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What Do These ECG Reports For Intermittent Chest Pain Indicate?
Question: 2 different doctor offices, 2 EKGs both said possible Anterior Infarct. I'm current 37, had both of those EKGs over the summer.
Also stated Poor R Wave Progression, but then cardio told me I was fine.
Began experiencing chest pain since 2011, had a couple of ER visits and visit to another cardio that basically made me feel stupid because I was wasting their time as a 30 something woman coming in with my issues.
Im a veteran, currently exercise, do not feel much chest pain/discomfort these days, but would like to feel like I'm heard.
Also stated Poor R Wave Progression, but then cardio told me I was fine.
Began experiencing chest pain since 2011, had a couple of ER visits and visit to another cardio that basically made me feel stupid because I was wasting their time as a 30 something woman coming in with my issues.
Im a veteran, currently exercise, do not feel much chest pain/discomfort these days, but would like to feel like I'm heard.
Brief Answer:
I would explain as following:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would like to explain that it is very important for me to directly review both your ECG (if you can upload them as attachments to this question) for a more professional opinion.
You should know that a poor R Wave progression on resting ECG may be explained by several causes, such as:
- chronic pulmonary disease
- inter-ventricular septal hypertrophy
- pulmonary hypertension
- special thoracic anatomy (like round thorax).
So, I would like to reassure you that, though the ECG machine, by using some rigid predefined algorithms has concluded for possible anterior myocardial infarction, this conclusion should not be considered as a definite and reliable diagnosis.
Because anterior myocardial infarction (and any other infarctions) is not concluded by the presence of poor R Wave progression, but from a composite of the following:
- clinical signs (typical prolonged chest pain, shortness of breath, etc.)
- ECG signs (ST segment elevation or depression, appearance of Q waves, ischemic T waves)
- increased cardiac enzyme levels (CK-MB and Troponin I).
Also Left Ventricular wall motion abnormalities on a cardiac echo would be a strong additional evidence to confirm the hypothesis of a past myocardial infarction.
But as there is no evidence of the above criteria, the diagnosis of anterior myocardial infarction seems to be unlikely.
Please could you provide me with any of the above mentioned medical tests if you have already performed them?
You should discuss discuss with your doctor on the above mentioned issues.
I remain at your disposal for any further questions!
Kind regards,
Dr. Iliri
I would explain as following:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would like to explain that it is very important for me to directly review both your ECG (if you can upload them as attachments to this question) for a more professional opinion.
You should know that a poor R Wave progression on resting ECG may be explained by several causes, such as:
- chronic pulmonary disease
- inter-ventricular septal hypertrophy
- pulmonary hypertension
- special thoracic anatomy (like round thorax).
So, I would like to reassure you that, though the ECG machine, by using some rigid predefined algorithms has concluded for possible anterior myocardial infarction, this conclusion should not be considered as a definite and reliable diagnosis.
Because anterior myocardial infarction (and any other infarctions) is not concluded by the presence of poor R Wave progression, but from a composite of the following:
- clinical signs (typical prolonged chest pain, shortness of breath, etc.)
- ECG signs (ST segment elevation or depression, appearance of Q waves, ischemic T waves)
- increased cardiac enzyme levels (CK-MB and Troponin I).
Also Left Ventricular wall motion abnormalities on a cardiac echo would be a strong additional evidence to confirm the hypothesis of a past myocardial infarction.
But as there is no evidence of the above criteria, the diagnosis of anterior myocardial infarction seems to be unlikely.
Please could you provide me with any of the above mentioned medical tests if you have already performed them?
You should discuss discuss with your doctor on the above mentioned issues.
I remain at your disposal for any further questions!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The darker file is an older ecg from a year ago, the pink is one is from the summer. I do not have the second ecg from the summer; the obgyn who had the ecg performed after learning I had an implanted loop recorder ran an ecg, and concluded he could not continue with my tubal ligation because of my "old heart attack." He did not provide me a copy of the ecg & there was not a copy when I sent for a copy of my records.
Between 2011- 2014 after years of palpitations, chest pain, pain that radiated to the upper middle of my back, tingling in my left hand and 4, 24 hr Holter monitors, more pain, chest tightening, shortness of breath upon exertion and no exertion, and severe fatigue that would occur with a drop in blood pressure they diagnosed me with anxiety. Later, they decided they'd insert the Loop Recorder. After a yr and a half or so, they concluded that I had "Ectopic Atrial Tachycardia" (on 7, May 2015, per Dr. Caruso, VA Cardiologist) suggested I lay off the caffeine (which I was not drinking because I was pregnant) and VA Cardio in Temple, TX suggested I not have an ablation because I would just probably have to have another because palpitations would occur again and another ablation would be performed. "They can pop up wherever, whenever at anytime. It's basically pointless."
