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Can ECG changes occur due to anxiety?

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Can ECG changes occur due to anxiety?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At December 27, 2017
Reviewed AtFebruary 6, 2024

Patient's Query

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 mm of Hg 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, so do not worry about it. Your 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 keep taking 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 important blood work to see how your blood sugar level, cholesterol, kidneys, and liver are working. I am advising you to take some tests for that. It is necessary to see if diabetes and high blood pressure have affected your body organs.

Investigations to be done

Go to the laboratory with overnight fasting and have the following tests such as serum proteins, serum electrolytes, liver function tests, kidney function tests, fasting blood sugar, HbA1c (Glycated hemoglobin), fasting lipid profile, and thyroid profile.

Treatment plan

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

Regarding follow up

Revert back with the laboratory results to a cardiologist online.

Patient's Query

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.

I would like to mention the following points. Your 2D echo report (attachment removed to protect the patient's identity) 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.

Patient's Query

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 the patient's identity) and can well understand your genuine concerns.

The Probable causes

Your blood sugar levels had not been in good control. Either you are not taking medicines on time or your diet is not proper as it should have to be. Also, you need to be physically active to keep glucose in limits. Your (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. Control your diet. It is very important to take no added sugars and salts. No, coffee, tea, beverages, energy drinks, meats, chicken, fried foods, or junk food. Avoid alcohol and cigarette. You do not have viral hepatitis, but you still have fatty liver. This may be due to alcohol intake or another disease. 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 must be done.

Treatment plan

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

Regarding follow up

Revert with the thyroid report.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Majid Hanif
Dr. Muhammad Majid Hanif

Cardiology

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