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Date of last update: 10/20/2017.

Forum Name: Cardiology Symptoms

Question: EKG: P Wave Alternans with mild discomfort

 rockstar98 - Mon Oct 26, 2009 9:52 pm

Hello, I am a 29 year old paramedic. I am a smoker of 12 years, about half a pack per day. No medical history, however there is significant heart history in the family. Today at work I have been feeling under the weather and decided to evaluate my EKG. I immediately noticed an abnormality, which after careful research I have learned to be known as "P Wave Alternans". There is no other obvious findings to me on my EKG. I also have mild chest discomfort particular to the Left side "pressure/burning" near the mid-axillary line under the clavical, I have had this persistant discomfort all day along with mild back pain and shoulder pain. I initially passed off the discomfort as inflamation due to a previous shoulder/back injury. I have however been feeling easily fatigued for a couple of years, feeling like sleeping a lot more. I have done previous EKGs and have never seen the " P Wave Alternans". 12 lead EKG was also taken, unfortunately it was not during a phase of the "P Wave Alternans" but it did read Left Axis Deviation and Pulmonary Disease Pattern, which previous 12 lead EKG's have shown years ago. I occasionally get light headed if I stand from a supine position to rapidly, or overwork myself. I am obviously going to see a cardiologist very soon. Just wondering if there are any other thoughts on these symptoms, "cardiomyopathy?, paricarditis?, paricardial effusion?, tamponade?" Kind of worried about it, as my research has shown that this reading on an EKG is extremely rare. The local ER doctor said he had heard of it before but never seen it, and consulted with a local cardiologist that seemed to have no clue about it. Also spoke to a nursing student who found no reference to it in any of his books. And, there is very little information about it online. My vitals are in great limits, BP 120/79, heart rate mid 80s slightly irregular but strong. Please give me advice/opinions/suggestions about what might be going on......I know, quit smoking and see the cardiologist are priority :)
 John Kenyon, CNA - Wed Oct 28, 2009 12:21 am

User avatar Hello -- Two possibilities come to mind right away. First, given the admittedly atypical discomfort with the finding of P wave alternans, pericardial effusion (usually in conjunction with pericarditis) is possible, esepcially if deep breathing causes the pain to increase in with pleurisy (pericarditis/effusion will cause pleuritic pain). This would need to be proven first, then usually responds well to NSAIDs.

Another possibility is a misinterpretation of the P wave anomaly which may actually be wandering pacemaker rather than alternans, and might well account for a slightly irregular rhythm as you mention. This would also allow for the otherwise fairly normal findings you report. As a rule this requires no intervention.

The cardiologist should be able to nail the diagnosis at first glance, especially if you've mistaken wandering pacemaker for P alternans -- which happens more often than you might believe (rode the ambulance for 30 years, spent another 10 inside, have seen some pretty interesting things).

Hope this is helpful. Please follow up with us here as needed, and by all means update us after you've seen the cardio. Good luck!

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