Septal Infarct-EKG

[Jacquelynn822]

Someone close to me and went in for a physical. Everythingcame back great except the EKG. It came back 4 times showing septal infarct. This person was born with heart problems which have subsided and he has had no SX at all since infancy. This was an accidental finding with no SX. He started smoking this last year and half.... What are the odds that there is really a problem? If so, what could cause it and how can we fix it. This person is seeing a Cardiologist soon but I work in the medical field and am having a hard time not constantly worrying... help?

[ed34]

What happened to the other posts? I had an unanswered question. I wanted to know who the insult was aimed at. Things like this can't just be wiped under the carpet, we have a right to know who the comment was aimed at.

[Mom2four85]

Here's the ask a dr expert forum -http://www.medhelp.org/forums/Heart-Disease/show/114

it may be really helpful if you try and get your question in there and get one of the physician's there to answer you with an unbiased opinion =)  they're very helpful and answer alot, so it may take quite a few tries to get your post in

[ed34]

"I'd be stuck and keep repeating the same mantra as some individuals seem to do. "

Perhaps you need to be more specific here. Who are you aiming your insults at this time?

[kenkeith]

Q: In order to get a definitive answer, it is necessary to get perfusion images of the heart at rest and at stress.

>>>>>Disagree, if there is necrotic heart cells, a presumptive test for vessel occlusions is unwarranted for lack of any reasonable analysis or lack of evidence of ischemia.  The perfusion images of necrotic cells would show no perfusion at rest or stress wouldn't it?Your doctor is welcome to voice opinion on this forum, but your heresay evidence is questionable for the reasons I have stated.

Stated:"even if I saw something suspect on an echo I would order a Thallium Stress Test", that sounds reasonable, but an echo first on the subject in question with the circumstances involved.

Thanks for your comment, and I don't assume everyone is out to discredit me!  You know better than that! I have close to 10000 replies to medical questions on this forum and the other forum of mutual membership. I can say the same about you!  In fact I can produce proof! I have no idea what you are talking about?  If you have an issue, PM me as you oftened do. But my answer stands and is appropriate from my point of view,and I didn't mean to upset you however you may want to spin it.  Think about it, why a perfusion test when there is no evidence of ischemia?.  Your doctor would do a presumptive test for ischemia without any evidence of same, and in my opinion that is not necessary. We can agree to disagree and your doctor where you volunteer is very smart.  Give your doctor(s) my regards, and thank them for taking the time in their busy schedule to read my humble postings.  But I don't agree with your doctor were you volunteer or otherwise, no difference to me.  I wish I could agree to make you feel whole, but I don't agree so there is no need to go any further with the discussion unless you doctor appears :) I have always kept an open mind on this forum and other forums after about 7 years you and you of all people should know that!  If I hadn't kept an open mind, I wouldn't be able to answer any medical questions....I'd be stuck and keep repeating the same mantra as some individuals seem to do.

Ken

[kenkeith]

I don't agree with your cardiologist!  I understand your comment "interesting to hear from a cardiologist" and attempt to discredit. But you may not have asked the right questions, etc!. I also rely on the medical community for information,  and I review the relevant symptoms (none) and signs (EKG) with some knowledge on the subject. Also, there is an incomplete healthy history that could be helpful...does your cardiologist have that information?  

I don't see any need for a stress test.  Would a stress test be done if the doctor heard a murmur?   The OP's friend has a history of  heart problems, and there is a possible MI with the septum area.  There was no indication from the EKG (ST interval) there is ischemia.  Just based on that information why a stress test?  There are not ischemic related symptoms, why a stress test? etc, etc.

Very often when there is childhood heart conditions it is related to ASD.  And an ASD and an alleged MI would have structual significance.  An echo in my opinion would assess  the structual integrity.  That would include heart wall diminsions, heart wall movement, chamber size, valve suffciency, fractional shortening if there are ASD and mitral valve issues, heart's contractility, etc.

Where is the evidence of aschemia?....fishing for something not in evidence is not good medical practice, don't you thinkt?.  What is in evidence is alleged MI from an EKG, and no sign (ST inerval) of ischemia. If there are necrotic cells what would a stress on the heart prove?  An MI by definition are necrotic heart cells.  If there are necrotic cells, a perfusion test would be positive for both rest and stress...now an echo test?

