When is a first time echo indicated?

[Duff Man]

Hey guys, I have a brother that's in Iraq. Lately his usually brief palpitations have become something that's interfering with his morning runs and PT. He says it feels like his heart "stops" 3-5 times, it lasts for 20-30 seconds and he feels like he's going to die.

It's pretty obvious to me that he's getting PVC's or PAC's. To me, I'm a little worried that it happens when he runs, he gets a feeling of impending doom, and they're increasing in frequency/severity.

So my question; is this something that he should be aggressive in seeking an echocardiogram for if he has no known valvular issue and no previous echo? The first thing I thought of was an echo to rule out any valvular issues because our family has a history of problems with mitral and aortic valves.

What are your thoughts?

 

[Karlynn]

He definitely needs to get it checked out. An echo is in order, especially given your family Hx. It's a good idea for anyone with a family Hx to get screened. Fore warned is fore armed.

 

[Dina]

I think so too, especially since it's a non-invasive,safe procedure.

 

[ChouDoufu]

an echo is quick and easy and painless. do it. all valve disease is unknown until
they're known.

 

[netmiff]

I didn't know my aortic stenosis was caused by BAV until AFTER surgery; my brother went and, with my history and no other, got a full cardiac work-up done, including echo. Ruled out valve problems with him. However, he was the one with a murmur as a child - go figure !

 

[Adrienne]

He should also have a Holter monitor to diagnose exactly what type of irregular heartbeat he is having.

 

[Bina]

Yes, my doc would say: EKG, Holter, and then Echo.

 

[ALCapshaw2]

Yes, my doc would say: EKG, Holter, and then Echo.

I second this recommendation.

With palpations being his primary symptom,
someone should identify EXACTLY what kind of
arrhythmia is taking place.

That is done by EKG (if present) or Holter Monitor to catch the event(s) when they happen. DUH!

 

[tobagotwo]

I eighteenth it or twentieth it, or whatever...

It's an inexpensive, non-invasive procedure. There's no reason not to. Best case, he finds out there's nothing going on but PACs and PVCs. Worst case, his life gets saved.

What was the downside again?

Best wishes,

 

[Duff Man]

Thank you for all your thoughtful replies. I'm on the same page as you guys. The only issue/downside is that he's in Iraq. An echo machine isn't exactly readily available and the chain of command gets in the way and slows down the more mundane care (ie you're just being a wuss, soldier). I don't know how remote his location is compared to the main bases, but it's a pretty big deal to get this kind of medical care in the "field".

So... I told him I want him to push hard for an echocardiogram and not let the ball drop on it. I imagine when he gets to a medical facility, any doctor worth their salt will order an EKG. The holter might be something he'll have to wait on. I think he's already talked to his army trained medic, but that's a far cry from a doctor and an echo tech.

Thanks again folks.

 

[ALCapshaw2]

Thank you for all your thoughtful replies. I'm on the same page as you guys. The only issue/downside is that he's in Iraq. An echo machine isn't exactly readily available and the chain of command gets in the way and slows down the more mundane care (ie you're just being a wuss, soldier). I don't know how remote his location is compared to the main bases, but it's a pretty big deal to get this kind of medical care in the "field".

So... I told him I want him to push hard for an echocardiogram and not let the ball drop on it. I imagine when he gets to a medical facility, any doctor worth their salt will order an EKG. The holter might be something he'll have to wait on. I think he's already talked to his army trained medic, but that's a far cry from a doctor and an echo tech.

Thanks again folks.

HUH?

Why are you pushing for an Echo when his symptoms "are consistent with" an arrhythmia.

What's the 'big deal' about a Holter Monitor?
It's about the size of a Cell Phone and probably WAY more available than an Echocardiology Test Station (and trained operator).

There are MANY possible causes of arrhythmias (including a bad valve). I don't understand your focus on getting an Echo BEFORE they even know what type of arrhythmia he (possibly / probably) has.

If he needs to exercise to induce the arrhythmia, they could have him do a treadmill stress test (or run in place) while connected to an EKG monitor (if there are no Holter Monitors available).

Surely they have EKG monitors available and someone who knows how to interpret the plots.

 

[Duff Man]

HUH?

Why are you pushing for an Echo when his symptoms "are consistent with" an arrhythmia.

What's the 'big deal' about a Holter Monitor?
It's about the size of a Cell Phone and probably WAY more available than an Echocardiology Test Station (and trained operator).

There are MANY possible causes of arrhythmias (including a bad valve). I don't understand your focus on getting an Echo BEFORE they even know what type of arrhythmia he (possibly / probably) has.

If he needs to exercise to induce the arrhythmia, they could have him do a treadmill stress test (or run in place) while connected to an EKG monitor (if there are no Holter Monitors available).

Surely they have EKG monitors available and someone who knows how to interpret the plots.

Yes the symptoms are consistent with an arrhythmia, but with our family history I suspect an underlying cause like valve degradation. EKG's aren't specific for events unless it's happening at the time, echocardiograms can diagnose unknown valvular degradation and simultaneously diagnose chronic strain through ecg and visual measurements, and the holter and treadmill stress test is something that might not be available in Iraq in a field hospital. I have to believe that an echo is available because of the complexity of the surgery they perform.

