How is a cardiac structural abnormality diagnosed?

Question

Hello doctor,

I have a friend who is an athlete and has a history of panic attacks. Yesterday, he experienced palpitations and some tingling, so he was sent for an ECG. The findings showed sinus rhythm, marked right axis deviation, and no abnormalities. Would you be able to review it and advise on the next steps I should take?

Answer 1

Hello,

Welcome to icliniq.com.

I carefully reviewed your electrocardiogram images (attachment removed to protect patient identity) and would like to explain that, in addition to the right axis deviation, I also noticed prominent P waves in the DII lead, which could suggest a pattern consistent with the left posterior fascicular block. For this reason, I recommend performing a cardiac ultrasound to assess the heart and rule out any possible structural abnormalities.

Regarding the tingling, I also suggest checking thyroid hormone levels and blood electrolytes to identify any potential imbalances.

I hope you find this information helpful.

I am available for any further questions you may have, whenever you need.

Answer 2

Hello,

Welcome back to icliniq.com.

I would not send him to the ER, but I recommend avoiding strenuous physical activity until it is confirmed that the ECG changes (large S waves in V1-V3 and axis deviation) do not indicate any structural cardiac abnormalities. The next step would be a cardiac ultrasound, and if necessary, a cardiac magnetic resonance imaging (MRI) test.

I hope this helps you.

Thank you.