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What Does This ECG Report Indicate?

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Posted on Wed, 28 Dec 2016
Question: Hello, I am 74 years old, and have A-Fib pretty much all the time. Had prior CABG of the widow maker, and later had to get Pace maker, which doesn't help with A-Fib. Having angina once again slightly...trying to ignore it. I want to know what words on my Cardiogram from yesterday mean? !. Atrial Paced Complexes, and other complexes also detected. 2. Prolonged PR interval...PR>220, v rate 50-90 3.Abnormal R-wave progression, early transmission. QRS area >0 in V2.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

Regarding your concern, I would explain that your actual ECG reveals the usual pattern of a single chamber pacemaker with an inserted lead inside the right atrium.

That's why atrial paced complexes are registered.

Also, prolonged PR intervals (>200 ms) means that there exists an atrio-ventricular conductance delay (first degree AV block), which needs to be carefully monitored.

I would recommend discussing with your attending doctor (cardiologist or internist) for the opportunity of performing an ambulatory 24 to 48 hours ECG monitoring to investigate for the presence of a more advance atrio-ventricular conductance disturbance (second or third degree AV block) episodes.

If episodes of second of third degree AV block are present, then switching to a dual chamber atrio-ventricular sequential pacing would be recommended.

This latter strategy would be beneficial also regarding atrial fibrillation recurrences.

Meanwhile, I recommend discussing with your prescribing doctor on the possibility of reducing your daily Bisoprolol dosage.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (14 hours later)
I was under the impression there are two wires to my heart. Can you explain an AV Block. He always tells me my heart is doing great and has never mentioned this to me. Actually, I have had a pacer since 2006 and another in 2012. When I began having problems with my internal pacer, I was in the hospital over Thanksgiving of 2006, and awoke at 2 a.m. with excruciating pain in my face, where it felt like someone was peeling the skin off it. The night team came in with paddles, and something else I wasn't aware of...I was in too much facial pain to care, dying would have helped. I had no idea what was happening, and they told me my heart was beating at 28bpm. At the moment, half awake I didn't care as whatever they did, I think a needle, it stopped. It was a Tuesday of the holiday week, and they wouldn't let me go home, as you know, it was a skeleton crew. On Monday they gave mean Electrophysiology Study, and telling me I flat lined during it, my gentleman friend asked why I was getting a pacer rather than a Add to difibulator, my cardiologist jumped with the response of, well, if you wish to pay for it, we can. So I believe their hands were tied by my health insurance at the time. Why I think that, is I never was a smoker, have COPD from numerous Pneumonias and yearly Bronchitis since I was 3 years old. I think weak lungs is the reason. I just think my age was too young as well. I had my first angiogram at 57 years old. My mother died from CAD @ 48 years old, as did many of my cousin, even younger. I was denied care for months having daily angina that brought me to my knees, and my doctor at the time, an MD, said, you are imagining you have something wrong with your heart...you are a young woman who takes care of herself, slim, who doesn't smoke, drink or any of that, and you keep coming to my office complaining of chest pain...I screamed FAMILY HISTORY!at him, and told him if I was a man who walked in with chest and jaw, and back shoulder pain (1997) you would have called an ambulance...but you will not even refer me to a cardiologist. Months later I had an appointment with one. Right away the Cardio. took me by ambulance to XXXXXXX New XXXXXXX Hospital, and it has been 5 angiograms later, stenting and my main LAD was 100% blocked and a few other arteries were 70% and less. I now am beginning to get some light angina, and take up to 2 occasional Nitro pills.

I must tell you this, recently, My Cardiol. ws talking Cardio Ablation and I was excited. When he discussed this with the operating doctor, he said NEVER...she could not at 74 live through such a surgery. That is off the table. My honey is coming tonight for the weekend, and I will have him fix my scanner for me. My cardiogram shows I had I small heart-attack...I would like you to read it, and explain it to me.

Thanks for responding...I was not feeling well yesterday, so went to bed by 7 pm.

I do not have a death wish. Out of 5 children in my family, I am the only one still alive. The rest all passed in their 50's, and I question how soon am I going to just drop like everyone else. Cardiologist tells me, I have a long life ahead.
doctor
Answered by Dr. Ilir Sharka (12 hours later)
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

Regarding AV block, I would explain that it happens when there is an abnormal delay or even complete blockage of the electrical impulses travelling from its site of origin in the atria wall down to the ventricles.

AV block is the main reason for pacemaker implantation and the presence of a very low heart rate of around 28 bpm, raised a strong suspicion of AV block presence, or sick sinus syndrome.

These latter are frequently seen in the presence of coronary artery disease.

The fact you may have two wires inside your heart doesn’t necessarily mean you have a dual chamber pacemaker, as you had two pacemakers during this period.

Whether a pacemaker or ICD-pacemaker, it would depend on the presence of significant cardiac performance impairment and the risk of complex life-threatening arrhythmia.

As you have a known coronary artery disease, all the experienced rhythm disorders are quite understandable.

I agree with the EP doctor that electrophysiology study at your circumstances would not be the right choice.

