Hello,
Thank you for your query at DoctorSpring.com.
Please tell me why were the repeated ecgs done?
Did you have any symptoms for which you went to the emergency?
Does your family history include any sudden death or patients with long qt syndrome diagnosed?
A QTc of 480 and less is normal in females.
If you don't have a history of syncope or family history of sudden death or long QT then you need not be investigated further. Low potassium may prolong the QT interval. Different ECGs may have variations in measured QT if there is some artefact ib the ecg. So if you dont have syncope or family history of sudden death then there's not much to worry abt the QT interval 497 or 423 in 90 min as the difference could have been due to artefacts or machine errors.
If you have persistent low potassium levels then increase your fruit intake and avoid excessive sweating. Also potassium low levels could lead to a U wave in ecg which may confuse the machine into believing that it is a prolonged QT. T inversion in young females is normally observed phenomenon
Hope this helps, please feel free to discuss further.
Regards
Dr Vivek Mahajan
DM Cardiology
Patient replied :
Hello;
As for the answers to your questions:
- I don't know why it has been 2 ECG done...
- The reason why I went to the emergency is that I stopped to feel the 2 small fingers of my left hand, and I felt like a mini-paralysis of my lefet arm, that while I was at work. A colleague brought me to the hospital, and then some tests were done.
- No family history of sudden death or long qt (known to me). But I did have some things that felt like pressure drops. It happened once when I was standing still, once when I was in the Montreal metro and it was hot inside, and once it happens that I pratically lost it (conscience). All these episodes happened in a long history (10 + years), but it happens (I think) once or twice a year (I mean to have the feelind of a pressure drop, not all those circumstances).
I just received the result of the last ECG, and I am concerned. Not about the qt/qtc (336/422ms), but about the text that is written, It says « normal sinusal rythm » and « anomaly of st-t, possibility of anterior ischemy ». I looked back at the charts, and here are the results :
2007 : aVR negative,V1 negative, V2 positive, V3 positive (I think)
2011, the first : aVR negative,V1 negative, V2 positive, V3 negative (I think)
2011, the second : aVR negative,V1 negative, V2 positive, V3 negative (I think)
2013 : aVR negative,V1 negative, V2 negative, V3 negative (I think)
All the other markers are positive.
The cardiologist doesn't think that the last ECG is to be a problem (non-dangerous but atypic), but he doesn't have any of my past ECGs. Does that mean that the changes that seems to appeared at V2 and V3 mean that I had ischemy (ies) ? Or it can be normal and can happen to many people ?
Thank you
Hello again,
Thanks for the follow-up.
The low blood pressure feeling you had probably was vasovagal syncope which can occur in hot conditions. This is not to be worried about but can be avoided by lifestyle modifications.
Your QT doesn't seem to be a cause of worry in absence of history of sudden deaths in family and serious arrhythmias. Also the ecg changes of T wave Inversion in anterior leads from v1 to v3 may be a normal feature for young females and is called juvenile pattern.
Regards
Dr Vivek Mahajan
Patient replied :
I am 31 years old. Does the juvenile pattern can be associated to a 31 yo woman ? For me, 31 years old is not juvenile.... Also, I do not understand how it can fit the juvenile pattern when the t wave in 2007 was normal in v2 and v3 and they were anormal in 2012 and 2013. I have scanned the 3 ECG (2007, 2012, 2013).
Do you think it is possible that ischemies happened (like written on the top of the ECHOS) ?
Also, I got a functional heart murmur, and the doctors had a doubt about a prolapsus of the mithral valve. Finally, there is not by the cardiac echography I passed. Only the murmur. Does the murmur can have a link with the actual anomalies seen on the ECG ?
Thank you
Hello,
I agree a 31 year old female is no way a juvenile. But the pattern is seen in juveniles and commonly persists in females may be even to the age of 40. So the correct term is persistent juvenile pattern. My apologies for inadequate terminology.
Thank you for uploading your ECGs. The picture is more clear now. You are correct that the ECG of 2007 doesn't show T Inversion in V2 and V3 whereas the later ones do. Still I don't think they are suggestive of ischaemia because you don't have any symptoms. Secondly, because of your age, and thirdly because the pattern is non specific. Only T inversion without ST changes is very non specific.
With regards to the absence of the changes in 2007 ECG the only possible explanation I can think of is may be faulty lead placement or pregnancy may have changed the position of heart by slightly displacing the diaphragm upwards. If you don't have any echo abnormality then you should ignore the murmur.
Hope this helps, please feel free to discuss further.
Regards
Patient replied :
Hello;
The first thing that is bothering me in your answer about the differences of the ECGs. There was a change in the ECG of 2007 vs the ECG in 2012, and in 2012, I wasn't pregnant. And the ECG of 2013 have some changes from the ECG of 2012. So this point cancels the cause of the pregnancy for the changes of the T wave, and also the leads placement, because there would be errors 2 times. Do you have an explanation ?
In 2007, there was alreay problems with the T wave (written at hand « non-specific repolarisation anomalies » ). Do you see them ?
What do you think of the evolution of the ECGs between 2007 and 2012, between 2012 and 2013 and between 2007 and 2013 ?
Does the fact the the changes eliminates the possibility of a persistent juvenile pattern ?
About the symptoms, I cannot say that I don't have symptoms. I always have been anxious about my heart, and it happens that I have some palpitations and non-specific chest pains. Also, my dad had a heart attack at 54 years old, and people in my family has arterosclerosis/cholesterol (my aunt and my uncle on my dad side). You understand why my worries are still present.
Is there something that you see in the T wave that would make you think about an ischemia in my results (compared to the ones that you have seen with ischemias) ? The deep ? The length ? And do you see changes with the ST segement in my ECGs ?
Is there any other factors that can cause a T wave inversion ? On my side, I was recently diagnosed for a pregnancy diabete, I am regularly stressed (anxious), and I had palpitations 1 hour between the ECG.
Does it exists tests that I can do to be reassured about the possibility of ischemias, even if I am 7 months preganant ?
Thank you very much
Hello,
Thanks for the follow-up.
Your ECGs of 2012 and 2013 are similar. Only the ecg without date and with the hand written non specific abnormalities has T waves upright in leads V2 and V3. So I presume the ecg without date must have had some lead misplacement. The rest 2 ecgs have persistent juvenile pattern.
Your anxiety which stems from a positive family history is quite evident. The T Inversion of ischaemia are described as deep and symmetrical. There are tests like TMT to rule out if you have ischemia but they are best done after delivery. If you feel you have very frequent palpitations almost daily you could go for a 24 hour holter examination to rule out serious arrhythmia.
The probability that you have coronary heart disease is very low. And you already have an echo which has ruled out structural heart disease. Now if you have very frequent palpitations then get a holter done and rule out any arrhythmia which may be occurring.
Regards
Dr Vivek Mahajan
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