I did hear from previous cardio that there is an "abnormality due to poor R wave progression, but nothing I should concern myself with." At my last visit in July, cardio crossed out "cannot rule out anterior infarct " & wrote, "breast artifact tissue, R wave progression normal with exception of V5." I'm not sure what breast artifact tissue she speaks of because I'm 151 lbs, about an A cup & not much fat in upper body area between my skin and ribs and ribs can be felt in every area of my chest. Not much breast to get on the way to be honest.
My mother was diagnosed with small vessels disease about 3 years ago and is now on medication. She had similar symptoms to mine.
And not sure if it matters, but loop recorder showed heart rate would drop down as low as 38bmp, these days it hovers around 48 resting, according to my Fitbit.
Since 2011 I have battled fatigue and sometimes feel like maybe it's this heart rate that does not allow me enough energy.
Between 2011- 2014 after years of palpitations, chest pain, pain that radiated to the upper middle of my back, tingling in my left hand and 4, 24 hr Holter monitors, more pain, chest tightening, shortness of breath upon exertion and no exertion, and severe fatigue that would occur with a drop in blood pressure they diagnosed me with anxiety. Later, they decided they'd insert the Loop Recorder. After a yr and a half or so, they concluded that I had "Ectopic Atrial Tachycardia" (on 7, May 2015, per Dr. Caruso, VA Cardiologist) suggested I lay off the caffeine (which I was not drinking because I was pregnant) and VA Cardio in Temple, TX suggested I not have an ablation because I would just probably have to have another because palpitations would occur again and another ablation would be performed. "They can pop up wherever, whenever at anytime. It's basically pointless."
I did hear from previous cardio that there is an "abnormality due to poor R wave progression, but nothing I should concern myself with." At my last visit in July, cardio crossed out "cannot rule out anterior infarct " & wrote, "breast artifact tissue, R wave progression normal with exception of V5." I'm not sure what breast artifact tissue she speaks of because I'm 151 lbs, about an A cup & not much fat in upper body area between my skin and ribs and ribs can be felt in every area of my chest. Not much breast to get on the way to be honest.
My mother was diagnosed with small vessels disease about 3 years ago and is now on medication. She had similar symptoms to mine.
And not sure if it matters, but loop recorder showed heart rate would drop down as low as 38bmp, these days it hovers around 48 resting, according to my Fitbit.
Since 2011 I have battled fatigue and sometimes feel like maybe it's this heart rate that does not allow me enough energy.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
I carefully reviewed your uploaded ECG and would explain that they do not indicate a true poor R wave progression.
Instead, what could be noted from your uploaded ECG is a shifting of the transitional zone (the ECG precordial lead, where R and S waves are almost of the same amplitude) to the left.
This ECG pattern may be explained by each of the above mentioned causes at the beginning of our thread.
Coming to this point, I would recommend you to perform a check up of your pulmonary function, including:
- pulmonary imaging tests (chest X ray study, CT, etc.)
- pulmonary function test (PFT).
Pulmonary disorders are a well known trigger for generating atrial arrhythmias such as atrial tachycardia.
Regarding the chronic fatigue that you are experiencing, I would explain that a persistently low heart rate (bradycardia), may be an underlying reason.
I would also recommend checking your thyroid hormones levels to exclude a decreased thyroid function.
So, to conclude, my opinion is that from your ECG could not be concluded about any old myocardial infarction.
To fully clarify the issue of a hypothetical previous myocardial infarction, a cardiac MRI with contrast enhancement would be recommended (as it may reveal the presence of myocardial fibrosis, which universally remains after a myocardial infarction).
Regarding your chest pain, I would recommend performing a cardiac stress test.
Hope to have clarified some of your uncertainties:
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
I carefully reviewed your uploaded ECG and would explain that they do not indicate a true poor R wave progression.
Instead, what could be noted from your uploaded ECG is a shifting of the transitional zone (the ECG precordial lead, where R and S waves are almost of the same amplitude) to the left.
This ECG pattern may be explained by each of the above mentioned causes at the beginning of our thread.
Coming to this point, I would recommend you to perform a check up of your pulmonary function, including:
- pulmonary imaging tests (chest X ray study, CT, etc.)
- pulmonary function test (PFT).
Pulmonary disorders are a well known trigger for generating atrial arrhythmias such as atrial tachycardia.
Regarding the chronic fatigue that you are experiencing, I would explain that a persistently low heart rate (bradycardia), may be an underlying reason.
I would also recommend checking your thyroid hormones levels to exclude a decreased thyroid function.
So, to conclude, my opinion is that from your ECG could not be concluded about any old myocardial infarction.
To fully clarify the issue of a hypothetical previous myocardial infarction, a cardiac MRI with contrast enhancement would be recommended (as it may reveal the presence of myocardial fibrosis, which universally remains after a myocardial infarction).
Regarding your chest pain, I would recommend performing a cardiac stress test.
