Abnormal ECG - "Essentially" Normal stress test results

[jaded47]

Hello,

I went to the ER with chest pains. I have been having skipped beats on a regular basis for weeks and since i was told months ago by a cardiologist and the ER that everything was normal i ignored the skipped beats.
It finally got to the point i was having chest pains accompanied by extreme upper and lower abdominal pains so I went to the ER.

Here are the results of my ECG that they took in ER triage:
note: I am typing them below as I an reading it directly from my copy of the ECG
-----
"Abnormal ECG"
Sinus Tachycardia
Nonspecific ST and T wave abnormality
Vent rate: 119 BPM
PR Interval: 172 ms
QRS duration: 80 ms
QT/QTc: 314/441 ms
P-R-T axes: 69 - 58 - 63
-----

I was told by the ER doc that is was going to be admitted into the hospital immediately.
He made this decision very quickly after he saw the ERG and before any blood work was done
so I assume the ECG was very abnormal.

Initial blood work in ER results:

All it shows on the initial blood work ( done in ER ) are these two results:

CKMB = 3.7 with reference <3.6 ng/mL ( Flag = HIGH )
Troponin I = 0.00 with reference <0.6 ng/mL

More Blood work done after admission appx 18 hours later are these results:

CK = 84 with reference 35-232 IU/L
CKMB = 1.8 (significant drop from first blood work ) with reference <3.6 ng/mL
CKMB Index = 2.1 with reference <3.0 %
Troponin I = < 0.04 with reference <0.6 ng/mL
Cardiac Risk = 4.03 ( this was noted on blood work with no reference so i do not know if it means high risk or not )

Notes:

Remember i said i was admitted into the hospital from the results of the ECG alone and the doctor was not unsure of himself when he made this decision.

while i was on a bed in the ER they put a NITRO patch on me. they told me that this was protocol for ANYONE that they think might be having a heart attack or if they even suspect there is an issue with the heart. Is this true? I have never heard of such thing as putting NITRO on EVERY patient that they "suspect" is having a heart problem. I thought that only if they are VERY SURE you are having a heart attack/problem that they would put on a NITRO patch.
This worried me even more when they ran in and stuck the patches on me ( they put two patches on my upper right chest area). My blood pressure dropped so radically that they took them off fearing my blood pressure was dropping too low. If I recall correctly at the time they took it off my BP was around 95/50.

Once I was admitted to a hospital room they put a heart monitor ( the kind you can walk around with ) on me
for appx 12 hours.

The next morning they gave me a stress test.

The cardiologist said that everything was normal on the stress test.

They released me from the hospital with no referral to a cardiologist. Only telling me that i needed to see my PCP within one week for a followup.

I am concerned that my CKMB was high on the initial blood work. From what i have read , and i have done extensive research all over the internet, the CKMB being high means that damage was done to the heart muscle.

Should I be concerned about this at all? The doctors told me before releasing me from the hospital that my heart was normal and there is nothing to worry about.

What about the very abnormal ECG they took in the ER that prompted the doctor to admit me into the hospital in the first place? IS this first ECG to be ignored?

Thanks for any input

[csmuna]

II have done normal ECG on 17th May 20412 and following result arises
ECG reading: Vent rate 91bpm, PR interval 200ms, QRS duration 78ms, QT/QTc 352/416ms. P-R-T axes 40-16-101.
Normal sinus rhythm
Inferior infract, age undermined
ST&T wave abnormality, consider lateral ischemia
Abnormal ECG
Unconfirmed

Is this result good or bad?

[jondsam]

It depends on the type of stress test they gave you.  In a regular stress tests, where they do not inject you with nuclear dye , they are checking for maximum heart rate, blood pressure during strenuous activity, and most importantly your EKG during exercise.  In a normal stress test they are looking at whether you have any arrhythmia's during exercise and more importantly after exercise when the heart is in the cool down phase. Never heard of giving a blood thinner before a regular stress test, but I could only imagine it could lower your blood pressure, and make it easier to pass the test,  I would not see a huge deal in giving you the thinner before the regular stress test.  However, If you took a nuclear card lite stress test, where they inject dye into you, perform the same test as above, and then put you under a special camera that takes pictures of your heart before and after the stress test.  During this kind of test, the doctor can look at your arteries and vessels to check to make sure there is no blockage in cardio system.  Taking a blood thinner before one of these tests would be a big no no, as it would definitely have an effect on the outcome of the test.  I imagine you had a regular stress test.  It is weird you are receiving  these thinners if you presumably do not have a problem.  I wish I could have saw your EKG but if a doctor confirms the EKG and says you are fine, than I would trust that opinion.   Any time a EKG picks up Non-Specific , it means that it can not pin point exactly in the hearts electrical system where the abnormality is occurring.  Most of the time there is no real abnormality and patients are just fine.  I would go with getting an echo cardiogram done, and maybe an event monitor (worn for a week straight) so that if you get funny feelings in your chest you can press the button and the event monitor will record it.  After that is complete the doctor can confirm if it is a dangerous arrhythmia or not.  Most of the time arrhythmia's we experience are benign in nature and not life threatening.  A-Fib, PvC's, PaC's,SVT,NSVT, all things I see on a daily basis but with little or no medical significance.  Lets face it, if you have a dangerous arrythmia like V-Fib, V-Tach, anything of that nature, you are having a medical emergency and are either dead or getting fibrillated back.  9.5 times out of 10 it is a benign condtion that is really not a huge deal.  It may just be something you monitor as you age and your life moves on.

[jaded47]

Thanks for the input,

I failed to mention that i have copies of previous ECGs that were "normal"
and to compare them to this one is very scary just by looking at the lines.
Of course I am no doctor, however, the lines are perfectly straight and everything looks "even" and "steady" and the ECG they took in the ER the other night looks like pure "hell" compared to those. They even took a second ECG to make sure they got a proper reading and it also looks like hell.
Like I said, the ER doc said he was admitting me into the hospital right away after seeing the ECG. As you know , hospitals do not just "admit" patients anymore unless they have very good reason to do so.
Something has changed big time in my hearts resting beating pattern and rate.

Also, why would they give me nitro and a blood thinner?
They gave me the blood thinner after i was admitted , the next morning "right" before they did the stress test.
Is it normal for them to give a blood thinner injection to someone right before they have a stress test done? Wouldn't this affect the results of the stress test?

Thanks again
have a nice day

I am still worried.

[jondsam]

Nonspecific ST and T wave abnormality is usually not anything to worry about.  A reading like that can come from a multiple of things, including wrong lead placement, bad conduction between the leads and the skin and many other things.  I work in the OR and 9 times out of 10 a Nonspecific ST and T wave abnormality turns out to be nothing.  A doctor needs to confirm the EKG as many times the EKG machines are so sensitive they pick up just about anything, even movement of your body when the leads are on.  I have had an EKG say Nonspecific ST and T wave abnormality , and then take the test again and recieved a normal EKG.  Sinus tachy at a vent rate of 119 is absolutely no big deal.  Many things like anxiety, stress, etc. can throw your heart over 100.  I have NEVER heard of them putting a nitro patch on everyone like you said.  If you are having a heart attack it is easily recognized on an EKG.  I really dont know what that is all about.  A BP of 95\50 is getting on the low side, but really not on the dangerous level.  If your stress test was normal and 12 hour monitor than you are fine.  I might ask the doctor for a Echo of your heart to rule out any valve problems, or E.F. with your heart.  Sounds like you are going to be just fine

Have a nice day