Inverted T Waves

On 30 Oct 2003 02:04:34 -0800, Andrew Brown <[email hidden]>

Quoted message said:

I recently had a routine ECG as part of a hospital outpatient
assessment of hypertension. During the ECG, the technician noted my
T waves were inverted and asked me to take some deep breaths. (I cant
remember whether I was asked to hold the breath for a second or so) and
then the T waves normalised. I have since read that T waves can
invert if one is hyperventilating. I suffer from anxiety and so I
sense I am often partially hyperventilating. At the time I guess the
reality of the clinical setting might have affected my breathing
patterns. I would be pleased to know what anyone thinks about this ?
I do remember the technician saying that it was a good sign that
the breathing request made the T wave normalise. Is this a common
technique used when taking ECG if a potential irregularity presents on
the emerging patterns on the paper.

On another aspect, I would add that my blood pressure levels are very
variable. Doctors seem to chop and change my diagnosis. But I am
seeking to have an echocardiogram done for the elimination or
identification of LVH but they seem to want to depend only on the ECG
which I understand is not so dependable for such purposes .I gather it
is good at detecting the hearts functioning but that as Left
Ventricular Hypertrophy concerns "muscular morphology" it is better
detected and measured by echocardiogram that is a sort of imaging
technique. Should I push for an echo or is it pointless. My BP
averages on 24 hr readings ranged between 125 / 93 and lower, one 24
hour set produced a average diastolic of about 83. However my
pressures do not drop at night, or drop only marginally. (non dipper) I
am not presently taking medication. The hospital doctor decided to
classify me as white coat hypertensive. The two previous diagnosis
within a 12 month period were Hypertensive, then normotensive. My
CLINIC readings are often higher, with high dioastolics of up to and
exceeding 100 and rarely lower than 95. At home. Typical readings
are on the high normal to high side . Last night I have several of
167/105. In the night I woke and felt a bit restless and took my
pressure which was around 150/98. My medical history suggests I
have been borderline/actual hypertensive for perhaps a decade without
treatment. I have no known family history, normal/good blood lipid
results, I dont smoke. My alcohol consumption is about 28 units a
week and so ought to be lowered. I am not diabetic.

Any advice would be really appreciated. Thanks Andrew Brown

You would be an excellent candidate for a 24 hour blood pressure monitor.
This is a device that you wear for 24 hours and it takes your blood
pressure every 15 minutes, even while you sleep. Talk to your doctor about
it.
--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

M.D. said:

You would be an excellent candidate for a 24 hour blood pressure monitor.
This is a device that you wear for 24 hours and it takes your blood
pressure every 15 minutes, even while you sleep.

If you can sleep. This is an good tool but be prepared for the
possibility of a sleepless nite.

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.

Andrew Brown said:

I recently had a routine ECG as part of a hospital outpatient
assessment of hypertension. During the ECG, the technician noted my
T waves were inverted and asked me to take some deep breaths. (I cant
remember whether I was asked to hold the breath for a second or so)
and then the T waves normalised. I have since read that T waves can
invert if one is hyperventilating. I suffer from anxiety and so I
sense I am often partially hyperventilating. At the time I guess the
reality of the clinical setting might have affected my breathing
patterns. I would be pleased to know what anyone thinks about this ?
I do remember the technician saying that it was a good sign that
the breathing request made the T wave normalise. Is this a common
technique used when taking ECG if a potential irregularity presents on
the emerging patterns on the paper.

It is not.

