Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXXXXX

Welcome on HCM!

Regarding your concern, I would explain that your ECG parameters (P/PR; QRS; QT/QTc; P/QRS/T Axis) are within normal range.

So, you shouldn't worry about!

Heart rate 59 bpm is quite a slight bradycardia, commonly found at certain periods in normal individuals.

Also, those prescribed non-specific repolarization changes in left precordial leads should be differentiated between a left ventricular systolic overload due to hypertension, a valvular disorder like aortic stenosis, left ventricular hypertrophy, or even cardiac ischemia.

Cardiac ischemia is less likely to be an explanation of your ECG findings, as you have not any clear cardiac ischemia symptomatology (no chest pain, dyspnea, etc); and you don’t refer any coronary risk factors.

Do you suffer from hypertension? Diabetes or dyslipidemia?

Do you smoke?

Any family history of CAD (coronary artery disease)?

Coming to this point, it is necessary to perform some medical tests as follows:

- Fasting blood glucose,
- Blood lipid profile,
- BUN & creatinine,
- Cardiac ultrasound (ECHO)
- Blood electrolytes level

For investigating any possible coronary risk factors, as well as to confirm/exclude any cardiac structural abnormalities (left ventricular hypertrophy, valvular dysfunction, etc.).

The most important issue to consider in this history is your clinical symptomatology.

Just a few seconds sleepiness while driving is not considered sufficient to raise strong suspicions about cardiac ischemia.

If your heart rhythm is persistently slow (persistent bradycardia), then an ambulatory 24 to 48 hours ECG monitoring (Holter) would be necessary for investigating a possible sick sinus syndrome (which could be an explanation of your episodic sleepiness).

But, you should know that an episodic sleepiness could be also:

- Transient hypotension,
- Hypoglycemia,
- Sleep apnea syndrome,
- Neurogenic syncope, etc.

That’s why, I recommend you performing the above mentioned tests.

I would like to directly review your ECG recording.

Could you upload it here when available?

Hope to have been helpful to you!

Feel free to ask me again in case of any further uncertainties.

Kind regards,

Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:
Hello again, dear XXXXXXX

I would like to explain that you can make two other follow up questions included in your payment.

So you don't need to pay any more, if you continue with our opened query.

I would be glad to review your medical reports (tests) and give my professional opinion.

Wishing you a pleasant weekend!

Regards,

Dr. Iliri

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Brief Answer:
I would explain:

Detailed Answer:
Dear XXXXXXX

I carefully reviewed your uploaded ECG recording and would explain that nothing wrong could be found.

Your resting ECG is within normal ranges.

You shouldn’t worry about!

It seems that you have a major non-modifiable coronary risk factor (heredity for CAD, as your mother has suffered from premature coronary heart disease).

I recommend following a healthy diet and life-style, keeping that way any possible modifiable coronary risk factors under control in the future.

Meanwhile, I still insist performing the medical checkup with the above mentioned tests, also including thyroid function test (FT3, FT4, TSH), which could exclude/confirm any thyroid dysfunction responsible for you easy tiredness and bradycardia.

A Holter monitoring would be advisable if your bradycardia is persistent.

Wishing you a good health!

Greetings!

Dr. Iliri

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