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Follow up tests to abnormal ekg
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Follow up tests to abnormal ekg

I just wanted to let you know the results of my visit to the cardiologist. He did an echo and ekg at the first visit and said that the echo showed good heart function but there was a murmur which I probably had since birth.
The next day he did a stress echo and I was able to complete the full test which went upto 5.5 incline.I was even able to talk to him through th whole test.  He said the results looked very good.
He then compared my EKG to the one he had just received from 2 years ago which was normal. He now wants to do a thallium stress test because he said that I could have a blockage in a minor branch of an artery. He could not see this artery in the echo.All the major arteries looked good.
My question is "when is all this going to end' Am I going to be having test after test? What would the blockage signify? My cholesterol, blood pressure were all normal. Weight is 115 lbs. I am very active.
It is very worrying to find out that I have heart disease with no symptoms and after maintaining a healthy life style.
It would help if you can tell me what I should be doing if there is a blockage and what lifestyle changes it would signify.
I thought that the very fact that I was able to do so well on the stress echo meant that my heart was working fine.
Could you please reasuure me?
Thank you so much for the wonderful help this forum has provided.
Related Discussions
Avatar_n_tn
tomnya,

Thanks for the post.

Q1:"when is all this going to end"

This is largely up to you.  If you are still worried about your heart, then maybe a stress test makes sense.  If, however, you feel that things are ok, then talk to your doctor about conservative management.

Q2:"It would help if you can tell me what I should be doing if there is a blockage and what lifestyle changes it would signify"

The answer depends on the criticality of the blockage, if present.  Most patients with CAD need to adopt a lifestyle of healthful eating and exercise.

Q3:"I thought that the very fact that I was able to do so well on the stress echo meant that my heart was working fine.
Could you please reasuure me?"

A good result on a stress echo carries good prognostic information.  

Best of luck.
20 Comments
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Avatar_n_tn
I dont know if you remember me from last week, so let me add that I am a 42 year old female with no family history of heart problems.
I wrote to you last week about my abnormal ekgs. Thank you once again for your prompt reply.
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Avatar_n_tn
I need reassurance!

I have a history of mitral valve regurgitation from my mid 20's.  In June of 2000 my doctor ordered an echo and concluded, "no valvular abnormalities.  Borderline enlarged heart - care with exercise."

Now for a pre op I had an ECG.  It was abnormal.  

Beats per minute - 60
normal sinus rythem
possible inferior infarction - age undetermined
can not rule out anteroseptal infarction - age undetermined
abnormal ecg

On the top of it she wrote, "No history of MI syndrome. Patient had MR (mitral regurgitation, I guess) on echo 6/2000." She then said, "don't worry you can still have your elective surgery."

She told me more than likely the ecg is noticing my heart murmur.  But that if I had a heart attack in the past it would be too late to do tests for enzymes.

This is upsetting!  Did I have a heart attak?  Or is this my heart murmur?

The only thing that counts against me is that for a few years I carried an extra 20 to 30 pounds.  But for the past two years I  vigorously exercised, lost 25 pounds (10 pounds near my ideal weight), don't drink or smoke and eat right.

This comes at an awful time.  I was quiting my job, possibly moving overseas, going to have elective surgery (reason for the ecg in the first place) and some very bad news about my family.  I was having chest pains for the past three weeks, but I thought it was stress.  Now I am not so sure.

Please help!

Thank you. Tina
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Avatar_n_tn
Hi Tina,

If you are referring to what the machine interpreted on your ekg, then it could very well be nothing.  The machines are programmed with algorithms (I will paste the definition for you below).  I have had ekg's that suggested MI's, too and then the dr. looks it over and discounts it altogether.  At one time I was even hospitalized for an abnormal ekg (which drs. read) and my history.  I was monitored for 3 days and tested, and everything checked out fine.  Wait to see how the dr. interprets it.  :o)

algorithms
A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task.

Not knowing and waiting for answers is hard, but try not to worry or call now and see if you can discuss it with your dr.

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Avatar_n_tn
Dear Jan,

Thank you for your words of encouragement!  I feel better today than I have all week!

I insisted on having another echocardiogram yesterday to evaulate my heart murmur and see if things have changed since 2000.  

