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potsiebarbie

Another disappointing cardio appt

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I followed up with my new cardiologist whom I've only see once before since my new EKG abnormality. He said the echo and 24 hr holter were "fine". He gave no details and I asked about my newly acquired EKG abnormality and he said he could barely read it on the EKG and it's not a big deal and to follow up in a year. The EKG abnormality is a incomplete right bundle branch block, by the way. And as far as I can tell it seems to come and go, or not get picked up. I guess I'm just having a hard time accepting it. I left the appt thinking to myself "no, I don't want it. No thanks. I do not accept" lol I'm like a kid who doesnt want to eat their veggies. IDK. Any advice, or experience to share? Anyone else go that long in between cardio visits? Anyone else with abnormal ekgs? 

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@potsiebarbie - yes, I have an abnormal EKG - it shows inverted T-wave. This CAN be serious if it is a new finding but in my case it is always there, so it is no big deal. The abnormality you are mentioning - incomplete right bundle branch block - was that what the doctor told you or was it the interpretation from the EKG machine ( on the print out )? Often the print-out interpretation is incorrect. I already had EKG's that claimed I had an inferior MI ( heart attack ) but the actual wave-forms did not support that. So - if your cardiologist is not concerned I would not be either. And yes - if you have no serious abnormalities or complications a one year follow-up is pretty standard. I have a rare heart condition and see my cardiologist every 6 months. But my husband - who has a minor arrhythmia - sees him only once a year. Sounds standard practice to me. But if you are concerned you can always go for a second opinion. 

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It's one of those things that we encounter with doctors. If it doesn't show up on standard tests, it doesn't exist or it doesn't show up consistently or its rare, so it doesn't matter. The best for me was a neuro-ophthalmologist at Mayo that told me I have 4th cranial nerve palsy. I asked why, as I've never had eye problems, especially double vision. She was like, you've had it for awhile, but for some reason you've decompensated. Why? No answers. So she sends the report to my regular eye doctor who tells me if it stabilizes get prism glasses otherwise I'll see you in a year. Whiskey Tango Foxtrot? On one level, he doesn't think it's serious enough to do more. On another level, do you trust his judgement? I am a little self-centered about health issues in that I know what normal should be and when I am told abnormal is ok or we can't find anything, I don't accept it either. The choices are to shut up and accept their diagnosis/decree, challenge them or move on to someone that will listen and look further. I am finding it difficult to be an effective advocate for myself as whatever I am doing, it's not reaching the right synapses in doctors. It seems like they don't like the patient having ideas of what's wrong with them, they want to diagnose it themselves. Then again, William Osler, the father of modern medicine said that if a doctor listens to a patient, he'll get the diagnosis. Something that's not taught anymore or isn't taken to heart. 

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8 hours ago, Pistol said:

@potsiebarbie - yes, I have an abnormal EKG - it shows inverted T-wave. This CAN be serious if it is a new finding but in my case it is always there, so it is no big deal. The abnormality you are mentioning - incomplete right bundle branch block - was that what the doctor told you or was it the interpretation from the EKG machine ( on the print out )? Often the print-out interpretation is incorrect. I already had EKG's that claimed I had an inferior MI ( heart attack ) but the actual wave-forms did not support that. So - if your cardiologist is not concerned I would not be either. And yes - if you have no serious abnormalities or complications a one year follow-up is pretty standard. I have a rare heart condition and see my cardiologist every 6 months. But my husband - who has a minor arrhythmia - sees him only once a year. Sounds standard practice to me. But if you are concerned you can always go for a second opinion. 

Those EKG's are really finicky sometimes. I had a whole bunch of them saying "meets the voltage diagnostic criteria for left ventricular hypertrophy" and when they did the echo of my heart, it turns out I have right ventricular hypertrophy. It was not showing up in the EKG properly. I'd say, it's much better to have no heart issue than to have one. I'd take that as a win. 

