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Is The Left Atrial Abnormality Due To My Hypertension And Is It A Serious Concern That Needs To Be Addressed?
Question: I am 57 and have hypertension and IGA nephropathy for the past 8 years which is being treated with Cardace 10 mg, Minipress XL 5 mg, Lipitor 10 mg, and fish oil capsules. I had an ultrasound in XXXXXXX 2017 which showed normal kidneys. In addition I have a benign prostrate (Grade 1) - no medication. BP is usually around 130/80. Total cholesterol in Feb 18 was144 mg/dl .
I had an ECG done in July 16 and June17. Both ECGs said "Sinus Rhythm with left atrial abnormality".The July16 ECG final comment was "within normal limits" and the June17 final comment was "non specific T wave changes lead III".
I have the following queries
1. Please review the 2 ECGs and advise if there is any cause for concern.
2. What does "non specific T wave changes lead III" mean?
3. Is the ECG for XXXXXXX 2017 also within normal limits or does the comment "non specific T wave changes lead III" indicate there is some underlying serious issue with my heart.
4. Is the left atrial abnormality due to my hypertension? Is it a serious issue and a cause for concern? Is there any action I need to take for this besides my BP medication?
5. How does aortic stenosis show up on an ECG? I am curious as a colleague was diagnosed with this on a recent health check.
I had an ECG done in July 16 and June17. Both ECGs said "Sinus Rhythm with left atrial abnormality".The July16 ECG final comment was "within normal limits" and the June17 final comment was "non specific T wave changes lead III".
I have the following queries
1. Please review the 2 ECGs and advise if there is any cause for concern.
2. What does "non specific T wave changes lead III" mean?
3. Is the ECG for XXXXXXX 2017 also within normal limits or does the comment "non specific T wave changes lead III" indicate there is some underlying serious issue with my heart.
4. Is the left atrial abnormality due to my hypertension? Is it a serious issue and a cause for concern? Is there any action I need to take for this besides my BP medication?
5. How does aortic stenosis show up on an ECG? I am curious as a colleague was diagnosed with this on a recent health check.
Brief Answer:
Ecgs are within acceptable limits
Detailed Answer:
Hello,
I have gone through your ecgs and they are within acceptable limits. Some changes are there, but not worrisome.
1. There is nothing of concern in your both ecgs.
2,3. Both your ecgs shows nonspecific T wave changes in inferior leads, however bit marked in later one, which is acceptable and considered as normal only. Not suggestive of any significant abnormalities. Such variation may be due to just Change in lead position.
4. Left atrial abnormality is not marked, just a slight one which can occur with hypertension. Nothing to worry about it.
5. There is nothing to suggest aortic stenosis on your ecg .
However, echo will clarify everything. Although, not absolutely necessary, but it's better to a screening echo done as you hypertensive and kidney patient.
So overall, there is nothing to worry about ecg findings and your target should be bp control. Try to keep bp less than 130/85.
Hope this helps you and get back if you have any doubts.
Ecgs are within acceptable limits
Detailed Answer:
Hello,
I have gone through your ecgs and they are within acceptable limits. Some changes are there, but not worrisome.
1. There is nothing of concern in your both ecgs.
2,3. Both your ecgs shows nonspecific T wave changes in inferior leads, however bit marked in later one, which is acceptable and considered as normal only. Not suggestive of any significant abnormalities. Such variation may be due to just Change in lead position.
4. Left atrial abnormality is not marked, just a slight one which can occur with hypertension. Nothing to worry about it.
5. There is nothing to suggest aortic stenosis on your ecg .
However, echo will clarify everything. Although, not absolutely necessary, but it's better to a screening echo done as you hypertensive and kidney patient.
So overall, there is nothing to worry about ecg findings and your target should be bp control. Try to keep bp less than 130/85.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Thank you very much for your comprehensive analysis and reassuring diagnosis.
Regarding your answers -point 4 and 5 above - how do I recognise this in an ECG i.e. which quadrants v1, v2 etc do I need to look at to determine that left atrial abnormality is slight or that nothing to suggest aortic stenosis on the ecg. How does left atrial abnormality and aortic stenosis show up in an ECG ?
Thanks and regards
Regarding your answers -point 4 and 5 above - how do I recognise this in an ECG i.e. which quadrants v1, v2 etc do I need to look at to determine that left atrial abnormality is slight or that nothing to suggest aortic stenosis on the ecg. How does left atrial abnormality and aortic stenosis show up in an ECG ?
