EKG report and interpretation

  My daughter who has a history of mild connective tissue disease, unspecified...and Graves' Disease is currently being evaluated for episodes of chest pain.  A typical episode is sharp, retrosternal, and is associated with shortness of breath.  She is receiving anti reflux medications, but the gut feeling is that it is not a GI problem.  She has received extensive cardiac evaluation.  Her first EKG was abnormal....I don't know the name of the abnormality but the cardiologist drew me a picture and said that the spike that follows the high spike was significantly higher than it should be...it was approximately 3/4 the height of the large spike.  Since then she has had several EKGs that have been reported as being within normal limits.  They sent me a copy of her last EKG to give to her primary doctor....the analysis reads "normal sinus rhythm, and nonspecific T wave abnormality".  This T-wave abnormality was not commented upon in the cardiologists notes to the doctor, it was just stated that the ekg fell within
  normal limits.  The plan is to return her to Emergency room of local hospital during next episode of severe pain to have cardiac enzymes checked, to rule out ischemia.  If enzymes are elevated, then a thallium stress test would be the next step.
  My question is what significance, if any, is a nonspecific T wave abnormality?  Would this be the same abnormality that was noted in the original abnormal EKG, based on the description of the elevated spike?  Or would these be two separate issues?  The initial EKG read enlarged right atrium, but chest xrays have found no heart enlargement, and echocardiogram was normal.  Because my daughter has a history of medical conditions, I want to understand what is going on.  Because my daughter is a competitive athlete (former gymnast, currently swimmer) and spends a significant amount of time doing heavy amounts of exercise, and because the pain seems to be related to exercise, I worry.  Thanks for your help!
  Dee

[CCF CARDIO MD APS]

Dear Dee,
Non specific T wave abnormalities can be normal in young people and they can
be abnormal, so the investigation is warranted.  The whole spike thing you talk
about is useless to me, it could mean anything.  I find it hard to believe that the
ecg showed signs of right atrial enlargement and the echo was completely normal, it
makes me wonder if the echo was thorough, i.e the chamber sizes were measured, an
ASD was ruled out, the right side of the heart was scrutinized as vigorously as
the left side, etc.  The other point I have is why wait for another episode in
which case it would be great to get an ecg, but why wait to do the stress test?
You should discuss these issues with her doctor, especially because a normal echo,
stress test and physical exam in a young person like your doctor is a ticket to not
worry and conclude that the ecg is just a variant of normal.
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