EKG Changes and Electrode Placement

[erijon]

I am a 49 year old male with controlled HBP, good cholesteral, 40 pounds overweight, don't smoke and no family history of early onset heart disease. I had an interesting experience at the cardiologist today for my annual check up. Everything went great, blood pressure good, cholesterol good, weight down (60 pounds in 13 months) and heart sounded fine. Like I said, everything was great until she saw my EKG and compared it to one from January when she said there was a subtle change which may indicate a blockage.

She said she needed some honest aswers to some questions. She asked me again about my exercise routine, which is 45 minutes a day on the treadmill with no symptoms. She asked agian if I really did not experience chest pain or other cardiac symptoms and I told her I did not. The more she pondered, the more questions she asked and finally said she wanted the EKG done again saying based on my answers she thought there was a lead placement error on the original EKG. She had a "better" tech do a second EKG and she said it was a perfect match for the last one in January and there were no changes, so everything was fine.

I don't know much about EKG's, does this sound realistic to you? Is there such a thing as placing a lead incorrectly so that it can alter an EKG? Also, I am going in for an echo this week, first one in two years, last one was normal and my EF was 62%. Should I see any improvement after exercising and weight loss over the past year?

Tony

[CCF-M.D.-CA]

Yes, lead placement although often overlooked has caused me and many of my colleagues a considerable amount of frustration, because many decision based on the management of patients depend on very specific information from their EKGs.
The reversal of one single lead can cause an overwhelming change in the EKG, and since statistically the most common cause for this is CAD any symptoms are then attributable to the heart.
However, despite this large amount of weight we place on the EKG and cardiac monitoring in general, it is not know how reliable it is in detecting coronary artery disease.
It is symptoms which should alert you to the presence of CAD: chest pain or pressure, shortness of breath or swelling in the legs. Since you exercise 45 minutes daily without any symptoms such as these you can rest assured that if you do have coronary disease it is not severe enough to cause you to have 'angina' or anginal symptoms. COntinue on the exercise, lower your weight and continue with blood pressure and cholesterol control.

[erijon]

Sorry, I made an error, my last echo was one year ago, not two, when I started my exercise program. The results showed mild diastolic dusfunction and a slightly enlarged left atrium (4.2cm), everything else was normal. I was wondering if the chages I have made wll result in an improvement in these areas in particular.

Thanks,
Tony