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Forum Name: Cardiology Diagnostics

Question: help with my ekg


 mmansur - Thu Mar 31, 2005 2:20 pm

About 3 weeks ago, I thought I was having a heart attack and my wife took me to the ER. I was admitted to the hospital for observation. I was told that my cardiac enzymes were normal, my Ekg was fine, and that my xray showed a slightly enlarged heart but that it was ok. The next day they did a stress echo and said that showed my heart was fine. I was not referred to a cardiologist. This was all done by my family doctor. Well, I did get a copy of my ekg and it read: Sinus rhytum. Inferior T wave changes, consider ischemia early transition- cannot rule out old posterior MI RSR' in V1, normal variant. I also had a lipid panel done recently and found out that I have high cholesterol and all my other levels on those labs were outside of normal limits. I have been having chest pain on and off for about 6 years now. I had a stress test done about 4 years ago and they said it was fine. I do have an appointment with a cardiologist next week. This was only due to me asking for the referral. My family doctor didn't think I needed to see one. I tried to be brief in the history. My question is does this EKG seem questionable and what does it mean? Also, did I make the right move in requesting to see a cardiologist?
Thank you for your help.
 Dr. Wafaa Abdel-Hadi - Fri Apr 01, 2005 5:05 pm

Hello Mmansur,

Ofcourse it is always right to ask for a referral especially when you are in doubt...or else you will be you in continous stress all the time because you are concerned about your heart condition and that can cause cardiac problems as well!

Listen... your EKG is good...you cannot judge inferior t-wave changes unless you have an old EKG to compare it with and see if that's new.

I am concerned about your repeated attacks of chest pain(can you describe it?)...and your high lipid profile. I suggest you to cut down the fat in your food and increase your healthy habits and start doing a light exercise.

There are a lot of factors predispose to Ischemic heart diseases...includes smoking, drinking alcohol, high fat intake,genetic predisposition(does any of your family have heart problems?) , if you are hypertensive, if you are diabetic, and the list goes on, you can read about it in our website in the cardiology section :

http://www.doctorslounge.com/clinlounge ... angina.htm

but I think if the stress test was all right ...then there are no worries...provided that it was done correctly ....it shows the electrical activity of the heart during stress...and this is a simple test to show if the heart is having enough blood supply when you are doing effort/ in stress or not.

That's all for now,
Best wishes,
 kcteach - Thu Sep 01, 2005 10:11 am

Hi! I am a 49 year old female that mentioned to my dr. that I was having short, sharp pains on my left side for a few months. They were never severe. My dr. did an EKG and said that it showed I had had a heart attack, but he didn't think I had. I was sent for a treadmill stress test where I did fine. The test showed boderline/normal. Some plaque beginning to build in right artery. I was referred to a cardiologist. Another EKG was done. It also showed I had had a heart attack. I couldn't tell you when. I am now being told I need a stress test with an echocardiogram. The pains in my chest have become less frequent, but I have a spot in my back that aches. It also feels sore in that spot. Is is possible to have a stress test that shows borderline/normal and not show any heart damage? I'm very scared and I'm afraid to do anything in case I have a heart attack.
 Dr. Wafaa Abdel-Hadi - Thu Sep 01, 2005 4:23 pm

Hello KCteach,
Well, I think you should do the Echocardiogram....to visualize your heart's walls and if you have any clogged arteries it can be reflected as wall motion abnormalities.

Were/are u an athelete? that might be why you have a border/line stress test...But they can't say you have had an old heart attack...UNLESS you had an old EKG before the pain attack(in th epast) that didn't have those changes they found. That's wht you call a dynamic EKG...so we compare it to an old one... if your stress test is fine....and you still have these pains...please do the echocardiogram and there are also a lot of other causes for chest pain not necessarily the heart..including oesophagitis , myositis,etc... you can check them out in our site here.

Keep me updated,
Best regards,
 kcteach - Fri Sep 02, 2005 8:10 pm

Thanks for your quick reply. Here's the update. I went in for the echo. The cardiologist read it and he tells me that my heart is perfectly fine. He can find no damage and everything is in good working order. I did ask about the EKG showing a past heart attack. I was told that it could have been a false/positive. I was told not to worry anymore and to let them know if felt I needed them. The dr. said he did not need to see me again.
 Dr. Wafaa Abdel-Hadi - Sun Sep 04, 2005 9:13 am

Well done:-)....so you don't have a cardiac problem ...
Best regards
 kcteach - Sun Sep 04, 2005 11:15 am

I do have one more quick question. Even though a cardiologist has said that my heart is fine, the two positive EKG's bother me. Isn't it a little unusual for two different doctors to get an EKG that shows a past heart attack? Could I have two false/positives?
 Dr. Wafaa Abdel-Hadi - Sun Sep 04, 2005 4:26 pm

I cannot comment on that because i haven't seen the EKG myself...but what i can say is that....if they suspect a past heart attack depending on something called the T-Wave in the EKG....then it can be a false positive,,,that's why i've asked you if you had done any EKGs before the presumed chest pains you've had.That's because if the T-wave was different than the ones they see now...that would be called "dynamic T-wave" which might indicate (with other criteria) that you've had a heart attack before.