[erijon]

This is an interesting question and I understand what you're saying. I asked the cardiologists I volunteer with about this last night, asking what their protocol would be. They would certainly order both tests, but the nuclear stress test is the more critical of the two for an asymptomatic patient with a new artifact on an EKG as it will identify;

Muscle damage from MI
Muscle damage that presents with stress (Echo will only show heart at rest)
Heart wall motion abnormalities
Patient exercise tolerance which is extremely important in an asymptomatic individual
EKG changes during stress
Calculate EF%

The purpose of the echo would primarily be to determine the heart structure and identify any possible birth defect as noted. It would not be definitive of an underlying condition or previous MI, that can only really be determined with nuclear imaging and stressing the heart or with angiogram which is not done without the presence of a positive nuclear stress test.

Interesting to get a Cardiologist's opinion.

Jon

[kenkeith]

An echo can detect hypokinesis (heart wall impirment) as well as akinesis (necrotic heart cells from an infarct), and it is correct it will detect those structual abnormalilies.  Because  condition is SX, but a possible infarct of the septum according to the EKG, a perfusion stress test would be unnecessary...confirm an infarct?   An echo without stress testing would show any structual abnormalities, but if there were chest pain, etc., then a nuclear perfusion stress would be beneficial for an evaluation of a resting heart and a stressed heart and perfusion thereof.

Additionally, there is a congenital heart problems and no evidence of schemia....an echo would be a better choice based on the information provided....it seems to me.

Ken

[erijon]

Wouldn't a nuclear stress tests with gated Spect be a better choice for a next test? Why would you think an echo? If they are looking for evidence of an infarct it would seem to me that looking at the perfusion of blood to the heart would be the first thing to look at as well as EKG changes under stress. The gated Spect will determine if any heart muscle is damaged and measure how well the heart muscle is contracting as well as calculate an EF%. I'm not saying an echo wouldn't be a good choice along with a nuclear perfusion test, but the later would provide more details given the circumstances.  An echo would be more useful if they were looking for heart structure abnormalities.

Jon

[kenkeith]

You indicate your friend has had no symptoms from childhood to currently.  The EKG is not a reliable souce for any structual damage, etc....EKG better for electrical impulse rhythm evaluation, etc. If there has been no symptoms, what is the reason for the EKG?

Septal infarct refers to a prior heart attack and the cells are necrotic at the wall (septum) that separates the left and right side of the heart, and is also serves as a pathway for electrical impulses to contract the left and right ventricles.

A stress test is not a useful tool to evaluate an infarct (dead heart cells...necrotic)!.  The appropriate test would be an echocardiogram.  This procedure uses ultrasound to view the heart as it beats.  If there is septal heart cell damage in will be apparent when viewing the wall movement or lack thereof.  Also, if there is some heart wall damage from a prior heart attack, the degree of damaged can be measured with an EF,,,EF is the amount of blood pumped with each heartbeat and normal is 50 to 70%.  Also, an infarct may have some significance for heart chamber filling as a necrotic septum does not relax and the wall may be rigid and that will impede the filling process (diastole).  

Smoking will stress the heart to work harder, and a necrotic septum has already burdened the heart to overcome a heart wall impairment. An echo will reveal the degree of impairment. if any. Causes can be congenital, ischemia (lack of blood flow) to the septum, medication, alcohol, drugs, etc. If the cells are necrotic (verified by echo), there isn't much help available other than reduce the heart's workload so as not to stress or burden the heart further.  

Thanks for sharing and if you have any further questions or comments you are welcome to respond.  Take care

Ken

[erijon]

An EKG is not always an accurate way to determine if there has been an actual cardiac event. EKGs can read septal infarct if the electrodes are placed too high on the chest.  For example, the V1 and V2 electrodes must be in the 4th intercostal space, not higher. If they are placed higher the EKG will interpret the results as a septal artifact.

They should do a stress test with nuclear imaging to be sure. Its fairly non-invasive, very safe and will clear up any issues as it will show if there are any EKG changes during stress or areas of the heart that are damaged.

Good luck,

Jon

[vienna13]

I hope his cardiologist will tell him: no more cigarettes for you.:) I like it if a cardiologist like that, not everybody do. It is amusing for me how people became their own enemy with smoking. I will never understand that.

  Good luck to him.

[Jacquelynn822]

Thank you very much for your answer Jesus. That person is seeing the Cardiologist today.

[Jacquelynn822]

Thank you

[jrbon]

If might have been a false positive, or a wrong interpretation of the EKG, but of course the possibility always exist that he have had a "silent" heart attack without any symptoms and that his heart is permanently damage.

The cardiologist will do tests to see the extension of the damage and the causes of it.

In the mean time, to smoke does not help.

If there is damaged tissues, as the EKG seems to indicate, this cannot be fixed, the normal causes are problems in the coronary arteries that can be fixed by stents or bypass, but also can be other reasons.

The good news is that, many  of us are able to live normal lives after a heart attack.

Jesus