How to manage a high heart rate?

Question

Hello doctor,

I was in the ER the other day with tachycardia that started about 20 to 30 minutes after eating. It persisted nearly all day, and the next morning, I went to the ER. They performed some blood work and a chest X-ray, and they told me I was okay and discharged me. The only abnormality in the blood tests was a potassium level of 3.2 mEq/L. All my CMP and CBC results were normal. I noticed that the ECG showed non-specific ST-T wave changes, and I expressed my concern about it. They told me it was nothing and that it was not the type of T-wave changes they usually worry about.

However, I am not sure if they compared it to previous ECGs. Later, I saw the laboratory write-up that they posted, and the comparison between the two ECGs greatly worried me. They did not post the new ECG, but based on the little research I did, it seems that a potassium level of 3.2 mEq/L could not cause such a significant shift in the ST-T segment.

What is likely going on here? I am worried that this could be ischemia that they neglected to thoroughly analyze because I am a repeat patient and they have not discovered it earlier. I have attached the reports for your review.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed the attachments (attachment removed to protect patient identity). First of all, your ECG (electrocardiogram) looks normal to me. However, the symptoms you are experiencing may be due to an inherited arrhythmia syndrome or channelopathy. If your symptoms persist, please undergo 24-hour Holter monitoring and echocardiography for further evaluation.

Follow up with the Holter report.

Answer 2

Hello,

Welcome back to icliniq.com.

The study interpretation provided by the clinic is the machine-generated version of the EKG (electrocardiogram) interpretation. We should not be overly concerned about the ECG machine-generated interpretation because it can be misleading and may produce a falsely abnormal report for a normal ECG. Therefore, what a cardiologist thinks about your ECG matters more than the machine interpretation.

As I mentioned earlier, you may have an arrhythmia syndrome or, remotely, ischemia. To rule this out definitively, please undergo 24-hour Holter monitoring and an echocardiogram. You have lactic acidosis and hypokalemia, which have affected the waves in your previous ECG. This is an acceptable finding, but it is not a dangerous one.

Thanks and regards.

Answer 3

Hello,

Welcome back to icliniq.com.

The last ECG (electrocardiogram) you posted looks abnormal, showing significant J-point depression in the inferolateral walls. All the changes you expect occur when the heart rate exceeds 150 beats per minute. When your heart rate normalizes, the ECG also returns to normal. If T wave inversion is associated with downsloping ST changes, it indicates ischemia.

However, in your case, the T wave inversion is associated with upsloping ST changes, so this alteration is related to tachycardia and not ischemia. I would suggest taking Metoprolol sustained-release 50 mg once a day. Please consult your specialist doctor to discuss this with them and obtain their consent before starting any medications. Additionally, please undergo a 24-hour Holter monitor and an echocardiogram.

Thanks and regards.

Answer 4

Hello,

Welcome back to icliniq.com.

Yes, your ECG (electrocardiogram) does not suggest ischemia but indicates a high heart rate. I strongly believe you may be experiencing some form of arrhythmia. I recommend taking Metoprolol sustained-release 50 mg. Please consult your specialist doctor to discuss this with them and obtain their consent before starting any medications. Additionally, please undergo Holter monitoring and an echocardiogram to rule out ischemia and arrhythmia.

I hope this helps you.

Thank you.