One thing I have to say in light of the ecg....On Sunday night I took a Charitan D (1 pill works for 24 hours) to help with some hives.  I had severe palpatations for the whole time the Claritan D was in my system. Not to mention the added stress of having my credit cards stolen. It was horrible a day. I started "coming down" from the Claritan D at 11pm Monday.
I did tell my doctor all this and she still wanted to do the ecg on Tuesday morning.  Could that have affected the ecg?

I am also beginning to wonder if the really bad chest pains I was feeling is the result of my heart racing so fast from the Claritan D?

Anyway, now I am just waiting to hear from my doctor.  

But still, Jan, thank you for replying to my anxious post. Hearing others have had abnormal ecg's that eventually prove to be a non-issue gives me hope.

Sincerely,
Tina
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Avatar_n_tn
Tina,

I am glad my post helped a bit.  I do hope you get this sorted out soon, so you can either just plain ole relax or take the appropriate measures.

Hugs
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Avatar_n_tn
I really feel for you since I just went thru a similar very anxiety-producing mess as I posted on your other thread, with a "no problem" result.  

I do think this will be nothing.  Worse case, you have a minor blockage, and can do something like Dr. Dean Ornish's program of stress reduction, more rigorous eating habits, etc. to clear it.

I have even seen a doctor turn off the ekg machine's interpretive capability because it is so often wrong.
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Avatar_f_tn
I had 3 "abnormal" EKG's within the last 2 months.  The first one mentioned a "previous heartattack" don't remember the exact terminology, the second one showed bradycardia (slow heartbeat) and the third EKG showed "none specific ST segment abnormality".  To make a long story short I never had a heart attack, the "bradycardia" was caused by the Beta Blockers I was on and am off since, and the "none specific ST segment abnormality" my cardiologist said "its none specific, nothing for you to worry about".  About the "previous heart attack" my cardiologist said "to many EKG's have the computer print out that there was a "previous heart attack" when people never had a heart attack."
I then had an echocardiogram done which showed a SEVERE mitral valve leak.  I freaked out and worried like you would not believe.  I then had another test done called TEE where a tube is put down your esophagus so the cardiologist can see how bad your heart valve/valves are leaking.  Well, it showed that I had a VERY MINOR leak.  So minor that I don't need any follow up or any pre-medication (anti biotics) when going to the dentist.
Please DON'T worry like I did if you have an "abnormal" EKG or an "abnormal" echocardiogram.  These are NOT the FINAL results.  I thought I was losing my mind from worrying until the day of my TEE test.  I learned that certain breathing due to anxiety can mess up an echocardiogram.  I suffer from severe anxiety when going for a doctor's appointment or for tests.  I'm not afraid of needles, blood or pain, but afraid of what my anxiety will do to me, and what they will find out from my tests.
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Avatar_n_tn
Well, I just got a call from my doctors office.

I did not have a heart attack.  The echocardiogram has picked up a slight thickening of the heart muscle, which she feels is related to my heart murmur (previosly diagnosed a mild mitral valve regurgitation).  And this is probably what is throwing off the ecg.

Thank God!  

I have to tell you all I did have a lot of stress last week.  Too give you a brief idea:

1)  Quiting job - last day april 30
2)  Moving overseas
3)  Having elective surgery
4)  Thought my credit cards stolen/lost
5)  Found out sister in Australia was assaulted (not sexually thank god!) by a person crazy on meth
6)  Located my estranged father, who has been missing for year, had a stroke and is now having Vietnam flashbacks in some hick town in the outback.

To top it off, took one of the those Claritan D pills that makes your heart pound a mile a minute before an ecg.
  
I want to thank all of you for helping me out!!!!!!  Because even with the **** I went through last week, it was the support that I got here that really made me calm down and get prepared for whatever else I would need to handle.

I wish you all the best!

Tina
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Avatar_n_tn
Dear Barbarella:

Thanks!  I also am not afraid of needles, blood or things like that.  But terrified of doctors.  I guess it has to do with the fact I associate doctors as "bearers of bad news, death and illness."