It's a bit complicated I know...that's why i have to see an old EKG and a recent one to compare....Because there are alot of changes in an EKG that can diagnose a heart attack , not only the T-wave(that is the least).

Tell me if i can be of any help. And please check out the other causes of Chest pain in our site.
Best regards,
 Dr. Wafaa Abdel-Hadi - Sun Sep 04, 2005 4:27 pm

I cannot comment on that because i haven't seen the EKG myself...but what i can say is that....if they suspect a past heart attack depending on something called the T-Wave in the EKG....then it can be a false positive,,,that's why i've asked you if you had done any EKGs before the presumed chest pains you've had.That's because if the T-wave was different than the ones they see now...that would be called "dynamic T-wave" which might indicate (with other criteria) that you've had a heart attack before.

It's a bit complicated I know...that's why i have to see an old EKG and a recent one to compare....Because there are alot of changes in an EKG that can diagnose a heart attack , not only the T-wave(that is the least).

Tell me if i can be of any help. And please check out the other causes of Chest pain in our site.
Best regards,
 joann725 - Mon Oct 03, 2005 9:51 pm

Hello!
i joined this forum to find someone to help me interpret my ECG results from my anatomy & physiology laboratory class using the IWorx LabScribe system. i have the image of my ECG at the end of this post. i am quite alarmed that my ECG looks like i took it after i exercised (shorter P-T intervals) when in fact, this was taken when i was at rest. also, i noticed that my QRS complexes are quite high (my heart is overworking). i am a 20-year old asian female, quite overweight, 5'6" tall, with a BP almost always below the normal range (170/65) and a pulse in the mid-70s. i cannot imagine myself having a heart problem. i am scared, since my mom has a history of cardiomegaly. please help me :)

ecg.png" alt="Image" />

the link: http://img.photobucket.com/albums/v86/joann725/ecg.png
 Dr. Wafaa Abdel-Hadi - Fri Oct 07, 2005 4:16 am

Hello,

Thank you for your attachment, well .... it's a bad quality picture though...through the scanner and it's only 2 leads...!? but all I can say is that your EKG is fine...there might be an element of atrial enlargement but it's trivial and I cannot comment 100% on it since the EKG is not taking a straight line to comment on the "isoelectric line"....To sum it up...as long as your stress EKG is fine and your Echocardiography as well,please don't worry... because anxiety is not good for the heart!

Best regards,
 joann725 - Mon Oct 10, 2005 4:01 pm

thanks, Dr. Hadi.
we only used 3 leads (one on each wrist and the other on the left ankle) for that EKG.
i am planning to have a check-up once i get included in my mom's family insurance plan.
and i want to clear that this was not a stress EKG, it's a resting EKG.
i only mentioned that my resting EKG (the one in the scanned picture) looks like a stress EKG...i think that's quite abnormal?
anyway, thanks for your reply and i won't worry anymore :)
 momsdaone - Wed Nov 16, 2005 1:12 am

hi,
my 13 year old son had an ECG today. it says that he has sinus bradycardia with premature supraventricular complexes. should we be concerned? he is autistic and has tardive dyskinesia from an antipsychotic he was given when he was 8. lately he has been sweating very badly at night while sleeping and his reynaud's syndrome has been acting up. could these symptoms be related to the findings on this ECG? he has joined the wrestling team. should we allow him to continue working out or wait until we know more? his last ECG done 6 months ago was normal but did show early repolarization. My sister died unexpectedly of a heart attack when she was 13..thirty some years ago.

thank you for answering my multitude of question.
 Drt20racer - Tue Nov 22, 2005 9:46 pm

Okay let me give you some backround, I have been experiencing some palpitations, so my doctor ordered me to have a EKG and a holter, I did the EKG first, and I got the results baack and here is what they say :

-Otherwise Normal ECG-
*Sinus rhythm with poor R-wave progression from V1-V3, otherwise unremarkable

was just wondering what this means? havent seen the doctor yet, it will be a few weeks...

holter tests are not back yet
 Style - Sat Nov 26, 2005 3:26 pm

went to the doctor yesterday because I thought I had a chest cold......well to make a long story short, I had a lot of tests ran, EKG, bloodwork, chest x-ray etc. My EKG result was "Abnormal T Wave". Is this serious? My doctor didnt seem to overly concerned, he sent me home and told me to come back in 1 week. I had a stress test in Dec of last year and everything was fine. I also had a high Lipase count...not too high, like 272 and normal is 118-246 I think.