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The big question is, "Does it matter?"  What are you hoping to gain with/without having an abnormality?  What are the consequences of treating it?  What are the consequences of ignoring it?  Even if you manage to get an official diagnosis of something, are you any further ahead?  Trust me, the number of disappointing Dr appointments way outnumbers the positive ones for me.  

My body was trashed 20+ years ago due to severe anorexia.  Nothing about it really works right.   Diagnoses and labels can be helpful, but they can also get in the way.  I stopped worrying about them many years ago.

Validation is nice, but I only bother with it when it's going to pose a threat to my health.  Case in point: Last week with an oral surgery consult. Bradycardia & hypotension are on the typed, multi-page medical history sheet I hand over to every new Dr I see.   I'm already apprehensive of doing surgery, have a long history of bad experiences with doctors, have a past history of abuse (and saw a dental chair with restraints on it as they sat me in the consult exam room).. you bet my BP and pulse were through the roof.  The nurse wasn't buying the bradycardia & hypotension until I show her my BP reading from that morning -- 83/39, p45.    Yep, that took general anesthesia & sedation right off the table.  Otherwise, I would have just brushed her off. 

I pass out (among other issues).  No big deal.  It happens.  It's part of "normal" life for me.  It's not too different from someone who has epilepsy, or someone who is an amputee.  To the world, their bodies aren't "normal", but that doesn't change their situation. They've been dealt the cards they have. It's up to them to make the most of it.  Sometimes problems are easily fixable.  Sometimes the treatments put you in worse shape and can cause permanent damage to your body.  Sometimes doing nothing really is the best approach.  

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13 hours ago, potsiebarbie said:

I followed up with my new cardiologist whom I've only see once before since my new EKG abnormality. He said the echo and 24 hr holter were "fine". He gave no details and I asked about my newly acquired EKG abnormality and he said he could barely read it on the EKG and it's not a big deal and to follow up in a year. The EKG abnormality is a incomplete right bundle branch block, by the way. And as far as I can tell it seems to come and go, or not get picked up. I guess I'm just having a hard time accepting it. I left the appt thinking to myself "no, I don't want it. No thanks. I do not accept" lol I'm like a kid who doesnt want to eat their veggies. IDK. Any advice, or experience to share? Anyone else go that long in between cardio visits? Anyone else with abnormal ekgs? 

There are a couple of positives, the echo-cardiogram indicates that the  structure of your heart normal and your holter was normal.   Incomplete RBBB in a ECG is often a normal variant or a slight delay in conduction.  It is okay to feel they way you feel, it is a shame that your cardiologist couldn't explain more about the anomaly in your ECG - it would take away a lot of worry and concern.

I too have a normal echo (phew),  My own ECG shows a narrow QRS complex.   I also have IST.  I am prone to SVT's - HR have been up to 250 BPM - chest pain extra-ordinary BUT not dangerous. 😀 I have I I have also had whilst an inpatient  twice showing p wave pauses,  though the symptoms of this is the same as with the dysautonomia. 🤨


 

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I have Incomplete Right Bundle Branch Block, and I was told it was a normal variant and not any kind of problem at all.  Left BBB, now, that is more likely to be a problem.

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I am with Pistol on this one.  I see my cardiologist once a year and his NP 6 months after I see him.  I see my neurologist NP every 3 months.  If you don’t trust this one ask for a second opinion from another one.  Different eyes/experience are usually helpful and can give you peace of mind.

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On 3/26/2019 at 12:15 AM, blizzard2014 said:

Those EKG's are really finicky sometimes. I had a whole bunch of them saying "meets the voltage diagnostic criteria for left ventricular hypertrophy" and when they did the echo of my heart, it turns out I have right ventricular hypertrophy. It was not showing up in the EKG properly. I'd say, it's much better to have no heart issue than to have one. I'd take that as a win. 

Well there's no debate that I have the IRBBB. One of my concerns is that it is a new finding. Hopefully I can eventually locate some reassuring research or get a second opinion with someone who's willing to educate me on this. 