Thanks and regards
Brief Answer:
You need to see lead 2, v1,2
Detailed Answer:
You need to see lead 2, where you need to see p wave duration and more than 3 small squares indicates abnormalities, which is just three in you. Also, in v1,2, we need to see the negative deflection of p wave which should be more than one small square long and high, which is just approaching one in you. So it's borderline and not definitive.
For aortic stenosis, there will evidence of left ventricular hypertrophy as indicated by increase in height of qrs complexes especially in v5,6. The height of qrs in V5 or v6 plus downward deflection in v1 should be more than 35 which is not there so no LVH and no indirect evidence of aortic stenosis.
So hope this clears your doubt.
You need to see lead 2, v1,2
Detailed Answer:
You need to see lead 2, where you need to see p wave duration and more than 3 small squares indicates abnormalities, which is just three in you. Also, in v1,2, we need to see the negative deflection of p wave which should be more than one small square long and high, which is just approaching one in you. So it's borderline and not definitive.
For aortic stenosis, there will evidence of left ventricular hypertrophy as indicated by increase in height of qrs complexes especially in v5,6. The height of qrs in V5 or v6 plus downward deflection in v1 should be more than 35 which is not there so no LVH and no indirect evidence of aortic stenosis.
So hope this clears your doubt.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for this detailed information. It is very informative.
"....p wave duration and more than 3 small squares indicates abnormalities which is just three in you. Also, in v1,2, we need to see the negative deflection of p wave which should be more than one small square long and high, which is just approaching one in you"
- From your comment above, does it appear that that I am quite close to having an abnormality?
-- Can changes (e.g. exceed 3 small squares) occur very fast or does it take time for these changes to occur?
---- What happens if I exceed 3 small squares and in v1and v2 exceed one small square ? Would that mean I have a left atrial abnormality? How significant will that be for me health wise and what impact will that have on my heart and on my future medication?
--- Based on the existing 2 ECGs do you recommend an echo or would having yearly ECG is still fine ?
Sorry for all these questions as I am quite concerned about having a heart condition in addition to my existing health issues of kidney and hypertension.
Thanks.
"....p wave duration and more than 3 small squares indicates abnormalities which is just three in you. Also, in v1,2, we need to see the negative deflection of p wave which should be more than one small square long and high, which is just approaching one in you"
- From your comment above, does it appear that that I am quite close to having an abnormality?
-- Can changes (e.g. exceed 3 small squares) occur very fast or does it take time for these changes to occur?
---- What happens if I exceed 3 small squares and in v1and v2 exceed one small square ? Would that mean I have a left atrial abnormality? How significant will that be for me health wise and what impact will that have on my heart and on my future medication?
--- Based on the existing 2 ECGs do you recommend an echo or would having yearly ECG is still fine ?
Sorry for all these questions as I am quite concerned about having a heart condition in addition to my existing health issues of kidney and hypertension.
Thanks.
Brief Answer:
Its better to have baseline echo done
Detailed Answer:
Considering you are having kidney disease and hypertension, it's better to have a screening echo done, although not emergency, may be few months or may be within a year, if it's easily available, otherwise yearly ecg is also fine.
These ecg changes progress very slowy, may takes years to develop XXXXXXX left atrial abnormality. Also, ecg is not very specific and sensitive investigations and it can easily miss the diagnosis of left atrial enlargement. But, nothing to worry about it. Its quite common problem and frequently found as age progressis. It doesn't have significant impact of life expectancy and it's not a major problem. Although it may increase the risk of atrial fibrillation, but can be managed well if something happens. And its not cent percent that you ll get it. So I think you should not be concerned so much about it and focus on your routine activities.
All the best and get back if you have any doubts.
Its better to have baseline echo done
Detailed Answer:
Considering you are having kidney disease and hypertension, it's better to have a screening echo done, although not emergency, may be few months or may be within a year, if it's easily available, otherwise yearly ecg is also fine.
These ecg changes progress very slowy, may takes years to develop XXXXXXX left atrial abnormality. Also, ecg is not very specific and sensitive investigations and it can easily miss the diagnosis of left atrial enlargement. But, nothing to worry about it. Its quite common problem and frequently found as age progressis. It doesn't have significant impact of life expectancy and it's not a major problem. Although it may increase the risk of atrial fibrillation, but can be managed well if something happens. And its not cent percent that you ll get it. So I think you should not be concerned so much about it and focus on your routine activities.
All the best and get back if you have any doubts.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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