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Diagnosed with active diagnoses of rheumatoid arthritis and bulimia. EKG showed a partial RBBB. Meaning? Serious?

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Cardiologist, Interventional
Practicing since : 1998
Answered : 410 Questions
I am a 33 yo old female. I am a smoker with active diagnoses of rheumatoid arthritis and bulimia nervosa. I have had serial ekgs over the years for various admissions into eating disorder facilities. My first EKG showed a partial RBBB. My echo in early 2010 following that was normal with what they called a "low normal" EF of 50-55%. My subsequent ekgs have been unchanged until recently. My most recent ekg (last Monday) showed an inverted T wave in lead III. My MD said I needed a cardiology consult but wouldn't say why. The physician at the eating disorder facility also said I needed a cardiology consult before they would prescribe any medications. They did not draw cardiac labs but drew some metabolic labs. My HGB was 13.9, my Na+ was 139, K+ 4.2, Cl 104. BUN/creat/glucose WNL. Mag level 2.2, calcium 9.3. My cholesterol was 193, LDL-C 110, HDL-C 53, trig-NMR 106. LDL-P 1,152, and small LDL-P 3000. My LP-insulin resistance score was 48. My TSH was 0.4, free T4 was .72, and vit D 35. I have had intermittent chest pain that I have chalked up to bulimia. I underwent an EGD and colonoscopy in late April that were both normal. I do have exercise fatigue but I do not exercise and am not fit. My BP was 120/82. HR 98 sitting. What is your interpretation of the labs? (I know the electrolytes are fine and I'm not sure about the LP-IR or lipid panel). I get the feeling this is probably another normal variant to my EKG; is it at all concerning that there was a change? What are the chances this is actually something serious?
Posted Wed, 7 Aug 2013 in Hypertension and Heart Disease
Answered by Dr. Prabhakar C Koregol 7 hours later
thanks for query. I don't see anything abnormal in your reports. everything looks fine. having T wave inversion one lead especially on lead III is quite common finding and would not call for cardiac evaluation or consult under routine circumstances. It would not need any treatment as well. but if two consultants have asked for opinion there could be more tha n this minor ECG finding either in ECG or clinical examination that would have made them request the cardiac consult. please rediscuss with your GP and also have scan copy of ECG uploaded so that I can review and advise further. still after all this discussion I definitely don't see anything alarming or worrisome.
do get back to me.
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