Dr. Muhammad Majid Hanif
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
Hi doctor,
I have attached my two ECG reports here. Are they normal? They were taken consecutively, 1 minute apart, the one with 106 heart rate was taken first and the second one with 93 heart rate was taken later). I see some broad peak in the second one. I am not sure if it is an error or something else. My questions are as follows: Do both ECG charts represent healthy heart? The reason why I went to the hospital is that I felt chest pain and I checked my heart rate by a phone application. It gave a normal reading except for one time it gave 39, but immediately after that it gave 79. Do you think the 39 heart rate is an error? Should I feel relaxed and be assured that my heart is fine? What is that broad peak? I have very mild mitral valve regurgitation that was diagnosed to not have any treatments. Also, before I did the ECG, I just ate and I was very concerned about the chest pain. Please explain. Thank you.
Hi,
Welcome to icliniq.com.
You may rest assured as I have carefully reviewed your health query, including both the attachments with different heart rates (attachment removed to protect patient identity). The peak you are most concerned about is a simply nothing. It is an artifact and is a recording error of the stylus. Yes, the ECG (electrocardiogram) mainly seems to be of the normal heart. There is no obvious sign of ischemic heart disease or any other issues of rhythm and electrical conduction of heart. You should rest assured and relax.
Patient's Query
Thank you doctor,
Please clear my doubt regarding the heart rate of 39, which I got in my mobile app. But, later it was changed to 79. Do you think it is an error from the phone app or I have to do further examination to see if I have something wrong?
Hi,
Welcome back to icliniq.com.
Well, the heart rate recorded through smartphone applications is totally for recreational purpose and never a depiction of true heart events and heart rate in actual can never be accurately measured like this. I recommend you to not use it often. Even if you use it, never believe it completely. You do not need to worry about that low heart rate reading and there is absolutely no need for any further investigations based on the heart rate your smartphone recorded.
Patient's Query
Hello doctor,
As I told you before, I have a history of mild mitral valve regurgitation. It was detected occasionally by hearing a heart murmur. I did an echo, which showed mild mitral valve regurgitation, trace aortic regurgitation, and trace tricuspid regurgitation. The doctor told me that I only have mild mitral valve regurgitation without telling me about the other vavles trace regurgitation. I just read them in the echo. A year later, I did an echo which showed no change in the amount of the regurgitation. I uploaded a copy of the echo report of these two and they are written in one report because they have the same information. 10 months later, that is a few days ago, I did an echo at another doctor's office and only showed trivial mitral valve regurgitation. I also uploaded this echo and want you to see it as well. My questions are as follows. Which one should I believe, the one with mild mitral valve regurgitation or the one with trivial regurgitation? Do I have problems with the aortic valve and the tricuspid valve since I have trace regurgitations in both of them? How likely will the regurgitations in all the valves increase and become significant? Why do you think the first doctor did not tell me anything about the trace regurgitations in both the aortic and tricuspid? Should I do an echo yearly? Please read the two echo carefully and answer my questions.
Hi,
Welcome back to icliniq.com.
I appreciate you uploaded all the supporting documents (attachment removed to protect patient identity). It makes this discussion more worth. Trivial regurgitation in that each means the same as the reports of previous two echos say. There is no difference in all of them. Trivial we take medically as unimportant or of very small value or negligible. No there is no major issues with aortic and tricuspid valves as there is no medically important change seen. There is not a big issue to affect your heart's pumping function. Your ejection fraction is great and it is depiction of hearts function. If you get high blood pressure and do not treat that, or get obese, high cholesterol levels and deranged other lipids, diabetes mellitus in future then this regurgitation may exacerbate. Yes, keep a yearly heart evaluation. If felt appropriate, your Cardiologist may go for an echo. Your cardiologist did not tell you because he may have thought that those are so insignificant that discussing them will simply add up to your worries and no benefit for that. They are harmless. Let me know please if you need further assistance. Thank you.
Patient's Query
Hi doctor,
Thank you so much. Now, should I say I have mild mitral valve regurgitation or trivial from what you have seen? Because the trivial one is recommended to not have any follow up while the mild one should be evaluated yearly. For the new echo (which suggested trivial regurgitation), the echo report showed no regurgitation in the aerobic valve. I am afraid that the doctor only checked the mitral valve and ignored the aortic vavle because I only mentioned that I have mitral valve regurgitation. Can the doctor only check the mitral valve or the other valves will be seen if the mitral valve is checked by an echo? Do you think the regurgitation in all these valves will increase or not? Should I not be worried and lead normal life? About going to the gym, what do you recommend?