But, that's not fair.  I just got good news!
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Avatar_n_tn
I was so glad to read about other people freaking out about mistaken ekg results.  I no longer feel like a nut.  Honestly, sometimes I think we would all be healthier and happier if we never went to the doctor's :-)
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Avatar_n_tn
Thank you everyone for your support through the last 2 weeks. My tests all came back normal. I guess the abnormal ekgs were wrong.
Thanks once again for helping me through these tough weeks.
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Avatar_f_tn
Dear Nutty,  I feel the same way you do.  I had some real bad experiences as a child with doctors which at this point I do not want to get into for it would end up being a very long post, but because of this I developed a phobia of doctors, a phobia of "what if", "what if he/she finds something serious".  At age 30 I found out that I react hypertensive when coming to the doctor's office or hospital, I then developed a phobia of having my BP taken on top of the doctor/hospital phobia.  And some doctors didn't help with scaring me which was unintentional I'm sure, but scaring me how I could have a stroke any minute.  I'm sure they felt they had to pump it in their patients so they will take their BP meds, but it scared me even more.  I could not even take my BP at home anymore, my couch/chair turned into the doctor's office, it was a nightmare.  It got so bad that I threw my BP machine out and said to myself "I will NOT put myself through this any longer, I will pray to god to keep me healthy" end of story.  I didn't go to any doctor for 7 yrs, but kept my yearly eye appointments.  Like I said in one of my other posts the eye doctor found a very small leakage of one of my blood vessels in my eye, and therefore had to take my BP, it was so high because I went into high anxiety immediately that they rushed me to the ER.  After 4 hrs I was released.  A Cardiologist finally told me "to take my BP at home, if its high wait a few minutes, don't panic it will go down, and for me to bring my readings to my doctor's appointments from now on".  I'm on meds for the BP like I said before I can live with that, no problem, but the phobia and axniety was unbearable.  Tranquelizers and therapy has not helped me yet to overcome this nightmare. But just knowing that I can go for a doctor's appointment without having my BP taken calms me down some.  I always make sure that I don't forget my BP readings from home otherwise I probably would have to bite the dust, and have my BP taken at the doctor's office.
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Avatar_n_tn
Dear Tomnya,

I want to apologize for "hijacking" your thread of inquiry on this board.  I really had nowhere else to go!

I am glad for you that you did well on your stress echo and that the doctor here thinks that is a good sign.  I hope all will be ok with you and with doing the right things (healthy lifetyle) you will maintain/improve your heart health.

Dear Barbarella,

Thank you for the support you gave to me.  

I got my echo results back and I was diagnosed with " concentric moderately severe left ventricular hypertrophy. Hyperdynamic EF of 75 to 80."  Otherwise normal results."

This is worse than my last echo from 2000 which showed, "borderline left ventricular hypertrophy."

Unfortunately, my pcp is leaving practice in 7 days and seems to be too busy to explain the difference.  All her assistant said was that my echo was normal and that "I should control I blood pressure."

But I have don't have hypertension (if they would look at their charts they would see this!!!)!!! At most I suffer from "white coat hypertension" which even then still is in the upper level of normal.  It usually goes down markedly by the end of doctors visit.

So this has left me with questions!!!  

I thought I was doing all the right things.  Losing weight, exercising (weight training and cardio) and healthy lifestyle.  So why is getting worse?

I even looked to my family history.  My father and mother are both very healthy (better than me!) and their siblings are all very healthy (longevity, healthy longevity!, runs on both sides).

I am confused as to what to do to prevent the worsening of this LVH!.
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Avatar_f_tn
Tomnya, first of all I want to apologize for not congratulating you on your good test results.  Since I've been through similar things I always get this strong feeling to type away about my experiences etc. hoping I can help somebody with their anxiety about tests and the whole nine yards.

To Nutty, I can understand your concern.  But like I said in one of my previous posts, I had an echogram which showed a "severe mitral valve leak" but after having an additional test called a TEE test it showed that I only had a "very minor leak".  I'm not saying that all echo tests and all EKG's come out inaccurate, but I can only speak from my experience, I worried my head off like you would not believe after my echo test, the waiting period till I was scheduled for my TEE test was unbearable.  You might want to ask your doctor if you could have another test done or repeat the echo test again, I was told by the technician who did the echo that certain type of breathing due to anxiety for example can cause a false result.  And I always have high anxiety when going for tests. Before you put yourself through  unnecessary worrying (and I know what a nightmare that is) ask your doctor if he could repeat the test, if he refuses then I'd go for a second opinion. Just think if my cardiologist had not ordered the TEE test.  We would have thought that I'd have had a "severe" mitral valve leak, and I would've been treated for something I don't have.  I had 3 abnormal EKG's. The first one showed a "previous heart attack" (which I never had) the doctor in the ER approached me with "did you ever have a heart attack" and I said no.  5 days later another "abnormal" EKG but showed no previous heart attack, a week later another "abnormal" EKG again it showed no previous heart attack.  Just think if they had settled for the first "abnormal" EKG I'd have been made to believe that I had a "silent" heart attack some time in the past.  All my tests came out o.k. Caridiologist said I had a strong and healthy heart aside from the very small mitral valve leak.  Why the 3 "abnormal" EKG's he could not answer me, but said "computerized EKG's are not always reliable".  DON'T worry like I did, not after only one test.  I worried myself sick for nothing.  I wish I could be like my husband, he says "why worry let them worry about it they are the Specialists in that field".  He will probably outlive me for he doesn't worry about anything .  I envy people like him.

