Inferior Infarct?

I am an 18 year old male (240 pounds). Last year after drinking a large amount of caffeine, I ended up in the ER with a rapid pulse and chest pain. The EKG (http://www.fastsilicon.com/ECG1.jpg) taken at the time showed an inferior infarct. They did a cardiac blood test, it came back normal. I was sent home and told to rest.

A week later, another episode happened. They continued for about 4 months. I remember feelings of fear, pain in my chest, and pain and tightness in my left arm. After these events, my doctor ordered a few more tests.

I underwent a resting SPECT scan which came back normal (normal LV function). I also had a 24 holter monitor done which showed a rather rapid pulse (110-180bpm) sinus. After the holter monitor, I was put on Atenolol and continue to take 25mg a day.

Here are my questions:

1) What could cause my pulse to stay high for so long?
2) Is it possible for a 17 year old to have a heart attack without using cocaine?
3) Is normal for my resting pulse to slow and speed up when I breathe in and out?
4) Even if I did suffer an MI, are there any reasons why I would still be having chest pain/left arm pain?
5) Someone said I may have panic disorder, could that cause these problems?

Thanks,

Nigel

[CCF-M.D.-RCJ]

Nigel,

Thanks for showing the picture, but you might want to remove your full name at the top.

Q1:"What could cause my pulse to stay high for so long?"

Here is a theory, but only a theory.  First the caffeine caused the rapid pulse, then anxiety about the diagnosis of an inferior MI caused continued tachycardia.

Many, many other possibilities exist for tachycardia.  Hyperthyroidism is a common reason for persistent tachycardia.  Numerous other metabolic conditions can also cause tachycardia.  A good internist would be a great place to start.

Another possibility for the "inferior MI" on the ECG is a pseduo-infarction pattern caused by WPW syndrome.  This would explain both the infarct pattern and the tachycardia.  Going against this diagnosis is the relatively long PR interval on the ECG.

Q2:"Is it possible for a 17 year old to have a heart attack without using cocaine?"

Yes, but extremely unlikely.  With the normal SPECT and bloodwork, the ECG diagnosis is likely erroneous.

Q3:"Is normal for my resting pulse to slow and speed up when I breathe in and out?

Yes, in fact it is a sign of a healthy autonomic system, and is called sinus arrhythmia.

Q4:"Even if I did suffer an MI, are there any reasons why I would still be having chest pain/left arm pain?"

I'm not sure I can answer this adequately.

Q5:"Someone said I may have panic disorder, could that cause these problems?"

Yes, although other possibilities need to be evaluated before a set of symptoms is attributed to panic.

Best of luck.

[fastsilicon]

I forgot to mention that almost every other day I have long lasting chest pain/left arm pain. Is this typical or atypical for cardiac pain? In addition, when I stand up, exercise, ect.. my heart rate becomes so rapid it

[Makaveli]

This is pretty hilarious. I am an 17 year old and I have been very woried about the same thing. I haven't been diagnosed with what you have but I have been having episodes of chest/left arm pain and a very high pulse rate. In fact today has been worse than ever I woke up with a pulse around 140, and my climb of the stairs got it to 190, which is WAY abnormal for me, or for anyone for that matter. Luckily it is back down and is resting around 98 bpm right now.

And to let you know something I do have anxiety, and about 90 percent of the people on here do as well believe or not. Trust me when I say there isn't much to worry about and is long as you trust the doctors and not people who post here you will be ok. A while back when I first came here someone told me I could drop dead from palpitations that are harmless, so beliebe when I say you are ok. The pain in your chest and arm are more than likely muscle related even if it sounds crazy. Cause it did for me!

[knicks30]

what is this teen day! LOL!

Im 18 years old and i just posted the question above yours in the forum. Wow seems to me us young people go through some problems ourselves!

I highly doubt you can experience a MI at your age...i mean 18 years old? I never heard such a thing unless they really did use toxins like cocaine but that resulted in cardiac arrest not heart attacks. I see your 240 im 245(lost 45 lbs) so i suggest you do the same thing and eat more healthier, exercise, and live a stress free life(kinda hard since at our age we got college!) you do that itll do wonders for you health. Oh dont smoke and drink to!

[fastsilicon]

Alright, I'm rather lost. I thought in order to have WPW, a delta wave needs to be seen. I know there are some people with infarct patterns that have preexcitation conditions, but they also have a short PR interval and there Q waves are intermittent unlike mine. Mayo Clinic has published an article regarding this very subject (http://www.mayo.edu/proceedings/2003/jul/7807a5.pdf)

Now I'm worried I have WPW!!

[sheryl1945]

I too had a racing heart rate; it used to be 120 at rest.  I was put on a beta blocker (atenolol) and it's slowed my heart down beautifully.  Perhaps you would benefit by it; ask your doctor. Good luck!

[Makaveli]

I will thanks for the advice. Since my heart has slowed down to about 78 bpm (resting) I decided to wait and see. I have a doctors appointment next week anyway for a physical.