Hi,
Welcome back to icliniq.com.
I feel obliged for your trust in my healthcare services and have reviewed your query in detail. Thanks for adding more details and I am happy to clear your doubts. Both forms need yearly follow up nowadays as practice changing updates warrant. It is because of drastic changes in lifestyles over the decad. Whatsoever form you have you need a follow up. No, you doctor did not miss actually. They see all the valves and hemodynamics of heart are seen altogether. If you keep your weight and lipids in limits, remain physically active and keep a check on your diet and blood pressure, then I say no problem with regurgitation in future. You are not at all a cardiac patient. Take it normal and do not bother about it as this is nothing. It is not something that may cause any trouble to your normal lifestyle. In gym, do only the exercises that cause no discomfort to you. Do not go beyond your capacity. No limitations otherwise. Cardio exercises are good if done in limit and under supervision of a gym instructor. Let me help you if you need further assistance.
Patient's Query
Hi doctor,
Thank you so much. I still have some questions. I feel small fluttering on the left of my chest and on my left arms. It also happens under my left breast. It happens once a day and it is not followed by fast or strong heart rate. I always check my heart rate after this happens and find it normal. Also, when I put my fingers and on the middle of my chest (a little bit to the left), I feel beats bouncing against my fingers (but not strong at all) and then this bouncing disappears. I am not sure if it is just my heart beating normal or palpitations. I did an ECG a week ago and it was normal. Also, I did a 24 hour Holter monitor two months ago, but it was done for something else and I do not remember if I had this feeling of fluttering at that time, and it was completely normal. What do you think this is? And what do you recommend? I always feel chest pain and my echo and ECGs are normal (but you are aware of the regurgitations). Do you think the pain is from the muscles? It comes and goes and not very strong.
Hi,
Welcome back to icliniq.com.
I appreciate your continued trust in my healthcare opinions and want to assure that I have thoroughly understood what you are worried about. Actually palpitations are defined in clinical language as feeling and sensing one's own heart beats. It has nothing to do with physically palpating the chest with fingers. It is a touchless feeling of hearts activity. That is a different thing. What you feel when pressing on the chest is actually the normal apex beat of heart and is normal. No worries. The pain may be due to muscular spasm of chest (non-cardiac especially in the absence of any bad labs and tests) or it sometimes is due to anxiety and mimicks a heart related pain. I do not think regurgitation is behind this pain. Actually pain from heart comes when there is a block or lack of blood supply to heart's own muscles and there is an issues related to vessels of heart (coronary artery disease CAD). You do not have CAD so least chances of pain from heart. Please take a deep breath when you feel like that. Deep breathing exercises work best in this situation. Coughing afterwards is also a good technique. Hope it helps. Please have a note that I am always here to serve you whenever needed for anything. Feel free to contact back.
Patient's Query
Hi doctor,
About the regurgitations in the mitral valve, aortic valve, and the tricuspid valve. My questions are as follows. Do you see trace aortic regurgitation in healthy people and they have lived with in without any problems? Is it normal for someone to have trace aortic regurgitation and it is not something that needs to be monitored over the years? Is it normal for someone to have trace tricuspid regurgitation and it is not something that needs to be monitored over the years? Is it normal for someone to have trivial mitral valve regurgitation, trace tricuspid regurgitation, and trace aortic regurgitation? If you see trace regurgitations in aortic valve and tricuspid valve, will consider something to tell the patient or just ignore it? Please answer them all. Thank you so much.
Hi,
Welcome back to iciniq.com.
I appreciate your concerns and happy to assist you as I can understand your worries. Being young and having some findings related to heart bothers of course. Yes, it happens many a times and people live quite a normal life without problems/complications. Yes this is quite common to have aortic regurgitation but you need to monitor it over the years to see everything is ok. Yes it is quite common to have tricuspid regurgitation too but again we need to keep an eye on it. It is recommended to have it checked on regular follow ups. We cannot say regurgitation to be totally normal as you know this is negligible degree of pathology of these valves. Nothing much, just a profound advice of timely follow ups, healthy and active lifestyle. Hope it helps. Please feel free to ask for if you have any doubts. I will be happy to assist.
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