Q. Echo shows 60% ejection fraction and Holter shows 190 heart rate. Should I worry?

Answered by
Dr. Muhammad M. Hanif Md.
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 05, 2020 and last reviewed on: Mar 07, 2020

Hello doctor,

I am 25 years old. I have palpitations for the past three months. No anemia, TFT is normal, MRI abdomen and chest are normal. Echo shows atherosclerotic aortic valve with ejection fraction 60%. Holter shows minimum HR-120 and maximum HR-190. I have associated fatigue at times, tremor and difficulty in breathing. Chest pain is aching sometimes and pins and needles more often. I have seronegative arthritis. Previously I had dengue, cerebral malaria and typhoid. I am currently taking Betacap TR 40 mg bd for one month then stopped. Clonazepam 0.5 mg bd for two months but no help.

Dr. Muhammad M. Hanif Md.

Cardiology Critical Care Physician General Medicine Internal Medicine

Hello doctor,

I have thoroughly gone through your case and can well understand your genuine concerns. First of all, you have a high BMI (body mass index). Try to reduce the weight as you know it is high for this age and height.

Ejection fraction of 60% shows you have aortic stenosis due to sclerosed aortic valve. In this regard, we have to keep in mind that this much back pressure on the left ventricle with every heartbeat is making the ventricular walls and interventricular septum more thickened and dilated. Improper output is making your heart beat faster and it also reduces the cardiac output.

The Probable causes:

Stenosed aortic valve. Hindrance to outflow of blood.

Investigations to be done:

Cardiac angiography.

Treatment plan:

Beta-adrenergic blocking agents are the mainstay of treatment to reduce heart rate and control palpitation and to reduce cardiac oxygen demand that has increased due to increased heart rate. Maybe we need cardiac ablation and also there may be a need for valvular replacement sometime later in life.

Preventive measures:

Avoid strenuous physical activity. No junk foods, caffeine, tea, coffee, chocolates, and energy drinks.

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