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Forum Name: Ischemic Heart Disease

Question: Abnormal EKG


 rpelley133 - Sun Feb 27, 2005 2:01 pm

I am a 51 year old female. Diagnosed 2 years ago with SLE, but relatively symptom free except for mild joint pain and sun sensitivity.

I have had slight discomfort in my left chest for the past year. A recent EKG noted "Inferior Myocardial Infarction" . The test result showed:

Q Waves inferiorly II-III aVF
Poor R-wave progression V1-V3

A Holter monitor noted Palpitations of up to 2.5 minutes to 130bpm. Typical heart beat is 67bpm.

2-D Echo showed --Left ventricle small. Est. ejection fraction 65-70% No regional wall abnormalities --Trace Tricuspid regurgitation

On a recent visit to a cardiologist he dismissed the chest discomfort, ordered Atenolol 50mg, if I wanted. Told me to not worry and that I was very healthy. The Atenolol has helped the discomfort and tachycardia.

I feel as though I was dismissed without the answers I was hoping for regarding the abnormal EKG, which still reads the same. Can you explain the results of the EKG? Why are they of no concern to this cardiologist? What do these results mean? Why were no further test done?

I will have this discussion with my Rheumotologist, who the Cardiologist was to confer with. But am wondering your opinion.

I should note that I have been drug and alcohol free for 25 years, but was an alcoholic and cocaine abuser for years prior to that. Could this have an affect on the situation? Is this something I should mention to the Rheumie?
 Dr. Yasser Mokhtar - Sun Feb 27, 2005 3:26 pm

User avatar Dear rpelley133,

It is important to elaborate on the chest pain a little bit more to know its characteristics in order to know whether or not it resembles the pain of coronary disease.

For one to decide whether or not chest pain is due to coronary disease, major risk factors for coronary disease and characteristics of pain are looked at and then the probability of this pain being due to coronary disease is determined. You don't have any major risk factors for coronary disease but i am not sure about the characteristics of the pain.

If your pain is atypical, then most probably, this pain is not due to coronary disease. If your pain is typical, this pain could or could not be due to coronary disease. So, i think that your cardiologist believes that your pain is atypical. i think if your cardiologist thought that your pain is typical, most probably he would have ordered a stress test.

Any myocardial infarction pattern on an ekg could be a false positive, ekgs are not the best tool to diagnose or confirm the diagnosis of coronary disease.

q waves in leads ii, iii and av-f can mean for instance that you are short and stout or that when the ekg was done, you were in expiration rather than in insipiration.

q waves usually mean that the patient had a previous heart attack, this heart attack should appear on the echocardiogram as well which is way far better than the ekg to find abnormal contracting walls in the heart (sign of previous heart attacks). You don't have a history of heart attacks and your echo did not show that you have an abnormally contracting inferior wall, so i think that you don't have to worry about that.

The tachycardia on the holter should be correlated to your diary of activity and if you were doing any activity at that time that would explain the tachycardia and i think the atenolol would not be needed.

Chest pain in an sle patient could be due other reasons such as inflammation of the membranes surrounding the lungs amongst others. i would definitely recommend that you mention this pain to your rheumatologist.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 rpelley133 - Sun Feb 27, 2005 4:50 pm

Thank you for your fast reply!

Well, could be the Cardiologist is correct. I just felt left with no good explanations other then his "every heart is unique and EKG's can be quirky". He elaborated that I'm the healthiest person he's seen all day :roll:

I'm 5'6" and 145 pounds. I excercise routinely, lift weights and power walk. I never have discomfort when excercising.

The discomfort typically happens at night, laying in bed, or late in the afternoon, at rest. It can be a pounding in my chest with rapid heartbeat. The pounding moves up into my throat, with skipped or early beats.

The discomfort can also be a twinge or fleeting stabbing feeling that is in the left chest. Sometimes it moves into my left back, between the shoulder blades. It can also radiate down my arm and give me a tightness in the chest. This past summer this was happening one night...I could not lay on my left side because the pain in my chest hurt more when I rolled over. My left arm became numb. I got up, took an aspirin and went back to bed. The pain did pass. That was probably the worst night. My husband's comment was that I probably pulled a muscle excercising. Could be............... :?:

I did note my activity on the Holter dairy and I was at rest when the episodes happened.

I mentioned this pain to my Rheumatologist, she suggested the EKG, Holter and Echo. As well as Pulmonary function tests which came back fine.

I did intitally blame this discomfort and palpitations on menopause, which I have plowed through this year. That could be the cause.

The Atenolol does help with the sensations, but if I find it leaves me too tired, perhaps I will "tough it out" as the Cardiologist suggests.
 Dr. Yasser Mokhtar - Sun Feb 27, 2005 5:29 pm

User avatar Dear rpelley133,

Thank you very much for the update.

What you describe sounds actually more of a palpitation description to me than chest pain. And it is not typical, so there is no fear here.

However, with the back and arm pain, i would also suggest that you have a neck x-ray/ct scan to exclude cervical spine problems.

Your symptoms can definitely be due to menopause.

Atenolol and all of the beta blockers group actually are notorious for this side effect of leaving people very tired and fatigued and some people actually decide to stop them.

If atenolol is giving you relief, i would recommend trying the least dose possible that would give you relief of symptoms without the side effect if possible.

Please, don't stop the atenolol suddenly on your own, this has to be done under medical supervision, because sudden cessation can lead to rebound high blood pressure and angina.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 rpelley133 - Sun Feb 27, 2005 6:12 pm

Good point re: the neck x-ray. I complained of neck pain and headaches to my Pulmonary specialist back in 1997 and he did x-rays that revealed mild Thoracic Scoliosis. Perhaps that has begun to bother me again??

Thank you for relieving my concerns.
 Dr. Yasser Mokhtar - Mon Feb 28, 2005 5:20 pm

User avatar Dear rpelley133,

Thank you very much for the update.

i think you ought to have a ct scan of the cervical/thoracic spine and if the thoracic stenosis is getting worse, then may be you ought to see a neurologist to have nerve conduction studies.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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