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Follow Up re. LAFB
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Follow Up re. LAFB

Dear Doctor,

I posted yesterday re LAFB on EKG and chest pains following cocaine use.  Thanks for responding and BTW I don't plan to use cocaine again.

I saw a cardiologist yesterday, who told me that what he saw was a minor conduction interference in EKG that he characterized as a small "hemi-block."  He said that he was fairly positive (95%) that the cocaine use was completely unrelated to the hemi-block, judging by the fact that the EKG was atypical of someone who had suffered MI and my ECHO came back completely normal.  (And taking into account Troponin and CK levels were normal, even though taken at tail end of diagnostic window.)  He said chest pains I experienced may have been due to "vaso-reaction" from cocaine use, but that true infarction (involving myocardial cell death) did not occur.  

1) Is it possible to tell from just EKG and ECHO that no minor MI occurred?

2) From what you know, would you rule out infarction in this case?  You said in your previous posting that LAFB was likely congenital.  Does this mean it was unrelated to cocaine use?

Thanks again,
Thomas
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Dear Thomas,

An ECG may rule out transmural or through the wall MI's  but cannot rule out smaller MIS that may damage small areas. This is generally done with creatinine kinase or troponin levels drawn at the time of chest pain.

The LAFB may be due to a lack of blood flow to the particular area of the heart through which the LAF runs.  It would be difficult to say this was congenital without having a prior ECG.  One must assume it is new if it is not known to be old.

Glad to hear that you will not be using cocaine anymore.  That is the best thing that you can do for yourself.
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