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On 3/25/2019 at 3:25 PM, Pistol said:

@potsiebarbie - yes, I have an abnormal EKG - it shows inverted T-wave. This CAN be serious if it is a new finding but in my case it is always there, so it is no big deal. The abnormality you are mentioning - incomplete right bundle branch block - was that what the doctor told you or was it the interpretation from the EKG machine ( on the print out )? Often the print-out interpretation is incorrect. I already had EKG's that claimed I had an inferior MI ( heart attack ) but the actual wave-forms did not support that. So - if your cardiologist is not concerned I would not be either. And yes - if you have no serious abnormalities or complications a one year follow-up is pretty standard. I have a rare heart condition and see my cardiologist every 6 months. But my husband - who has a minor arrhythmia - sees him only once a year. Sounds standard practice to me. But if you are concerned you can always go for a second opinion. 

Thanks! I'm going to try to get a second opinion, and maybe even give my cardio a call and ask questions until I get a better understanding. 

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On 3/26/2019 at 12:17 AM, bunny said:

The big question is, "Does it matter?"  What are you hoping to gain with/without having an abnormality?  What are the consequences of treating it?  What are the consequences of ignoring it?  Even if you manage to get an official diagnosis of something, are you any further ahead?  Trust me, the number of disappointing Dr appointments way outnumbers the positive ones for me.  

My body was trashed 20+ years ago due to severe anorexia.  Nothing about it really works right.   Diagnoses and labels can be helpful, but they can also get in the way.  I stopped worrying about them many years ago.

Validation is nice, but I only bother with it when it's going to pose a threat to my health.  Case in point: Last week with an oral surgery consult. Bradycardia & hypotension are on the typed, multi-page medical history sheet I hand over to every new Dr I see.   I'm already apprehensive of doing surgery, have a long history of bad experiences with doctors, have a past history of abuse (and saw a dental chair with restraints on it as they sat me in the consult exam room).. you bet my BP and pulse were through the roof.  The nurse wasn't buying the bradycardia & hypotension until I show her my BP reading from that morning -- 83/39, p45.    Yep, that took general anesthesia & sedation right off the table.  Otherwise, I would have just brushed her off. 

I pass out (among other issues).  No big deal.  It happens.  It's part of "normal" life for me.  It's not too different from someone who has epilepsy, or someone who is an amputee.  To the world, their bodies aren't "normal", but that doesn't change their situation. They've been dealt the cards they have. It's up to them to make the most of it.  Sometimes problems are easily fixable.  Sometimes the treatments put you in worse shape and can cause permanent damage to your body.  Sometimes doing nothing really is the best approach.  

Thanks for your response! It does matter to me. It's a new finding (last 2 months) after being in and out of doctors offices, specialists offices, and ers for about a year. I wouldn't even know I had pots if I had accepted my doctors "anxiety" diagnosis when I knew something was wrong with my body. I am slowly accepting that I won't feel my old normal anymore. I agree sometimes the treatments are worse than the thing you are trying to treat. O cut out all my prescriptions. Many doctors blindly throw meds without digging any deeper. I guess I feel like in the meantime, I need to take the best care of myself physically and mentally so I get a better idea what's going on with my body. Easier said than done. Lol Andkeeping up with my other appts, docs, and tests. One thing I'd love to improve is not being a silent doormat in the doctors office. Lol I leave with more questions than I came in with. 

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On 3/26/2019 at 7:04 AM, p8d said:

I am with Pistol on this one.  I see my cardiologist once a year and his NP 6 months after I see him.  I see my neurologist NP every 3 months.  If you don’t trust this one ask for a second opinion from another one.  Different eyes/experience are usually helpful and can give you peace of mind.

Thank you! I'm definitely going to try for a second opinion!

