If an EKG shows a previous heart attack, why do follow up EKG's don't

[Barbarella]

Dear doctor,

I was brought to the ER at one tome because of extreme white coat hypertension anxiety and a BP of 255/160.  I had a ton of tests in the ER, and my EKG showed a "previous heart attack" which I never had.  The Cardiologist checked me out throughly and said I had a healthy heart except for a minor leak of the mitral valve.  He said he gets quite a few "previous" false heart attacks due to the now computerized EKG's.  All my follow up EKG's showed no "previous heart attack".  My question is:  If I really had a "previous heart attack" wouldn't ALL EKG's show the "prvious heart attack"?  I believe what the Cardiologist said, but this question is still in the back of my mind.  Could my severe anxiety messed up the EKG in the ER?  It gave a falso echo test result as in "severe regurgation" and therefore I had to have a TEE test which showed the exact opposite a "mild regurgation".  The Cardiologist told me when people are under severe anxiety during an echo test that even the way people breath can mess up the echo test.

I'm on BP meds now, and my BP is fine.  The Cardiologist told me not to have my BP taken at a doctor's office again, but to take it at home and bring in my readings due to my severe white coat hypertension.  Am trying to get help with this.

Thank you for taking your time to read this.

[CCF-M.D.-MJM]

hello,

EKG lead position can sometimes show old heart attacks when they infact never happened.  EKGs are not the gold standard for finding old MIs and can show heart attacks where they haven't happened and sometimes miss ones that did.  If your cardiologist ran tests and didn't see evidence of an old MI, it probably never happened.  The key at this point is managing your blood pressure to decrease your risk of future cardiovascular events.

It is possible for people with very high blood pressure to have moderate to severe mitral regurgitation (MR) that virtually dissappears when their blood pressure is controlled.  There probably was significant MR in the ER that improved when your blood pressure was controlled -- all the more reason to make sure you keep you blood pressure controlled with medications.  Remember they give you relaxing medication to decrease  your stress during the TEE -- we often see improved MR under these conditions.

I hope this answers your questions.  good luck and thanks for posting.

[tickertock]

Just curious. I have mild LVH due to hypertension, very controlled with beta blockers and losartan. Do you know your dimensions of your LV? Only thing I am told I have no diastolic dysfunction whatsoever with normal EF and no valve leaks whatsoever , not even trivial. The cardio told he checked me thoroughly for leaks due to a connective tissue disease I have, but no leaks so I guess that's good news. I'm very interested in LVH, apparrently some develop it even if they have mild hypertension and others never even with severe HBP.

[line]

I am not sure which is showing the LVH, but my

LV post wall is 1.2 and 1.4
LV internal dimensions are 4.6 and 3.0
I have getting a echo for 6 years, yearly and my values change. Just had one done.

I have read that to have LVH the value is 1.5 or above and also it an come from aging also.

Linda

[tickertock]

Thanks alot on my last echo(July 2005) my interventricular septum was 14mm
my LVPWD 10.4mm, LVIDD 44.1mm,LVIDS32.3mm, Ef 55%, so I guess our values are very similiar , mine probably more asymetrical, rather than concentric.I've always wonder about HCM, but the cardio assures me I don't have that.Thanks again.

[Flycaster305]

I think the placement of the leads is very important, as explained by my cardiologist.  A careless or innapropriate placement can, as I've been told, determine a false cardiac problem.  

[Barbarella]

