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Dr. Andrew Rynne

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What do the following EKG results indicate?

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Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 909 Questions

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Posted on Thu, 30 Mar 2017 in Hypertension and Heart Disease
Question: Good morning. I have received 2 EKG's and the most recent is very concerning to me. These were conducted in my Dr.'s Office by his nurse. The 2nd (abnormal) shows the following:
QT.QTc 422/424
QRSD 102
P Axis 10
QRS Axis -15
T-Axis -1

He stated that it is possible that there was a lead placement done incorrectly. Can you please confirm? I suffer extreme anxiety over my heart health, as I have had 2 immediate family members suffer heart attacks prior to the age of 50.
doctor
Answered by Dr. Priyank Mody 37 minutes later
Brief Answer:
Both ECG s are withen normal limits

Detailed Answer:
Hello ,
I went through both the ECG

As per your concern about the second ECG. it's perfectly within normal limits .
Many times in female patients due to breast, the technician is not able to place the leads are at exact recommended position. However instead of that , there is no gross abnormality in the ECG recording either the 1st or 2nd .
It's within physiological limits .
The rsr patten will not assume significance till your QRS is withen 120 mswc.
The heart rate is 61 at rest in the 2nd ECG suggesting you are into exercise or are living a healthy lifestyle. if not just rule out hypothyroidism once by doing Sr TSH, It's just me trying to interpret too much from the ECG.

Hopefully I have been able to resolve your apprehension .

Regards Dr. Mody
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Priyank Mody 1 hour later
Thank you. So the fact that several of the waves are in the opposite direction of the prior EKG are of no significance? And that the QRS and T axis are now negative numbers are not of concern? My doctor could not explain, and I am actually in the process of looking for another one.
I tend to have anxiety, and with my younger brother (33) suffering a heart attack this year is putting me on edge.

Thank you so much for your review! You have already calmed me down immensely.
doctor
Answered by Dr. Priyank Mody 13 hours later
Brief Answer:
In 2nd Ecg probably there is reversal between left upper n lower limb leads

Detailed Answer:
Hello ,
Sorry I did not want to confuse you with technicality so did not put that info .
The second Ecg the technician has inverted the leads between left upper and left lower limb , hence the waves are in opposite direction and so axis changed . There is no disease where that axis changes in one day without gross symptoms. However if we that this information under consideration,even the 2nd ecg is normal.
I don't think you need to take 3rd ecg, however if you have already taken you may forward the same for interpretation.
Regards Dr. Mody
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Priyank Mody 12 days later
I did get a referral to a Cardiologist. Attached are the results of the Echo and Stress Test. My major questions are these:
The Echo shows the Septal Thickness is mildly increased. What exactly does this mean? I see it is just outside of normal measures. I have read that this is usually caused by high blood pressure, but my BP is typically 110/65. Is this something that can be hereditary, and cause for concern given my family history?
I have already made a few lifestyle changes, started exercising, cut out the diet soda (biggest challenge as I was drinking 2 liters a day) and have a plan in place to stop smoking by the end of April.

Any information you can provide would be greatly appreciated! Have a great day.
doctor
Answered by Dr. Priyank Mody 4 hours later
Brief Answer:
Both TMT and ECHO are withen normal limits

Detailed Answer:
Hello XXXX ,
I went through the reports attached .

At 39 years of age, particularly in female where you are protected by hormones and if you don't smoke , An 2D echo cardiogram and TMT ( Stress test ) , effectively rules out any severe heart disease .

As I state both the reports are normal ,

1) For your doubt regarding the 2D echo, isolated septal thickness to be significant is more than 15 mm , Your is 10 mm which is just borderline normal, the 1 mm difference is very common as echo is a subjective measurement and it occurring in isolation at 39 years is of no relevance. Also the ECG has no corresponding changes and your TMT has a normal blood pressure response. So, personally I wouldn't look much into report . All the other parameters of echo are normal and even the septal thickness is normal .

As you may have read it on the Internet, yet it happens in hereditary problem , but if it has to come, it would have happened far more severe before you were 20 years of age.

Again, based on the history you gave, as I said earlier, you don't need further investigation for the same. However, it's for you to decide, as MRI helps to rule it out completely.

2) Your stress test is also normal, however I would have been more happy if you would have reached at 85 % of heart rate after 9 mins rather than 7 and half .

It just means your body is not used to strenuous exercise and so regular routine of exercise would help you in future .

Both the lifestyle changes are extremely important if you want to stay away from not only heart disease but also diabetes and other chronic problems .

Our aim is when after 2 years you repeat your TMT , You do better than this time in terms of walking duration.

Wishing you Good health.
Regards Dr. Mody

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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