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Forum Name: Cardiology Symptoms

Question: Right ventricular hypertrophy and panic disorder


 ryanschrang - Thu Feb 10, 2005 1:46 pm

A LITTLE OVER 6 MOS AGO I WENT TO THE ER BECAUSE I WAS HAVING TROUBLE BREATHING AND THEY GAVE ME SOME ALBUTERAL AND SENT ME ON MY WAY. AFTER THAT I STARTED GETTING DIZZY ALOT AND MY HEART WOULD STARTING RACING AND I WOULD FEEL LIKE I WAS GOING TO PASS OUT, THIS WAS ALSO ACCOMPANIED BY CHEST PAIN AND SHORTNESS OF BREATHE. I WENT TO THE HOSPITAL A FEW TIMES AND THEY DID AND EKG AND IT SAID THAT I HAD RIGHT VENTRICULAR HYPERTROPHY AND AND AN ABNORMAL BLOCKAGE. I ALSO HAD AN EKG THAT SAID I HAD AN MI BUT I AM ONLY 21 AND I WASNT ON ANY DRUGS OR ANYTHING AT THE TIME. I SAW A CARDIOLOGIST AND THEY DID THE FULL WORK UP AND THEY SAID EVERYTHING WAS NORMAL. THEY DID THE ECHO AND THEY SAID IT DIDNT SHOW ENLARGEMENT BUT EVERYTIME I GET AN EKG IS STILL SHOWS THAT I HAVE RIGHT VENTRICULAR HYPERTROPHY. AFTER THAT THEY TOLD ME TO SEE A PHYCHIATRIST BECAUSE I COULD BE HAVING PANIC ATTACKS, THEY DIAGNOSED ME WITH PANIC DISORDER AND NOW I AM TAKING MEDS FOR IT. I AM NOT GETTING DIZZY AND FEELING LIKE I AM GOING TO PASS OUT ANYMORE NOR AM I HAVING THE PALPITATIONS ANYMORE. I DO HOWEVER STILL GET CHEST PAIN AND SHORTNESS OF BREATH OCCASIONALLY BUT NOT AS SEVERE. I HAVE YET TO GET A REAL ANSWER FROM ANYONE ABOUT WHAT IS CAUSING THIS AND I AM SCARED BECAUSE I AM YOUNG AND I don't KNOW WHAT IS CAUSING THIS. IS IT POSSIBLE FOR AN EKG TO SHOW THAT YOU HAVE RVH BUT ITS NOT REALLY ENLARGED, LIKE A FALSE POSSITIVE. I AM ALSO WORRIED BECAUSE THE EKG ONCE AND ONLY ONCE CAME UP THAT I HAD AN MI WHICH I CANT UNDERSTAND WHY, IS IT POSSIBLE THAT MAYBE THE LEADS WERE OFF OR THE EKG WAS MESSED UP BECAUSE IT NEVER SHOWED THAT AGAIN AFTER THAT ONE TIME. PLEASE HELP I HAVE BEEN TO COUNTLESS DOCTORS WITHOUT ANY ANSWERS I WOULD JUST LIKE SOME INSIGHT ABOUT WHAT COULD BE WRONG OR IF I EVEN HAVE ANYTHING TO WORRY ABOUT. THANK YOU.
 Dr. Yasser Mokhtar - Tue Mar 01, 2005 11:12 pm

User avatar Dear Ryan,

The sensitivity and specificity of the ekg at diagnosing chamber hypertrophy or enlargement whether right or left, atrium or ventricle, is not that good. The best tool at diagnosing the size of heart chambers is the echocardiogram. If the echo says that your right ventrile is ok, then it is ok if the person who interpreted the echo is a well trained cardiologist (which i assume nearly all cardiologist are).

Some ekg machines interpret ekgs automatically and if you read the interpretation without having the doctor look at it and confirm it then this is invalid, because a doctor has to confirm this interpretation before it is officical.

There are certain criteria to diagnose right ventricular hypertrophy. Do you know how was right ventricular hypertrophy diagnosed on your ekg? One of these criteria actually is considered a normal pattern in many patients.

Your ekg looks like this and that's it and you don't have to worry about it.

Regarding the mi, anything could have gone wrong while taking the ekg for that pattern to appear, you might have been in expiration rather than in inspiration when they were taking the ekg. You don't have any risk factors for coronary disease and the chest pain that you are feeling does not sound typical as compared to the pain of coronary origin, so the probability that the pain be of coronary origin is very low and consequently (and specially since ekgs are not the best tool at diagnosing coronary disease), this mi pattern that appeared once is not to be taken into consideration as a reliable piece of information when it comes to trying to see whether or not you have coronary disease.

You had an echocardiogram and if you had a previous mi, it would have shown on the echocardiogram as abnormal pattern of heart contraction. Since your echo was normal then you did not have an mi before.

You don't have to worry about anything.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 CardsDr - Wed Apr 27, 2005 8:49 am

As a Cardiologist I second the response from Dr Mokhtar. The EKG is not as sensitive or specific as an echocardiogram. The advice you received from your cardiology consult is the most sound. EKG's are tempermental and subjective and as the other reply stated. RVH has many different criteria and may be seen in "normal" hearts.
Your best bet would be to follow up once a year or so, keep your "risk factors" under control. Watch your blood pressure, aerobic exercises, 4-5 times per week.


Again, I would question who made that first interpretation of RVH and MI, you would be suprised by how lax EKG training is today in the ERA of echos and automatic EKG computer interpreting. Some fellow cardiologist state that the only qualified interpreters of EKG's are cardiologists.....

Good luck and don't stress about this.

Tom
 ryanschrang - Tue Sep 27, 2005 1:41 am

THANK YOU FOR YOUR RESPONSES, I HAVE RECENTLY SEEN ANOTHER CARDIOLOGIST TO BE ON THE SAFE SIDE AND TO GET THIS DOUBLE CHECKED AND NOW IT LOOKS LIKE MY EKG IS SHOWING RIGHT BUNDLE BRANCH BLOCK. ITS JUST SO WEIRD HOW ALL THESE THINGS COME UP CONTINOUSLY ON MY EKG YET THEY TELL ME THAT NOTHING IS WRONG BUT I STILL HAVE CHEST PAINS. THE NEW CARDIOLOGIST HAS HAD ME DO ANOTHER ECHO BECAUSE IT HAS BEEN ALIL OVER A YEAR SINCE THE LAST TIME I HAD ONE. I HAVENT HEARD FROM THE DOC IS ABOUT 5 DAYS SO I AM GUESSING THAT NOTHING SHOWED ON THE EKG BECAUSE I WOULD HOPE IF THERE WAS A PROBLEM HE WOULD HAVE CONTACTED ME BY NOW.THE NEW DOC I AM SEEING IS DOCTOR JAYBERETH. HIS PARTNER IS DR, ARMUCHAND AND FROM WHAT I HAVE HEARD THEY ARE SUPPOSED TO BE VERY GOOD CARDIOLOGIST. I DO HAVE ASTHMA AND I HAVE TROUBLE BREATHING SOMETIMES FOR NO SPECIFIC REASON EVEN WHEN I AM DOING NOTHING EXCERTING. IM NOT SURE IF THIS IS JUST ANXIETY SINCE I AM ALWAYS WORRYING THAT SOMETHING IS WRONG WITH ME OR NOT. I AM JUST CURIOUS WHAT KIND OF TEST MY DOC COULD DO TO CHECK AND MAKE SURE I don't HAVE PULMONARY HYPERTENSION SINCE I HAVE HAD ASTHMA MY WHOLE LIFE. THANK YOU AGAIN FOR YOUR RESPONSES.

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