ST Elevation False Alarm

[theolocke]

I am a 32 year old male with high blood pressure.  I take 12.5 mg of Carvedilol twice a day and 12.5 mg of HCTZ once a day.  It is usually 116/75 now.  

I have battled with anxiety and heart palpitations over the last two years.  Two years ago I had an echo – normal except that left wall motion was borderline reduced; EF 53.  Normal stress, but my cardiologist put me on bp medicine.  In March I started having issues again.  Had a stress test with depressed ST waves so they had me do a nuclear stress test, which came back completely normal and I was moved from an ACE to a beta blocker.  After a long battle with anxiety I managed to start running again in June and have been up to 3 miles a day since.  A few days ago, 30 min after running, I had odd upper abdominal sensations, started sweating, and my heart rate monitor went up to 130.  It lasted less than 30 seconds and I was fine.  To be on the safe side I called my cardiologist’s office.  My cardiologist was doing rounds so I had to see the PA.  She did an EKG.  It showed ST elevation.  Even though I was asymptomatic for a heart attack, they made me take an ambulance to the ER.  My blood work came back normal, so my cardiologist had them release me.  I have a follow up next week, and I’m not supposed to run until I see my doctor.  Are my running days over?  Why did the EKG show MI?  If I wasn’t having a heart attack, what’s the problem?  Is the fact that my cardiologist decided not to do a heart catheterization a good sign?

[Gopi Aniyayhodiyil, MD]

Dear theolocke,

I have noted the details provided in the query.

All the work up done till now is not consistent with features of 'Coronary Artery Disease'. Your blood pressure also appears to be under control.

ST elevation though is a classical sign of a heart attack; it can be seen in other situations such as 'Early Repolarization Pattern'. This is considered to be a normal variant seen more commonly in young individuals like you.

I think the symptoms you experienced recently are related to anxiety. That said referring you to the emergency room was the right thing to do at that time. We cannot be certain about the benignity of the problem in a person with a risk factor such as high blood pressure. Hence each time the tests would be done to rule out a heart attack.

You have been advised not to run as a precautionary measure until the doctor physically checks you up and confirms that all is well. The fact that the cardiologist did not advise a heart catheterization is a very good sign and would imply that he too feels your EKG changes are a normal variant. You should be back to your running days shortly.

Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Gopi A

[theolocke]

That's very hopeful!  Thank you so much!

[theolocke]

I should add that my EKG was the day after I experienced symptoms.