Nevertheless, I would like to directly review your medical reports including ECG, cardiac echo and coronary angiogram, in order to be possible for me giving a concrete and more adequate professional opinion.

I remain at your disposal for further discussions.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (4 days later)
Yes, your explanation of my cardiogram, put my mind at rest…Do you know anything about Dercum’s Disease? I have no time left, and cannot afford it this month. Have a wonderful Christmas Holiday.
doctor
Answered by Dr. Ilir Sharka (4 hours later)
Brief Answer:
You are welcome!

Detailed Answer:
Hello again,

I am glad to have relieved your concern. You may ask me directly in case of any further uncertainties.

Regarding Dercum disease, I could explain that it generally affects women around 45-60 years old, mainly obese individuals and is characterized by multiple painful lipomas (fatty tissue masses).

It is a rare and not well-known disease, because no clearly approved causes and specific treatments exist.

It is associated with multiple, painful, fatty masses; persistent fatigue and neuropsychiatric disturbances, including emotional instability, depression, epilepsy, confusion, and dementia.

Rarely, it is complicated by necrosis of fatty masses, septicemia and even septic shock.

Treatment is nonspecific; prednisone has been used in some cases.

Also, pain relief drugs, such as lidocaine, nonsteroidal anti-inflammatory drugs and even opioid analgesics have been successfully applied.

Surgical treatment, such as liposuction and also excision of localized painful lipomas have been effective at relieving the pain.

Hope to have been helpful to you!

Wishing to you all the best,

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (15 hours later)
I have lumps under my skin, clusters of them, and they are painful to the touch. I suffer at night mostly with my legs. I use Blue Emu, and Aspercream with Lidocaine on my entire legs, put socks on, and pj's and most nights it keep my legs pain free. My daughter was told by her kidney transplant doctor, she has it too. I cannot find any doctors on the East Coast to see...only if I was rich and could fly to XXXXXXX where there is a specialist who could diagnose me, but its not practical. I suffer any time I touch my inner thigh near my knees, and I can feel many clumps of them. I used to weigh 214 pounds at 5 feet tall...I know, I had 3 children, and kept packing on the pounds until I saw a family member get thing going to Weight Watchers, so with my determined personality, I lost 114 pounds in a year, and that was in 1972...I would rather be dead than ever gain that weight back again. So daily, I step on the scale, if I am over 124 I panic. If you go on Facebook you can look up my name and see me. Most people think I am in the 40 or 50's. They are shocked. I have long blonde hair, take great care of my skin, and refuse to dress or look like an old lady. I love my body now, and am always having men in their 30's asking me out...I thank them, and say, I am maybe your grandma's age, and I don't think my adult grandchildren would think it was cool. I am called a couger because I date a guy who is 6 years younger than me, and looks older. I love who I am now, and look forward to every day. I drive a 1935 hot rod Ford, with a faster engine than I could handle myself, so it keep it under 80 on the tpke. It is also my page on my Facebook...It is called Little XXXXXXX a cartoon from the 1940's. Anyway, thanks on the Dercum's, I was always hoping for something. I do have really bad Neuropathy in my feet, legs, and hands. I suffer so much with both. I thank you for your answer, and wish you a wonderful Holiday with your family, and I already know all 4 of my grandchildren will be there, as well as my 3 children and spouses. I do love life.
doctor
Answered by Dr. Ilir Sharka (9 hours later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I can understand how you feel.

It is important to care about your body and weight.

But, I would explain that Dercum disease has a good prognosis, which means that you can live as long as other healthy persons.

Unfortunately there is no proven efficacy therapy against this disorder.

But, I would recommend you starting pregabaline for the pain. You can take it 75mg twice daily. It can be really helpful for the pain caused by neuropathy. But as an anticonvulsivant, it can also be helpful in chronic pain.

So, I think it may be helpful to you. You should discuss with your doctor about this issue.

I recommend having a balanced diet and performing a lot of physical activity (walking, aerobics, recreational sports, Yoga), in order to stay fit.

You should feel blessed that you have a beautiful shape and body!

I wish you have a wonderful Holiday with your family too!

Best wishes,

Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9536 Questions

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What Does This ECG Report Indicate?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome on HCM! Regarding your concern, I would explain that your actual ECG reveals the usual pattern of a single chamber pacemaker with an inserted lead inside the right atrium. That's why atrial paced complexes are registered. Also, prolonged PR intervals (>200 ms) means that there exists an atrio-ventricular conductance delay (first degree AV block), which needs to be carefully monitored. I would recommend discussing with your attending doctor (cardiologist or internist) for the opportunity of performing an ambulatory 24 to 48 hours ECG monitoring to investigate for the presence of a more advance atrio-ventricular conductance disturbance (second or third degree AV block) episodes. If episodes of second of third degree AV block are present, then switching to a dual chamber atrio-ventricular sequential pacing would be recommended. This latter strategy would be beneficial also regarding atrial fibrillation recurrences. Meanwhile, I recommend discussing with your prescribing doctor on the possibility of reducing your daily Bisoprolol dosage. Hope to have been helpful to you! In case of any further uncertainties, feel free to ask me again. Kind regards, Dr. Iliri