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Have bradycardia. Got positive stress test and qrs-t angle on ekg. Risk of heart attack?

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Posted on Fri, 22 Feb 2013
Question: My eKG shows QRS-T angle , consider primary T wave abnormality. I had a stress test 2 years ago and it was negative. I had a coronary calcium score 18 months ago and the result was 0. I have a history of heart arrhythmias ( including ventricular bigeminies) which seems to be genetic. I also have bradicardya. I exercise ( walk on a treadmill 3 x a week for 3 minutes at 4.0 mph with a little incline of 2%), getting my pulse to 125 or sometimes to 132. I am having a stress echo today and am very scared ... my cardiologist saw me yesterday , we did blood enzymes and they were normal. He tells me that I am ok but I am very frightened as the info I read in the internet about QRS T is basically death sentence .

I am a woman 53 years old , 5'6" and weigh 152 pounds .At age 32 I had a positive stress test and had a XXXXXXX and the XXXXXXX was negative. Can you tell me your opinion please ? I am very very scared. Do you think I am at risk of sudden death from heart attack ?
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Answered by Dr. Shoaib Khan (8 hours later)
Hello and welcome to XXXXXXX

Thank you for your query.

At first you should know that your cardiac enzymes returned normal, which means you are currently not suffering from any serious threat.

A stress test helps your doctor to find out how well your heart works in response to stress. Whether it can handle it or it needs help. This test shows if there is a lack of blood supply to the heart through the arteries or not. Which once diagnosed, can be corrected, and controlled to prevent future unfortunate events.

You have not mentioned your drug history (if you are on any medications at present?). Please help me with that.

Next, we shall shed some light on the different types of 'T' wave abnormalities that could help in making a diagnosis.

Types:
1. Hyperacute 'T' waves: seen in ST-elevation Myocardial Infarction, Prinzmetal angina, new Ischemia
2. Inverted 'T' wave: Normally seen in children, Myocardial Ischemia or Infarction, Bundle Branch Block, Ventricular hypertrophy, Pulmonary embolism, Hypertrophic cardiomyopathy, raised intracranial pressure, Wellen's syndrome
3. Biphasic 'T' waves: Ischemia, Hypokalemia, Wellen's syndrome
4. 'Camel hump' T waves or double hump T waves: Severe hypokalemia, heart block
5. Flattened 'T' waves: Ischemia or electrolyte imbalances

Finding out the exact type of 'T' wave abnormality could narrow down our search for a diagnosis. You could either attach the EKG document, so I can have a look at it, or you could discuss the result of your EKG with the exact type of 'T' wave abnormality shown in your EKG with your cardiologist,for a clearer picture.

A 'T' wave abnormality can occur because of many other less serious conditions, which can be easily treated like an anemia or a potassium deficiency in the blood. I am sure a blood investigation was done to rule these possibilities out, if not you could request for these.
Please note, that even if an abnormality has been diagnosed, an early detection of a 'T' wave abnormality is a sign, and only helps in realizing what we are doing wrong, and rectify ourselves from there on to live a long healthy life.

Your last stress test was negative, and you calcium level was zero, which are both signs of good health. Your cardiac enzymes (which are what I am assuming was checked the previous day) were also normal, which means you are at no immediate risk.

We could repeat an EKG, an echo-cardiography, a chest x-ray and a thorough blood work which would greatly help in ruling out all possible threats and underlying conditions.

From the information you have provided you seem to be fine, and healthy. Further testing shall confirm that.

I hope I have helped in clarifying your doubts. I understand your anxiety, but a thorough work-up and regular follow up visits to your cardiologist should ensure a good, long and healthy life.

At present, you seem to be fine, and at no immediate risk. Continue the same lifestyle, with a good healthy diet and mild form of exercise and you should be fine.

I hope I have helped in answering your queries. Do write back to me with any further clarifications, and I shall be glad to help you.

Best wishes.
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Shoaib Khan

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Practicing since :2009

Answered : 9409 Questions

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Have bradycardia. Got positive stress test and qrs-t angle on ekg. Risk of heart attack?

Hello and welcome to XXXXXXX

Thank you for your query.

At first you should know that your cardiac enzymes returned normal, which means you are currently not suffering from any serious threat.

A stress test helps your doctor to find out how well your heart works in response to stress. Whether it can handle it or it needs help. This test shows if there is a lack of blood supply to the heart through the arteries or not. Which once diagnosed, can be corrected, and controlled to prevent future unfortunate events.

You have not mentioned your drug history (if you are on any medications at present?). Please help me with that.

Next, we shall shed some light on the different types of 'T' wave abnormalities that could help in making a diagnosis.

Types:
1. Hyperacute 'T' waves: seen in ST-elevation Myocardial Infarction, Prinzmetal angina, new Ischemia
2. Inverted 'T' wave: Normally seen in children, Myocardial Ischemia or Infarction, Bundle Branch Block, Ventricular hypertrophy, Pulmonary embolism, Hypertrophic cardiomyopathy, raised intracranial pressure, Wellen's syndrome
3. Biphasic 'T' waves: Ischemia, Hypokalemia, Wellen's syndrome
4. 'Camel hump' T waves or double hump T waves: Severe hypokalemia, heart block
5. Flattened 'T' waves: Ischemia or electrolyte imbalances

Finding out the exact type of 'T' wave abnormality could narrow down our search for a diagnosis. You could either attach the EKG document, so I can have a look at it, or you could discuss the result of your EKG with the exact type of 'T' wave abnormality shown in your EKG with your cardiologist,for a clearer picture.

A 'T' wave abnormality can occur because of many other less serious conditions, which can be easily treated like an anemia or a potassium deficiency in the blood. I am sure a blood investigation was done to rule these possibilities out, if not you could request for these.
Please note, that even if an abnormality has been diagnosed, an early detection of a 'T' wave abnormality is a sign, and only helps in realizing what we are doing wrong, and rectify ourselves from there on to live a long healthy life.

Your last stress test was negative, and you calcium level was zero, which are both signs of good health. Your cardiac enzymes (which are what I am assuming was checked the previous day) were also normal, which means you are at no immediate risk.

We could repeat an EKG, an echo-cardiography, a chest x-ray and a thorough blood work which would greatly help in ruling out all possible threats and underlying conditions.

From the information you have provided you seem to be fine, and healthy. Further testing shall confirm that.

I hope I have helped in clarifying your doubts. I understand your anxiety, but a thorough work-up and regular follow up visits to your cardiologist should ensure a good, long and healthy life.

At present, you seem to be fine, and at no immediate risk. Continue the same lifestyle, with a good healthy diet and mild form of exercise and you should be fine.

I hope I have helped in answering your queries. Do write back to me with any further clarifications, and I shall be glad to help you.

Best wishes.