Resting ECG Showed Sinus Arrhythmic, Atrial Enlargement, High Blood Pressure, Have White Coat Hypertension. Want Comments

Posted on Thu, 4 Oct 2012

Question: I am male, 49 years old and during a recent routine medical for insurance purposes, I had a resting ECG done. The data were Vent Rate: 80bpm, PR 160ms, QRS 90ms, QT/QTc 354/408ms with comments sinus rythym with sinus arrhythmic, Possible Left atrail enlargement, Borderline ECG. The secod set of data were VR 81bpm, PR 162MS, QRS 90ms QT/QTc 350/406ms, comments Normal sinus rythm, Possible left atrial enlargement, Borderline ECG. My blood pressure was taken three times and started out high 170/90, second reading lower 140/90 and third lower still 130/90. I am normal weight (68.8kg) height 5" 8" and the rest of the medical was fine. I regularly measure my bp before and after exercise (average 30mins/day) and it is usually in the normal range. I measured my bp when I got back from the surgery and it appeared to be in the normal range again. At the medical, the Doctor mentioned that I may have "white coat hypertension". It all sounds a bit alarming so I would like to receive comments on this. Thank you

Answered by Dr. Ravindra L Kulkarni (1 hour later)

Hi,

It is good to know that you have maintained normal weight and regularly monitor blood pressure.

Pre insurance check up reveals

1. ECG parameters within normal range.
2. Left atrial enlargement is not a clinically significant unless confirmed by echocardiography.
3. Though we say that white collar hypertension is common thing all your blood pressure readings show diastolic BP (Blood Pressure) of 90 which is significant and needs attention.

Plan for management should include

1. Consult a cardiologist and discuss about start of anti hypertensive drugs if required at the end of cardiac evaluation.
2. Detail cardiac evaluations should include lipid profile, echocardiography to know size of left ventricle and left atrium. We also know pumping capacity of heart.
3. we can consider strict diet changes as per dietician instruction, yoga and meditation as non pharmacological approach to control BP as it is in early stage.
4. If BP remains elevated inspite of all above things, consider start of low dose antihypertensive treatment.

Hope this will help you understand your situation.

Please feel free to discuss any health query if you have.

Thanks

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ravindra L Kulkarni (3 hours later)

Many thanks - your reply makes me feel better! My recent (december 2011) lipid profile (I dont have the exact numbers to hand) was normal total cholesterol, with very good hdpl, and very good triglyceride levels, although the ldpl level was above the normal range. My main concern,although I understand business is business, was that following the medical exam, the insurance company doubled the pre-medical premium, which put me into a blind panic thinking i was about to have a heart attack/stroke. However, the insurance co. also said they would consider reducing the premium if I consulted a cardiologist and send them the results. Your comments please and thanks for your response.
Regards
XXXXXXX

Answered by Dr. Ravindra L Kulkarni (2 hours later)

Hi XXXXXXX

Thanks for your report updates.

It is good that cholesterol levels are within normal limits.

About pre-insurance evaluation, it is basic practice by companies to have expert opinion from cardiologist esp. when general physician examination shows some abnormalities like mild elevated BP, or deranged lab parameters.

In your case, it is good to have expert cardiologist evaluation, which I am sure will be within normal limits. So do not panic about cardiac check up.

Once the examination is within normal limits, the premium of insurance can be reviewed.

Hope this information will help you.

Wish you a good health.

Thanks.

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

Above answer was peer-reviewed by : Dr. Shanthi.E