Dr. Prashant Valecha
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 use an ECG device to keep an eye on my heart. I am under treatment for high blood pressure and mitral valve prolapse and have incomplete LBBB. I notice that sometimes when I take my recording, I have these very low amplitude waves, which suddenly snap back into nice crisp waveforms. Usually, if I walk around and take my recording shortly after sitting down, I get these low-amplitude waveforms, sometimes constantly; other days, they are always crisp. Am I overreacting to what I am looking at? Is it normal to look at how it does and then suddenly pop back up?
Hello,
Welcome to icliniq.com.
I can understand your concern. It might be due to the device taking some time to get stable conduction. Otherwise, it looks good. Do not worry. You can get a normal 12-lead ECG (electrocardiogram) to confirm once in a while.
Patient's Query
Thank you for your reply, doctor.
So the change in the waveform is not due to any heart condition? Kindly help.
Hello,
Welcome back to icliniq.com.
I reviewed the reports (attachment removed to protect the patient's identity). I can see that the first complexes are broad and low voltage but later becomes normal. There is no broader complex between normal complexes, so it is because the device takes time to get proper stable conduction. Broader complexes throughout can only suggest incomplete LBBB (Left bundle branch block) is progressing to complete LBBB (12 Lead ECG needed to confirm). I would suggest getting a 24-hour Holter monitoring to see if there are these complexes in 24 hours in between normal ECG complexes. Kindly revert for more queries. Thank you.
Patient's Query
Thank you for your reply, doctor.
How about this that happens occasionally? Kindly help.
Hello,
Welcome back to icliniq.com.
Not able to see the reports. Kindly share the reports in the desired format. Thank you.
Patient's Query
Thank you for your reply, doctor.
I am attaching the reports again. Kindly go through the reports and help me.
Hello,
Welcome back to icliniq.com.
I have gone through the reports (attachment removed to protect the patient's identity). This is sinus rhythm, a little bit broad complex, but no need to worry. These ECGs are mainly used to comment on arrhythmias (commonly for atrial fibrillation). Kindly revert for more queries. Thank you.
Patient's Query
Thank you for your reply, doctor.
I have been on Atenolol 50 mg twice a day for about 30 years. I guess my extra worry was why did the former ECG look that way and now this way. Kindly help.
Hello,
Welcome back to icliniq.com.
This looks normal. Complexes in the previous ECG were downward. Is there any difference in holding the device because if you flip your right and left hand, then the lead will show reversed effect. Kindly revert for more queries. Thank you.
Patient's Query
Thank you for your reply, doctor.
It was placed properly. That is what makes me bothered. Kindly help.
Hello,
Welcome back to icliniq.com.
The ECGs you uploaded previously have downward QRS complexes and inverted P waves too. This can happen in ectopic atrial rhythm (not sinus) or electrode reversal (arm lead interchanged). If it is ectopic atrial rhythm, it can be when the sinus node rate is low and taken over by some ectopic atrial foci can possibly be due to high atenolol doses. I hope this helps. Thank you.
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