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What Do The Following ECG Reports Indicate?
Question: Hi. I have had 3 ECG's in the last year. The first showed a QRS duration of 112 ms. This was regarded as abnormal and it was reported that I have non specific IVCD. I then had CT angiogram and later diagnosed with mild unobstructive coronary artery disease. Since then ECG's have shown QRS duaration of 98 ms after 6 months and the latest after one year showed 108 ms. I was told that although abnormal there is nothing to worry about. I am confused though as I have read much about IVCD. Is there a risk of further complications or sudden heart failure or increased mortality etc. Please advise.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
Welcome on HCM!
Regarding your ECG findings, I would like to explain though there exists some degree of variation in QRS duration. it doesn't seem to be clinically significant.
Furthermore, none on your QRS results are greater of 120 ms (which would denote a true IVCD).
You should know that an important coronary disease may develop even without any obvious ECG changes.
So, to conclude, I would suggest you to not worry too much about those slight ECG findings, but instead to pay continuous attention at controlling potential coronary risk factors (hypertension, blood glucose metabolism disorder, high blood cholesterol, avoid close smoking contacts, follow a physically active daily activity and a healthy life style, etc.), in order to prevent further progression of those mild coronary artery plaques.
Periodically performed medical check-ups and additional tests (imagine coronary tests, cardiac stress tests, etc.) are advisable.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello,
Welcome on HCM!
Regarding your ECG findings, I would like to explain though there exists some degree of variation in QRS duration. it doesn't seem to be clinically significant.
Furthermore, none on your QRS results are greater of 120 ms (which would denote a true IVCD).
You should know that an important coronary disease may develop even without any obvious ECG changes.
So, to conclude, I would suggest you to not worry too much about those slight ECG findings, but instead to pay continuous attention at controlling potential coronary risk factors (hypertension, blood glucose metabolism disorder, high blood cholesterol, avoid close smoking contacts, follow a physically active daily activity and a healthy life style, etc.), in order to prevent further progression of those mild coronary artery plaques.
Periodically performed medical check-ups and additional tests (imagine coronary tests, cardiac stress tests, etc.) are advisable.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the answer. I understand that I need to look after my heart health to help restrict further plaque progression and this is an ongoing lifelong process. I thought that this was the only problem. Now that I have read about non specific and specific IVCD, that has just added another dimension to the situation. Although clinically insignificant I am concerned about development of further heart complications separate from the plaque build up. Heart attacks and coronary heart disease information is quite straight forward for me to understand from reading. However this new information about IVCD etc I am unable to comprehend too easily hence the consultation. What I am trying to know is whether I am susceptible to further complications unrelated to coronary heart disease but related to this stated abnormality. I appreciate that this is not possible to predict with certainty but I want to know whether I may be at increased risk and if it is something I should continue to get investigated in future years as formality, again, separate from the artery issue. I didn't ask these questions to the hospital cardiologist and hence the anxiety. I thank you for you attention.
Sincerely,
XXXXXXX
Sincerely,
XXXXXXX
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again, dear Mohammed!
You are right when discussing about alternative reasons of IVCD unrelated to coronary artery disease.
But, as your QRS values are not significantly prolonged (the longest one is only 112 ms), I am not sure that we can talk with certainty on a true presence of IVCD (because IVCD by definitions in adult is considered a delay in the intra-ventricular propagation of supra-ventricular impulses, giving rise to changes in the shape and duration of the QRS complex.
To make it more simplified, I would say that it is necessary a QRS duration greater than 110 ms, in order to start suspecting of IVCD. In fact your longest on is only 112 ms.
You should also know that QRS duration is largely influenced by normal variations in age, sex, body mass and hence also heart dimensions. It may normally vary also within the same ECG (depending on the leads taking for investigation). S, depending on the algorithm used by the ECG equipment, the average QRS duration may result slightly different.
