Dr. Pramod Bhanudas Narkhede
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am attaching my recent ECGs along with readings of aerobic capacity and VO2 max. The VO2 max and aerobic capacity are estimated low as exercise was interrupted after five minutes in the speed of 2.3 Kmph whereas I could have gone on for at least five more minutes with speed of 3.5 Kmph. I have undergone stenting two years back. There were no symptoms but thallium stress test and then angiogram indicate a blockage. I am also attaching my ECGs of six months back when I have been advised a pacemaker. I did not follow the advice as my ejection fraction was 73% and I did not have any symptoms of blackout or fainting. I am currently on Crestor 5 mg, Telma 20 mg, occasional Asenapine 2.5 mg, Oxetol 1200 mg, Lamitor 300 mg plus some nutritional supplements. Can you tell if there has been any improvement in the ECG? What would my aerobic capacity and VO2 max go up to if I was allowed 10 minutes of exercise on the treadmill reaching a speed of 3.,5? Any other observations or advice on your part.
Hello,
Welcome to icliniq.com.
I have gone through your history and your reports (attachment removed to protect patient identity). You are not symptomatic, ECG (echocardiogram) indicated a rhythm block. You are having a high-grade atrioventricular block which is the availability of the rhythm and not the blood flow. You have to assess the blood flow of heart by doing angiography. If the blood flow is good, the pacemaker will regularise your heartbeats. If there is a problem with the blood flow, it has to be tackled first as it can be a cause for this rhythm blockage. I hope this helps. Thank you.
Patient's Query
Thank you doctor,
How can I regularise the rhythm block noninvasively? How can I assess the blood flow noninvasively? I will be doing a cardiac MRI and a CT of coronary arteries in the near future. Can the suggested tests be conducted soon after undergoing the above two tests? That is, with the same contrast material. I do not want to undergo a full-blown angiography.
Hello,
Welcome back to icliniq.com.
You can assess the blood flow by doing a coronary angiogram. If the blood flow is fine then look for other reversible causes like electrolyte imbalance, thyroid dysfunction, metabolic abnormalities, and any drug interactions. It is difficult to treat the first type of blockage noninvasively. I hope this helps. Thank you.
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Cardiology
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