Brief Answer:
Some tests should be run

Detailed Answer:
Greetings. Thank you for your question and welcome to HCM. I understand your concern.

I shall address your issue regarding the heart rate first, and then regarding the low QRS voltage in the precorsial leads.

Well, let me start by telling that the normal heart rate is between 60 and 100 beats per minute. It is accepted as normal down to 45 beats per minut in priorly trained athletes or physically active people, and in resting/sleeping state. If under any medication, particularly beta-blocker or certain calcium channel blockers, then it is expected to have lower than normal heart rate figures, in some people. However, a heart beat of 50 per minute, should not be a limitation to physical/workinf activites. Also, heart rate - during physical activity/sports, psychological stress, after consuming caffeine-containing beverages, due to physiological daily hormonal changes - can spike, double or reach the maximum heart beat (the formula being 220-age - 168 beats per minute, in your case) and is still considered normal. I do not think that there is anything to worry about. Just to be "in the clear", however, I would recommend you to be put on a 24-hour rhythm monitor, and your heart rate trends can be more effectively evaluated with this test.

Second, voltage of the QRS complex in the precordial leads is directly correlated with the ventricular muscular mass which is under the registering lead. Therefore, it starts with being negligable in V1 and is highest in V5 (where the ventricular mass is vast). Now, every condition or physiological state, which increases the distance between the heart and the reading lead, can cause low voltage QRS. Although insignificant in most of cases, this has happened to be an important diagnostic cue in some conditions. While being on the side that "there is probably nothing to go home", we cannot say "go home you are fine" just like that. Therefore, according to conditions, I would recommend some tests: an echocardiogram (to evaluate the structural integrity of the heart muscle and the valves, the motility and function of these structures and, also important, to see if there is any inflammation or more-than-allowed fluid build up within the pericardium - the sac that encompasses the heart) and a plain chest X-ray (to evaluate whether there is an inflammation or fluid build-up within the pleura - the lining of the lungs, or any visible problem with the organic mass of the lungs, since these problems can also be accompanied with low-voltage QRS).

I hope I was helpful with my answer. I am happy to help, if you have follow-up questions. Please rate the answer, if you do not. Wish you a good health.

Best regards,
Dr. Meriton

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Brief Answer:
Hello again.

Detailed Answer:
Hello again. I understand your concern.

Basically, the main suspicions, even though their probability is low, should be confirmed or excluded by the tests I recommended in my first answer. At least, after the tests, we can be safe to say "okay, this certain thing is the problem" or "there is absolutely nothing to worry about". Even the passing out episode, which was referred in the follow-up question, is an important history cue, and echocardiogram and 24-hour monitor will determine whether there is an organic problem that caused this episode. My opinion is that you should keep your job, as this condition, at least based on the clinical description, does not limit you to work. It is only after the tests when we can speak thoroughly about starting or withholding certain treatment.

I hope this helps. Wish you the best.

Kind regards,
Dr. Meriton

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