Questions about EKG's (really long) - UPDATE post #46

[Aidensmom]

Just want to start this off with the disclaimer that I do have doctor's appointments scheduled and have been seeking help, I just have some questions that I am hoping some medical people or people with heart problems might be able to give me insight into....

Let me start by saying that 20 years ago I was told I have a Mitral Valve Prolapse with regurgitation when I had a physical to get into the Coast Guard Academy (I was denied because of that finding). Over the years the murmur comes and goes as being detectable, so it apparantly isn't too severe, though I do take antibiotics before going to the dentist as recommended. I have for as long as I remember gotten occassional fleeting sharp pains in my chest.

About 10 years ago, I had some trouble where I would get dizzy and have some tachycardia on occassion, and often ran a low grade fever for no determinable reason, and so was sent to a cardiologist. I had several tests done and had to wear a Holter monitor for a day or two and nothing was found....

Then again about 5 years ago I went through all the same stuff. All tests were still normal. The cardiologist at that time told me to cut out all caffiene (I only had 2 cups of coffee a day at the most), and that did seem to help. I have gone back to a cup of coffee a day over the last 6 months however.

Well, a few weeks ago I woke up in the morning with some moderate chest pains. They got worse through the day, and started radiating to my arm. My face become numb and I had trouble breathing, and I called my DH at work to come take me to the ER. I have asthma, and the triage people thought I was having an asthma attack, but believe me, that is not what it was. They did an EKG and the doctor's exact words were "Wow, we expect to see an EKG like this on someone much older that has had a few heart attacks." I had something called an incomplete right bundle block or something very similar, but after doing some more research on the net and talking to some people, I have found that it is not necessarily a bad thing, though it can be a sign of a problem. They did other tests, including a chest xray, catscan, and blood tests. Everything came back OK except it was found that my potassium was quite low. I was given potassium and told to follow up with my primary care physician.

I went to my doctor, who is quite confused as to why my postassium is low because there is no obvious reason. She tested me again to make sure that it was back up from what they gave me in the ER and it was OK. She referred me for a stress test. A couple days after that, I caught my son's flu, and the whole time I was sick my heart rate stayed above 100. It scared me a bit because of the whole ER thing earlier in the week, but the doctor said it was due to my fever. Once the fever went down, so did my heartrate so I am sure that was probably true.

Then comes Christmas Eve. I was extremely fatigued all day, and in the evening I felt very sick and was so weak I could hardly walk. I took my temperature and was amazed to find it was normal, I was sure I was sick again. Well, I started feeling really bad and started getting chest pains again so DH insisted I go back to the ER. They did an EKG again, and it indicated inverted T waves and eschemia (sp?). I was given IV fluids and a medication called Tenormin and also some Xanax, and was told I was dehydrated from my earlier sickness and had chest wall inflammation. I was sent home with prescriptions for Naprosyn (for the inflammation) and Xanax, and again told to follow up with my doctor. I already have an appointment next week to follow up for my previous ER follow up, so I haven't gone back yet. However, I looked up the inverted T waves and eschemia stuff on the net, and it is kind of scary. I do realize that reading med sites can make things sound scarier than it should, which brings me to the whole point of my post.

What do all these EKG findings mean? Incomplete right bundle block, inverted T waves, eschemia??? I am not overweight, I have great cholesterol levels, my blood pressure is towards the low side....but from what I am reading all of these things in the EKG can be signs of problems...or not. It is so confusing. Now I know why they gave me Xanax at the ER, it was so I'd not stress so much over this stuff! The ER doctors are just very vague in what they tell you, I guess because they don't want to be making diagnoses, but it is stressful not knowing what is going on.

 

[mtblujeans]

Someone will know.....if not tonight, then tomorrow.

 

[FroggyinArk]

not a clue aidensmom, but you are still in our prayers and thoughts... you take care of you and dont scare me like that again..lol

 

[MScott1851]

I work in a chest pain ER... and truthfully, I would have to look at both 12 leads to make any sort of informed opinion...Sometimes EKG's on the same person can look wildly different based on lead placement, technician, etc. And high or low potassium can CERTAINLY affect an EKG. Plus...you can't always go by what the EKG machine 'reads' the EKG as. I've had several printout "acute MI" but when you get down to it, the patient is having early repolarization or something else that interferes with the baseline.

But I will say this. Your symptoms bother me. A LOT. You have what we call a 'good story' accompanied by EKG changes. They gave you a freaking beta-blocker, for pete's sake! Were you tachycardic on the second visit? Or had high BP then? Did they draw cardiac enzymes (troponin, CPK, CKMB, etc?)

I think you need a stress test and an echocardiogram. JMHO, but I feel pretty strongly about it. Please call your PMD in the morning and ask to be worked in.

 

[Aidensmom]

But I will say this. Your symptoms bother me. A LOT. You have what we call a 'good story' accompanied by EKG changes. They gave you a freaking beta-blocker, for pete's sake! Were you tachycardic on the second visit? Or had high BP then? Did they draw cardiac enzymes (troponin, CPK, CKMB, etc?)

