Suggest Treatment For Shortness Of Breath And Tachycardia

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello Elisabeth!

Welcome back on HCM!

After passing carefully through your medical history and uploaded tests, I would like to explain as follows:

1- Regarding your ECGs (from march up to july), I would explain that no specific signs of myocardial infarction are present. Instead of that these ECG findings mimic patterns similar to an incomplete Right Bundle Branch Block (RBBB), but it is not such the case. In fact we are in front of a J-wave syndrome pattern, that is better seen in the precordial leads V1-V3. It is denoted by a terminal spike inside the QRS complex.

Also the negative T waves (Twave invertion) are compatible with such findings. So, to conclude there is a suspicion of Brugada Syndrome, that is a high predisposition for the occurrence of complex and even life-threatening cardiac arrhythmia.

But meanwhile, the ECG machine doesn't recognize these patterns in general.

2- Regarding your cardiac MRI, I would say that there is not any signs of a heart attack

Considering your clinical symptomatology on March, I would explain that the chest pain doesn't seem to be related to any myocardial ischemia issues.

Nevertheless, If you experience new episodes of chest pain and even arm pain, I would recommend going through additional tests, like nuclear perfusional cardiac stress test or Dobutamine cardiac ultrasound, because cardiac ischemia is an issue to be first excluded when considering a differential diagnosis of Brugada Syndrome ECG patterns.

So finally, to conclude, I would say that it is not a heart attack issue that worries me (because there are no sufficient data to support this alternative), but you should discuss with your cardiologist on the option of a J-wave syndrome (Brugada Syndrome) and to see the opportunity of undergoing through a Aimaline provocative test (it is important to finally confirm or exclude Brugada Syndrome)

In addition, it is necessary to repeat a resting ECG with V1-V2 leads displaced to the second intercostal spaces and also performing ECG before and after having meals.

If Brugada Syndrome is confirmed at the end, an implanted cardioverter defibrilator (ICD) should be considered.

Hope to have been helpful!

Kind regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again, dear Elizabeth!

That ECG (img) showing slightly inverted T waves in V1-V3 leads doesn't imply an antero-septal infarct has occurred; there were no cardiac enzymes elevation, no findings on cardiac MRI.

Regarding cardiac MRI, I would explain that reliable evidence of important cardiac ischemia leading to myocardial infarction may be found quite early through the evidence of myocardial edema on T2 MRI sequences within 30 minutes after the beginning of clinical angina (chest pain). So the diagnosis would be precise and in a fast manner.

Performing ECGs before and after having meals, especially when precordial V1-V2 leads are displaced in the second intercostal spaces are helpful for investigating J wave syndrome (Brugada). Ajmaline test would be important in this regards.

Hope to have clarified your questions!

Wishing you are having a pleasant weekend!

Regards,

Dr. Iliri

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Brief Answer:
I would explain :

Detailed Answer:

I would explain that extensive data are available on the beneficial effect of salt in the management of POTS, meanwhile no established data on Cardizem.

Nevertheless, neither of them could be accused on your slightly abnormal ECG changes.

Regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Dear Elizabeth!

I totally agree with your doctor regarding surgery.

There are no medical data to postpone or avoid surgery program.

Now returning to your ECG discussion, I would say that it is true that ECG resembles an incomplete right bundle branch block, but the same is true also in J wave syndrome (J wave may mimic a R`wave (commonly found in right bundle branch block). It is necessary to consider a careful investigation in this regard.

The issues I mentioned earlier in our thread are advisable to be followed (V1-V2 on the second intercostal space, if enough suspicions are raised then Ajmaline test).

As you are heaving a previous history of tachycardia an cardiac symptomatology, it is necessary to carefully consider what the medical tests may suggest us.

Many times cardiologists may overlook rare cardiac syndromes as they don't seem familiar to them.

Anyway, you could get through the surgery program without worrying about serious issues.

That's my opinion.

Hope to have been helpful to you!

Regards,

Dr. Iliri

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Brief Answer:
I would explain:

Detailed Answer:
Dear XXXXXXX

I was talking about those J waves presence on V!-V2 leads that are evident in almost all the uploaded ECGs.

When an incomplete right bundle branch block pattern is present and the terminal portion of QRS complexes is much likely to be in fact a J wave, then it is necessary to consider a J wave syndrome (which in fact comprises 2 separated disorders: Brugada syndrome and early repolarization).

It would be prudent to perform some ECG maneuvers like repeating ECG by placing V1-V2 leads in the second intercostals spaces. If suspicions are raised then an Ajmaline test is warranted.

The tachycardia appearing when standing up doesn’t seem to be related to what we are talking.

Without investigating through the above mentioned procedures, we couldn’t rule out or confirm such an alternative.

Let me know if you have any further questions.

Regards,

Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful to you!

Wishing all the best!

Dr.Iliri

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