Quoted message said:

On another aspect, I would add that my blood pressure levels are very
variable. Doctors seem to chop and change my diagnosis. But I am
seeking to have an echocardiogram done for the elimination or
identification of LVH but they seem to want to depend only on the ECG
which I understand is not so dependable for such purposes .I gather it
is good at detecting the hearts functioning but that as Left
Ventricular Hypertrophy concerns "muscular morphology" it is better
detected and measured by echocardiogram that is a sort of imaging
technique. Should I push for an echo or is it pointless. My BP
averages on 24 hr readings ranged between 125 / 93 and lower, one 24
hour set produced a average diastolic of about 83. However my
pressures do not drop at night, or drop only marginally. (non dipper)
I am not presently taking medication. The hospital doctor decided to
classify me as white coat hypertensive. The two previous diagnosis
within a 12 month period were Hypertensive, then normotensive. My
CLINIC readings are often higher, with high dioastolics of up to and
exceeding 100 and rarely lower than 95. At home. Typical readings
are on the high normal to high side . Last night I have several of
167/105. In the night I woke and felt a bit restless and took my
pressure which was around 150/98. My medical history suggests I
have been borderline/actual hypertensive for perhaps a decade without
treatment. I have no known family history, normal/good blood lipid
results, I dont smoke. My alcohol consumption is about 28 units a
week and so ought to be lowered.

Alcohol causes elevations in blood pressure in those who are susceptible.

Quoted message said:

I am not diabetic.

Any advice would be really appreciated.

Sounds like you should be asking your doctor about better control of your
blood pressure. The ideal goal is 115/75. Yours is consistently too
high. Given the EKG abnormalities (even transiently), would suggest you
also ask about a referral to a cardiologist. You are at higher risk for
heart disease because of the hypertension.

Quoted message said:

Thanks Andrew Brown

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Patrick Blanchard said:

On 30 Oct 2003 02:04:34 -0800, Andrew Brown <[email hidden]>

Quoted message said:

I recently had a routine ECG as part of a hospital outpatient
assessment of hypertension. During the ECG, the technician noted my
T waves were inverted and asked me to take some deep breaths. (I cant
remember whether I was asked to hold the breath for a second or so) and
then the T waves normalised. I have since read that T waves can
invert if one is hyperventilating. I suffer from anxiety and so I
sense I am often partially hyperventilating. At the time I guess the
reality of the clinical setting might have affected my breathing
patterns. I would be pleased to know what anyone thinks about this ?
I do remember the technician saying that it was a good sign that
the breathing request made the T wave normalise. Is this a common
technique used when taking ECG if a potential irregularity presents on
the emerging patterns on the paper.

On another aspect, I would add that my blood pressure levels are very
variable. Doctors seem to chop and change my diagnosis. But I am
seeking to have an echocardiogram done for the elimination or
identification of LVH but they seem to want to depend only on the ECG
which I understand is not so dependable for such purposes .I gather it
is good at detecting the hearts functioning but that as Left
Ventricular Hypertrophy concerns "muscular morphology" it is better
detected and measured by echocardiogram that is a sort of imaging
technique. Should I push for an echo or is it pointless.

_________________________________________________________________________

Quoted message said:

Quoted message said:

My BP
averages on 24 hr readings ranged between 125 / 93 and lower, one 24
hour set produced a average diastolic of about 83. However my
pressures do not drop at night, or drop only marginally. (non dipper) I
am not presently taking medication.

---------------------------------------------------------------------

Quoted message said:

Quoted message said:

The hospital doctor decided to
classify me as white coat hypertensive. The two previous diagnosis
within a 12 month period were Hypertensive, then normotensive. My
CLINIC readings are often higher, with high dioastolics of up to and
exceeding 100 and rarely lower than 95. At home. Typical readings
are on the high normal to high side . Last night I have several of
167/105. In the night I woke and felt a bit restless and took my
pressure which was around 150/98. My medical history suggests I
have been borderline/actual hypertensive for perhaps a decade without
treatment. I have no known family history, normal/good blood lipid
results, I dont smoke. My alcohol consumption is about 28 units a
week and so ought to be lowered. I am not diabetic.

Any advice would be really appreciated. Thanks Andrew Brown

You would be an excellent candidate for a 24 hour blood pressure monitor.
This is a device that you wear for 24 hours and it takes your blood
pressure every 15 minutes, even while you sleep. Talk to your doctor about
it.
--

Careful reading of Andrew Brown's submission
strongly suggests he has had 24 hour monitors
on more than one occasion.
A.L.

