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Dr. Ben
Dr. Ben, Doctor
Category: Cardiology
Satisfied Customers: 946
Experience:  GP Partner, practicing Medicine for 14 years. I have broad experience with special interests in Cardiology, Dermatology, Paediatrics, Sexual Health and Oncology.
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I’ve been having tests because I had an abnormal ECG and I’d

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Hi I’ve been having tests because I had an abnormal ECG and I’d like a second opinion
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Yes, citalopram 20mg
JA: Anything else in your medical history you think the doctor should know?
Customer: No

Hello, thank you for your question. I’m Dr. Ben and I’m here to assist you today. Please allow me a few moments to review your question and I’ll be right back.

If you receive an invitation for a phone call, please know this is automatically generated by the site and has not come from me. Feel free to ignore it.

Please can you elaborate on the problem for me?

Customer: replied 6 months ago.
I have had numerous ECG with t wave inversion in a couple of leads, i have also had 3 echo scans done since 2003 all showing normal function. I saw a cardiologist last week who said that he was 95% I was ok but I could have an MRI if I wanted but would take 9 months. I am an anxious person so I’d like more reassurances. I can send you an ECG I had at a walk in heart check clinic if you want? I do not have any other symptoms apart from some light headed ness but that is aligned with my anxiety, I excercise a lot and do triathlons but this is holding me back until I know all is ok. My question is, do you see this type of ECG in people without any underlying issues?

Thank you, that’s really helpful.

Yes, please do go ahead and upload a copy of your ECG for me to review.

Please would you also be kind enough to tell me:

- How old are you?

- Are you male or female?

- Any medical problems or previous surgery?

- Any medications (including contraception, supplements etc)?

- What is your height and weight?

- Do you smoke?

- Do you drink alcohol?

- Is there any family history or heart problems or fainting/collapse?

Many thanks

Customer: replied 6 months ago.
I have attached 4 images
I am Male 34 years old
General anxiety
Citalopram 20mg
5ft 11
87kg
Do not smoke
Drink alcohol on weekends
Grandfather died 60 of heart attack but no other issues or sudden deaths

That’s great, thank you - I am reviewing them now...

Can I ask just a couple more questions to aid my interpretation?

- What is your ethnicity?

- Was there any stress or anxiety present when you had these ECGs taken?

Customer: replied 6 months ago.
I am white British
Yes I normally feel a little nervous with ECG
Are you a cardiologist or a GP?
Customer: replied 6 months ago.
I clicked call me accidentally sorry

Thank you for that.

There is isolated TWI in two non-contiguous leads (III, V4). The main issue to rule out is cardiomyopathy and you have already had x3 satisfactory ones carried out - this is very highly reassuring. A cardiac MRI is marginally more sensitive and I think this accounts for the Cardiologist quoting 95% confidence.

This certainly can be a benign variant and is more likely to be found in young athletes. It is also worth bearing in mind that anxiety can actually provoke ECG changes including TWI (due to hyperventilation).

I hope that this provides some additional reassurance to you. By all means go through with the Cardiac MRI, but I would not let this put you off carrying out your normal activities in the meantime.

I am a GP with a special interest in Cardiology.

Does this help?

Customer: replied 6 months ago.
Thanks for the reply, when you say isolated does this mean it is not there on every beat of the heart, I also had one ecg and there was no inversion, if there was an issue would it always be there? And one more question, do you see this in people my age with good results on echo etc?
Customer: replied 6 months ago.
Also, is there t wave inversion large or just minor?
Customer: replied 6 months ago.
My t wave that is meant to say?

Hi, sorry I mean isolated as in it is not present in more than one contiguous leads (Inferior - II, III, aVF; Lateral - I, aVL, V5-6; Septal - V1-2; Anterior - V3-4).

The TWI present here is minor.

It is reassuring that you have also had a normal ECG without TWI (possibly reinforces the concept that anxiety/hyperventilation may be playing some role).

This is likely to be a benign variant - normal for you and more likely because you are young and athletic.

Customer: replied 6 months ago.
When you say young I am 34 so getting on now haha. Thank you for all your help, I feel a lot better now and will continue with my training with piece of mind
Customer: replied 6 months ago.
One more question I promise, do you see this regular in other young patients?

Younger than me so yes, you are young!

Various ECG changes including this are quite common in young, athletic patients.

Dr. Ben and other Cardiology Specialists are ready to help you
Customer: replied 6 months ago.
Thanks very much for your help, I will leave a review

You’re very welcome, all the best.