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ECG abnormalities in T-waves

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by kermit frogsquire, May 19, 2014.

  1. kermit frogsquire

    kermit frogsquire *****

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    Hello everyone,

    I know a lot of people have had ECG's and eventhough they know something is wrong with their heart, they get told the report is normal. However, a friend recently told me about abnormalities on these tests that most cardiologists overlook. If anyone has got a copy of their ECG I would be really interested to know if they have got the following abnormalities because three people I know have got them.

    My friend told me to look for a T-wave in the ECG report marked "V1" and compare it to the T-wave in the line marked "V6". If the "V1" T-wave is taller than the "V6" one then it is a clear sign of heart problems. I looked at mine and sure enough the "V1" one was slightly taller than the "V6" one. The difference can be quite subtle, but normally the "V1" T-wave is much smaller or even upsidedown.

    There is a great description of T-waves here:- http://lifeinthefastlane.com/ecg-library/basics/t-wave/

    Scroll down to the section called "Loss of precordial T-wave balance". There is even a nice video explaining exactly what these tall T-waves are all about in line "V1".

    Another clear abnormality that cardiologists often don't look for is an inverted T-wave in the line that is marked "aVL" on the ECG report. Just look for an upsidedown hump, it should be the right way up especially if the one in line "I" is also the right way up.

    These T-wave abnormalities are a sign that the heart is in trouble - not enought blood supply, ischemia, or just under strain. People often have these abnormalities in A&E before full blown cardiac arrest due to blocked arteries. Eventhough the abnormalities are subtle, patients can have really serious symptoms with them. Therefore, these abnormalities could give objective evidence to why people with ME/CFS cannot exercise. Obviously most people with ME don't have blocked arteries, but something just as serious must be causing the heart to be under similar stress.

    The only caveat is that if someone is on too much thyroid med or other meds that affect the heart, like antidepressants, it could cause these abnormalities eventhough nothing is really wrong.

    I would be really interested to know if you have any of these abormalities. This is one a friend sent to show the subtle differences: http://tinypic.com/r/312zhfl/8

    Best wishes - Kermit
     
    Ema likes this.
  2. Hanna

    Hanna Senior Member

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    I had inversed T waves reported in 2000 (along with I, T and Q). I had to follow one month of cardiac rehabilitation exercice (I was already deconditionned since 1998). But my cardio tells me that everything is "OK" for sure.
     
  3. kermit frogsquire

    kermit frogsquire *****

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    Hi Hanna,

    That's really interesting, do you know if you still have T-Wave inversions? Also what lines was it reported in? The aVL line seems most significant for inversions because T-wave inversions are completely normal in V1, V2 and aVR.

    Also, I don't suppose you know if you had upright tall T-waves bigger in "V1" than "V6". These are the hyperacute T-waves that seem most related to cardiac stress.
     
  4. Hanna

    Hanna Senior Member

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    Jerusalem, Israel
    I apologize I don't have the scientific background to answer your question Kermit. Neither do I know if I still have the problem. Everything was written in Hebrew, and I also have some trouble to understand the language...
    Maybe I read it the wrong way : it is written (from bad translation)
    " T waves inversed in V-1-3 L1AVL".
     
  5. kermit frogsquire

    kermit frogsquire *****

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    Hi Hanna,

    No worries, I didn't understand a thing about ECG's until I read the site I posted above, everything is really simply laid out.

    http://lifeinthefastlane.com/ecg-library/basics/t-wave/

    From what you say it looks like you had an inversion in lines "V1" "V2" and "V3" plus and inversion in line "L1" and line called "aVL".

    Since your T-wave was inverted in "V1" it cannot be taller than the one in "V6" which is the thing I was interested in.

    But you have so many T-waves inverted that it surely can't be normal? The "aVL" inversion is interesting - there is a video about inversion in "aVL" here:

    http://ekgumem.tumblr.com/post/17948735839/killer-t-wave-inversions-in-avl-episode

    Other places talk about an inversion in aVL and L1 as showing ischemia - it's so bad that your doctor ignored it. If a repeat ECG was also abnormal then I think it should be followed up.
     
    Last edited: May 20, 2014
    Hanna likes this.
  6. Ema

    Ema Senior Member

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    I have half a dozen ECGs if you would like to look at them from my time last year with Dr Lerner.
     
  7. kermit frogsquire

    kermit frogsquire *****

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    Hi Ema,

    That would be great. I know Dr Lerner talked about T-waves quite a bit and suggested the abnormalities were caused by "abnormal cardiac wall motion" and herpes viruses.

    I'd really like to see your ECG's especially as you saw Dr Lerner. I thought about seeing Dr Lerner once, but the trip was too far. What was your experience with him like?

