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What Do Several Inverted Waves In An EKG Indicate While Standing Upright?

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Posted on Tue, 3 Oct 2017
Question: Hello, I have a handheld EKG known as Kardia. I was feeling weird after standing up from the floor and decided to sit down and take a reading. I am a bit concerned about the several inverted waves that showed up but the device showed a normal reading. Should this be something to worry about? Subsequent readings did not show inverted waves at all and again both showed up as normal. I know the algorithm is based on finding AFIB and will show as "unclassified" if it detects other arrhythmias or if HR is below 55 or above 100. I am not sure if it's equipped to make an assessment based on inverted waves.
doctor
Answered by Dr. Prof. Kunal Saha (53 minutes later)
Brief Answer:
Further inputs needed

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through your query and understand your concerns. I have checked the attached ECG tracing. It does not have any leads mentioned. I need to ask you if the instrument lets you select the chest leads, and how many electrodes are you needed to place on your body when you obtain the tracing. Please mention if you have any chronic ischemic heart disease and whether you have suffered any heart attacks in the past. Also mention if you are diabetic and whether you suffer from chest pains. Based on your inputs I would guide you further.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (13 minutes later)
It is a single lead device that you use with two fingers on each metal plate. Please do a quick search for Kardia and you will see what it looks like. It allows you to use a cell phone. I believe in the literature is the equivalent as lead 1. I do not have heart disease and have not had any heart attacks. I have gone to the ER 2 times in the last two years for chest pain, shoulder tightness, and arm pain. One ended up being an ulcer that took almost a year to heal and the other time I was diagnosed with tietze syndrome after a chest X-Ray and examination by my PCP. I also have 4 bulging discs in my upper/middle back and 2 in my neck. I've been told this causes some nerve issues that can explain the chest and or arm pains I sometimes get. I am not diabetic, and have very good BP as well as bradycardia (my resting HR gets in the 40s when sleeping). I will upload the hospital discharge papers, results from a recent CT scan for a different issues that also mentions the heart, and a pic of the device I use. I've only seen these inverted waves once before and didn't think anything of it. This time it was a bit concerning. Thanks for your help

Here are two links to the remaining documents. They were too large to upload.

3-30-16 Hospital Discharge:
https://1drv.ms/b/s!Ahyff0BDgl0WhdchyurwnlvigRGvWg

Picture of Kardia device:
https://1drv.ms/b/s!Ahyff0BDgl0Whspd1kUAJ3_BrdAzcA
doctor
Answered by Dr. Prof. Kunal Saha (8 hours later)
Brief Answer:
No need to worry

Detailed Answer:
Thanks for writing back. Sorry for the inadvertent delay in responding. I have checked the attached documents and have tried to correlate. There is a certain variation in your ECG. Technically speaking there is likelihood of a left bundle branch block which has led to ST prolongation. As such, it is nothing to be concerned about. For a proper correlation a full 12 lead ECG would be needed. It would help in interpretation of the other parameters. As of now, unless you have a heart related ailment (like intermittent chest pains or a previous episode of heart attack) you need worry or get concerned.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (5 hours later)
Thanks for the reply. I do get palpations, PVCs and PACs occasionally throughout the week. Chest pain and shoulder tightness are unfortunately common for me because of the other issues mentioned. Could the LBBB just be from getting up from the floor too quickly? None of the following EKGs since have shown inverted waves, just the occasional palpation. The hurricane is starting to hit us so I'm a bit anxious about leaving my family and having to go to the hospital.
doctor
Answered by Dr. Prof. Kunal Saha (33 minutes later)
Brief Answer:
No need to panic

Detailed Answer:
I would insist you not to panic. I do not think that any serious finding would be obtained. In fact, a 12 lead ECG will help in clearing your worries. In case the weather is not ok, and if you do not have any clinical presentations you can simply wait for the weather to clear out. That should not be an issue.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (7 hours later)
Thanks for your help. I have a follow up with the cardiologist on Thursday. I'm assuming it's fine to keep that appointment and not try and move it up? We are under a curfew now so I don't think I could leave and go to the ER even if I wanted to.
doctor
Answered by Dr. Prof. Kunal Saha (1 hour later)
Brief Answer:
It is fine

Detailed Answer:
I think Thursday is absolutely fine and you need not move it up. Once again, I would insist you not to panic. Get a 12 lead ECG done before you visit the cardiologist.

Regards
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4467 Questions

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What Do Several Inverted Waves In An EKG Indicate While Standing Upright?

Brief Answer: Further inputs needed Detailed Answer: Thanks for asking on HealthcareMagic. I have gone carefully through your query and understand your concerns. I have checked the attached ECG tracing. It does not have any leads mentioned. I need to ask you if the instrument lets you select the chest leads, and how many electrodes are you needed to place on your body when you obtain the tracing. Please mention if you have any chronic ischemic heart disease and whether you have suffered any heart attacks in the past. Also mention if you are diabetic and whether you suffer from chest pains. Based on your inputs I would guide you further. Let me know if I could help further. Regards