I do not understand ???

[Vettster]

Can someone help me.
I was just made aware of a potential medical problem which has me very concerned.I am currently in Fla. taking my divemasters course and have run into some questions regarding the medical exam.
I am a Gringo living in Mexico, so prior to traveling here for my courses, I had a complete physical performed. The local doctor performed the standard medical entrance exam just as they do for the 18 year olds who wish to enter the local industrial diving university. This exam included a general health history questionare, Rufier-Dickison (stress test"), a chest x-ray an as ear exam and EKG.
In Mexico they questioned the EKG stating that it was "abnormal" and proceeded to ask some additional questions. When they asked about my activity I informed them that I generally tried to take care of myself and ran about 4-5 km, a minimum of 4 times a week.
When they found this out it was like a bolt of lightening. The doctor said "Oh well, that explains it, he's athletic".
I thought everything was OK until I got to Florida and found out that PADI wouldn't accept my medical cert because it was written in spanish and did not specificially state "diving". (It just said sports)
I guess I'll cut to the chase here. I was required to go to a local doctor here to get "signed off" in english. Upon arrival, I promptly showed him all of the documents and was told that I needed "more tests". They then proceeded to give me another EKG which was diagnosed to be questionable for tall T-waves. The graph says "tall t-waves- consider hyperkalemia". (it looks similar to the first one, but I really do not know what i am looking at)
Three hundred and some dollars later, the doctor still is not sure and wants me to come back and take a stress test.
Is this necessary?
I am a 41 year old male in excellent health. I run 4-5 km, at least 4X per week, do not smoke at all or drink excessively and there is absoloutly no history of heart disease on either side of my family.
What is a "tall T-wave"? I have been diving for a couple of years (60+ dives) and have never had a problem.
What is hyperkalmea? Am i being penalized for being in good physical condition?
My BP is normal, actually on the lower part of the range and always has been.
Can someone explain top me what's going on.

Thanks in advance.
Frank

 

[John Reinertson]

Tall Peaked T waves on an EKG are usually seen either in electrolyte disturbances such as hyperkalemia or in well conditioned athletes.
The T wave represents the electrical activity of the heart muscle as it gets ready for the next beat, a process referred to as repolarization.
Without seeing you in person and seeing the cardiogram, I can't be real specific, but if you've already had a stress test and it was OK it sounds more like athletic heart than anything else. If you have a local doc that does diving medicine, a second opinion might be a reasonable alternative to another stress test.
Either Way, You'll get checked adequately. Good Luck! John

 

[DocVikingo]

Hi Frank,

This is way outside my area of expertise, but let me take a crack at it.

Tall T waves generally can be meaningfully interpreted only within the context of the entire EKG, although they do have some diagnostic specificity for hyperkalemia. As you mentioned, they can also be seen in the records of well-conditioned athletes.

The term hyperkalemia simply means an abnormally high level of serum potassium. This ion is very important in nerve functioning & either too much or too little, especially the former, can have very serious consequences.

There are several causes of hyperkalemia, some worrisome, such as leakage of potassium from muscle in the heart that has been damaged. This damage may be clinically silent at the time of the EKG, but can progress to the point where there are manifest signs & symptoms.

Based on this, if it was me I'd follow through with the physician's suggestions.

This material is for educational purposes only. It does not indicate or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best of luck.

DocVikingo

 

[Vettster]

Gentlemen,
Thank you very much for your replies.
I will definately get the second opinion.
I have always been told that it was athletic. (ever since I was a teenager) and it has never been cause for alarm.
By the way, In a worse case scenario, how is the potassium level controled? Is it diet?

Thanks again,
Frank

 

[The Chairman]

Hey Vettster and all,

Yeah, what does high K actually mean??? My last physical showed it, and it has me worried, and the doctor perplexed. He has not even given me an inkling of what signigigance it has, or even might have. Elucidate please!!!


Pete from Orlando... (cuttin' off of nanners for now)

 

[BillP]

Hi Pete:

High serum potassium (hyperkalemia) on a single lab test in otherwise healthy people is often due to lab error. Red blood cells have a very high level of potassium in them and if the cells are broken by the way the sample is drawn or handled it can make it look like the serum has a high level of potassium when it doesn't really. If an otherwise healthy person has an abnormally high potassium level on a single test first thing I do is repeat the test.

Other causes of hyperkalemia include kidney failure, abnormal adrenal gland activity (from various causes), and an increase supply of potassium (broken cells, potassium retaining medicines, taking too much potassium supplement, etc.)


HTH,

Bill

 

[The Chairman]

Hey Bill and All,

My wife (the neo-natal nurse) said the same thing about the way the sample is drawn, and I DID have a horrific bruise from the first ordeal. I did have a urinary/prostrate infection that seems to have cleared itself up, and they have re-drawn the sample, discarding the first vial and going to the second one. I actually asked for my physical early because of pain in my back (felt like kidneys) an elevated temperature (@100F) and being dipheretic (sp?) without much cause. Obviously I have not gone diving since the onset(late January), but the doctor has cleared me to do some bottom time... probably next week. They were sure of an infection, but never narrowed it down to bacterial or viral, and the temperature and pain have subsided. They also said they would contact me if the serum levels were abnormal, and they have yet to do that (taken a week ago last Thusrday ). I WILL be calling them just to be sure they didn't lose the lab or simply misplace me (I hate being lost).

 

[Vettster]

Hi People,
Thanks for all of the replies and comments. Theres some very interesting stuff here.
Just thought I'd let you all know. I got the second opinion and was informed that i am athletic (and have the lungs of an 18 year old). Needless to say, I am currently going ahead with my D.M. training and having an excellent time.
Just wante to say Thanks to you all and to Scuba Board.
Regards,
Frank