Thanks for your comments.  The Cardiologist explained to me that everybody reacts different when under high anxiety.  Some people get diarrhea, vomit, some people cannot control their urine, some sweat like crazy and some get real high pulse. He said that I happen to react hypertensive.  I used to work myself up days before my appointment, wake up with extreme anxiety the night before the appointment.  Valium or Xanax did NOT calm me down once I got to the doctor's office.  Afterwards I slept for hours from exhaustion.  I've been having this phobia for over 30 yrs.  Thank god the Cardiologist said to take my BP at home and bring in the readings.  If I ever have to go for a test which requires that my BP needs to be taken before the test oh well, I do not want to think about it.  When I had the TEE test done it was required to take my BP before, during and after.  I started out with a BP of 220/120 (I was on BP meds then).  The Cardiologist said "you will live, I'm not worried", and my BP dropped immediately to 170/100, and a few minutes later it was 150/79.  In the recovery room a nurse made an expression after she took my BP and I got immediate anxiety again, and it shot back up to 170 syst. even though I was still on meds which was suppose to put me in a semi sleep during the test but I was wide awake because of my anxiety. Doctors and nurses attitudes also can make a BIG difference in a patient's BP who suffers from severe white coat hypertension. I need to add one more thing, the Cardiologist told me that there was a survey done at one time where the BP of weight lifters were taken during their weight lifting, and their BP shot up to 240 syst. during the weight lifting, some of them even had 250 syst. and the Cardiologist told me none of them had a stroke or heart attack, and they are still alive.  I was asking the Cardilogist if a severe spike in BP like I had could cause me to have a stroke or stroke.  He then talked about the weight lifters, but at the same time told me not to have my BP taken anymore at the doctor's office and to take it at home.

[Barbarella]

Thanks, if you remember the book please let me know.  I read several of them, and the ones by Dr. Claire Weeks helped me a lot.  I used to suffer from severe panic attacks, and due to her books I'm now 95% over my panic attacks.  I had them so bad I was afraid to leave the house, tranquelizers, anti depressant, none of the meds helped me until I got ahold of her books.  I can now go anywhere including crowds, can drive my car anywhere including the expressway and long distance etc. Don't need to take any anxiety meds.  If I only would get rid of this BP phobia my life would be close to perfect.  But I will not give up.

[line]

This is an interesting post because I have white coat syndrome also. My b/p at home is always good, 120/70 and lower, it may go up to 140/80 under stress at home but at the Drs. offie it always hovers around 160-170/ 90- 97. I have a acho done every year due to left ventricluar hypertrophy, supposedly this comes from high b/p. I wonder if my LVH is showing that it is there because my b/p is elevated when I have the test done. My report always says concentric LVH with dyastolic dysfuntion. I even take an anti-anxiety pill before going to the Dr.

Linda

[line]

I just received a copy of my echo report today, now my hypertrophy is mild. It says all my measurements are essentially  within normal limits. my echo changes year to year.

lv post wall is 1.0 and 1.2
intra. septum is 0.9 and 1.0
lv internal dim. 4.6 and 3.1

my ef is 58%

Do you know how to calcuate the different readings we have as yours comes back with mm.seen this often but do not understand it.

Linda

[tickertock]

(1.0 cm is 10mm) (1.2cm is 12mm) as far as I know. As far as I know 7mm to 11mm or .7cm or 1.1cm diastole is the normal measurements at most hospitals thouugh I have 8mm to 12mm or 0.8cm to 1.2cm as normal at some just 1mm difference either way, so I guess thats not much significance(my opinion only).

If your B/P is under control and your LVH is caused by hypertension then with treatment as understand LVH can regress or doesn't get any worse. I have often wondered about my measurements also and wonder if I truly do have LVH. There appears to a difference of 1-2mm depending on the type of echo equipment used and reader interpretation. This is my opinion only, if in doubt get a second opinion.Thanks for sharing and I'm happy your LVH has regressed.This I would take as a very positive sign.

[NanaRose]

Just what is the GOLD STANDARD for finding an MI?   In late 2002, a Septal MI showed up on an EKG.  I was never told about this as they felt the leads were on wrong. I found out about this DX when picking up records a year later. Same DX showed up again and then it did not show up.  I had a heart cath and I was told NO MI....Wrong!  I felt I did have one and asked for a Cardiac MRI.   The Cardiolgist (no fly by nighter) bet me a trip
that the MRI would not show a thing.

He lost the bet....Yes, there it was.  MI in the SeptaL/Apex area.

[NanaRose]

Yes typically Al, but in my case the Septal MI did not show up. This is why the Cath doctor bet me that the Cardiac MRI would not show an MI.  He lost the bet. The Cardiac MRI did show the heart attack.

[NanaRose]

I would also like to comment on Echo's.  I had two Echo's done 10 days apart at two different World reknowned heart centers. (stress and non stress)

One Echo  was done on an upright bike and the other Echo was done on a supine bike.

The suprine bike Echo doctor did not believe the report on the Echo I had 10 days earlier.  

