Patient's Query
Hello doctor,
I had a DVT with a massive pulmonary embolism and infarction four years ago. Since then, I have experienced a few anxiety or panic attacks. Two months ago, I had a heart ultrasound and ECG, both of which the physician deemed perfectly normal. Based on his advice, I stopped taking Bisoprolol and started using Alprazolam and Lorazepam as needed. Two weeks ago, I had an incident where my blood pressure spiked to 210/107 mmHg, and my heart rate was 110 bpm. I went to the ER, where I had an ECG and a blood test for cardiac markers. The doctor who reviewed the ECG mentioned that it appeared the right side of my heart might not have received enough oxygen. I then scheduled an appointment with another physician, who now wants to send me for an angiogram. I would like a second opinion on the most recent ECG. The ER doctor suggested that a panic attack could also affect the ECG results.
Please suggest.
Hello,
Welcome to icliniq.com.
Your electrocardiogram is fine (attachment removed to protect patient identity). There is left axis deviation, which is commonly seen in hypertension or with age. This left axis deviation may have been mistakenly interpreted as Q waves by a physician, leading to the assumption that the right side of the heart is not getting enough oxygen. Based on the ECG you provided, I do not see an immediate need for an angiogram. However, considering your age, hypertension, and history of pulmonary embolism, it would be advisable to get an echocardiogram if one has not been done recently. Additionally, it would be beneficial to undergo a stress test, such as a treadmill test or a stress echo. The blood pressure spike may be related to age, combined with panic or anxiety. I recommend that you keep a blood pressure monitor at home and check your readings at least three times a day for a week. If most of your readings are above 140/90 mmHg, you should consider starting regular medication for hypertension. Also, adopting a low-salt diet and engaging in regular exercise would be beneficial.
I hope this information helps, and feel free to reach out if you have any further questions.
Patient's Query
Hello doctor,
Thank you for the reply.
It puts my mind at ease. My blood pressure is mostly within the range mentioned above. I am generally inactive due to the damage to my leg, and I believe the blood pressure spike was influenced by stopping Bisoprolol. I feel normal with a heart rate between 85 and 100. I suspect that if I can start exercising again, it would help a lot. I am not sure if you have had a chance to review my lung function test, but I am wondering if that is also within normal limits after PE with infarction.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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