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Q. My ECG last week showed sinus rhythm and right axis deviation. Should I be worried?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 16, 2021

Hello doctor,

I had an abnormal electrocardiogram (ECG) last week with sinus rhythm and right axis deviation. It has gotten worse the last few days, and I have episodes of severe electric pain, heart rate spiking and dropping very low, dizziness, and nausea. I purchased a portable ECG, and I took some readings, but they do not look right. Should I be worried?

#

Hello,

Welcome to icliniq.com.

The 12 leads ECG (electrocardiogram) shows a left posterior hemiblock (attachment removed to protect the patient's identity). As you had myocarditis a few months ago, please share echocardiography, and MRI (magnetic resonance imaging) reports. And now repeat echocardiography if not done in the last six months. Regarding your device ECGs, these are single leads, but there are artifacts, and the baseline is fluctuating, so they cannot be commented on. Please tell what medicines you are taking for myocarditis, what was left ventricular ejection fraction (share echocardiography report) and repeat echocardiography so that your medicines may be adjusted accordingly. Chest pain does not seem to be due to the heart.

Thank you doctor,

I am not able to get copies of the echocardiography. I am attaching my MRI as well as the most recent resting ECG. I have learned further since I last liaised with you. My main challenge is my heart rate which suddenly drops to around 30-50 beats all of a sudden, and I can feel when it happens I want to fall asleep. I get so weak and nauseous, and lightheaded that I need to lie down and take a couple of hours to pass. It happens daily. I have a Holter ECG put on. My cardiologist is not very helpful. May I ask about the hemiblock? Is it ok to ignore it? Could anything pulmonary explain it? I am so desperate for someone to tell me anything. I cannot get help. I have erythromelalgia, severely low plasma proteins, and cutaneous manifestations started at the same time as chest trouble.

#

Hello,

Welcome back to icliniq.com.

Thanks for the follow-up, madam. I have read your query, and I can understand your concerns, worries, and pain you are going through. I hope my reply will clarify your concerns and give you a sigh of relief. Your previous ECG (electrocardiogram) showed slightly broad QRS complexes (107 ms), signifying incomplete left bundle block, but this ECG (attachment removed to protect the patient's identity) is better (rather normal) with a QRS width of 100 ms (normally less than 100). MRI (magnetic resonance imaging) findings are not specific for myocarditis, but to be on the safe side, we can assume myopericarditis. Cardiac enzymes (CK-MB and Troponin I) elevation may further guide towards myocardial involvement. Contraction and overall function of the heart are normal in MRI, which are against the diagnosis of myocarditis. If myocarditis was diagnosed ten months ago, then now repeat echocardiography or MRI should be done, and ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and CK-MB (Creatine kinase-MB), Troponin I levels be done to document normalization. I hope echocardiography would also be normal. No treatment is needed. Only refraining from exertion for atleast three months from myopericarditis diagnosis or until normalization of cardiac enzyme levels, ESR, CRP (whichever longer) is all that is required. Regarding heart rate, sometimes less than 40 and sometimes 200, it needs documentation in the form of ECG. Holter is needed to capture the intermittent rate fluctuations and to diagnose the abnormality in rhythm. Once you have the Holter report, please send me so that I may guide you accordingly. In recent ECG, there is no block. Do low plasma proteins lead to swelling of feet or around the eyes? Do you have swelling? What are the albumin levels? Are you taking any medicine for heart or rate-controlling?


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