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Suggest Treatment For Ectopic Palpitations
Question: How about Brugada Syndrome.
Seeing I do have the RBBB
I do have palps
Ectopics
Sudden onset of pulse up to max-heartrate out of nowhere?
Tachy
Etc.
Please do agree with me that I do have a point here? :D
Oh and typically these people die at 41. ;)
This has definately gotten worse with time.
Seeing I do have the RBBB
I do have palps
Ectopics
Sudden onset of pulse up to max-heartrate out of nowhere?
Tachy
Etc.
Please do agree with me that I do have a point here? :D
Oh and typically these people die at 41. ;)
This has definately gotten worse with time.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello dear XXXX!
Welcome back on HCM!
I reviewed again the ECG you have uploaded here.
As I have explained you before, it has the pattern of the Right Bundle Branch Block.
But, besides this finding I couldn't detect any other features that might raise enough suspicions toward Brugada syndrome or what is generally called J wave syndrome.
Coming to this point, I would say that your ECG doesn't have a distinct J wave, which in fact in Brugada syndrome is lower than the R wave in leads V1-V2. Your ECG displays a R' wave taller than the R wave which goes more in favor of a pure RBBB.
In addition, the elevation of ST segment in V1-V2 which is typical and commonly diagnostic for Brugada syndrome is missing on your ECG.
Furthermore, you may have palps, even ectopic beats but you don't have any confirmed syncope or even near syncope caused by ventricular tachycardia or any other life-threatening cardiac arrhythmia.
So, I am sorry for having a different opinion this time, dear XXXX, but I couldn't find enough data to support the Brugada syndrome alternative.
Nevertheless, if we want to be completely sure of the absence of Brugada we need some extra procedures, which includes performing a new ECG recording with leads V1-V2 displaced slightly higher in the second intercostal spaces, and if any suspicious findings (I mentioned you above) appears, then Ajmaline test is recommended.
That's my opinion regarding this issue.
Hope to have clarified your concern!
I remain at your disposal for any further discussions.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello dear XXXX!
Welcome back on HCM!
I reviewed again the ECG you have uploaded here.
As I have explained you before, it has the pattern of the Right Bundle Branch Block.
But, besides this finding I couldn't detect any other features that might raise enough suspicions toward Brugada syndrome or what is generally called J wave syndrome.
Coming to this point, I would say that your ECG doesn't have a distinct J wave, which in fact in Brugada syndrome is lower than the R wave in leads V1-V2. Your ECG displays a R' wave taller than the R wave which goes more in favor of a pure RBBB.
In addition, the elevation of ST segment in V1-V2 which is typical and commonly diagnostic for Brugada syndrome is missing on your ECG.
Furthermore, you may have palps, even ectopic beats but you don't have any confirmed syncope or even near syncope caused by ventricular tachycardia or any other life-threatening cardiac arrhythmia.
So, I am sorry for having a different opinion this time, dear XXXX, but I couldn't find enough data to support the Brugada syndrome alternative.
Nevertheless, if we want to be completely sure of the absence of Brugada we need some extra procedures, which includes performing a new ECG recording with leads V1-V2 displaced slightly higher in the second intercostal spaces, and if any suspicious findings (I mentioned you above) appears, then Ajmaline test is recommended.
That's my opinion regarding this issue.
Hope to have clarified your concern!
I remain at your disposal for any further discussions.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Enclosing one of the ekg of my daughter.
Next days i will get the results from the stress test she did as well.
What do you see here, rbbb?
Great great answer on the last question sir. I will communicate this to the cardiologist here. You have no idea how much this help me.
I think it is there now!
Next days i will get the results from the stress test she did as well.
What do you see here, rbbb?
Great great answer on the last question sir. I will communicate this to the cardiologist here. You have no idea how much this help me.
I think it is there now!
Brief Answer:
Glad to have been helpful to you!
Detailed Answer:
Dear XXXX,
I am glad to have been helpful to you!
You are welcome for any further discussion on any health issues you are interested!
Regarding the uploaded ECG, I can see only the written conclusion, which says it is a normal ECG, but not ECG recording can be found. Probably an error while uploading.
Please could you try again to upload the ECG?
I remain at your disposal!
Regards,
Dr. Iliri
I think it is there now!
Brief Answer:
ECG parameters seem to be normal.
Detailed Answer:
Hi again!
I can see the same uploaded ECG report ( 0000_224307.jpg ) which confirms the ECG parameters that are all normal and also can see the date of ECG performance together with the name at the bottom part of the paper, but no ECG tracings.
If you have another ECG recording please upload it for a direct review!
Regards,
Dr. Iliri
Glad to have been helpful to you!
Detailed Answer:
Dear XXXX,
I am glad to have been helpful to you!
You are welcome for any further discussion on any health issues you are interested!
