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Had serial EKG normal for various eating disorders. Suggested a sign of oxygen deprivation or dehydration. Have fatigue. Remedy?

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I have had serial EKGs for admissions to various eating disorder facilities. All have been consistently normal with flattened T waves and a partial bundle branch block (normal variants per PCP). Most recent EKG for another admission to an eating disorder facility showed new onset inverted t waves in one lead only (she told me lead V4 but her chart notes say lead III). CMP was completely normal with no electrolyte abnormalities. They referred me to cardiology and I was scheduled with an interventional cardiologist for next Friday. All they told me was a change from 5 previous EKGs that looked the same to this new change was concerning and it could be a sign of oxygen deprivation or dehydration. Labs show it is not dehydration (K+ is 4.1 and Na is 140). I do have poor exercise tolerance (aka winded climbing stairs), but I've chalked that up to being out of shape. I also have fatigue, which I chalked up to depression. Do I actually have something to potentially worry about? Why an interventional cardio versus regular? They said it's always concerning when it's a change from a long established baseline? Any thoughts or ideas?
Posted Thu, 1 Aug 2013 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later
welcome to healthcare magic,
single lead T wave invertion in persons with without cardiac symptoms and risk factors may not be significant.

The differential diagnoses of T-wave inversions are
diverse and ischemia, inflammation, electrolyte abnormalities, cocaine use, trauma, and others.

T-wave inversion can be normal in leads aVR, III, and V1.

It may be seen in young adults (juvenile T-wave pattern).

T-wave inversion is also seen in anxiety states, hyperventilation syndrome, and even with digoxin use.

The T wave is considered inverted when it is deeper than 1 mm; it is considered flat when its peak amplitude is between 1.0 mm and −1.0 mm.
so you need further evaluation
thank you.
Above answer was peer-reviewed by
Follow-up: Had serial EKG normal for various eating disorders. Suggested a sign of oxygen deprivation or dehydration. Have fatigue. Remedy? 31 minutes later
I have no history of electrolyte abnormalities and my complete metabolic profile yesterday was normal, except my cholesterol is a little high; no drug use, no trauma, no digoxin use, no panic disorders, and certainly hyperventilation isn't an issue. It seems to me this is probably much to do about nothing. I guess a lot of the causes you listed seem not applicable to me. So I am wondering what tests should I anticipate will be done? Is the fact the EKG changed to inverted T waves from years of flat ones significant or just another normal variant? I am really interested in what tests they would order for me.
Answered by Dr. Anil Grover 28 minutes later
The t wave inversion may be normal varient for you .
as you does not have any condition that cause .
but yo may need an ECHO, stress test to rule out CAD.
thank you.
Above answer was peer-reviewed by
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