Discharged with abnormal ECG

[mpbser]

Did anyone have heart problems during surgery/ablation? Because of my husband's cardiac condition, they did ECG monitoring. I looked at the reports which were uploaded to the portal yesterday and am not sure if I should be concerned.

Just sent a fax to his local oncologist: Dear Dr. ****, These are the ECGs from ******s liver resection & ablations March 7th. He was discharged with an abnormal ECG, no follow-up appointments scheduled at MSK, and no recommendation to follow up with his local cardiologist, you. I am concerned that he needs follow up to make sure his heart normalizes before he begins chemo.

His loving wife,

[KimT]

I’m a cardiac nurse. An abnormal ecg doesn’t necessarily mean there is a problem. Depending on the heart condition, some people will never have a normal ecg. An ecg is a tool to monitor heart health but it isn’t the end all be all. The patients actual symptoms and condition should be considered. Also abnormal ecg should be compared to previous ecg. If your husband has a heart condition, the abnormal ecg may be his new normal. What they will look for if his ecg is radically different from previous ecgs or this if a person develops symptoms not there before. Abnormal heart rhythms are more common than you think. A lot of people would never know unless they slapped on a heart monitor as they have no adverse symptoms. Always good to get clarification if from your doctor but I wouldn’t be too concerned. They would not have released your husband if they felt he was in danger from his heart condition.

[radnyc]

He went in with heart issues, sounds to me like abnormal ECG is the norm for him. I’m sure they wouldn’t release him unless they were sure he’s ok.

[mpbser]

Actually, he hasn't had an abnormal ECG before this except when he was in congestive heart failure in January 2017, right before he was diagnosed. It was normal this August and normal on February 25, 2019. It was also normal on the day of surgery, March 7th, then became abnormal, March 8th. In any case, I learned that an elevated T wave would be alarming, but an "nonspecific T-wave abnormality" as on the March 8th report is not.

[LPL]

Actually, he hasn't had an abnormal ECG before this except when he was in congestive heart failure in January 2017, right before he was diagnosed. It was normal this August and normal on February 25, 2019. It was also normal on the day of surgery, March 7th, then became abnormal, March 8th. In any case, I learned that an elevated T wave would be alarming, but an "nonspecific T-wave abnormality" as on the March 8th report is not.

mpbser, if you feel you want.. can you talk to/get reassurance from his doctor who was involved when his congestive heart failure was diagnosed in January 2017 ? Wishing you both well.

[mpbser]

Yes, that would be his local oncologist. I brought copies of the ECGs to his office this afternoon. I might call him Monday to follow up and see if he wants to see my husband in the near future.

[mpbser]

Here is the latest: So, there was an appointment for a CT scan on the MSK portal that did not make sense to me as CT scans do not accurately show spots in my husband's liver. Dr. Kemeny's office, when I asked about this appointment, seeking clarification about it, blurted back through the portal: "The CT scan is a baseline scan. It is required after surgery and yes you will get filled." Nothing about needing to view his chest or anything and sounded routine for the average patient (CTs being the norm for most stage IV colon cancer patients, except in people such as my husband for whom liver lesions cannot be seen in CT). As CT is only good for my husband when the chest needs to be analyzed, I wrote back reminding them that it was inappropriate in his case due to his habitus, except for surveillance of the chest. They deleted the appointment.

This morning, I see that the report from Tuesday's flow scan test was uploaded to the portal last night. It says that he has new bilateral small pleural effusions and compressive atelectasis (collapsed lung). Apparently, according to my Dr. Googling, this is very common in obese people who had upper abdominal surgery. Breathing and coughing exercises help resolve this, although no one had mentioned any of this at all to us.

I hand delivered husband's ECGs from day of surgery and day after to his local cardiologist yesterday with the plan to follow up with him on Monday. My husband and I spoke last night about how he had left his follow-up appointment with him unscheduled for the time being, so perhaps one is warranted in this case. Now that I have this information about the pleural effusions and compressive atelectasis, I think so. He (local cardiologist) can order a chest CT (chest Xray even better) if necessary, thus avoiding the issue of dealing with MSK CT appointments. They are ALWAYS many hours behind at the Manhattan location at which they scheduled him.

It would have been nice if his MSK cardiologist responded to my inquiry on Thursday: "Given the fact that this post liver surgery ECG is abnormal, should we have a follow up ECG done by husband’s local cardiologist?" She had insisted, against the surgeon's wishes, that they do intraoperative/perioperative ECG monitoring (monitor put into his left arm artery, bruising him all up something fierce) to make sure his heart was OK during and immediately after surgery, but I guess that is where her responsibility ends. Who oversees his cardiopulmonary issues now?

No idea. I know that our local hospital blood lab will do blood draws on "foreign" orders, e.g. from MSK, so I am now wondering if local radiology department will do the same. Will be a very busy Monday.

[mpbser]

The post abdominal pleural effusions and atelectasis usually resolve within a 2-3 days post surgery. The scan that showed these was done five days post-surgery. I definitely think there ought to be follow up. I wish I had known that he had post-op cardiopulmonary issues before I made a stink about the CT. Or they could have explained that it was important b/c of those issues. Oh well, I contributed to the mess, so I will help fix it.

[Rock_Robster]

Hi mbpster, not sure if this is helpful, but I had a liver resection about 10 days ago. I had moderate bibasal atelectasis with mild pleural effusion, still present 7 days post-op. Not sure if it’s relevant but I’m a fairly lean guy (BMI 22), and am told this is fairly common. Treatment was with frequent (hourly, ideally) breathing and coughing exercises, plus light exercise (walking). I also was tachycardic for over a week post-op, but that seems to have resolved now. I had an ECG (normal), a CT (found issues above, plus some mild abdo fluid accumulation), and later a CTPA when my GP was concerned about pulmonary embolism (all clear). Liver function was all over the shop post-op but now all in normal range. I still have residual shoulder tip pain (referred pain attributed to fluid/gas accumulation, and irritated diaphragm). I have a checkup with the surgeon in another week or so, and he has referred me back to my GP for assessment if I have any concerns in the meantime. Any questions on any of the above, just let me know.

[Rock_Robster]

Apparently, according to my Dr. Googling, this is very common in obese people who had upper abdominal surgery. Breathing and coughing exercises help resolve this, although no one had mentioned any of this at all to us.

Ironically, I got my info on this from MSK’s website... had to order my own incentive spirometer online though!

[mpbser]

Thanks, rock! That's super helpful.

The SPECT-CT flow scan that showed the atelectasis with mild pleural effusion four days after surgery said there was only trace fluid in my husband's abdo. All in all, he did extremely well. His surgeon is amazing.

Curious why your GR was concerned about pulmonary embolism. Did you have any worsening symptoms or was it just a precautionary concern?

[Rock_Robster]

No worries at all, and indeed, it sounds like he’s handling it all really well!

I went to the GP a week post-op for a check and to have the dressing removed, and he wasn’t happy that I was still tachycardic (~100 bpm at rest) and exertion intolerant (walking a block jumped to ~120 with shortness of breath). That, plus my prior DVT, was enough for him to recommend scans. At the ER they thought PE was unlikely but couldn’t really send me away without checking, hence the CTPA which was thankfully clear! The tachycardia and shortness of breath has since resolved itself.

Best of luck for a smooth ongoing recovery!