Fluttering in Chest with Sudden Slowing of Heartrate
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Recently, I was diagnosed with moderate-severe aortic regurgitation (AR) and bought a single lead ECG to monitor for ectopic beats. While I have managed to capture and interpret the odd PAC and PVC, this one has me stumped. It always begins as a faint flutter in my chest. This is then followed up by a sudden and significant drop in heart rate as can be seen from the attached files.
As the waves (PQRST) themselves show no deformation at all, I was wondering if this is something other than a regular ectopic as PVCs and PACs or even Afib would be clearly visible. I've had an echo and 24-hour Holter monitor done recently, but that turned up nothing (other than the AR). I've approached my own cardiologist on this issue, but he doesn't seem to think anything of it citing PVCs and PACs. Another cardiologist has said that it was respiratory sinus arrhythmia. However, these have been rather episodic and is something I have been experiencing only since the beginning of the year, lasting anywhere from two to twelve hours at a time. I have been trying to identify and eliminate triggers from caffeine and large meals to poor sleep but to no avail.
Before I started taking beta-blockers in August to reduce episodes of anxiety and tachycardia, these sudden slow beats would be associated with tachycardia and cause my heart rate to maintain in the 100s for hours. I didn't have the portable ECG at that time yet, so I only have the waveform from a pulse-oximeter to illustrate the events.
While I don't have any symptoms like fainting or chest pain during these episodes, they tend to cause anxiety and mild chest discomfort as I am very aware of the sensations.
If it is simply respiratory sinus arrhythmia, why does it become so pronounced from time to time? Could it be just a regular fluctuation of my heart rate that I've just become far more sensitive to? Or is it related to body position/muscle spasm that leads to heart irritation? Or does it have something to do with the AR? Or is it something more serious like sick sinus syndrome/sinus block?
The thing is, I've rather at my wit's end as I've tried so many things over these past months to no avail and none of my cardiologists seem to be able to tell me what's going on. Thank you for reading and I'm hoping for some advice on what this could possibly be or what further action I could take...
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