Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been suffering from hypertension and immunoglobulin A (IgA) nephropathy for the past many years, which is being treated with tablet Cardace 10 mg, tablet Stamlo 5 mg, tablet Lipitor 10 mg, and fish oil capsules. In addition, I have had a benign prostrate (Grade 2) for the last six years. For the same, I have been taking tablet Urimax 0.40 mg since the previous year and multiple thyroid nodules (largest left & right side 0.81mm x 0.50 cm, no medication). BP is around 130/80 mmHg. My latest blood test results are as follows, Total cholesterol - 155 mg/dl, LDL 95.6mg/dl, Triglycerides 92 mg/dl. FBS 90 mg/dl, Hb1AC 5.7, Sodium 140 mmol/L, Potassium 3.92 mmol/L, Uric Acid 5.9 mg/dl, Calcium 9.3 mg/dl, Phosphorous 3.6 mg/dl, Serum Creatinine 1.22 mg/dl (lab range 0.72-1.20 mg/dl), BUN (blood urea nitrogen) -11.9 mg/dl, Thyroid tests - Free T3 - 3.34 ng/dl, Free T4 - 1.58 n/dl, TSH 0.76 uIU/ml, Haemoglobin - 14.7 gm/dl. I am attaching my latest electrocardiogram (ECG) reports and my previous one from last year. I did an echocardiogram three years back, and the result was normal, with an ejection fraction (EF) of 74 %. My queries on the electrocardiogram (ECG) are as follows. The electrocardiogram (ECG) report mentions sinus tachycardia- is this due to anxiety? I was anxious during the checkup (even a year back) and noticed my increased heartbeats or chest-thumping. My pulse rate is 60 to 75 beats per minute (bpm) as I exercise daily. I have never had any episodes of tachycardia or palpitations regularly. During the recent electrocardiogram (ECG), I took several deep breaths to control my heartbeats, and the technician adjusted the leads a few times while asking me to relax. The recent electrocardiogram (ECG) mentions: Non-specific T-wave abnormality, please explain what this means. The electrocardiogram (ECG) of the previous year noted "non-specific ST-wave abnormality." Why the different comments in the two electrocardiograms (ECGs)? The electrocardiogram (ECG) mentions " occasional premature ventricular contractions (PVC)", was this due to my anxious state and fast pulse rate? I have never had any fainting episodes, feeling of missing a heartbeat, etc. What causes premature ventricular contractions (PVC)? Could my multiple thyroid nodules be a possible cause? Last year the largest nodule was 0.88 x 59 cm on the right side, but this year both the left and right sides had a nodule of 0.81 x 0. 50 cm each. Given the above electrocardiogram (ECG) results for this year and the previous year, please advise if I need to take any further action. Also, my last echo was three years back - when should I take another echo given the electrocardiogram (ECG) results?
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. Sinus tachycardia is usually due to anxiety or physical activities before taking an electrocardiogram (ECG) and is usually not a cause of concern. Your previous and current electrocardiogram (ECG) (attachments removed to protect the patient's identity) are similar except for the presence of premature ventricular contraction (PVC) in the recent electrocardiogram (ECG). Nonspecific ST or T wave changes refer to minor variations (maybe age-related) not amounting to significant abnormalities. So the only significant finding is a premature ventricular contraction (PVC). These premature ventricular contractions (PVCs) can be benign and harmless. However, we should rule out the possibility of underlying heart disease by undergoing certain tests. So you should undergo a blood test like serum potassium, calcium, and magnesium level (if not had recently), repeat a two-dimensional echo, undergo a treadmill test (TMT) or computed tomography (CT) coronary angiography to rule out the possibility of ischemic heart disease. These premature ventricular contractions (PVCs) can be asymptomatic. A thyroid nodule per se will not cause it. However, if a thyroid nodule is causing more amount of thyroid hormone in the body, it can cause both sinus tachycardia and premature ventricular contractions (PVCs). Anxiety alone is unlikely to cause premature ventricular contractions (PVCs). So, in a nutshell, besides premature ventricular contraction (PVC), there is nothing significant on electrocardiogram (ECG), and this premature ventricular contraction (PVC) can also be a benign and harmless finding (many individuals get these extra beats normally as well). However, the possibility of underlying heart disease should be ruled out after further tests, as I mentioned above. I hope this helps you, and get back if you have any more doubts or information to share.
Patient's Query
Thank you for the reply doctor.
I have a few more queries. My recent blood test reports were: Calcium 9.3 mg/dl, Potassium 3.92 mg/dl. I did not do a magnesium test. How will ischemic disease appear on a two-dimensional (2D) echo? The electrocardiogram (ECG) stated occasional premature ventricular contraction (PVC). Was this frequently showing on the electrocardiogram (ECG), or was it an isolated instance? Can premature ventricular contraction (PVC) develop within a year? My previous year's electrocardiogram (ECG) did not indicate sudden ventricular contraction (PVC), but the recent electrocardiogram (ECG) stated occasional premature ventricular contraction (PVC). Given the two electrocardiograms (ECGs) and my blood test results, in your opinion, do you think there is a high possibility of ischemic heart disease? Will premature ventricular contraction (PVC) show up on a stethoscope examination by a doctor?
Hello,
Welcome back to icliniq.com.
It would help if you repeated these blood tests once, including thyroid profile (triiodothyronin, tetraiodoithyronin, and thyroid stimulating hormone), as electrolyte imbalance may occur in kidney disease. Premature ventricular contractions (PVCs) usually occur intermittently, so it is possible that they might get missed on an electrocardiogram (ECG) examination. On the stethoscope, the doctor may appreciate the skipped beat (which implies the patient may have atrial or ventricular ectopics); final confirmation requires an electrocardiogram (ECG). Premature ventricular contractions (PVCs) can develop within a year. There are only occasional premature ventricular contractions (PVCs) rather than frequent electrocardiogram (ECG). To know the exact frequency and severity, you can undergo 24-hour holter monitoring. On a two-dimensional (2D) echo, ischemic heart disease will be seen as regional wall motion abnormalities (RWMA) or reduction in ejection fraction. There are no ischemic changes on electrocardiogram (ECG), so the probability of ischemic heart disease is not high, but the possibility of ischaemic heart disease (IHD) should be ruled out at this age.
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