12 Lead ECG change

  Dear Doctor;
  Just recorded my resting 12 lead ECG with the following changes, became concerned when out walking the dog started having mild chest pressure, slight dizzyness and darkening of vision, this has continued for over 2 weeks, also increase in BP to an average of 140/92mmHg.
  This is the first time a change has taken place. I am not familiar with this type of change any ideas?
  I am a 40 year old male with ongoing GI issues, mild hypertension and random sinus tachycardia. Have recently started with labored breathing, random
  chest pressure, sub sternal on mild exertion.
  Hve had elevated liver enzymes randomly and ammonia, see posting under GI forum.
  All previous ECG,s: non-specific st-t wave changes (inverted T3) all other amplitudes and duration within normal limits.
  Latest on 3-26-98, list of changes:
  Atrial nad ventricular rate of 88 BPM.
  NSR
  R1 change in amplitude from 10mm to 19mm,
  R2 change in amplitude from 15mm to 7mm,
  P2 duration  .12 second,
  P3 now inverted,
  T3 inverted as before but much deeper, changed from -1.5mm to -3.5mm,
  Deep S3 -10mm none before,
  R3 change from 1mm was 6mm,
  R AVF change in amplitude from 12mm to 2mm,
  V4 T wave notched and reduced in amplitude from 3mm to 1.5mm,
  V2, V3, T wave flat were all about 3mm,
  V1, R wave amplitude change from 1mm to 2mm, terminal - deflection of >1mm x 1.5mm following P wave.
  Other: No significan Q's, all other amplitude and duration with in normal limits for age.
  Could I have:
  LAE, early hypokalemia?
  Any suggestions?
  Regards;
  Robert Muller
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Dear Robert:
The symptoms you describe are concerning.  In patients with complaints of chest pressure on exertion, many cardiologists would proceed with an exercise stress test.  In someone whose baseline ECG is abnormal, it is best to include an imaging modality with the stress test (such as a stress echocardiogram).  If the symptoms of chest pressure are occurring at rest and are severe, this usually prompts hospital admission and a cardiac catheterization.  You should inform your doctor of all your symptoms immediately.  Forty year old American males are definitely at risk for having coronary heart disease.  If you should have severe or concerning symptoms, you should call 911 and get to your closest emergency room.  
If you wish to be evaluated here at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at desk F15.  Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your doctor.