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Treated for asthma attack. Getting muscle spasm. EKG showed inverted U. Cause of concern?

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I had an asthma attack after sprinting through a large airport to catch a flight (the airline's fault) and had to go to the ER where they treated me with a few rounds of a nebulizer and some steroids. The nebulizer made me very twitchy and I had some small muscle spasms. I had an EKG done and it came back abnormal. They did it again with another nurse and it was also abnormal. They said I had an inverted U wave that was indicative of heart disease or a heart attack or something else and they did a heart xray to make sure my heart wasn't enlarged (I am 33). They told me to follow up with my Dr. and get a stress echocardiogram.

My NP ordered a regular echocardiogram which came back normal. I didn't get the stress echocardiogram. My questions and concerns are that I've read about abnormal inverted U waves and they are usually pathological. Why do I now have a normal echo? Should I get the stress one since this happened following a physical exertion? Could the nebulizer or the exercising have triggered the abnormality? My mother has congenital bicuspid aortic valve disease and had an artificial valve replacement at 29 so that got me doing a lot of searches. Also, I did have high LDL, but it has dropped 55 points to a normal range after losing about 30 pounds.
Posted Mon, 4 Mar 2013 in Asthma and Allergy
Answered by Dr. Anantharamakrishnan 1 hour later
Hi friend,
Welcome to Health Care Magic

Ischemic heart disease is not common in women at your age.
You are already taking care of risk factors like LDL.

U waves are not necessarily pathological.
The anti-depressant drugs / beta agonist drugs used in nebulisers / fast heart rate – each one of them might have been contributing. You need to get your electrolytes checked.

ECHOcardiogram throws light mostly on structural changes like wall and valves - If there was a problem in your aortic valve (like your mother), it is unlikely to have been missed. It also gives some idea of function – like ejection fraction.

Ischemia is diminished supply in relation to demand – at rest, the demand is not much, the available flow is sufficient and changes may not manifest. That is why a stress ECHO or TMT (Treadmill Exercise EKG) is done – increasing the demand and testing. It is better to have it done, though not on an emergency basis.

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Treated for asthma attack. Getting muscle spasm. EKG showed inverted U. Cause of concern? 1 hour later
So, do you suggest getting a stress test done? This is what I thought would be the most useful since this entire incident happened after a strenuous event.

My electrolytes were normal in November.

As for the antidepressant drugs, should I be concerned they are causing damage/abnormal u wave? I have no idea about this stuff. I've been on antidepressants for over 8 years. I have not been on the same ones the entire time, we change them as needed and sometimes I'm on only 1.

Thank you
Answered by Dr. Anantharamakrishnan 1 hour later

Many antidepressant drugs can affect - especially the conduction system.
One may need to watch, especially, when one is added.
Since you are taking the drugs for long, there may not be a problem, in your case.

November is too far back / check electrolytes again.

Stress test should be done – TMT (Treadmill Exercise ECG) / preferably with thallium isotope – will be the ideal way to evaluate ischemia. This is to assess the physiology (function).
If there is a suggestion of disease, then the next step is to see the anatomy - catheterisation and coronary angiography with a view for possible intervention. Coronary arteriography is invasive but it is the gold standard for this. [CT angio is non-invasive study for the anatomy. If positive, she will need catheterisation, anyway.]

Above answer was peer-reviewed by
Follow-up: Treated for asthma attack. Getting muscle spasm. EKG showed inverted U. Cause of concern? 15 hours later
Last questions -

If I have some abnormality that shows up with a stress test can I still exercise? How would they know something is due to ischemia vs. prescription drugs I am taking?

Thanks for the information!
Answered by Dr. Anantharamakrishnan 4 hours later

If an abnormality is seen in the stress test, you need further tests like angiogram, with a view for further assessment and assistance.

To affirm the role of the given drug in the individual - the drug has to withdrawn and the changes will disappear / challenging again with it will bring out the same issues.

Good luck
Above answer was peer-reviewed by
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