Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hi doctor,
Please read my query and give me your best opinion. I am currently under a cardiologist due to fears that I have had a heart attack in the past and chronic chest discomfort. My cardiologist asked me to take a Holter monitor for 24-hours and the reports he gave me last week were normal. He said that everything was normal. He stated that my maximum pulse was 134 (while working hard), minimum 55 (while sleeping) and average 87. He did capture palpitations but said these were normal increases in pulse associated with activity. He stated that my ECG shows Q wave. Though he said, that is not a pathological and I do not have right BBB, (last week) he did, however, referred me for an echocardiogram to reassure me. He also said that it would be very unlikely for it to be abnormal considering everything else normal.
I have had lots of ECGs for the last few months and all normal aside from the Q waves. I have also had my troponin levels monitored, and these too were normal. All doctors say that it is due to anxiety. Before four days, I was taken to A and E due to a sudden increase in pulse from 81 to 135. It then settled within 2 minutes, however as it had panicked me I attended A and E. In A and E, they checked my oxygen (99%), BP (153/92 mmHg) and my pulse (118). The ECG showed normal, sinus tachycardia; however, I was concerned over what looked like ST elevation in AVR. When I asked for the second opinion, I was told that it is fine as it was only in one lead in AVR and not an acute heart attack. I then requested a second ECG as my pulse had gone down to 90s. It again showed normal sinus rhythm and no issues and was sent home from A and E. I have since been in a state of worry over my ECG, which I have attached here. I would like to ask you if the ECG show any issues aside from my usual Q waves. Also, my QRS is long on the new ECG and on this day I started a new course of medication called Omeprazole, which can allegedly cause changes to heart rhythm. Could this have caused my long QRS and heart rate spike? I am a non-smoker, do not drink and have no family history of heart disease.
Hi,
Welcome to icliniq.com.
Anxiety and panic are the first possibilities. Sudden onset of palpitations is a very unusual sign of heart attack. None of the investigation and symptoms are compatible with the heart attack. Although there are some ECG changes like Q waves, which can be present, are indicative of heart damage in case of heart attack. But, your echo is normal and so no need to worry at all. There is also T-wave insertion in lead 3 and non-significant elevation in AVR. So, given these changes, I would advise for some stress test like treadmill test or stress thallium, which you did not mention anything about. If you have not undergone it, then you can have it to rule out the possibility of inducible ischemia. The QRS prolonging of such mild degree is not significant, and this much variation may normally occur with different ECG. It is not very common with Omeprazole.
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