septal infarct interpretation

[medgrl31]

Yesterday at work I was walking and carrying a heavy object.  My chest began to hurt and I was having to take deeper breaths.  About 15 mins later I had a chance to run a 12 lead on myself.  The monitor interprets "septal infarct, age undetermined".. treat the pt not the monitor, right?  But my 12 leads 90% of the time do interpret "septal infarct". Background: I am a 33 (yikes! already?) yoF who is 5'5" and 138 lbs with pmhx of connective tissue/auto-immune and no meds.  The ep ordered a loop monitor, after my complaints of chest pains/sob with exertion, palpitations, and an arrythmia that I can feel which causes me to feel as if I am going to faint,  which caught a six beat run of wide complex tach about 6 mos ago, also recorded PVC, PAC, PJC, atrial tripletts, atrial couplets and nonsustained (three beat run) of narrow v-tach.  She explained that with a structurally normal heart on echo that the multi foci are of no concern and are poss due to sensitivity to adrenaline.  

As for the septal infarct:  on the tracing there is no normal R wave progression, but v1 and v2 are inverted with v3 upright.  p waves are inverted in avR, v1 and v2, t's are depressed in avr, v1 upright in v2.  

When my heart cath was done the cardiologist mentioned that I have a vertical heart.  Is this septal infarct based on the verical anatomical position of the heart in the chest cavity?  I also do have large breast implants and these 12 leads are made for men, not women's anatomy.  Is this simply a case of lead placement and large breasts?

Thank you for your opinion

[medgrl31]

Of course my cardiologist looked at it.  If he had explained it to me properly or answered my questions or even if I had thought of asking them before leaving the office, I would not be asking the questions here.  Unfortunately, not all physicians are good at answering questions or explaining things.

It is somewhat frustrating when a physician says you are only "x" years old, you don't have heart problems.  I have personally coded and worked on three pts. in the past year under thirty years old.  "People under 30 years old dont have MI's" is changing.  I have cardiac related symptoms and complaints, I have a cardiologist, and I have had a heart cath at 28 years old.  Cardiologists dont just cath a 28 yr old for lack of something better to do.  The ejection fraction after a nuclear stress test/scan was too low.  

My specific questions where

1. can large breasts (implants) cause a misreading of septal infarct due to v1 and v2 being the septal leads and not being able to properly placed at the fourth intercostal space due to size of breasts.

2.  does the more vertical anatomical positioning of the heart cause misinterpretation (especially of the axis)

I was not asking have I had a septal infarct, nor was I asking out of fear of having done so.  I was asking for general knowledge both for myself and for the future pts. I work on.  

Also, I have heard that if the complex is inverted in v1 and v2 but upright in v3 that this is always misinterpreted as septal on a ekg.  Any thoughts on this?

[Michael J. McWilliams, M.D.]

EKG machines are always calling septal infracts in people that have never had a heart attack.  It has to do with lead position and the fact EKG interpretations are meant to miss as few things as possible.  They tend to over call infarcts.  If you have a normal cath, normal echo and are 33 years old, you probably haven't had a septal infarct. Have your doctor look at your EKG.

I hope this helps.