Dr. Isaac Gana
Cardiology
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Patient's Query
Hello doctor,
My doctor prescribed an ECG to determine whether there is a possible postural orthostatic tachycardia syndrome diagnostic or something else. I received the following results for my stress test and resting ECG, "baseline ST segment abnormalities with the presence of inverted T waves. During exercise, there is an accentuation of the ST segment abnormalities without significant depression at the J point; however, clinically and electrically negative stress test. Low exercise tolerance for age. Normal heart rate response during exercise." What could this mean? I am taking Ozempic, Citalopram, Vyvanse, and Pms Ferrous sulfate. Thank you.
Hello,
Welcome to icliniq.com.
Baseline ST segment abnormalities with an inverted T wave could mean a narrowing in your heart vessel, reducing oxygen flow to some parts of the heart. It can occur due to atherosclerosis or fat buildup in the heart. The stress test has ruled out the chance of narrowing to a great extent. During exercise, there was no sign to suggest narrowing. Low exercise tolerance is due to your weight. Did you check your glucose and calcium levels? Thank you.
Patient's Query
Hello doctor,
Yes, I have had an intolerance to exercise, heart palpitations, and extreme fatigue, amongst other symptoms, which is why we were looking into POTS. I have taken some screenshots of the results you have asked for, which should be attached to this message. Thank you.
Hello,
Welcome back to icliniq.com.
Glucose and the other variables are normal. Nothing in these investigations suggests POTS (postural tachycardia syndrome) disease. Did your doctor do a tilt table test or an active stand test? Both of these tests are more diagnostic of POTS. Try to lose weight to increase your tolerance to exercise. How long have you been taking Ozempic? Thank you.
Patient's Query
Hello doctor,
What is your opinion on the Holter and ECG or stress test results? I have attached the 24-hour Holter test I recently did. We still need to do a tilt table test. We stopped the stress test because I felt dizzy and not because of muscle fatigue, as the report would indicate. Typically, my BPM will rise a lot when I stand between 30 to 50 more on average. I am also often dehydrated though I drink 64 Oz of water per day. I have been on Ozempic for around two months, increasing to 1 milligram a week. Thank you.
Hello,
Welcome back to icliniq.com.
Dizziness and faintness are what I often see in patients during stress. It is not a specific indication of a problem. Chest pain is more of an indicator. So in your case, it may not be significant. How many minutes did you run on the treadmill before you began to experience symptoms? Did you get any chest pain? Do you have a history of any chronic respiratory diseases like asthma? Have you ever experienced any chest pain before you started experiencing exercise intolerance? Have you always been overweight? Thank you.
Patient's Query
Hello doctor,
I did not time the minutes, so I am not sure. I did not feel any chest pain, only dizziness, lightheadedness, or a feeling of my legs getting limp. No history of asthma and no prior chest pain. I was not the skinniest kid, but I noticed weight gain around the time I was diagnosed with PCOS. I have also taken Citalopram for years which has a side effect of weight gain. In the past eight months, I have slept half to three fourth hours of the day, leaving little room for me to do anything, let alone do exercise other than walking. Why does my heart rate go up significantly when I stand up and have all these symptoms? Thank you.
Hello,
Welcome back to icliniq.com.
I have taken time to study the result of the Holter test carefully. The only findings are mostly PVCs (premature ventricular contractions). The PVCs are usually not harmful and do not explain your symptoms, nor does the stress ECG (electrocardiogram). Based on all your symptoms, I am certain you have POTS (postural tachycardia syndrome). Dehydration and alcohol can worsen your symptoms. The majority of the time I had made a diagnosis of POTS in the past, the investigations were usually normal. The only test that often comes out positive is the tilt table test. Why has your doctor not ordered the tilt table test? To help reduce the symptoms, you will need to hydrate more. You need a beta blocker medication to ease tachycardia, depending on your symptoms. Thank you.
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