A quick review of what I know so far. I am a 33 year old obese white male, smoker, with hypertension. I was recently diagnosed with hypertensive cardiomyopathy including left ventricular hypertrophy and left atrial enlargement. I am on metoprolol, amlodipine and 81mg aspirin. I take simvastatin for my high sensitivity c-reactive protein number (8.9). I was recently given nitrostat for chest pain. This past week, I was put on a 48 hour holter monitor to see, as my cardiologist put it, why I had so many skipped beats. What follows is the narrative:
"Monitoring started at 2:04 pm and continued for 47 hours 59 minutes. Average heart rate was 73 BPM. The minimum heart rate was 39 BPM at 3:38 AM. The maximum heart rate was 136 BPM occuring at 9:05 PM.
Ventricular ectopic activity consisted of 3 beats, of which, 3 were in single PVCs. Ventricular ectopic beats occurred at a rate of less than one VE per hour.
The patients rhythm included 12hr 34 min 34 sec of bradycardia. The slowest single episode of bradycardia occurred at 3:38:19 AM D1, lasting 3 min 53 sec, with minimum heart rate of 39 BPM.
The patient's rhythm included 2 hr 10 min 43 sec of tachycardia. The fastest single episode of tachycardia occurred at 9:04:02 PM D2 lasting 5 min 21 sec, with maximum heart rate of 136 BPM.
Supraventricular ectopic activity consisted of 1836 beats of which, 39 were in 5 runs, 12 were in atrial couplets, 1545 were single PACs, 7 were in bigeminy, 233 were in trigeminy. There were 2 dropped beats. The longest R-R interval was 2.3 seconds occurring at 6:00:46 AM D1. The longest N-N interval was 2.3 seconds occurring at 6:00:46 AM D1. The longest supraventricular run occurred at 9:49:35 PM D! consisting of 26 beats, with a maximum heart rate of 138 BPM. The fastest supraventricular run occurred at 1:24:33 AM D1, consisting of 3 beats, with a maximum heart rate of 169 BPM. Supraventricular ectopic beats occurred at a rate of 38.2 SVEs per hour
Sinus rhythm with episodes of 2nd degree AV block, rates of 39 to 136 BPM.
Rare PVCs without VT.
Occasional PACs with 5 atrial runs, the longest was 26 beats and the fastest was 169 BPM.
No pauses seen.
Patient reported symptoms of palpitations and chest pain, which correlated with sinus rhythm.
My cardiologist wants to run a sleep study. Obviously the 2nd degree AV block is of the greatest concern. The nurses told me it was of the type 2 variety. My question is that I had a sleep study done 4 years ago and it was negative for sleep apnea. Is a new sleep study warranted at this time?