
How Accurate Is An Ekg That Repeatedly Comes Back With Anterior Or Anteroseptal Infarct ?

Thank you for your query.
I would like to know some more specific details from you.
1) Can you upload the scanned ECG using the file upload feature of this site? A scanned ECG with the rhythm strip showing the SVT will also be useful.
2) What did the stress test show exactly? What test was done - TMT? or a Stress thallium scan or a dobutamine stress echo? What were the abnormalities shown?
It appears from your history that you suffered a heart attack when you were 39 yrs old, probably an anterior wall MI. This is most likely due to a blockage of the Left anterior descending artery. Whether that is the only blockage or whether there are other blockages will be answered by the coronary angiogram. Since you have had some treatment, it is also possible that at least part of the blockage might have regressed. But, since you do have chest pain on and off, it is likely that there is persisting blockage.
The shortness of breath is probably due to a reduction in the ejection fraction after the MI.
The presence of ischemia and/or scar due to the MI can produce ventricular arrhythmias like PVCs, NSVT VT and someimes even VF. These PVCs can trigger SVT in a person with "dual AV nodal pathway" or if you have accessory pathways (manifest WPW syndrome or concealed accessory pathways). The timing of the PVC with respect to the normal cardiac cycle is critical in inducing the arrhythmia. The SVT can also cause chest pain, dyspnea and palpitations.
The uncontrolled BP is not helping matters much. The high BP puts an additional strain on your heart that is already weakened by the MI. The levels of 227/119 are quite high. A possibility is that there may be obstructions of the renal arteries (symptoms, the presence of a past MI, hypertension, abnormal stress test and abnormal CT angio, it is definitely advisable to undergo coronary angiogram and renal angiogram. Further treatment can be planned according to the results of the angio. If there are significant blocks, and if there is significant "viability" of the affected areas, it is worthwhile to do revascularization (CABG vs angioplasty, depending on the anatomy and feasibility). If the blocks are <70% in severity, or subserve non-viable areas, medical management can be optimized.
You will also need drugs to control your arrhythmias. Many of these may be controlled with medicines. Revascularization also will produce a beneficial effect. In case of persistence of arrhythmias despite adequate revascularization and optimal medicines, you should undergo an EP study and RF ablation, as indicated.
I hope this answers your query. Please feel free to get back to me for further clarifications.
With regards,
Dr RS Varma

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