MD/PhD said:

The ideal goal is 115/75

Why here?

http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Andrew Brown said:

I recently had a routine ECG as part of a hospital outpatient
assessment of hypertension. During the ECG, the technician noted my
T waves were inverted and asked me to take some deep breaths. (I cant
remember whether I was asked to hold the breath for a second or so)
and then the T waves normalised. I have since read that T waves can
invert if one is hyperventilating. I suffer from anxiety and so I
sense I am often partially hyperventilating. At the time I guess the
reality of the clinical setting might have affected my breathing
patterns. I would be pleased to know what anyone thinks about this ?
I do remember the technician saying that it was a good sign that
the breathing request made the T wave normalise. Is this a common
technique used when taking ECG if a potential irregularity presents on
the emerging patterns on the paper.

It is not.

Quoted message said:

On another aspect, I would add that my blood pressure levels are very
variable. Doctors seem to chop and change my diagnosis. But I am
seeking to have an echocardiogram done for the elimination or
identification of LVH but they seem to want to depend only on the ECG
which I understand is not so dependable for such purposes .I gather it
is good at detecting the hearts functioning but that as Left
Ventricular Hypertrophy concerns "muscular morphology" it is better
detected and measured by echocardiogram that is a sort of imaging
technique. Should I push for an echo or is it pointless. My BP
averages on 24 hr readings ranged between 125 / 93 and lower, one 24
hour set produced a average diastolic of about 83. However my
pressures do not drop at night, or drop only marginally. (non dipper)
I am not presently taking medication. The hospital doctor decided to
classify me as white coat hypertensive. The two previous diagnosis
within a 12 month period were Hypertensive, then normotensive. My
CLINIC readings are often higher, with high dioastolics of up to and
exceeding 100 and rarely lower than 95. At home. Typical readings
are on the high normal to high side . Last night I have several of
167/105. In the night I woke and felt a bit restless and took my
pressure which was around 150/98. My medical history suggests I
have been borderline/actual hypertensive for perhaps a decade without
treatment. I have no known family history, normal/good blood lipid
results, I dont smoke. My alcohol consumption is about 28 units a
week and so ought to be lowered.

Alcohol causes elevations in blood pressure in those who are susceptible.

Quoted message said:

I am not diabetic.

Any advice would be really appreciated.

Sounds like you should be asking your doctor about better control of your
blood pressure. The ideal goal is 115/75. Yours is consistently too
high. Given the EKG abnormalities (even transiently), would suggest you
also ask about a referral to a cardiologist. You are at higher risk for
heart disease because of the hypertension.

Quoted message said:

Thanks Andrew Brown

You are welcome.

Thank you to all who replied to my submission. The issue of a referal
to a cardiologist has become one of conflict between me and my primary
care practitioner. Originally, I was sent to a "nephrologist" for
request with help in my case management (despite my normal kidney
function) and with a request for an echo in view of the inverted T
waves and voltage irregularities. The nephrologist organised only the
ECG and the echo was never performed. I want the echo for several
reasons. (a) I( know that ECG is not the modality of choice for
identification of Left Ventricular Hypertrophy . It is simply nowhere
near reliable enough, (b) The drug treatment and other management of
my case would be different if it was found that I had clinically
significant LVH (c) I should also regard the echo as a good check
on aspects of heart function anyway and taken together with the ECG
results, the two would give a very good indication of my cardiac risk
and good information on which to manage my case
The simple position of my primary care practitioner is that "your
clinic ECG was normal" and therefore there is no need for referral
for echo.

It is a simplistic retort because of the inherent inefficacy of ECG in
the detection of LVH and the questionable status of the EKG which
showed T waves that were significantly inverted only to flatten on my
being instrusted to breath a particular way. According to my own
study, (I accept I am a layperson with no medical skills) inverted T
waves are often found but have a great variety of possible
explanations, some benign, some more sininster and it is relevant to
explore further to try to find out why.

