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Q. Can ECG changes occur due to anxiety?

Answered by
Dr. Muhammad M. Hanif Md.
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 27, 2017

Hi doctor,

I am a diabetes patient. Recently, I had an ECG done which showed borderline normal sinus arrythmia. Immediately, I had a 2D echo and it showed a normal study. But my blood pressure is not normal. It is around 150/90 and so my doctor advised me to take Betaloc-50. In addition to this, I have anxiety problem for many years. Please help with some advice.

#

Hi,

Welcome to icliniq.com.

I want to assure you that do not worry as everything is going to be fine soon. I have thoroughly gone through your case and can well understand your genuine concerns. I appreciate the efforts you put in to upload the case completely along with EKG reports (attachment removed to protect patient identity).


The Probable causes:

There is only a slight variation in the normal sinus rhythm and so do not worry about it.
Your BP (blood pressure) is high and needs treatment. For that you said you are on Betaloc-50 (Metoprolol). When did you start taking this medicine? I will suggest you to keep taking the medicine for BP and hope that will control your blood pressure. Keep a record of your blood pressure and after sometime make a follow-up to see how things are working. If needed we may add some medicine for blood pressure.

Diabetes and high blood pressure are two important risk factors for heart diseases, coronary artery diseases and heart attacks.
You also need to go for some blood work important to see how is your blood sugar level, cholesterol, kidneys and liver working. I am advising you some tests for that. It is necessary to see if diabetes and high blood pressure has affected your body organs.

Investigations to be done:

Go to lab with overnight fasting and have the following tests:-
1. Serum proteins.
2. Serum electrolytes.
3. Liver function tests.
4. Kidney function tests.
5. Fasting blood sugar.
6. HbA1c.
7. Fasting lipid profile.
8. Thyroid Profile.

Treatment plan:

1. Continue the medicine and consult a psychiatrist for anxiety.
2. Make an appointment, as you need in person visit to discuss in detail about the past medicines too.

Regarding follow up:

Revert back with the laboratory results to a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

As I informed my ECG report showed normal borderline with T-wave abnormality (flat) and also sinus arrythmia, can the ECG changes occur due to anxiety? In this, I have also attached my 2D echo report. Please have a look.

#

Hi,

Welcome back to icliniq.com.

  • Your 2D echo is markedly unremarkable as it is massively normal. No major change seen especially in the septum which is the wall between the heart chambers.
  • The heart is pumping the blood normally and there is no thickness or dilatation of the chambers of the heart seen. Your heart's covering is not inflamed and heart chambers have no issues.
  • This is not an anxiety induced change. Also flat T-waves as I mentioned in my previous reply are not an issue of major medical concern. No doubt that flat T-wave may also be due to heart muscle ischemia (partial loss of blood supply) but this is unremarkable and has no significance especially in your case where there is no finding and no more abnormality seen.
  • Please take your blood pressure medicines regularly and let me know after a few days how are you doing. Please make a chart right now. Write down blood pressure recordings with date and time on that chart and attach the picture of the same. We will see how to proceed.
  • Also go for the blood work as advised and attach the reports. It is necessary to keep the blood pressure in check to save the heart from enlargement and to save the blood vessels from clogging and getting stiff due to high blood pressure.

Revert back with the blood work reports to a cardiologist online -->  https://www.icliniq.com/ask-a-doctor-online/cardiologist


Hi doctor,

I am attaching my laboratory reports as you said. In my ultrasound scanning, it is given as fatty liver and kidney stones. Please verify and comment on these. I am feeling some little pain in the upper back and on the sholuders, better to say a kind of tightness.

#

Hi,

Welcome back to icliniq.com.

I want to assure you that do not worry as everything is going to be fine soon. I have thoroughly gone through your case and laboratory reports (attachment removed to protect patient identity) and can well understand your genuine concerns.


The Probable causes:

Your blood sugar levels had not been in good control.
1. Either you are not taking medicines on time or your diet is not proper as it should have to be for diabetes.
2. Also you need to be physically active to keep glucose in limits and to save your eyes and kidney from diabetes. Also brain and heart, peripheral nerves and other major organs from the worst effects of diabetes.
3. Your glycated hemoglobin (HbA1c and HbA1) levels in blood work are high and show that your blood sugar levels had not been in normal limits in the past 120 days.
4. Control your diet and it is very important that you take no added sugars and salts.
5. No, coffee, tea, beverages, energy drinks, meats, chicken, fried foods, junk food.

Avoid alcohol and cigarette. You do not have viral hepatitis but still you have fatty liver. This may be due to alcohol intake or other disease.

You have kidney stones and also stone in ureter. This may be the reason for the pain in back and shoulders.

Rest of the reports are grossly unremarkable. Your kidneys and liver is working otherwise fine. Your lipid profile is normal and you have little to no cardiac risk due to cholesterol.

Investigations to be done:

Thyroid profile.

Treatment plan:

1. For urolithiasis (stones) you need an appointment with an urologist.
2. Take plenty of water and avoid hot and humid environment.
3. Take cranberry juice to help maintain urinary hygiene.

Regarding follow up:

Revert with the the thyroid report to a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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