abnormal EKG result/inferior infarct

Hi, I am pretty healthy 36-year-old with no prior history of heart disease and no family history of heart disease. I have a remote history (16 years ago) of panic disorder for which I was on medication for a short time. Recently, I had been noticing some increased anxiety symptoms, and then on Saturday, I had a panic attack and had to go to the ER because of tachycardia (185 bpm). After an EKG was done, the doc gave me 0.5 mg xanax and within an hour I felt better and my heart rate had dropped. The doctor told me my EKG showed sinus tachycardia and some ischemia caused by the rapid rate. My blood work was okay, including cardiac enzymes and test for clot was negative. ....I was discharged with diagonoses of anxiety and anxiety induced tachycardia and given a script for a few xanax....When I went to the hospital today to pick up the EKG and blood work to take to my PCP, I read the EKG report. It did mention the ischemia, but also said "inferior infarct, age undetermined".....Does that mean that I have had a heart attack in the past? I have never had symptoms of such, and why wouldnt the doctor tell me this?  Any advice would be greatly appreciated.
MM

[is_something_wrong]

Inferior infarct is a quite common misreading from EKG machines. It has happened to me a lot of times.

Young people tend to have so-called Q waves in the inferior leads (initial downstroke on the QRS complex) in the inferior leads (II, III, aVF) and they tend to change with respiration. It depends on the QRS vector (which determines the electrical current in the heart) but the machine interprets it as electrical silence due to a damaged part of the heart, which, of course, isn't necessarily correct.

Rapid heart rate and lots of adrenaline can also cause so-called "early repolarization", and the EKG machine interprets the start of the T wave (repolarization) as a part of the ST segment, reading it as elevated, and again "stamping" it with an infarct diagnosis. If your doctor said it's OK, it probably is.

The slightly worrisome part (in my opinion) is the ischemia. Your heart should handle a heart rate of 185. Again, this may be a misreading, but you could ask your doctor if this is correct or not.

We are not doctors, so the only "good" answer is provided by your PCP or the doctor that interpreted your EKG. Panic attacks can cause lots of strange EKG readings, so you should probably not worry too much.

[chuparosa]

If this comment was generated by the machine, you can likely ignore it. The machine sometimes puts out wacky info. It's best you have the dr interpret the results. I've had many odd readings generated by the ekg. Don't be alarmed.

[momoftwo74]

Thanks for the feedback...Yeah the inferior infarction and possible lateral ischemia comments were generated by the machine. There was a written note at the top that said STEMI? But the ER doc never said anything about that, just told me that my cardiac enzymes were normal and my venous thromb./clot test came back negative. Once they gave me 0.5 mg of alprazolam, my rate and blood pressure came down, but they didnt do a repeat EKG. So I was sent home. Thanks for the reassurance, so I wont worry until I hear from my PCP. I did get the labs and EKG report over to my PCP to see what she thinks.

[is_something_wrong]

Inferior infarct is a quite common misreading from EKG machines. It has happened to me a lot of times.

Young people tend to have so-called Q waves in the inferior leads (initial downstroke on the QRS complex) in the inferior leads (II, III, aVF) and they tend to change with respiration. It depends on the QRS vector (which determines the electrical current in the heart) but the machine interprets it as electrical silence due to a damaged part of the heart, which, of course, isn't necessarily correct.

Rapid heart rate and lots of adrenaline can also cause so-called "early repolarization", and the EKG machine interprets the start of the T wave (repolarization) as a part of the ST segment, reading it as elevated, and again "stamping" it with an infarct diagnosis. If your doctor said it's OK, it probably is.

The slightly worrisome part (in my opinion) is the ischemia. Your heart should handle a heart rate of 185. Again, this may be a misreading, but you could ask your doctor if this is correct or not.

We are not doctors, so the only "good" answer is provided by your PCP or the doctor that interpreted your EKG. Panic attacks can cause lots of strange EKG readings, so you should probably not worry too much.

[momoftwo74]

Thanks so much for the feedback..Since I was panicking, Im sure my breathing was shallow and fast. The lateral ischemia possibilty generated by the machine had to do with either the ST T waves or the Q I think .I took the EKG to my PCP who did say that it is quite possible that the adrenaline/anxiety induced tachycardia could cause my EKG reading to look like that....Since I cannot tolerate SSRIs, he is going to give me alprazolam in a small dose for a short time. He actually wants me to try a beta blocker because that will protect my heart from the tachycardia AND help with the anxiety. I am agreeable to trying it because I dont want to rely on the xanax to keep bringing my heart rate back down to normal. I have to see a cardiologist because it is possbile that the tachycardia is starting first and I am having anxiety and panic as a result of it. He wants a cardiologist opinion on the fact that my heart rate is going up to 165-185.

[is_something_wrong]

Yes, I had the same issues, and the beta blocker works great. Of course, the best is to not take any medications for anxiety, but I'm sure beta blockers are better than taking Xanax at all times.

By the way, did you have chest pain with the high heart rate?

[momoftwo74]

No I didnt and dont have any chest pain at all, just the feeling of the very fast heart rate/palpitations. I didnt get any of the sweating, nausea, or chest/arm pain. I did feel flushed and the "I dont feel very good at all and I might pass out soon" Plus the severe anxiety. I think I could handle the anxiety issues if my heart wasnt jumping from normal to so high in a matter of seconds, then remaining there even if I lie down, etc. Once I take the xanax, it slows down, but it is still a little faster than normal throughout the day (around 100) and I still feel a little anxious on and off, so it's not working as well as the beta blocker probably would, but the xanax is keeping me from going to the ER. I see the Cardiologist on February 2nd, and if it turns out only to be a anxiety induced or spontaneous tachy problem, my reg doc will give me the low-dose beta blocker. Thanks so much for the advice...It makes me feel better that someone else has had the same experiences. Ive never had any health issues really so this is really scary.