I agree he needs to recreate the event and catch it on an event monitor but he might not have the luxury. We don't know if there's a treadmill stress test machine at his field hospital. I'm not even sure he has the option for an echo. The issue is his location, not the diagnostic method. The reason I'd like to see him get an echo and of course an EKG first is because it can rule out structural abnormalities in the heart like hypertrophic cardiomyopathy or cardiomegaly that can lead to VT, SVT and PVC's or PAC's. The usual reason behind those structural changes that lead to arryhthmia is because of valve issues, long standing hypertension, ischemia or even pulmonary issues.

If he pushes for an EKG, that could be all he'll get. I feel like the echo is the best way to uncover a wide range of pathology.

You asked what the big deal is, well, he's living in a hut in the sand. He's not near a nice hospital. The indigenous people poop in the street and they live in mud homes. They don't have sophisticated equipment, so the only way to get to the modern equipment he needs is by way of a convoy. That means at least 3 or 4 vehicle changes. Humvee to an MRAP to an apache and then maybe even an airplane. It's a big deal to get someone out of the field.

 

[Mary]

Having had a son in Iraq for 2 years, unfortunately I doubt that your brother comes out of the field unless it' evolves into a bona fide emergency. And yes, I realize how serious it might be, but seriousness is the name of the game in Iraq, and those in command might have different ideas about what action should be taken. On the other hand, if it's found to be heart related, he will probably come out of there for good.

 

[ALCapshaw2]

IF they were able to identify a Heart Arrhythmia (in the field) by either EKG or Holter Monitor or Event Monitor, would they then 'pull him out' for further evaluation to determine the cause of the arrythmia(s) or as a risk to either himself or his unit?

(The reason I ask is because I have no idea how this would be viewed or handled).

 

[Mary]

IF they were able to identify a Heart Arrhythmia (in the field) by either EKG or Holter Monitor or Event Monitor, would they then 'pull him out' for further evaluation to determine the cause of the arrythmia(s) or as a risk to either himself or his unit?

(The reason I ask is because I have no idea how this would be viewed or handled).

I think he would immediately be pulled out for evaluation, and he would have to have a clean bill of health before he would be released back to the field.

 

[Duff Man]

Having had a son in Iraq for 2 years, unfortunately I doubt that your brother comes out of the field unless it' evolves into a bona fide emergency. And yes, I realize how serious it might be, but seriousness is the name of the game in Iraq, and those in command might have different ideas about what action should be taken. On the other hand, if it's found to be heart related, he will probably come out of there for good.

I agree Mary, it'll be hard to get himself to a doctor. They don't care about non emergent medical issues. They consider it a war, and you're stuck there until you're not able to stand anymore or when your time is up.

IF they were able to identify a Heart Arrhythmia (in the field) by either EKG or Holter Monitor or Event Monitor, would they then 'pull him out' for further evaluation to determine the cause of the arrythmia(s) or as a risk to either himself or his unit?

(The reason I ask is because I have no idea how this would be viewed or handled).

There's no way they'll be able to actually identify the arrhythmia because the equipment isn't available. No way in hell they'll send him an event monitor.

I guess 3-5 PVC's aren't horrible to have as far as arrhythmia's go, but obviously I want my brother to be safe and get it checked out. It's out of my hands anyway, but I was curious to see what you guys would say.

 

[zipper2]

Very stressful situation

Very stressful situation

Im so sorry to hear about this Duff and truly

is stress on everyone of you all envolved with

this situation,if it came to it with his symptoms

and God forbid he's unconsious,they would have to

fly him out of there,but no leaving on your own is

what u and Mary are saying....correct?

This is a terrible perdicument,this is awful and it

sure is an awful feeling imagining the symptoms i have

being stuck in sand and huts and noise anf fear,we not

only remember our heros tomorrow the 11th of nov.

we remember all the ones still out there like our fellow VR

family members and Duff i saw this post earlier and i am sending

all of you ,your family and brother alot of prayers.Let alone being

in Irauq but not being healthy is a big big concern and this is saddenig

to say the least and we need to also remember these people get ill

like any of us would only they arenot able to get the help as quick

as us.......Im sorry for all your stress and your familys and your brother.

Prayers are all i can offer and my saddened ton of weight in my chest

for all of you.......It saddens me also

zipper2 (DEB)

 

[pamela]

I served in the Canadian military for years and yes, he's in the field far away from specialist care. Odds are though, that they do have a MASH or aid station within range of where your bro is. I think that if I were on the line with someone I knew was having heart issues, I wouldn't feel very backed up if I had to depend on that person for cover fire or to call in artillery. Having to carry that person out because they're in vfib would be something I wouldn't look forward to either.

It's not cowardice or laziness to admit you'd like a check out. If he'd talk to his section commander and went through the chain of command to see a doc I'm sure it would happen eventually. What will go on if he says nothing is that nothing will be done about it until he has a serious cardiac event that he may not survive.

It's better if he gets checked out than it is to stay put and possibly jeopardize the mission or his unit because of his cardiac situation being the worst thing we can imagine and failing during a fire fight or patrol.