I am a worrier though, should I be overly concerned about the abnormal t wave thing? I have been having chest pains, not bad, more of a burning and a dull ache than anything else, some dizziness and shortness of breath. I also have bad stomach problems......acid reflux real bad, and gastritis.

Please tell me what you think....like I said, my doctor didnt seem too worried about it, should I be?
 Mamarivera - Tue Nov 29, 2005 8:17 pm

Subject: My athletic 16 y/o Hisp/Amer. son. 160#, 5’6” with chest pains and rapid heart rate.
Over 3 months he self managed a 20 pound weightloss program utilizing low carbohydrate/high protein diet, whey protein shakes and wtlifting/workouts. Per my snoop/investigate no other supplements used. At the time of these incidents, only medication he was taking was Pannaz for sinus congestion – this was d/c when the chest pains episodes began.

Hx:
1. Oct, 05 c/o of bad chest pain w/episodes of racing heart beat – increasing over a couple of weeks. He could make the pain stop by lying down and bringing his knees up to his chest. Make racing heart slow by walking around real fast to “catch up to his heart”. At times the pain is not associated with a racing heart. Some occurrences have not even been related to workouts occuring during unstressful times – e.g. Sun. morning at church; Sat. night playing cards.
2. Pain described as “a cramping up” or “someone sitting on my chest”, sometimes, a sharp pain occurs w/ deep breaths.
3. When he was a small child, I recall feeling his heart beating hard – pediatrician never heard anything abnormal so no testing was ever prescribed
4. That Oct. weekend he also had 2 incidents c/o of total exhaustion, once was after a bout of racing heart and chest pain, the other seemed unrelated to pain/racing heart.
5. Family Dr. did office EKG – noticed a short PR interval and wanted to rule out pericarditis and Wolfe Parkinson White syndrome, so he initiated a 24 hour monitor and sent us to cardio for ultrasound.
6. Echo/u.s. normal with no unusual anatomy noted. The cardiac event mon. read by a cardio and the study revealed numerous runs of Supraventricular tachycardia with rate as high as 150.
7. Inderal 10 mg BID prescribed and was taken on Wed.PM and again on Thurs.AM. On Thurs. PM, he wanted to change his window blinds, and after about 10 min. of working in this overhead reach position, he climbed down off the chair complaining of pain and exhaustion, sat down on the end of the bed, and then went down on the floor c/o being so exhausted he couldn’t move. BP was 110/40 and pulse 40 - 45. Remained conscious w/feet elevated to prevent syncopal episode. Skin cool, clammy, very pale. MD notified and the Inderal reduced to 5 mg BID. A reduced dose that PM and on Fri. AM. Then Inderal d/c per order of the EPstudycardiologist.
8. EP study on following Monday A.M. – Dr. said that he could not induce an abnormal rhythm (other than sinus tachycardia with an Isuprel infusion) but did express concern that during the study, my son woke up in severe chest pain associated with the sinus tachycardia – concluded that EP was considered normal, but the fact of the severe chest pain during the stimulation was not and should be investigated and followed up. No ablation occurred; no need for pacemaker.
9. He was placed on a 30 day event monitor – only several minor “uncomfortable” chest feelings which he recorded. There have been neither further bad chest pain nor heart racing episodes since the EP study.
10. Now that we are taking his pulse, his pulse seems to run between 45 and 75.
11. The original cardio has informed me that he does not know why my son is having these incidents and believes that the chest pain does not correlate with anything – therefore, he will outgrow it.

Problem: I am his Mother – I feel very concerned about just “letting him outgrow” something that we don’t know what it is. I just want to be sure that he will outgrow everything, just keep growing period -- I want to know what it is that he can outgrow.


Question: What other avenues should be investigated to get to the bottom of a “short PR interval” and and racing heart rate and chest pain that doesn’t seem to correlate with anything? Where do I turn now? What questions do I need to ask of the cardiologist or the family doc?
 kimkel6 - Fri Dec 02, 2005 8:51 pm

Hello, my husband's work had a mobile testing service to come and do ekgs on all employees and we were mailed the results today. They are freaking me out!! The cardiologist report states that he will need medical follow-up. The items that are checked on the page are: Sinus bradycardia 57/min, RSR' or QR Pattern in V1& V2, and Nonspecific T-wave changes(Anterior Septal), he also wrote that there were non specific T wave changes in V2 & V3. Please tell me I am jumping the gun on overeacting before he has even had the chance to see our primary physician.

Thanks,

A Very Worried Wife

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