I hope I win my "campaign" for the referal to the cardiologist, it
doesnt seem to be asking the earth, even though I know there will be
people with more pressingly urgent problems who should be allocated a
place in front of mine .

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Andrew Brown said:

I recently had a routine ECG as part of a hospital outpatient
assessment of hypertension. During the ECG, the technician noted my
T waves were inverted and asked me to take some deep breaths. (I cant
remember whether I was asked to hold the breath for a second or so)
and then the T waves normalised. I have since read that T waves can
invert if one is hyperventilating. I suffer from anxiety and so I
sense I am often partially hyperventilating. At the time I guess the
reality of the clinical setting might have affected my breathing
patterns. I would be pleased to know what anyone thinks about this ?
I do remember the technician saying that it was a good sign that
the breathing request made the T wave normalise. Is this a common
technique used when taking ECG if a potential irregularity presents on
the emerging patterns on the paper.

It is not.

Quoted message said:

On another aspect, I would add that my blood pressure levels are very
variable. Doctors seem to chop and change my diagnosis. But I am
seeking to have an echocardiogram done for the elimination or
identification of LVH but they seem to want to depend only on the ECG
which I understand is not so dependable for such purposes .I gather it
is good at detecting the hearts functioning but that as Left
Ventricular Hypertrophy concerns "muscular morphology" it is better
detected and measured by echocardiogram that is a sort of imaging
technique. Should I push for an echo or is it pointless. My BP
averages on 24 hr readings ranged between 125 / 93 and lower, one 24
hour set produced a average diastolic of about 83. However my
pressures do not drop at night, or drop only marginally. (non dipper)
I am not presently taking medication. The hospital doctor decided to
classify me as white coat hypertensive. The two previous diagnosis
within a 12 month period were Hypertensive, then normotensive. My
CLINIC readings are often higher, with high dioastolics of up to and
exceeding 100 and rarely lower than 95. At home. Typical readings
are on the high normal to high side . Last night I have several of
167/105. In the night I woke and felt a bit restless and took my
pressure which was around 150/98. My medical history suggests I
have been borderline/actual hypertensive for perhaps a decade without
treatment. I have no known family history, normal/good blood lipid
results, I dont smoke. My alcohol consumption is about 28 units a
week and so ought to be lowered.

Alcohol causes elevations in blood pressure in those who are susceptible.

Quoted message said:

I am not diabetic.

Any advice would be really appreciated.

Sounds like you should be asking your doctor about better control of your
blood pressure. The ideal goal is 115/75. Yours is consistently too
high. Given the EKG abnormalities (even transiently), would suggest you
also ask about a referral to a cardiologist. You are at higher risk for
heart disease because of the hypertension.

Quoted message said:

Thanks Andrew Brown

You are welcome.

I will post my ECG on a webpage perhaps with some other clinical
information as soon as I get a moment and then posters can have a look
..

MY ECG can be seen here at http://members.lycos.co.uk/wawel6/ekg1.jpg
and http://members.lycos.co.uk/wawel6/Ekg2.jpg The first
one shows "inverted T waves" ? and the 2nd one, I was asked to take
a deep breath (see the technician noted "Inspir" on the paper

On the 2nd one that instruction seems to have corrected the T wave.

Or so it seems

Thanks Andrew Brown

Andrew Brown said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Andrew Brown said:

I recently had a routine ECG as part of a hospital outpatient
assessment of hypertension. During the ECG, the technician noted my
T waves were inverted and asked me to take some deep breaths. (I cant
remember whether I was asked to hold the breath for a second or so)
and then the T waves normalised. I have since read that T waves can
invert if one is hyperventilating. I suffer from anxiety and so I
sense I am often partially hyperventilating. At the time I guess the
reality of the clinical setting might have affected my breathing
patterns. I would be pleased to know what anyone thinks about this ?
I do remember the technician saying that it was a good sign that
the breathing request made the T wave normalise. Is this a common
technique used when taking ECG if a potential irregularity presents on
the emerging patterns on the paper.

