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Forum Name: Ischemic Heart Disease

Question: T wave abnormality


 fool4iam - Tue Aug 26, 2008 2:47 am

Background:
39 yo, female, 50# overweight, FHx Heart Dse (Father)
Hypothyroid since 1999, on Synthroid
Hx 2 gall bladder attacks 3 years ago immediately after fatty meals, unresolved
A lot of family stress due to adult teen rebellion
A lot of occupational stress due to new job involving weekly out of state travel
4 days missed Synthroid dose (last week) - temporarily lost meds


In a busy evening of clothes shopping with family I neglected proper hydration and hadn't eaten in several hours, so my husband and I shared a caffienated chocolate bar and went on with shopping. About 30 minutes later I began to experience a little racing heart rate and deep sternal pain which radiated to my back. It worsened so I promptly found my husband and sat down for a few minutes then decided to lay flat in our car until he was done. We proceeded to the ER. I was quite emotional and anxious. My EKG showed "T wave abnormality", CXR was normal, CT Angiogram normal (r/o pulm emboli caused by frequent travel), CMP/CK/Myoglobin/TroponinI were all within normal range except Potassium and Calcium I noticed were on the low value of normal which I attributed to dehydration. My urine was very concentrate at that time (gold). I was given fluids by IV and we waited for time to pass for repeat CK/Myoglobin/TroponinI. Second EKG showed "T wave abnormality - consider anterior ischemia". After fluids urine was very dilute (clear). The repeat CK/Myoglobin/TroponinI were normal and we deduced together that this must have been a nasty Gall Bladder attack that radiated and presented unexpectedly 24 hours after a high fat meal, but only 30 minutes after chocolate. I have been instructed to take a baby ASA daily, rx'd nitrostat to have on hand and to schedule to see a Cardiologist.

But this doesnt explain the EKG findings...nor if the K+ and Calcium were significant.
Did the pain cause the Anxiety/Stress or did my Anxiety/Stress cause a heart problem?
Could this heart finding on my EKG have been caused by dehydration, stress, and/or missing 4 days of synthroid?
I have traveled this week and am not optimistic about getting in to see a Cardiologist quickly due to my travel schedule. Should this be considered urgent?


My pain is gone since the episode originally occurred and I am eating small fat-free meals under the assumtion that this was a gall bladder attack.
I understand that this may not be enough information but your opinion(s) and tips would be appreciated.

Thanks,
CRP
 John Kenyon, CNA - Fri Aug 29, 2008 10:40 pm

User avatar Hello -

Thank you, first, for a fairly comprehensive report of the episode and the immediate findings. It's a lot more than we usually get to work with.

While there is a history of cholecystitis and this could have accounted for all the symptoms (along with some dehydration), there is also the family history of heart disease, which cannot be overlooked, especially with the neatly overlapped classic cardiac symptoms and T-wave abnormality. It's not much, but it is enough to make a case for you to be seen by a cardiologist first, and take care of business-as-usual second. It's just not worth the risk.

Women often present with atypical heart symptoms, but when the present with classic ones that shouldn't be considered somehow "outside the box." While there is a very good chance this episode was a combination of chocolate-incited cholecystitis and some dehydration (and yes, the latter certainly could account for the T-wave abnormality, especially if it was flattened or flipped), one's gallbladder is a good deal more forgiving than the heart when something goes wrong, which is underlined by the fact that if the gallbladder goes bad enough, it can be removed and thrown away. That doesn't apply to the heart, which, once damaged, stays damaged.

Stress also may have played a part.

It sounds from the lab results as though you have no damage as yet, and of course you may not have any heart disease at all. But the symptoms and the EKG do, in my humble opinion, warrant making the time for a visit with a cardiologist.

If your heart is, in fact, fine, you can go about your business free from anxiety and uncertainty.

Best of luck to you. Please do follow up with us here.
 fool4iam - Mon Oct 13, 2008 11:37 am

Thank you for your opinion on my episode. Just to recap, I have a friend at church who is a cardiologist, and he gave me similar advice, but that jumping into a treadmill would not be the best move. So, I got ahold of my old EKG's from 2004 and 2005 to compare them to the ones from the ER and guess what.... T wave abnormality! My cardiologist friend felt after looking at them that it could have been a juvenile thing, normal for me. So, we're probably looking at a cholycystectomy within the next 6 months or so. Ive had no other symptoms, my cholesterol is still perfect, my stress level is lower, my hydration is better, and Im sure my T waves are still inverted at V3,4 etc.
Thanks again, your input was valuable to me during this time of uncertainty.
 John Kenyon, CNA - Mon Oct 13, 2008 7:28 pm

User avatar Great news! Some of us, for some reason, have these non-specific changes all our lives, as a sort of "normal abnormality" and it sounds very likely that's what it is in your case. The cholecystectomy should go without incident, and often is less disabling (short term) than having a wisdom tooth removed. It's great to find someone handy who's in the business (like the cardiologist at your church) and hopefully you'll have no more problems. It sounds as though this probably is a fixture on your EKG, and if so it's good to know, because change is what we really don't want to see as a rule.

Best of luck to you and thanks for the follow up. Do stay in touch here.

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