But, this is not enough. It is necessary that this QRS prolongation produces atypical QRS shape on the surface ECG in order to start thinking on a possible IVCD.
So, to summarize, it is necessary that first, a disctinct prolongation of QRS be present (a solitary borderline QRS duration, as in your case is not enough, irrespective of what an ECG device may roughly conclude).
Second an atypical QRS shape should be produced.
In this regard, a thorough examination of your surface ECGs is necessary.
If something suspicious would result, then an ambulatory 24 to 48 hours ECG monitoring (Holter) should be performed for a more profound study of ECG duration and dispersion.
Coming to this point, if true QRS prolongation is present in the greater percentage of Holter recordings, then I would recommend performing a cardiac MRI for properly investigating the presence of possible myocardial micro-necrosis, fibrosis, calcification, infiltrative lesions, etc. (besides coronary artery circulation disorders).
This would relieve also your fears on potential alternative causes of a possible IVCD presence.
Nevertheless, regardless of the above theoretical discussion, my personal professional opinion doesn't support the idea of IVCD in your case (in the absence of sufficient clinical criteria).
Hope I have clarified some of your uncertainties on these issues.
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again, dear Mohammed!
You are right when discussing about alternative reasons of IVCD unrelated to coronary artery disease.
But, as your QRS values are not significantly prolonged (the longest one is only 112 ms), I am not sure that we can talk with certainty on a true presence of IVCD (because IVCD by definitions in adult is considered a delay in the intra-ventricular propagation of supra-ventricular impulses, giving rise to changes in the shape and duration of the QRS complex.
To make it more simplified, I would say that it is necessary a QRS duration greater than 110 ms, in order to start suspecting of IVCD. In fact your longest on is only 112 ms.
You should also know that QRS duration is largely influenced by normal variations in age, sex, body mass and hence also heart dimensions. It may normally vary also within the same ECG (depending on the leads taking for investigation). S, depending on the algorithm used by the ECG equipment, the average QRS duration may result slightly different.
But, this is not enough. It is necessary that this QRS prolongation produces atypical QRS shape on the surface ECG in order to start thinking on a possible IVCD.
So, to summarize, it is necessary that first, a disctinct prolongation of QRS be present (a solitary borderline QRS duration, as in your case is not enough, irrespective of what an ECG device may roughly conclude).
Second an atypical QRS shape should be produced.
In this regard, a thorough examination of your surface ECGs is necessary.
If something suspicious would result, then an ambulatory 24 to 48 hours ECG monitoring (Holter) should be performed for a more profound study of ECG duration and dispersion.
Coming to this point, if true QRS prolongation is present in the greater percentage of Holter recordings, then I would recommend performing a cardiac MRI for properly investigating the presence of possible myocardial micro-necrosis, fibrosis, calcification, infiltrative lesions, etc. (besides coronary artery circulation disorders).
This would relieve also your fears on potential alternative causes of a possible IVCD presence.
Nevertheless, regardless of the above theoretical discussion, my personal professional opinion doesn't support the idea of IVCD in your case (in the absence of sufficient clinical criteria).
Hope I have clarified some of your uncertainties on these issues.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I thank you for your response. My case appears to warrant no further investigation. I just wanted to know whether the CT angiogram performed on me last year would reveal any of the other disorders you mentioned. In that case I could ask the consultant in my next visit next year without the need for further series of tests and cardiac MRI. I thank you for your response and am sufficiently convinced that there are no other serious complications at present.
Sincerely,
XXXXXXX
Sincerely,
XXXXXXX
Brief Answer:
You are welcome!
Detailed Answer:
I am glad to have relieved some of your concerns!
In case of any further medical issues in the future feel free to ask me directly.
Wishing you a pleasant weekend!
Regards,
Dr. Iliri
You are welcome!
Detailed Answer:
I am glad to have relieved some of your concerns!
In case of any further medical issues in the future feel free to ask me directly.
Wishing you a pleasant weekend!
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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