I Went Into The ER Because Of My Face Swelling

Posted on Mon, 29 Oct 2018

Question: I went into the ER because of my face swelling from and allergy that they never could identify but they ended up giving me an ECG and it came back abnormal. They kept me to monitor if it was having heart attack and did a total of 3 ECG's and they all came out the same. The doctor concluded that RSR or QR pattern in V1 suggests right ventricular conduction delay T wave abnormality, consider anterior ischemia. He told me I should contact a cardiologist on Monday because based on the biphasic T wave in V2 and V3 on all 3 test he mentioned that there must be a structural problem. He mentioned Wellens Syndrome as well. He took an x-ray of my chest and didn't seen anything. The enzymes he tested for twice to see if it was a heart attack came back normal. Basically, I would like someone to explain what the possibilities are for having a consistent biphasic T wave in V2 and V3 over about an 8 hour period? Basically what could it be medically. Or could it be nothing. He seemed concerned so that's why I am a little anxious about it.

Answered by Dr. Bhanu Partap (2 minutes later)

Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello Ma’am

After going through the medical details provided by you I can very well understand your concern for your health and I would like to tell you you that yes biphasic T wave in anterior precordial lead specially v1 to v4 are suggestion anterior myocardial ischemia (Wellens Syndrome).

I would like to know few things

1. Do you have diabetes or hypertension
2. Any family history of heart disease?
3. Do you smoke?
4. Any history of chest pain or easy breathlessness on exertion?

Also if you could upload your ecg image for me then it would be really helpful in giving a proper opinion.

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhanu Partap (51 minutes later)

Unfortunately I don't have a way to upload the ECGs right now but I can tomorrow at work.

No I don't have diabetes or hypertension.

Yes, my Grandma and my Great Grandma both wore pacemakers but I don't know the details about that. My Grandpa did have one heart attack. My 3 siblings don't have problems nor do my mom or dad.

No I do not smoke or drink and never have.

Honestly, my whole life I have had short breath on exertion. And yes sometimes chest pains if I really push my self. I don't exercise at all partly because of it. I do not feel "good" like other people do after exercising. I have the sickle cell TRAIT so I just figured I wasn't getting as much oxygen as other people and that's why I was such a wimp.

Question for you...I take a lot of medications for depression. The doctor said that could not cause this. When I look on line it looks like it is caused by high colesterol (I am 5'2'' and 136 lbs. I usually fluxuate but that is the highest I have been. I am usually more at 127 lbs. the last time I did labs I had high coleserol but never before that. I also heard it can be caused by stress. I do have a very stressful job. Maybe Is should consider changing that.

Anyhow, what can truly cause this? And can it go away on it's own or do you have to have surgery?

Answered by Dr. Bhanu Partap (7 hours later)

Brief Answer:
Hello again

Detailed Answer:
Thanks for the detailed feedback.

See your bmi is falling in obese category which itself is a risk factor for heart disease. Other risk factors in your case are family history of heart disease, depression, stress full job, high cholesterol.

Taking all these into consideration it becomes highly advisable to consult a cardiologist personally for evaluation as some basic tests will be required like ecg, Echocardiography and Stress test to rule out any underlying cardiac disease.

I hope this information will guide you properly.

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Bhanu Partap (3 hours later)

I am back in the ER and they are monitoring me and I will see a cardiologist tomorrow morning.

My question is....can I have now 4 abnormal EKG's and still have nothing wrong with me? Or does there have to be something wrong based on the V2 and V3 biphasic T waves?

Answered by Dr. Bhanu Partap (6 minutes later)

Brief Answer:
Hello again

Detailed Answer:
Yes some patients do have abnormal ecgs but no underlying cardiac disease but that can only be nae sure by further investigations.

In your case the possibility of having a underlying cardiac issue is more because of several risk factors.

I wish you all good health and my best wishes. Hope everything will come out to be normal after evaluation.

Do let me know.

Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Bhanu Partap (25 minutes later)

Thank you.

Answered by Dr. Bhanu Partap (4 minutes later)

Brief Answer:
Hello again

Detailed Answer:
If you are satisfied with my response then kindly close the discussion and rate the answer.

In future if you need my assistance kindly mention my name in your query.

Regards
Dr Bhanu Partap

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj