate in Toronto who has suffered from afib for 20 years and has had 4 ablations since 2008 - the most recent a few weeks ago. In 2008, the procedure was new, so he went to Cleveland Clinic, where it was apparently perfected. His afib/flutter returns after a few years each time. Now routine in Ontario (as I would expect) and for him its like going to the dentist. But that's all for afib.

Thanks all for the input. I'll see what my cardiologist says; I trust him very much but it’s good to be armed with some concepts to explore, or at least know a bit about if they arise in discussion.

Sustained would be a few beats in a row, how many tends to be arbitrary. Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) are just an extra beat every so often; they don’t happen in a row but they can be frequent which seems to be the case with you. It would be unusual for PACs to come just from one focus. In contrast PVCs in some people can just come from one spot in the heart (the outflow tract) and this is easily ablated; other foci may be on the surface of the heart or on the inside of the left ventricle—these are tricky to ablate and risky too.

A EP study can be done without a definite plan to ablate, but again this is for sustained rhythm disturbances like SVT, for example in a teenager you might want to know if the abnormal pathway is very close to the normal electrical wiring of the heart and therefore an ablation attempt confers a greater risk of winding up with a pacemaker which you’d like to avoid in young people, or if the pathway is on the left side of the heart, there is a risk of stroke. I would not offer an EP study just “to have a look” at where PACs or PVCs are coming from. One can have an educated guess from a 12 lead ECG (not a single lead Kardia) or a standard 3-channel Holter (which can be worn for 1-2 weeks).

AF ablations are very different. Success rates 70-80% if the heart is structurally normal and the patient is normal weight, doesn’t take much alcohol and has no sleep apnoea. Personally if someone’s had a couple of AF ablations already, a third is unlikely to help. Major complications can and do happen. But then again there’s brand new technology for AF ablations called PFA that has vastly improved success rates and complication rates.

 

[RooFlyer]

Thanks again. All helps me getting my mind around things and I know can't relate to me directly. My cardiologist takes good care of me.

I have had periods of 5-10 secs or so, of what I call '1-1 ectopics', one normal beat and then an ectopic pair. Other times 3-1 or 5-1, or wider spaced. Enough for my Kardia to come back with 'possible afib'. But numbers in a row and the time between increased ectopic activity vary a hellavalot. As I said, they have been happening for years, but now seem to be overcoming drug 'defences' - or at least the ones I have tried so far, hence my renewed curiosity. If only I wasn't so aware of them .....

My mate in Canada had his afib controlled by Flecainide but his cardiologist suggested a further ablation as he didn't want him to be on that for extended periods.

 

[JohnK]

last weeks random pain in my shoulder, doctor suggested it was a muscle spasm of some sort, its cleared itself.

I get regular sharp pain going through left shoulder / collarbone. Feels electrical to me so would hazard a guess some sort of nerve pain associated with the tendonitis/bursitis that was diagnosed in the shoulder around 20 years ago.

Woke up this morning around 7:00am to take wife to work and daughter to school. Extreme sharp pain/discomfort in middle 3 fingers of left hand. Immediate panic/anxiety. Then the pain subsided and it felt more like a dull pain where someone was crushing my fingers.

This gets tougher each day. Hard to explain if you've never experienced these pains.