Age: 36
Sex: Female
Weight/Height: 68.5 kg/160cm
Existing Medical Conditions: History of high blood pressure (not currently on medication), no diabetes.
Current Symptoms: Highly noticeable heart palpitations (PVCs/PACs), occasionally clustering for hours.
Context:
I recently had an echocardiogram done due to ongoing heart palpitations. My GP reviewed the report and told me everything is "completely normal" and nothing to worry about. However, looking closely at the specific values in the report, I see findings that point to early structural adaptations, and I’m wondering if I should seek a second opinion or a formal cardiology referral.
Echocardiogram Key Findings from Report:
Left Ventricle Geometry: Concentric remodeling present.
Relative Wall Thickness (RWT): 0.54 (Normal is typically ≤ 0.42).
Left Ventricular Mass Index (LVMI): 70 g/m² (Normal/non-hypertrophic mass).
Systolic Function: Normal. Ejection Fraction (EF) visually estimated at 60–65%.
Diastolic Function: Normal for age. No regional wall motion abnormalities.
Rhythm: Sinus tachycardia during the test (103 bpm). Report notes "occasional ventricular extrasystoles."
My Symptom & Palpitation Log:
While a recent 24-hour Holter monitor showed a total arrhythmia burden of less than 1% because I happened to be asymptomatic that day, my actual flare-ups are highly intrusive and often happen in clusters (especially while at rest or trying to sleep). Here is a snapshot of my recent symptom log showing how frequent and sustained these episodes feel to me:
May 4: Continuous, highly frequent ectopics from 4 PM until 3 AM.
June 2: Continuous flare-up from 11 PM to 1 AM.
July 3: Noticed at 11:47 AM, then continuous from 9:47 PM until 11 PM.
July 19: Frequent ectopic beats while trying to fall asleep.
July 28: Felt them actively at 8:30 AM during the actual echocardiogram scan.
July 30: 8–10 times right after waking up, followed by many in the night before sleeping.
My Questions:
Given that I have a past history of high blood pressure, is an RWT of 0.54 at age 36 truly something to overlook as "normal," or does it warrant a strict blood pressure management strategy to reverse the remodeling?
Could the concentric remodeling and changing wall tension be the physical trigger making my heart muscle electrically "irritable," explaining these multi-hour PAC/PVC clusters?
What further testing (like a longer 7-day Holter monitor to capture a true flare-up day, or an ambulatory 24-hour blood pressure monitor) should I request?