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On 3/26/2019 at 6:00 AM, Lily said:

I have Incomplete Right Bundle Branch Block, and I was told it was a normal variant and not any kind of problem at all.  Left BBB, now, that is more likely to be a problem.

Have you always had it? Do you have any other medical issues? If you don't mind me asking.

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On 3/26/2019 at 3:24 AM, Shepard1 said:

There are a couple of positives, the echo-cardiogram indicates that the  structure of your heart normal and your holter was normal.   Incomplete RBBB in a ECG is often a normal variant or a slight delay in conduction.  It is okay to feel they way you feel, it is a shame that your cardiologist couldn't explain more about the anomaly in your ECG - it would take away a lot of worry and concern.

I too have a normal echo (phew),  My own ECG shows a narrow QRS complex.   I also have IST.  I am prone to SVT's - HR have been up to 250 BPM - chest pain extra-ordinary BUT not dangerous. 😀 I have I I have also had whilst an inpatient  twice showing p wave pauses,  though the symptoms of this is the same as with the dysautonomia. 🤨


 

I totally agree! A better explanation could have left my mind at ease. What kind of chest pain do you get with that? 

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2 hours ago, potsiebarbie said:

I totally agree! A better explanation could have left my mind at ease. What kind of chest pain do you get with that? 

When I get SVT the chest pain I get is a crushing, heaviness mid sternum. I also get short of breath and light headed. 

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On 3/26/2019 at 3:17 AM, bunny said:

The big question is, "Does it matter?"  What are you hoping to gain with/without having an abnormality?  What are the consequences of treating it?  What are the consequences of ignoring it?  Even if you manage to get an official diagnosis of something, are you any further ahead?  Trust me, the number of disappointing Dr appointments way outnumbers the positive ones for me.  

My body was trashed 20+ years ago due to severe anorexia.  Nothing about it really works right.   Diagnoses and labels can be helpful, but they can also get in the way.  I stopped worrying about them many years ago.

Validation is nice, but I only bother with it when it's going to pose a threat to my health.  Case in point: Last week with an oral surgery consult. Bradycardia & hypotension are on the typed, multi-page medical history sheet I hand over to every new Dr I see.   I'm already apprehensive of doing surgery, have a long history of bad experiences with doctors, have a past history of abuse (and saw a dental chair with restraints on it as they sat me in the consult exam room).. you bet my BP and pulse were through the roof.  The nurse wasn't buying the bradycardia & hypotension until I show her my BP reading from that morning -- 83/39, p45.    Yep, that took general anesthesia & sedation right off the table.  Otherwise, I would have just brushed her off. 

I pass out (among other issues).  No big deal.  It happens.  It's part of "normal" life for me.  It's not too different from someone who has epilepsy, or someone who is an amputee.  To the world, their bodies aren't "normal", but that doesn't change their situation. They've been dealt the cards they have. It's up to them to make the most of it.  Sometimes problems are easily fixable.  Sometimes the treatments put you in worse shape and can cause permanent damage to your body.  Sometimes doing nothing really is the best approach.  

I just want to thank you for writing this. I'm totally with you on this approach.

To the OP, I don't understand much about hearts. Oddly, it's a field I just cannot seem to retain information about. I do have some heart irregularities but I have no idea where they land wrt seriousness. My drs say I'm ok so I take their word on that. I don't take their word for so many other things. And rightly so. If you don't feel comfortable with his advice and approach seek advice from others. Go with your gut.   

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12 hours ago, potsiebarbie said:

Have you always had it? Do you have any other medical issues? If you don't mind me asking.

I don't know if I have always had it, but it was found on an EKG when I first started noticing POTS-like symptoms.  I hadn't had many of those previously, so who knows.  I don't have any other heart conditions, just POTS, NCS, ADHD, migraines. 

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12 hours ago, Shepard1 said:

When I get SVT the chest pain I get is a crushing, heaviness mid sternum. I also get short of breath and light headed. 

Ugh! That sucks. How do they treat svt? 

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