    Can you upload your ECG's to somewhere like tinypics - obviously deleting your name and address before:)
    or you can email me on mister_k_frog@yahoo.co.uk
     
  8. kermit frogsquire

    kermit frogsquire *****

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    Hi,

    Following up on the ECG's I have just read that there is a blood test that can help distinguish if the heart is under strain. It is called B-type natriuretic peptide. Has anyone had that done? I was wondering if Dr Lerner does this test?

    http://en.wikipedia.org/wiki/Brain_natriuretic_peptide

    It seems very sensitive because even people with chronic inflammation from Hepatitis C come up positive on it. The reason that they did this research on Hepatitis C patients is because it was found that they had higher rates of cardiac problems, the conclusion being that chronic viral infection (even in the liver) causes heart problems. They have even studied the levels of B-type NP in Lupus patients - again it is elevated from controls.

    http://www.ncbi.nlm.nih.gov/pubmed/17318274

    Surely ME/CFS patients with heart problems and subtle ECG abnormalities must have elevated B-type natriuretic peptide. Why has this study never been done? It seems researchers don't have any common sense when it comes to ME. My thought process would be: Exercise problems = ECG abnormalities = Possible heart problems = Confirm it with a test. Keep it simple.

    Have you had a chance to look out those ECG's, Ema?
     
    Last edited: May 21, 2014
  9. Ema

    Ema Senior Member

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    I have not had that blood test. I'm not sure if Dr Lerner uses it, but he didn't test it in me.

    I have to scan the ECGs yet...hopefully later this morning but in the next day or two for sure.

    I'm interested to hear if you see anything. I certainly don't though Dr Lerner did make some notes indicating he saw his typical pattern of T wave flattening on some of them.
     
  10. kermit frogsquire

    kermit frogsquire *****

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    Thanks, Ema, I am definitely very interested in having a close look, it sounds like Dr Lerner must have seen something. Even tiny notching and J-waves are potentially abnormal.

    The trouble is, for every subtle abnormality there is a "normal" reason that could also explain it, which is why we could do with something like that B-type peptide test to prove there is something wrong - no one seems to care about the fact that our symptoms should be the proof.

    I'm going to try and get my B-NP tested next time I see my doctor, I looked it up and it is on the list of tests that the local lab can do.
     
  11. Ema

    Ema Senior Member

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    I actually have had the BNP test recently...the result was 60 (0-100) pg/ml.
     
  12. Ema

    Ema Senior Member

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    ECGs
     

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  13. Ema

    Ema Senior Member

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    More...
     

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  14. kermit frogsquire

    kermit frogsquire *****

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    Hi Ema,

    Wow, those are some pretty weird ECG's. Thanks for posting them.

    The automated report has churned out "right ventricular hypertrophy", "left ventricular hypertrophy" (LVH), "possible left atrial abnormality", "possible infarction", and suggested you have a "normal rSr'" pattern which comes and goes ... which I'm not sure it would come and go if it was "normal".

    Looks like you have stumped the computer analysis and I wouldn't like to say what was going on ... only that your ECG's look very strange.

    I can see why Dr Lerner has marked up flat T waves though as you have definitely got flat T-waves in a lot of leads. The slope of your ST segment is also very flat which they mention is an abnormal finding in the videos that I posted above. I also thought your P-wave was a little lopsided, it is marked up on one of your ECG reports.

    So, did Dr Lerner suggest those results were caused by a virus? Did you try valganciclovir?
     
    Valentijn likes this.
  15. Ema

    Ema Senior Member

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    They do look strange, don't they? I always wondered how accurate they were in general given how much variation there was in the results.

    They were always done at the tail end of a two day trip out of town for a cidofovir IV...after a stressful day in the hospital, a stressful night in the hotel, and a stressful appt with Dr L himself. I wonder if that also could have had an impact on the findings.

    Once I waved my hand just as she went to press the button on the machine and it came up with a real mess of wavy lines etc so it is seemingly very sensitive. Perhaps they should only be done quiet and laying down - not sitting up and chatting with the nurse?

    The flattened T waves seem constant, so probably that can be trusted as a replicable finding. But I don't know about anything else.

    I don't seem to have that V1/V6 T wave thing??

    Dr L never said *anything* to me about the ECGs. So I have no idea what he thought of them, really. He is not the type to share his interpretations much with patients. I asked for a report of his findings when I stopped seeing him and he declined to provide me with one.

    He did diagnose me with EBV, CMV and HHV6 and I have been on Valtrex for about a year, Valcyte for about 6 months and I did about 9 months of IV cidofovir.

    Honestly looking at these gives me horrible flashbacks to organic chemistry and having to try to name the chemicals based on spectroscopic analysis of their peaks.
     
    kermit frogsquire likes this.
  16. kermit frogsquire

    kermit frogsquire *****

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    Hi, Ema. Thanks so much for sharing all that, it's very very interesting.

    I know that the ECG machines are very sensitive to movement and coughing, I always get told to sit still, but it usually just causes interference and makes the output difficult to read rather than causing abnormal waveforms. It is very poor of Dr L not to share his findings with you.

    The only thing that I could find that was similar to your long flat T-waves was in people who have low potassium and other similar electrolyte disturbances. In that case you get a T-wave mixed in with a U wave making a long flat hump.

    Were you always on cidofovir when you had those ECG's?

