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DXD Admin from Singapore asked a question

Could I have a heart problem if I have a heavy heart, weary legs, and ECG T Wave inversion?

Dear doctors,

My mother 70 years old feel heavy and weary legs. Below is her ECG result that was performed 3 months ago (before eye Cataract surgery). One note in ECG is T wave inverted (3rd wave).

She is also slightly overweight and consumes hypertension medication for years.

Kindly advise.

Many thanks in advance.

DOCTOR’S ANSWER (3)
Dr Nandakumar Ramasami
Cardiologist
Singapore
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Dr Nandakumar Ramasami
Cardiologist
Singapore
Answered on Fri Mar 16 2018 08:12:56 GMT+0000 (UTC)

I fully agree with Drs Ethan and Dr Tan. Your mother will definitely benefit from a through review by her family physician. 

Though I suspect the T wave inversion to be probably secondary to longstanding hypertension and possible thickening of muscle (LVH with strain pattern).

Also of note, T wave inversion can be seen frequently in the inferior leads (i.e. lead III and aVF) and does not always indicate pathology.

A repeat ECG with deep inspiration and expiration may be useful to demonstrate if the T wave inversion is dynamic.

Yes, ischemia can cause these changes sometimes, but is more sudden in onset generally and depends on presentation and other risk factors. 

An echocardiogram will indicate changes of hypertension with thickened muscle causing both ECG changes and also swelling in legs (with age and hypertension the heart muscles are a bit stiff and relaxation can be an issue though pumping is well preserved).
 
As for weariness there maybe other issues such as anaemia, vitamin deficiency etc.

It would be best to have a comprehensive review with your family physician with further investigations as felt to be appropriate.

0 162 views 0 Doctors agree Fri Mar 16 2018 08:12:56 GMT+0000 (UTC)
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Dr Ethan
Singapore
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Dr Ethan
Singapore
Answered on Fri Jan 26 2018 04:26:19 GMT+0000 (UTC)

Hi Isuhendro,

As Dr Yan Yuan suggested, I’d strongly suggest that she visit a GP for a formal consultation.

As pointed out, she has clear risk factors for heart disease, especially in the context of experiencing symptoms such as a heavy heart and fatigue.

It’s worth noting that certain ECG abnormalities can be non-specific.

I’d still suggest for you to bring the actual recording of the old ECG down for the consultation (as well as all her other old medical notes/laboratory results) – it’s very helpful for the doctor to compare any current ECG readings against the old one that was taken.

He may go on to suggest an exercise treadmill test, which is a commonly used screening test for patients with risk factors for heart disease.

Cheers

1 227 views 0 Doctors agree Fri Jan 26 2018 04:26:19 GMT+0000 (UTC)
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Dr Tan Yan Yuan
General Practitioner
Singapore
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Dr Tan Yan Yuan
General Practitioner
Singapore
Answered on Fri Jan 26 2018 04:27:15 GMT+0000 (UTC)

Dear Isuhendro,

Your mum certainly is at risk of heart diseases in view of her risk factors such as hypertension as well as overweight. I noted that her ECG was done 3 months ago. This might not very useful in evaluating her current complaints and symptoms.

I would advise you to bring her to your family physician for a more thorough work- up which might include a repeat ECG and blood tests after taking her medical history and examining her.

Hope this helps and she gets well soon.

1 227 views 0 Doctors agree Fri Jan 26 2018 04:27:15 GMT+0000 (UTC)
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