I have them here and cannot figure the numbers out as I am trying to follow y'all numbers that you are posting.

So two great heart centers with two different opinions. )-:

[Barbarella]

Thank you very much.  I too came a very long way, but I wish I was already were you are i.e. not falling apart when my BP needs to be taken because of the "what if" and if doctors and nurses react with "oh my god look at your BP, you NEED to calm down, you will have a stroke or a heart attack", I then used to get even more intense anxiety which caused me to be sent to the ER. Yet when the Cardilogist saw me in this condition he smiled and reacted calm which calmed me down and he said "we're not going to have any strokes or heart attacks", he brought up his story about the weight lifters who get extreme high BP during weight lifting and are still alive.  At the same time he did not make light of my situation because he told me not to have my BP taken at doctor's offices anymore, and he told me that I need to be on BP meds which he put me on right away, but took me off immediately of the beta blockers the ER ordered me to take.  He said "I do NOT like beta blockers", that is all he said.  If regular doctors and nurses would not react so alarming in front of people with extreme white coat hypertension maybe these people lose at least some of the fear the next time they have an appointment, but if you get scared the hell out of, and get like scolded, like you've been bad, and you decided that your BP is going off the machine so to speak just to tick off the staff, if they make you feel like that of course people like me just go deeper into their anxiety and phobia about this issue.

[NanaRose]

Whenever I saw this certain cardiologist's RN, MY BP would be 170/90.  She would keep taking it over and over again on the same arm with no 15 min. rest and this would cause it to go higher and very painful.  I finally told her to give it a rest, one day or let the doctor take it.  That day she threw the cuff on the floor and went out of the room in a huff which scard the daylights out of me.   The doctor walked in and he took the BP on the other arm and it was 130/65.   But, he said if any patients upset his nurse whether she was right or wrong...they were not allowed to return to his office and for me to find another doctor.  Hmmmmm.

I wonder if this nurse was 1. his wife or 2. his girlfriend.

I learned I was not the only patient he kicked out of the "cookie" club that year.  It was a blessing.

But, I too am frightened of any health care professional taking MY BP now.

[Barbarella]

I always said before my BP was taken "I do have white coat hypertension, my BP will be high, maybe very high, don't say anything and let the doctor break it to me".  None of them ever followed my advise. One nurse actually blurted out laughing after I said the above and said "what is the matter are you afraid that the cuff wont deflate"?  I felt totally humiliated, and told the doctor, he said he would talk to her.  I never went back to him so I don't know if he talked to her, and how.

[Barbarella]

Thanks for the kind words.  I will keep your e-mail address in my file :)

[Barbarella]

Sometimes I wonder if they are told what "not to do" when going to school to become an RN.  When I was brought to the ER with this very high BP, I told them it was my anxiety and to give me something strong to calm me down otherwise my BP will not drop, keep in mind I have a phobia of having my BP taken and here I was hooked on that BP monitor which inflated often to record my BP. Just think of a person having claustophobia and would be locked in a closet for four hrs. For four solid hours they ran tests and I did NOT get anything to calm me down.  O.K. looking back maybe they thought if I'd get a strong tranquelizer maybe it would influence my tests, I don't know just a thought.  While I was hooked on this BP monitor (it was behind me and I could not see it, and could not see my BP numbers) a nurse kept on yelling periodically across the room "her diastolic is still 140, it wont go down", they did give me BP pills but nothing as in an IV, and kept on saying "you need to relax". I told the nurse "please don't yell my numbers across the room it will give me even more anxiety knowing how high my numbers are".  I finally had enough, I tore of the BP monitor and said "you either give me something to calm me down or I will walk out of here because once I'm in my car my BP will go down". FINALLY they called back the Cardiologist (so far he ordered all the tests over the phone, but I doubt they told him that I said I had severe white coat hypertension)he then showed up in person and calmed me down with his attitude and with an IV he ordered, and my BP dropped immediately from 250/140 to 160/79, and the Cardiologist told the nurse to take the monitor off that I was o.k. , and I felt immediately calm coming over me, and then I was FINALLY discharged with instructions for a follow up etc. Before I left I told the Cardiologist how this nurse behaved, and he said "I will deal with her", the look on his face was not very happy.