    Since cidofovir is quite harsh on the kidneys and you had the ECG after travel and stress, I wonder if perhaps it was being affected by that? Like you said, I don't think it was the best time to have an ECG, you could do with your local doctor to give you one so you can get a good baseline. If your ECG was still abnormal without cidofovir (or any other potentially toxic drugs) I think they are very significant for something.

    Incidentally, I had Valcyte too (for IgM and IgG HHV6). It was the only time in 20 years that my V1>V6 went away on my ECG. I could also exercise for the first time since being ill too. Having said that the Valcyte made all my skin flushed, so perhaps it had some weird nitroglycerine like effect in improving blood flow (in other words nothing to do with viruses). Unfortunately, I couldn't tolerate the Valcyte and had a really bad reaction to it, so perhaps I had an allergy and the flushing was caused by that.

    The trouble is that there is not enough help and too many possibilities - I'm very interested to hear of your experience on Valcyte and Cidofovir. I am assuming that they didn't help much since you are on here though?
     
  17. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    P waves look like an odd shape to me or larger then normal, but could be normal. Sometimes they can look enlarged as there maybe 2 signals coming from the SA node in the atrium, sort of one overlaps the other making it look like one larger p wave. some t waves seem to be further away from the QRS complex compared to a normal ecg, so maybe a delay in the heart resting and getting its own coronary blood supply. Inverted t waves in the V leads that u have can mean ischaemia, basically the heart is working hard and the heart muscles isnt getting quite enough oxygen??

    A quick run down on a few basics i know about ecg's.
    leads 2/3/avf are looking at the inferior side of the heart, v1/v2 are the septal part of the heart, v3/v4 is the anterior side of the heart and v5/v6 is the lateral side of the heart as well a lead 1. AVR is suppose to show inverted t wave? They mostly all looking at the left side of the heart. ST depression is a sign of ischeamia and elevation is a sign of a myocardial infarction, but also depends on the extent of the elevation or depression as well as it needs to be in several leads? Inverted T waves can be a sign of ischeamia or a possible myocardial infarction, but all this needs to be confirmed with blood work etc. Nothing taken in isolation.

    Twave abnormalities as lerner has mentioned being a sign of herpes virus infections could mean that the heart isnt resting or perfusing the heart muscle adequately in between beats as the t wave signals when the heart is in a resting state.

    There are alot of different variations of normal. looking at your ecg in isolation i would say they are minor abnormalities. It would be interesting to have an ecg done during a stress test to see if things change further. Also generally it is said not to take the computer diagnosis as gospel as they have a low accurracy rate.

    I will say that at work im normally only looking at ecg's in an acute situation, not really chronic conditions, so dont take what i have said as gospel either.;)
     
  18. kermit frogsquire

    kermit frogsquire *****

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    Interesting comments, Heapsreal.

    I think you have hit the crux of the issue - the abnormalities in the ECG's are fairly subtle, so if we were healthy it wouldn't be an issue ... but we aren't healthy, we are very ill and have symptoms that strongly indicate some form of strain and/or ischemia in the heart. Taken with the subtle chronic abnormalities on an ECG that could indicate the same, I think it is definitely an issue. What that issue is and what it means, I don't know precisely - abnormal wall motion - ischemia - some heart conduction defect - diastolic dysfunction - lack of venous return???

    Also with respect to stress testing, in an article I read (Eur Heart Journal 19 April 1998) patients with severe angina took on average 6 1/2 minutes on a treadmill to induce ST segment depression. That was an average of 809 patients in the study. Also on average those angina patients exercised for 10minutes in total.

    The problem is that when I do a stress test I collapse after 5 minutes, whilst reaching 50% of VO2max and 200bpm HR. So the ST segment depression on stress testing is possibly not as helpful as it could otherwise be. Also only 68% of patients with proven CAD had ST segment depression anyway.

    I'd be interested to know what you know about Early Repolarisation, especially Haïssaguerre ECG patterns, and also when it seems to affect almost every lead.
     
  19. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    Struth, your questions now are beyond me. I know with endocarditis that one can have global st elevation but the elevation there isn't a sign of a heart attack but just what happens to the ecg during this infection.

    I suppose the subtle changes along with viral blood work could be used as a diagnostic marker as Lerner uses it. As far as treating the ecg I guess we can't directly but indirectly through treating the infection. Also the stress test would also be useful. I guess it shows or explains that someone could have orthostatic issues?

    Be interesting if there has been and reviews of autopsies of ME patients hearts to have a real look at what's going on eg enlargement infection etc. Also common for certain infections to cause issues with valves.

    Probably wording it wrong yesterday when I posted, subtle difference generally probably not considered an issue in isolation but have other abnormalities to take into consideration. Most docs wouldn't think much of it unless was a mecfs specialist who has done research like Lerner.

    Cheers
     
  20. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    Im just searching autopsies of ME patients in particular cardiac abnormalities.
    I did find it mentioned that prolonged q-t interval is common finding, this was seen in Emma's ecg. The t wave was slow to occur after the qrs complex??
    Im still reading through this link http://www.stonebird.co.uk/hooper.html#CARDIO might find something interesting that i have missed??
     

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