It is not.

Quoted message said:

On another aspect, I would add that my blood pressure levels are very
variable. Doctors seem to chop and change my diagnosis. But I am
seeking to have an echocardiogram done for the elimination or
identification of LVH but they seem to want to depend only on the ECG
which I understand is not so dependable for such purposes .I gather it
is good at detecting the hearts functioning but that as Left
Ventricular Hypertrophy concerns "muscular morphology" it is better
detected and measured by echocardiogram that is a sort of imaging
technique. Should I push for an echo or is it pointless. My BP
averages on 24 hr readings ranged between 125 / 93 and lower, one 24
hour set produced a average diastolic of about 83. However my
pressures do not drop at night, or drop only marginally. (non dipper)
I am not presently taking medication. The hospital doctor decided to
classify me as white coat hypertensive. The two previous diagnosis
within a 12 month period were Hypertensive, then normotensive. My
CLINIC readings are often higher, with high dioastolics of up to and
exceeding 100 and rarely lower than 95. At home. Typical readings
are on the high normal to high side . Last night I have several of
167/105. In the night I woke and felt a bit restless and took my
pressure which was around 150/98. My medical history suggests I
have been borderline/actual hypertensive for perhaps a decade without
treatment. I have no known family history, normal/good blood lipid
results, I dont smoke. My alcohol consumption is about 28 units a
week and so ought to be lowered.

Alcohol causes elevations in blood pressure in those who are susceptible.

Quoted message said:

I am not diabetic.

Any advice would be really appreciated.

Sounds like you should be asking your doctor about better control of your
blood pressure. The ideal goal is 115/75. Yours is consistently too
high. Given the EKG abnormalities (even transiently), would suggest you
also ask about a referral to a cardiologist. You are at higher risk for
heart disease because of the hypertension.

Quoted message said:

Thanks Andrew Brown

You are welcome.

Thank you to all who replied to my submission. The issue of a referal
to a cardiologist has become one of conflict between me and my primary
care practitioner. Originally, I was sent to a "nephrologist" for
request with help in my case management (despite my normal kidney
function) and with a request for an echo in view of the inverted T
waves and voltage irregularities. The nephrologist organised only the
ECG and the echo was never performed. I want the echo for several
reasons. (a) I( know that ECG is not the modality of choice for
identification of Left Ventricular Hypertrophy . It is simply nowhere
near reliable enough, (b) The drug treatment and other management of
my case would be different if it was found that I had clinically
significant LVH (c) I should also regard the echo as a good check
on aspects of heart function anyway and taken together with the ECG
results, the two would give a very good indication of my cardiac risk
and good information on which to manage my case
The simple position of my primary care practitioner is that "your
clinic ECG was normal" and therefore there is no need for referral
for echo.

It is a simplistic retort because of the inherent inefficacy of ECG in
the detection of LVH and the questionable status of the EKG which
showed T waves that were significantly inverted only to flatten on my
being instrusted to breath a particular way. According to my own
study, (I accept I am a layperson with no medical skills) inverted T
waves are often found but have a great variety of possible
explanations, some benign, some more sininster and it is relevant to
explore further to try to find out why.

I hope I win my "campaign" for the referal to the cardiologist, it
doesnt seem to be asking the earth, even though I know there will be
people with more pressingly urgent problems who should be allocated a
place in front of mine .

You may print out my comments and see if they will help you win your "campaign" :-)

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

s promised, MY ECG can be seen here at http://members.lycos.co.uk/wawel6/ekg1.jpg
and http://members.lycos.co.uk/wawel6/Ekg2.jpg The first
one shows "inverted T waves" ? and the 2nd one, I was asked to take
a deep breath (see the technician noted "Inspir" on the paper

On the 2nd one that instruction seems to have corrected the T wave.

Or so it seems .

Thanks Andrew Brown