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Avatar_f_tn
Dear Nutty,

I looked over your post again, and I forgot to mention that on my echo it showed "moderate hypertrophy of the left ventricle" I guess that meant "enlargement of the heart".  Again, I worried my head off for nothing.  The TEE test (after the echo) said "NO SIGNIFICANT hypertrophy of the left ventricle".  

If I were you I'd get a second opinion.  As far as for your BP.  There are also different opinions among doctors.  For example I showed my cardiologist my home readings(I'm on BP meds) which were at times in the 135-145 upper numbers and lower numbers were in the 80-90 range, but I also had numbers like 125/75 but more in the 130's and my cardiologist said "your BP is fine I am very pleased" when I asked him about the new research that the BP should be below 120/80, all he said was "your BP is fine, don't worry about it".  My family doctor got hyper and increased my BP meds DESPITE what my cardiologist said, my family doctor said it should NEVER go over 130/80.  You see they can't even agree.  Unfortunately I only had so many visits my insurance company allowed me with my referreal to the Cardiologist, he finished his tests and gave his report, and I am now back to the family doctor again.
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Avatar_n_tn
I called my pcp's office to ask for clarification on why my current echo shows a worsening progression of LVH.

The nurse is pulling my old and new echo to show my pcp.

As for exercise....I do serious weights when lifting and 30 to 45 minutes cardo at my 80% heart rate.

As for HCM....don't freak me out!  As far as I know, the only person in my family who had heart problems was my uncle.  He died in his 90's from heart failure. But my Dad (74) runs two miles a day and is heart healthty - same with my mom.

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Avatar_n_tn
Dear Pluto,

Thanks.  My EF was approx 75 on the last echo too.  That has not changed.  And I believe it was termed "high end normal"

The only real change is left ventricular hypertrophy (borderline before - now moderately severe).

Can vigorous exercise, especially weight training, really cause a substancial change in ventricular hypertrophy?

I just asked my mom about family history of heart disease.  She said that my father's side all have the "centanarian gene."  And her side has no heart disease history.

Tina (Nutty)
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Avatar_n_tn
Again, thanks for replying.

My heart beat was 60 beats per minute on the ecg.  Which I was told was on the low end of normal (between 50 and 100).

I am laying off the weight training and will do cardio only for the next six months.  Bummer, because it is with the weights I really feel a difference in shape and tone.

I have a 10am appt tomorrow with new pcp, since my current pcp is leaving practice, to discuss how to proceed.  I am in kind of pickle because I am moving out of the country next week (I fly out on May 2nd.) Which means 1) I won't be able to follow this through here. 2) I won't have health insurance.  

But in Thailand, where I will be for a month at least before going to Australia, I can get a full cardio work up at one of the best hospitals there (on par with US quality). It would cost 1/8th of what it is here.

Pluto, thank you for helping me through this.

TinaTinaTinaTinaTina (Nutty)
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Avatar_n_tn
I, too, had an abnormal EKG recently.  Your posts all exemplified some cencerns that I, too, am having.  Here's my brief story:

BACKGROUND:
I had an EKG as part of my yearly routine exam.  One of the peaks was slightly big, indicating a possibly enlarged left atruim.  My doctor had me come back six months later for a follow-up, to see if anything had changed.  At the follow-up, he said that *all* the peaks were bigger than last time, but that they were still "in proportion."  I am now scheduled for an Echocardiogram for further study (and to hopefully just show that the EKG was wrong all along).

QUESTION:
My question is this - does the fact that ALL the peaks got
bigger (even though they stayed in the same proportion) mean
that not only did the left atruim get even more enlarged as
compared to the initial EKG, but does it also mean that the
ENTIRE heart was more enlarged as compared to the intial EKG exam?

Your thoughts are appreciated!
Thank you.
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