odd ecg finding

[Robfromwales]

over in Costa Rica and didn’t feel right after strange sensation in chest yesterday. Had ecg and first time there was no current at all on the bottom line. He then tested it on someone else and it was ok. Then redid it on me but referred to the electrical circuit as ‘low voltage’. I am coming back tomorrow to have it redone. Any thoughts?

[Robfromwales]

that’s coming back to the small clinic not coming back to the uk

[Autumn_Leaves]

I had a ‘low voltage’ result on a routine ECG before an outpatient appointment. I was very tense and not at all relaxed at the time. The cardiologist didn’t consider it of any significance at the time. It didn’t happen on my most recent ECG. It’s not possible for me as a layperson to suggest what might be happening as I don’t have the expertise. All you can do is to wait and see what the next ECG looks like and take it from there. You may need an echocardiogram to see if there’s anything that might explain it but if you’re abroad I can appreciate that complicates the situation.

[Robfromwales in reply to Autumn_Leaves]

Thanks autumn leaves. I had an ecg and electrocardiogram early Oct just gone and both ok. As you say being away makes these things more difficult.

[Robfromwales]

I might be confused and perhaps I should be looking at the aVF that has little ‘activity ‘ it seems?

[pip_pip]

I think you might wait to speak to the doctor...

[Docretd6]

It looks like the tape is running at twice what in the UK, is the normal speed, - the gap between the complexes is big. Or you have a slow heart rate. You do have "P" waves so your heart rhythm is normally controlled, you don't have atrial fibrillation. I don't see any "ST elevation" so that's good from a non-heart-attack point of view. To your question, a poor connection on the skin will reduce the voltage, and rarely if you have a collection of fluid around your heart '(pericardial effusion)' inside, that too. But the big message is that we don't have enough data, - your age, whether you have any classic heart symptoms, or what a physical examination of your heart and lungs shows. You can't just diagnose from an ECG, really, - you need the back-story and the physical examination.

[Halfheart in reply to Docretd6]

Looks like normal horizontal axis to me. 55bpm.

[Robfromwales in reply to Halfheart]

Thanks half heart. He seemed ok with results but He was concerned enough what he called low voltage to want to repeat it this morning.

[Robfromwales]

thanks docretd6. Aged 63. Male. Always had slow heart rate. Had barrage of pre operative tests early this year in advance of OHS to repair thoracic anerysm.bi have a bicuspid aortic valve with mild leakage. Had mild CVD on CT but angiogram clear ( I appreciate they focus on different things). I went to Dr in Costa Rica as had strange sensation in chest on Monday that didn’t correspond to my normal discomfort with oesphogatisis. Lasted 3-5 mins with no other symtoms. On physical examination he was happy but as I say he was surprised re what he called low voltage. The clinic doesn’t do tropinon levels so i may ask about going further afield. Hope this fills in some gaps

[Docretd6 in reply to Robfromwales]

Thank you, yes I see, you are a specialist patient! All those negative work-up findings, seem to make it less likely that something serious has suddenly sprung up on you, which is reassuring. I note that your pathology is, long-standing bradycardia, congenital bicuspid aortic valve with mild aortic incompetence, evolving thoracic aneurysm (I assume that Treponema pallidum has been excluded!), repair with presumably plastic graft?? and good result, general but mild atherosclerosis but coronary arteries clear. Plus chronic oesophagitis, I'm guessing reflux?? and presumably you're taking omeprazole or similar.

Well as you know I expect, chronic oesophagitis can give you Barrett's syndrome. I think I'd be asking for more details of the exact nature of your 3 to 5 minute chest discomfort. But my guess is that reflux or whatever, is most likely to be to blame, since common things occur commonly. Presumably your doc's don't think you need an oesophagoscopy, but they might want to consider doubling your daily dose of omeprazole/esomeprazole. That seems to me the way forwards, - that and making sure that you don't have Helicobacter pylori infection in your stomach (which is curable by tablets).

Rarities include something happening with your thoracic graft's endothelium, - but presumably nobody thinks you have had an aortic or graft lining infection. That should have shown up as leucocytosis in your blood.

I'm getting a bit speculative here, but my opinion would be towards considering Helicobacter pylori, and doubling the dose of omeprazole.

[MaryCa]

Rob any suncream or moisturiser on? That will massively affect the ECG!

[Robfromwales]

thanks mary. None on yesterday.

[Robfromwales]

thanks for all your replies. Dr did ecg and was happy that no further action necessary. ( see attached ecgs and note different speeds). I asked him what it could be ( strange sensation in left chest for 3-5 mins) and he asked about hiatus hernia which o am sure was checked for at endoscopy. He mentioned h pylori and can someone advise if I need to ask dr for a blood test for this. It certainly didn’t feel like normal Gerd symptoms that I constantly get

Ecg

[Robfromwales in reply to Robfromwales]

And this one

Ecg