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Crazy ECG
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Crazy ECG

I am hoping you can help.  For the last 3 weeks I have been having right sided chest pain most likely related to costocondritis or some type of muscle pull.  I went to a walk in center today to be examined and the doctor did an EKG just to rule out any type of cardiac event.  Although my chest pain does not appear to be cardiac in nature my EKG results were abnormal and I need to follow up with a cardiologist.  I am a 31 year old male and do smoke.  Outside of this I am reasonably healthy in regards to blood pressure etc.  I have no family history of cardiac disease.  Can you provide any guidance on the results.  I am pretty freaked out at the moment.  I am hoping the "ticker" does not stop.

Sinus Rythm
Marked left access deviation
Consistent with lafb.
Rsr in v2
ECG without significant abnormalities

P/pr 110/168 ms
Qrs 110 ms
Qt/Qtc 360/380 ms
P/qrs/t axis 25/-59/27 deg
Heart rate 67 bpm

Obviously I am thinking the worst case scenario.  Any insight would be greatly appreciated.
Dear Worriedsick1981,

Based upon the information you have provided, the likelihood of your “ticker’ stopping is very low. You will be best served by following through with the cardiology visit but in the meantime I hope that you will feel somewhat less anxious based on the information I can provide to you about EKG’s and left axis deviation.

The results reported in an EKG depend upon patient body size and shape, the patient’s level of fitness (slower heart rate in athletic people), position of the EKG leads (incorrect positioning of the leads gives incorrect results), and obviously any underlying heart abnormalities. It is also important to know that there should ideally be 2 levels of EKG interpretation: the first is the computer report (based upon mathematical calculations); the second is the doctor’s interpretation. It is not uncommon for doctors to edit/change the computer generator report due to incorrect ‘mathematical’ interpretation and/or knowledge of the patient’s medical condition that influences interpretation of the EKG.

In your case, the first step would be to check that the EKG was performed correctly (i.e. correct lead placement). A repeat EKG to confirm the finding would be important. An echocardiogram to rule out structural heart disease (i.e. valve problems, thickening of the heart muscle, and enlargement of the heart chambers) would also be important. Blood work, including an assessment of your ‘electrolytes’ (i.e. potassium, magnesium, calcium), and kidney function are commonly performed following an abnormal EKG.

Left axis deviation in an otherwise healthy young adult can be a normal variant, meaning that you have no underlying heart problems even though your EKG is different to the general population. In some patients, left axis deviation is due to a ‘block’ in one of the electrical tracts or pathways that deliver electricity to the pumping chambers or ventricles. The medical term for this is a ‘left anterior fascicular block’ and the diagnosis can be made by observing left axis deviation in the absence of other EKG abnormalities / heart problems.

In others, left axis deviation can indicate the presence of additional electrical ‘bridges’, tracts, or pathways, between the top and bottom chambers of the heart. In the absence of symptoms (i.e. no palpitations, dizziness, or collapse), these can often be followed without any specific treatment or intervention.

There is an association between left axis deviation and emphysema or smoking related airways disease. This is more common in older patients who have smoked for many years. A chest x-ray and lung function tests can be helpful if your clinical assessment (with your doctor) suggests airways disease.

I sometimes think of test results such as this as a ‘wake-up call’ to look after ourselves as best we can. Your reaction to the tests indicates a desire to not have heart problems now or in the future. You are now more aware of the importance of having a healthy heart. The best short term decision you can make is to stop smoking, irrespective of your future test results and appointments.

Take care and good luck.
I did end up visiting the cardilogist and am scheduled for an echo and stress test in 2 weeks.  They also re-did the EKG and got the same results.  He did mention something also about a RBBB due the rsr patterns.  I know I am not a doctor but I thought that with a RBBB you would need a QRS interval of greater than 120ms.  Mine was 110.  I am beyond concerned this is a Bifascicular Block.  He says that it is most likely congenital.  I did have a chest xray that was normal and lung functioning is normal as well.  I am beyond freaked out at this point thinking the end is near.
Dear WorriedSick1981,

There are many positives for you to focus on: Your are young. Your CXR is normal. Your lung function is normal. Appropriate tests have been organised, including an echo and stress test. A right bundle branch block 'pattern' is different to a true right bundle branch block. You seem to be aware of this based upon your referencing of the QRS interval. Your QRS is normal.

None of these results suggest to me that "the end is near" (to use your words). I suggest that you complete the investigations and discuss the results with your cardiologist. One of the biggest fears patients have is not knowing what is wrong with them or fear of the unknown. Hang in there because it won't be long until the tests have been completed and you will have a better understanding of your heart and whether any additional treatments are indicated.

A communication tip for you: If you still feel freaked out after you next visit your cardiologist let him/her know during the appointment and in your own words. You might say 'Hey Doc! I'm freaked out here because of these results! I'm scared the end is near". If you find it hard to speak at the doctors office, write it down and hand it to him/her to read. Give your doctor a chance to understand your level of concern and to respond directly to you.

If your anxiety feels as if it is getting out of control it will be important for you to discuss this with your family doctor and discuss treatment options for this. It's normal to feel concerned but if your anxiety, or being "freaked out", is interfering with your daily functioning, then you need help in managing these symptoms. Just like with your heart, there are many options for treating anxiety that range from talking with someone to different medications.

Take care
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