LVH/HCM, inverted twaves and ischemia

[Truelee]

I am a 62/female.On 9-30-05:adverse drug reaction while preparing for a bone marrow biopsy. I had seizure/convulsion w/temporarily loss of consciousness.  Taken to emergency room -admitted, discharged 10-2-05. Admitted due to inverted T waves in leads V1 through V4 and to ascertain why the seizure (1997 stress test did not show inverted T waves).The only other seizure I was in 1980 during an amniotic fluid embolism.

I had multiple tests while at the hospital – CT of brain, eeg, ecg, cardiac ultrasound, heart monitor etc.  Upon discharge, I was not told of any heart problems.  I was told that my convulsion was most likely due to the Demerol.  

Later, I picked up the records of my hospital stay.  The records stated that I had mild concentric LVH (per the cardiac ultrasound).  My granddaughter has HCM.  

Currently, I have normal blood pressure, but I did need to take blood pressure meds for about 7 years.  During those same years, I was taking estrogen replacement therapy drugs (on and off). When I stopped taking ERT in 2002, my high blood pressure disappeared and I have not needed blood pressure meds since.  I did not know that ERT can cause high blood pressure – it is a rare side effect. Because of joint problems, I get no exercise.  In Oct of 2000, I had a heart test at a heart center, using  EBCT. I received a calcium score of “0”.  

The most recent ECG from my hospital records (Oct. 1, 2005) said:

Vent rate 74 BPM,

PR interval 134m,

QRS du

[Cleveland Clinic]

Trulee,



Thanks for the post. Sorry to hear of your recent events.



1. Will I always have abnormal T waves and anterior ischemia -- do I have permanent damage to the heart’s blood flow?





It is not uncommon to have changes in the ECG associated with neurologic events. The body is remarkable and there is an evergrowing body of evidence to support a heart brain connection. There is even a heart brain research institute at the Cleveland Clinic to further elucidate the mechanisms relating the two. We often see T wave changes in stroke and seizure. These often resolve and do not neccessarily indicate permanant cardiac damage or negative cardiac outcomes.



2. I am scheduled to have a thyroidectomy in a few weeks and wonder if, based on the above information, I have any heart concerns regarding the surgery.



I would discuss your overall medical/cardiac risk with your physicians. There are set algorythms for determingin your risk based on your medical history and physical.



3. Concerning the LVH, I have read where the use of strain rate imaging by tissue Doppler ultrasonography can discriminate HCM from H-LVH, is this a test that I can get – if so, where? My family and I would really like to know if my granddaughter’s HCM is connected to my LVH. This information would be invaluable to everyone related to my granddaughter.



Doppler tissue imaging is not the diagnostic procedure for HCM. Severe LVH from HTN can cause the same structural derangments and physiology of familial HCM. Again I would discuss your history and family concerns with your cardiologist. If you would like a formal opinion from the Cleveland Clinic -- Dr Harry Lever or Dr Marin Thamalarison are 2 experts on HCM at the clinic.





good luck

[Truelee]

I am sorry, the above question was incomplete,  I will try to post it another time before my surgery. The rest of the question was:

PR interval 134m,

QRS duration 90ms,

QT/QTc 420/466ms,

P-R-T axes 51 38 41,

Normal sinus rhythm,

ST & T wave abnormality, consider anterior ischemia,

Abnormal ECG,  When compared with ECG of  Sept 30, 2005 no significant change was found

MY QUESTIONS:

1.  Will I always have abnormal T waves and anterior ischemia -- do I have permanent damage to the heart’s blood flow?  

2.   I am scheduled to have a thyroidectomy in a few weeks and wonder if, based on the above information, I have any heart concerns regarding the surgery.

3.   Concerning the LVH, I have read where the use of strain rate imaging by tissue Doppler ultrasonography can discriminate HCM from H-LVH, is this a test that I can get – if so, where?  My family and I would really like to know if my granddaughter’s HCM is connected to my LVH.   This information would be invaluable to everyone related to my granddaughter.  

Thank you very much for your help.