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dr-lake, Board Certified Physician
Category: Cardiology
Satisfied Customers: 270
Experience:  Cardiologist
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I had a "borderline" ecg. I need help to understand it. Is

Resolved Question:

I had a "borderline" ecg. I need help to understand it. Is there a way to email a scanned copy of it to you and get information on what it does/doesn't/might mean?
Submitted: 5 years ago.
Category: Cardiology
Expert:  Dr. Phil, MD replied 5 years ago.
Answers are for informational purposes only.
Just scan and attach to the chat box.
Customer: replied 5 years ago.
Expert:  dr-lake replied 5 years ago.

The EKG is essentially normal, although somewhat unusual for your age (more typical of a younger person). Why was it done?

Expert:  dr-lake replied 5 years ago.

I see you are offline, so let me add some comments for you to read when you return.

The "Borderline" may have been from the computer interpretation, and accepted by the overreading cardiologist because that's easier than taking the time to make the change to "Normal." It could have been b/o the somewhat slow heartrate, falling outside of the supposed "Normal Range" of 60-100 (rates down into the 40s can be normal, and asymptomatic rates into the low 30s are not a cause for concern, even though they are clearly outside of average. The "Early Repolarization" doesn't really mean anything (it's descriptive rather than a diagnosis), but it is much more common in people in their teens and early 20s.
I agree with everything in the interpretation except for the "Borderline" (I would have said "Normal"), but it's important to know why the EKG was done, as various conditions can masquerade as normal. (If this was a "routine" study, then you are paying the penalty for someone ordering a test that wasn't needed (unless you're an airline pilot or astronaut), getting a result that causes unnecessary concern.

Let me know if you have any more questions.

Customer: replied 5 years ago.
Hi did my reply with reason for ecg & further info get thru or should I send it again?
Expert:  dr-lake replied 5 years ago.
It seems to have been lost. Please resend.
Customer: replied 5 years ago.

Done as part of routine lab work, & because I had complained of some burning in the lungs which cleared some time ago; The reason I am wondering about the ecg is my doctor said it was borderline; When I pressed for more info he said it could mean ischemia. With exercise & healthy lifestyle I am wondering if/why/how I might have this. Can you elaborate on any of this?

Other info: I do equivalent of 5k run most days (not a racer, just a relaxed pace around 27minutes), as well as active work and life. Whole food plant based diet, 6' 3.5" 175lbs. I do get spells maybe 1 or 2 times a year where for several weeks or even months my exercise tolerance suddenly drops (based on using meticulous tracking of heart rate & speeds on my workouts). Nothing will bring it up to normal till it mysteriously comes back on its own. I have tried working out harder, lighter, skipping days, modifying diet, but it just stays in the same low range until without any evident reason it will abruptly jump back to normal one day and stays there. Cardiologist who did my stress test a few years back had no ideas, but I was in one of those slumps when tested and he said based on the test that I wasn't very fit. Any idea what could cause temporary recurrent "unfitness" when most of the time I am quite fit? Thanks. Note: your 2nd part of the answer covered some of this so feel free to just answer the parts you didn’t already cover.

Expert:  dr-lake replied 5 years ago.

Your EKG is not at all suggestive of ischemia; your doc may have been thinking of the EKG changes seen in early in the minutes of a heart attack (which bear a superficial resemblance to early repolarization). But that's not what your EKG showed. :)

I have no idea why you have your spells of reduced exercise tolerance, but I believe it's unlikely to be related to a heart problem (else your stress test would have shown clear abnormalities; and also because heart problems don't come and go like you described).

Customer: replied 5 years ago.

Could drinking too much water cause poorer heart performance by diluting electrolytes or anything like that? Or could some other blood/body chemical changes?

Or could flareups of colitis?

Expert:  dr-lake replied 5 years ago.
Probably not, unless it was extreme dilution. And that would resolve itself quickly. The only thing that sound reasonable to me would be a transient virus, but I can't see why that would be cyclical/recurrent. I don't see colitis as the cause, but that's way out of my field of knowledge.
dr-lake, Board Certified Physician
Category: Cardiology
Satisfied Customers: 270
Experience: Cardiologist
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