Hope to have clarified some of your uncertainties:
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Regarding a PFT, the doctor at the women's clinic at the VA determined I had asthma and prescribed me an EpiPen and an inhaler and 2 months later when I had a PFT that tech told me I had zero indication of asthma and thought it was silly to be diagnosed with asthma before I had even had the pulmonary functions test. Later when the women's Dr asked why I had been prescribed an inhaler she asked me why, I explained to her that she was the one who diagnosed me. She disagreed.
That same Woman's Clinic Doctor also told me that it look like I had an enlarged thyroid and so they sent me for an ultrasound and it was determined that I have zero wrong with my thyroid. It is perfectly normal.
I've had them test using all thyroid testing available (they use to do only one, and I pleaded for them to complete a full series (the T3, T4, Free T4, Free T3, RT3....etc.) They did not test all of those, but what they did test came back normal.
I had a nuclear stress test back in 2011 & a treadmill stress test I believe in 2013. It was at that time the doctor mumbled under his breath that I was wasting his time.
I was fine with a diagnosis of Ectopic Atrial Tachycardia and going about my business until all this "old heart attack" mumbo jumbo came up. After all that's happened, it's quite unnerving when the ob won't dare continue your surgery because of it.
As you can see, most of what you suggest has already taken place. I have looked further into this issue than I care to, but after what happened this past summer, it seems the issue wasn't quite closed yet. I certainly hope this is nothing, 5 years is long enough to have this in the back of mind, so we'll see.
That same Woman's Clinic Doctor also told me that it look like I had an enlarged thyroid and so they sent me for an ultrasound and it was determined that I have zero wrong with my thyroid. It is perfectly normal.
I've had them test using all thyroid testing available (they use to do only one, and I pleaded for them to complete a full series (the T3, T4, Free T4, Free T3, RT3....etc.) They did not test all of those, but what they did test came back normal.
I had a nuclear stress test back in 2011 & a treadmill stress test I believe in 2013. It was at that time the doctor mumbled under his breath that I was wasting his time.
I was fine with a diagnosis of Ectopic Atrial Tachycardia and going about my business until all this "old heart attack" mumbo jumbo came up. After all that's happened, it's quite unnerving when the ob won't dare continue your surgery because of it.
As you can see, most of what you suggest has already taken place. I have looked further into this issue than I care to, but after what happened this past summer, it seems the issue wasn't quite closed yet. I certainly hope this is nothing, 5 years is long enough to have this in the back of mind, so we'll see.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
It seems that something probably has triggered the first thought of VA doctor about a pulmonary abnormality resembling asthma.
As it is finally confirmed you don’t have asthma, this is the most probable truth.
I would like to personally review your PFT report for a second professional opinion; just to be sure no any additional pulmonary disorder (other than asthma) is suspected.
Please, could you upload it here for a direct review?
Regarding thyroid function, when we are in front of a suspicion about an enlarged thyroid gland, besides a thyroid ultrasound, it is necessary to check the full range of hormones (FT3, FT4, TSH) and in case of further suspicions a thyroid gland scintigraphy.
But if thyroid gland dimensions and TSH are normal an important underlying disorder is excluded in the majority of cases.
Now returning to our point of greatest interest, the cardiac issues, I would explain that facing a normal nuclear stress tests and normal treadmill stress test, the probability of a previous myocardial infarction is quite unlikely.
Your last resting ECG confirms this conclusion.
Coming to this point, the only advise would be just to relax and don’t worry too much about it, any more!
I would recommend discussing with your attending cardiologist about your heart rate trends and its influence on your daily fatigue and also to review his opinion on the matter to your ob doctor that there is nothing suspicious about a previous myocardial infarction alternative.
Feel free to ask me at any time!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello,
It seems that something probably has triggered the first thought of VA doctor about a pulmonary abnormality resembling asthma.
As it is finally confirmed you don’t have asthma, this is the most probable truth.
I would like to personally review your PFT report for a second professional opinion; just to be sure no any additional pulmonary disorder (other than asthma) is suspected.
Please, could you upload it here for a direct review?
Regarding thyroid function, when we are in front of a suspicion about an enlarged thyroid gland, besides a thyroid ultrasound, it is necessary to check the full range of hormones (FT3, FT4, TSH) and in case of further suspicions a thyroid gland scintigraphy.
But if thyroid gland dimensions and TSH are normal an important underlying disorder is excluded in the majority of cases.
Now returning to our point of greatest interest, the cardiac issues, I would explain that facing a normal nuclear stress tests and normal treadmill stress test, the probability of a previous myocardial infarction is quite unlikely.
Your last resting ECG confirms this conclusion.
Coming to this point, the only advise would be just to relax and don’t worry too much about it, any more!
I would recommend discussing with your attending cardiologist about your heart rate trends and its influence on your daily fatigue and also to review his opinion on the matter to your ob doctor that there is nothing suspicious about a previous myocardial infarction alternative.
Feel free to ask me at any time!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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