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EKG done when anxious and after Alprazolam

Resolved Question:

Hi,
Could you please check my 2 ekgs and tell me what's wrong,
the other day I went to ER and I had 2 ekgs and a chest xray and the doctor said I had two tiny blockages but not a concern. my question is you as a cardiologist what do I have? Why? and is it going to progress? what can I do so I doesn't progress?

My first ekg was because I had a lot of anxiety and the second is after they gave me alprazolam 0.5mg.But they are both the same night.

Thank you!


Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Hello

Thank you for your query at doctorspring.com. First and foremost please tell me what were your complaints in detail that took you to the ER. What were your vitals that is pulse and bp at that time. Were any other investigations apart from the ecg and chest xray done. Also I would like to know whether you are a smoker / hypertensive /Diabetic.

From whatever you told, you are 22 year old and the possibility of so called blockages is very very rare at this age. Not that they can never occur at this age but its rare. Secondly no of blockages cannot be determined by ECG. You have provided me the same ecg twice. The ECG shows a poor R wave progression and a borderline Right atrial enlargement. This does not indicate any block or hear attack. Bytheway Do you have any lung disease or chest deformity.?

I would request you to be more elaborate in your description of complaints and any other investigations that you may have.
You can reply as a followup question.

Regards
Dr Vivek Mahajan


Patient replied :

Here's the first ekg sorry.

not diabetic or smoker or hypertensive

I went to the er because of my stomach i had a lot of flatulences and burping. he told me I had parasites.
I do not have any lung disease or chest deformity from what I know

I do not have the pulse or bp of that time.

the two things you told me what should I do about that?


Expert:  Dr. Vivek Mahajan replied 3 Days.

Hello
Your first ecg before alprazolam shows sinus tachycardia along with the same p wave abnormality and poor r wave progression. There is incomplete Right bundle branch block RBBB. Its not very clear from the ecg but I feel you have a prolonged QTU interval too. There are T wave inversions in your ecg in inferior leads better seen in first ecg during tachycardia still I don't feel they are dynamic and related to any ischemia.
What I suggest is that you get a screening 2d echo for any underlying structural heart disease given the minor and not so serious ecg changes that you have. I would not recommend any test for evaluating ischemia as you are asymptomatic and the ecgs are not convincing about ischemia. Regarding prolonged QTU if you never had a history of sudden deaths in family or you never had a fainting episode, nothing more needs to be done.
So i would suggest you to get a 2d echo done. Hopefully it will turn out to be normal and the anxiety about the ecg changes shall be allayed

Regards


Patient replied :

hi,
Let's suppose there's only the second ekg, would I still need the 2d echo ? because in the first ekg I was almost having a panic attack so I'm sure it came bad because of that.


Expert:  Dr. Vivek Mahajan replied 2 Days.

Hello,

You are not having any symptoms. I don't have any access to your examination findings but probably they are normal or else you would have mentioned any abnormality there. Also you have incidentally detected ECG changes which may occur in normal individuals too. So there is nothing alarming here.

Strictly going by guidelines an Echo is not a must have. But going by your ecgs a simple test like echo which is noninvasive and takes only 10 min can easily take out the doubt off your and my mind. So why not get it done and settle the doubt about the ECG once and for all.

Regards
Dr Vivek Mahajan


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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