Regarding the uploaded ECG, I can see only the written conclusion, which says it is a normal ECG, but not ECG recording can be found. Probably an error while uploading.
Please could you try again to upload the ECG?
I remain at your disposal!
Regards,
Dr. Iliri
I think it is there now!
Brief Answer:
ECG parameters seem to be normal.
Detailed Answer:
Hi again!
I can see the same uploaded ECG report ( 0000_224307.jpg ) which confirms the ECG parameters that are all normal and also can see the date of ECG performance together with the name at the bottom part of the paper, but no ECG tracings.
If you have another ECG recording please upload it for a direct review!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
How about now, doc ?
Brief Answer:
It seems to be an incomplete RBBB:
Detailed Answer:
The last ECG has a pattern of incomplete Right Bundle Branch Block (iRBBB), QRS duration less than 120ms.
It doesn't confirm any distinct pathology, but a cardiac ultrasound is necessary to confirm the normal cardiac structure.
That's my opinion.
Kind regards,
Dr. Iliri
It seems to be an incomplete RBBB:
Detailed Answer:
The last ECG has a pattern of incomplete Right Bundle Branch Block (iRBBB), QRS duration less than 120ms.
It doesn't confirm any distinct pathology, but a cardiac ultrasound is necessary to confirm the normal cardiac structure.
That's my opinion.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good. Thank you.
Finally confirmed. She has been at cardiologists before and they never mentioned this. This was just a ordinary doc rutine exam because she has these fainting spell when very active. They have not Said anytjing after ultrasound nor did they say anything but she have some vasovagal reaction.
I dont agree as she get very dizzy and many times faints during exercise. But she did faints during ecg stress test on treadmill. I belive they Said both pressure and heart rate sent down
But after they sent letter actually saying she did not faint....
The last time she did stress test and echo they Said the did not know what caused it.
What do you recommend and or belive
Is she in danger?
She is going to dentist this thursday and because of nervøs she is taking some form of drink before to make her relax. Will these drinks mean trouble for her heart?
Finally confirmed. She has been at cardiologists before and they never mentioned this. This was just a ordinary doc rutine exam because she has these fainting spell when very active. They have not Said anytjing after ultrasound nor did they say anything but she have some vasovagal reaction.
I dont agree as she get very dizzy and many times faints during exercise. But she did faints during ecg stress test on treadmill. I belive they Said both pressure and heart rate sent down
But after they sent letter actually saying she did not faint....
The last time she did stress test and echo they Said the did not know what caused it.
What do you recommend and or belive
Is she in danger?
She is going to dentist this thursday and because of nervøs she is taking some form of drink before to make her relax. Will these drinks mean trouble for her heart?
Brief Answer:
I would explain as follows<.
Detailed Answer:
Dear XXXX,
Considering your daughter's medical history of frequent episodes of fainting I would say that a vasovagal component seems to be the most probable cause.
But, before concluding to such a logical alternative, we have to be sure that no structural cardiac disorders are present.
That's why a careful cardiac ultrasound is very important for investigating even tiny structures and excluding any abnormalities.
If the transthoracic cardiac ultrasound doesn't offer a full picture of the cardiac anatomy and function, then a transesophageal echocardiography (TEE) is necessary.
After excluding a structural cardiac disorder, then it is necessary to confirm a vasovagal reaction.
In this regard, a Tilt test would be helpful.
If a vasovagal reaction is present, then she should avoid stressful situations and environments, like overcrowded places, very warm and steamy places, prolonged upright positioning, etc.
Coming to this point a good hydration would be very helpful.
That's why taking a lot of fresh nonalcoholic drinks is very beneficial for avoiding or at least minimizing those vasovagal episodes of fainting.
That's my opinion!
Hope to have been helpful to you!
Regards,
Dr. Iliri
I would explain as follows<.
Detailed Answer:
Dear XXXX,
Considering your daughter's medical history of frequent episodes of fainting I would say that a vasovagal component seems to be the most probable cause.
But, before concluding to such a logical alternative, we have to be sure that no structural cardiac disorders are present.
That's why a careful cardiac ultrasound is very important for investigating even tiny structures and excluding any abnormalities.
If the transthoracic cardiac ultrasound doesn't offer a full picture of the cardiac anatomy and function, then a transesophageal echocardiography (TEE) is necessary.
After excluding a structural cardiac disorder, then it is necessary to confirm a vasovagal reaction.
In this regard, a Tilt test would be helpful.
If a vasovagal reaction is present, then she should avoid stressful situations and environments, like overcrowded places, very warm and steamy places, prolonged upright positioning, etc.
Coming to this point a good hydration would be very helpful.
That's why taking a lot of fresh nonalcoholic drinks is very beneficial for avoiding or at least minimizing those vasovagal episodes of fainting.
That's my opinion!
Hope to have been helpful to you!
Regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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