Q. My mother feeling lethargic and has chest discomfort. Is there anything abnormal in her EKG?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 17, 2020

Hello doctor,

My mother takes Losartan to manage her BP for a few years now. This week her BP went up to 190/115; she took an additional Losartan (50 mg) dose, which got better. The BP has been fluctuating since but has not been that high. She feels a little lethargic, with a dull headache and a little chest discomfort (not pain). I am attaching a PDF of her EKG. Her cardiologist appointment is not until next week, so I wanted to consult with someone right now. Can you please see the EKG and let me know what you think, is there anything abnormal? She is currently taking Losartan, Levothyroxine, Metoprolol, Metformin 850 mg and 500 mg, Aspirin, and Crestor. Thank you.



Welcome to icliniq.com.

Her EKG (Electrocardiogram) shows Q waves in III AVF (Arteriovenous fistula), and no significant ST T abnormalities are seen. These Q waves mean there might be a possibility of an old heart attack. So she should undergo an ECHO to rule out the case of an old heart attack. However, since this not a standard EKG, the reliability is questionable, and a standard 12 lead EKG is required. But there are no ST T abnormalities, which means there are no new or recent changes. So, EKG is fine, and her symptoms may not be cardiac (however, since this is 6 L EKG, it can miss some findings). Does she have any gastric symptoms like bloating, burping, or upper abdominal pain, which could explain her heaviness? or does she have tenderness over the chest on applying pressure (which suggests the possibility of local musculoskeletal causes)? Cardiac heaviness would classically increase or come on exertion and relieves with rest. BP target should be 110 to 130 systolic, and accordingly, you may adjust the Losartan dose. You may add Losartan 25 mg additional in the evening if BP remains above 130 systolic, which would also avoid such accelerated hypertension. Avoid consuming NSAIDs (Nonsteroidal anti-inflammatory drug) or pain killers, which could precipitate accelerated hypertension. I hope this helps you and get back if you have any doubts.

Hello doctor,

Thank you so much for the detailed reply.

She says that she does have some bloating but nothing too major. No burping, abdominal pain, or tenderness when applying pressure to the chest. We are not aware of any previous heart attack that she might have had. She does have a cardiologist that she sees; I am trying to get her in tomorrow to do the echo and any other necessary tests. When you mention an old heart attack, how old can it be? Are we talking about years or days?



Welcome back to icliniq.com.

More than a week atleast, and could be months or years. If there is no history and subsequent echo is normal, these may be physiological changes (can be customarily seen). However, ECHO is necessary in people with diabetes, sometimes heart attack or blockages may be asymptomatic. She should also be having some antacids like Pantoprazole or Rabeprazole, etc., once daily before breakfast. And at this age, due to diabetics, the probability of blockages is higher, so should be subjected to some cardiac screening tests like ECHO and stress test like TMT (Treadmill test) or stress thallium or CT (computed tomography) coronary angiography.

All the best.

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