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Forum Name: Ischemic Heart Disease

Question: MI or allergic reaction?


 Mery - Wed Jun 09, 2004 5:25 pm

I am a 5' 2", 120 pound, 52 year old female with mild hypertension of one year's duration that is well controlled by Norvasc. I had a normal ECG on January 19, 2004 as a part of a routine physical check up. While out of town on April 26, 2004, I went to an emergency room with bronchitis, asthma, and fever. While there I was accidentally given Motrin. I am allergic to aspirin and NSAIDs and previously I had an anaphylactic reaction to an NSAID. The Motrin caused a bright red rash, low blood pressure, tachycardia, chest discomfort, and shortness of breath. The first of several abnormal ECGs was then done, and the results stated: "Sinus tachycardia, Incomplete LBBB, Anterior infarct, possibly acute, Acute MI, Inferior MI age ?, Abnormal ECG." However, I was admitted and several repeat enzyme and troponin tests were all normal. The results of the last ECG done 24 hours after the first one were: "Sinus tachycardia, Anteroseptal infarct age undetermined, Abnormal ECG, Ventricular rate 119 bpm, PR interval 144ms, QRS duration 120 ms, QT/QTc 346/487, and P-R-T axes 72 18 67. I was released two days later with no recommendation to see a cardiologist. Do you think my abnormal ECGs were the result of my allergic reaction with tachycardia, or have I probably suffered a silent heart attack some time between my January check up and April hospitalization? I can email or fax a copy of the ECG tracings if that will help answer the question. Thank you very much.
 Dr. Yasser Mokhtar - Thu Jun 10, 2004 4:23 pm

User avatar Dear Mery,

Thank you very much for using our website.

It is obvious from the clinical setting that what you had was an allergic reaction.

You are hypertensive, not diabetic, family history is negative for coronary disease unless you have not mentioned it, don't know about smoking and lipid profile (but i assume that your lipid profile was checked at least once since you have hypertension and are followed by a doctor).

i don't know what does your base line ecg look like to be able to judge the changes that happened since.

The presence of a left bundle branch block on the ecg precludes looking for coronary disease on the ecg especially acute events.

In females also, it is sometimes hard to put the leads in the appropriate places on the chest.

Left bundle branch block occurs secondary to a heart disease, its presence is abnormal. In your case, most probably it is secondary to hypertension.

There is another entity called rate related bundle branch block which means that when the heart rate exceeds a certain limit, the left bundle branch does not conduct anymore and the ecg shows left bundle branch block.

i think you already know that you did not have a heart attack this time but i can not really tell whether you had a heart attack between january and the er visit or not.

Is it possible that you had a heart attack without having chest pain? Yes, it is possible especially in diabetics and hypertensives. But you have to have symptoms to say that you had a myocardial infarction and the symptom(s) that could have been a myocardial infarction are shortness of breath, heart palpitation, fatigue and feeling of being tired. If you have not had any of these symptoms (even though they are very non-speicific as you can see), i would strongly suspect that you had a recent myocardial infarction.

As for emailing the ecgs, it would be best that you email me both your ecgs from the er visit in addition to your last normal one so that i can compare them all to see the changes that occured in your ecg.

Finally, i would recommend that you have an echocardiogram (ultrasound of the heart) to check the function of the heart and to see whether there are the changes that occur if a patient had a heart attack.

At this point, i don't think you need to see a cardiologist but you have to see your doctor and if he thinks that this is an appropriate step, then that's ok.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your ecg pictures if you think that is necessary now and waiting for any comments.

Yasser Mokhtar, M.D.

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