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Forum Name: Cardiology Diagnostics

Question: T wave inversion


 sejiane - Thu Apr 16, 2009 3:27 pm

i,

Let me start with introducing myself. I am an Indian male 32yrs old 177Cms (5’ 10” )tall and a 74 Kgs ( 163pounds) with a BMI of 23.6.
A Year back I started having Chest pains clubbed with Burping. I did not mind that a lot. After a month my Brother –in-law got an Heart attack at the age of 36 and this scared me and I got an Master health check up done and it revealed a T wave inversion ( in one of the inferior leads ) and I went for follow – up Tread mill Test and ECHO . Both came out to be good . So the cardiologist told me that nothing to worry. But the incidence which happened to my brother in law made me worry about the T wave inversion . So I went for CT Angiogram and that came out with “Normal Study “ with no problems. My cardiologist send me to GI and an endoscopy was done . It revealed a “Severe inflamed esophagus” . I was treated with omeprozole. This happened by last May , even after taking this medicine the pain used to come on and off. Once when there was bad burning sensation in my chest so I rushed to an ER where they took and ECG and that came with the T wave inversion. (Incidentally I checked a master health report which I took in 2003 and that also had the same T wave inversion ) . They ordered TROP I test and CKMD test . TROP I said it is 0.00 and CKMD came in normal range. So they said its only the GERD with is acting on me . Even tough the logic says to me that its nothing to do with the heart , every time I get the burning sensation I get anxious.
Every time I get that burning sensation it will either be followed by a burp or passing Gas . There will be pain or burning sensation in the chest (mostly on the upper part of the chest ) (sometimes pain in the neck , ear and arms ) . This gets subsided by either passing of Gas or taking an Antacid. This normally happened before food and just after food. Now a days this happens in the evenings also. Some days this pain continues the whole days. In the scale of 10 I would say the pain is 3-4 . Even though is not very bad pain, since it’s in the chest area it makes me very anxious.
Because of this I started exercising at least 3-4 days a week (walk in the treadmill for 30 – 45 min at the speed of 6-7 Km/hr ( 4-4.2 miles/hr). When I exercise / walk this pain comes but does not increase in intensity as I do the exercise and 80 -90% of the days it starts in the 2or 3rd minute goes away when it go on and do the exercise in the 15th or 20th minute , but this pain has never made me short of breath. During my walk in the treadmill I release a lot of Gas. I have tried checking my exercise capacity my working out at 160 -170 bpm for a minute and then stop and check the pulse rate after a min rest. This will normally be 115-120 bpm.
I have stopped eating meat and I have only seafood (twice a week) and veggie and reduced my weight from 80kg to 74kilos in last 12 months. I did this because my doctor told reducing weight will help getting rid of GERD. But i still have this pain , but definetly lot less than what i had 10 months back.

With the symptoms of getting the pain in the chest and going to my arms, should I be worried for cardiac problems? This makes me very anxious, this anxiety is increasing my GERD, and this is becoming a vicious cycle.

Also to check for cardiac problems is it a good idea to get an ECHO and Tread mill test every year or would you recommend anything else.

My numbers look as below
Blood test Results
Haemoglobin – 15.4 gm/dl
WBC - 5200/cumm

Lipid Profile Results
Sr. Cholesterol - 174 mg/dl - This was 204 6 months back
Sr. Triglycerides - 160 mg/dl - This was 190 6 months back
Sr. HDL - 44 mg/dl - This was 34 6 months back
Sr. LDL - 116.6 mg/dl


Blood Pressure Results ( I normally make a note of BP from my digital meter( OMRON brand), this is the average value for a month)
Avg - Systolic -118
Avg - Diastolic-76
Heart rate - Avg – 73 with resting as 59


Thanks and Regards,
kalai
 John Kenyon, CNA - Fri Apr 24, 2009 11:58 am

User avatar Hello Kalai --

After reading your post carefully I think there are several things probably working to make you feel this anxiety. First, there was the fact that someone close to you and quite young had a heart attack. Now if this had been a blood relative, that would be a serious cause for concern, since these things (early onset heart disease) tend to run in families. But This fellow was not a blood relative. It's unnerving, but must be kept in perspective. These things will happen near us sometimes.

Then there is that one persistent inverted T-wave. This is actually a very common abnormality, and when it is not deeply inverted (merely "flipped" is the usual term) and occurs in only one lead, it is usually just an idiosyncrasy of that person and many have things like that. Usually it means nothing. Of course you also have something causing chest discomfort, so again this brings up doubts. Now what you describe in terms of chest pain is classic for GERD complicated by unconscious swallowing of air, which is probably the reason for the continual belching. Anxiety will cause this, a side effect of deep sighing, often an unconscious effect of anxiety and worry. Also, GERD itself, depending on its mechanism, may sometimes cause EKG abnormalities, which again are essentially meaningless.

It would probably benefit you to have a nulear scan stress test, next best thing to an unwarrented (at this time) angiogram. Stress echo would be next best after the nuc scan option. Any of these should help put your mind at ease with a negative finding. Now during your initial stress test with echocardiogram you had no chest pain, correct? But in the gym you do, after a few minutes, and then after a few more minutes if you continue it resolves. This is called "walking through" the pain and makes it very unlikely to be cardiac related, but all the more likely to be related to GERD, which is aggravated both by treadmill and other automated exercises, and which is turn is likely to exacerbate deep brerathing (on the treadmill).

My best suggestion would be to have one Stress echo or stress test with scan done to help ease your mind and then if negative, to let this go and treat the GERD and watch your breathing habits, as this can be very insidious and can cause much of the discomfort you've been feeling.

I hope this is helpful to you. Good luck and please follow up with us here as needed.
 sejiane - Mon Apr 27, 2009 3:34 pm

Thanks a lot for your reply. I got a Stress Test ( Tread mill test ) and a normal ECHO ( Not a stress ECHO ) done nearly a year back when all these chest pains started . Also at the same time (a month later ) I got a CT angiogram done . TMT test was negative with “Excellent exercise capacity “and CT angiogram came good with “Normal study “ . Do you think I should repeat a Stress test now? I thought CT angiogram will rule out cardiac issues fully . is that not true? If I did not have any plaques (I believe CT angiograms will also show soft plaques) 11 months back , should I bother about that now ? I also got an ECG done 5 months back and Cardiologist told me that he does not see anything wrong ( of course except the T wave inversion ). With all these do you think that I should still worry about heart problems?

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