I think you need a stress test and an echocardiogram. JMHO, but I feel pretty strongly about it.

I was not really tachycardic per se, but my heartbeat was close to 100. My BP really never gets high. I really don't know about the enzymes. Would that be part of a blood test? I do plan on following up with my stress test and whatever else I get referred for.

 

[Cool-Beans]

These are really all questions for a cardiologist. We read an entire book in school to learn to interpret ECGs, and I wouldn't know where to begin explaining it all, except to say the up and down points are labeled with letters, like Q, R, S, and T...and all that gets broken down with I and II and other sub-letters. T-waves show repolarization (which comes, of course, after depolarization...that help? ) It is just part of a cycle in how your heart works.

An big inverted T wave with chest pain can be indicative of ischemia, no doubt 'bout it. But it doesn't mean that is the fact in your case.

To interpret stuff like this, a person needs to see the print-outs (from the 12 leads - those little blippy things they put on you)...and really should be a cardiologist. Especially if you have issues with your potassium. Potassium plays a big part in heart stuff.

Right bundle blocks (the bundles are like little cables and send messages from one place in the heart to another) can be caused by different stuff, and (unlike left bundle blocks) may not even be related to cardiac disease.

You know how when you work out you breathe faster? It is because your bod needs more oxygen (and to get rid of the carbon dioxide.) Anything that works in the bod is going to need oxygen. If your heart is working, it needs it, too. If it can be slowed down a little, it won't need as much (like if you slow down when you work out...you don't have to breathe in and out quite so quickly.) That's what the Tenormin is doing for you...slowing down you heart rate. Ischemia means that (for whatever reason), some part of the bod isn't getting enough oxygen delivered by the blood. So, less work, less need for oxygen, less ischemia.

The naproxen is an anti-inflammatory and (supposedly) mild pain killer, and the Xanax is probably because they thought you were wigging out or just a person who isn't calm. Some docs give it out like candy, others don't.

BUT I DON'T KNOW, and I'm no doctor, much less a cardiologist. I'd recommend getting a cardiologist and asking him (or her...also not a sexist.)

And I'd recommend milking this for all it is worth and getting DH to do the laundry. ...but that's just me.

 

[Pea-n-Me]

from what I am reading all of these things in the EKG can be signs of problems...or not.

You're exactly right. Could be, or might not be. All of these can be related to mitral valve issues, electrolyte disturbances, pericarditis, and/or a host of other things. You really need a skilled practitioner to sort it all out for you. It's time to find a good cardiologist (or go back to the one you saw previously) who can look at you all over again and figure out if there's more to be concerned about. They will re-examine you and probably run more tests (definitely necessary, since things may have changed over the years, or even weeks). If you can't get an appointment I would call your nearest and best teaching hospital and see if there is a cardiologist who will see you fairly quickly, I wouldn't wait weeks.

The ER doctors are just very vague in what they tell you, I guess because they don't want to be making diagnoses

I don't think it's that they don't want to, it's that they can't, really, unless the data is definitive. As I said above, there are many differential diagnoses for all of the things you listed, and your test results were ok. Not a lot to go on other than your symptoms (which I agree are concerning).

Did you ever wind up having the stress test before you got the flu? Was it ok? I presume they ran cardiac enzyme tests in the ER and that they were negative (you would have been admitted if they weren't). Did the anti-inflammatory help your chest pain? Was the dose of tenormin a one time dose or were you started on it daily or more?

I hope these symptoms resolve soon and you get the answers you're looking for.

 

[poohandwendy]

I also think you need to see a cardiologist. I was sort of hoping they would have seen one in the hospital and/or been set you up with a 24 hr Holter monitor the first time you went in.

Some questions you need to ask, IMO, did they check your cardiac enzymes? Did you have an echocardiogram (you would know this, I can't recall if you did or not) Why the Beta Blocker? What exactly did they come up with, what was the final dx?

Cardiac rhthym issues, like others have said, can be difficult to dx at first (especially non-life threatening ones). So, what is going on could or could not be significant. That is why I think you need to see a cardiologist. And if your problems are non-structural but rhthym issues, I would ask to be referred to an electrophysiologist (a specialist dealing with cardiac electrical issues)

 

[horseshowmom]

Your situation is much different than my husband's (due to your continuing circumstances) but to show what others have said about the ekg "meaning something or not meaning anything", my husband recently had two ekg's (one was done and then another was done immediately afterwards due to the results of the first one). Our primary doctor started asking him questions and finally said that the ekg's showed that he had had a heart attack (which came as a very large shock to him).

We found that very hard to believe due to his physical condition (lots of exercise on an almost daily basis), but I was concerned due to the number of "silent heart attacks".

He had a stress test and found out that there was no problem at all - the problem was with the ekg (the nurse had trouble getting one of the things to stick properly which may very well have been the whole problem).

Best wishes to you!

 

[schmitty]

I have MVP also but I don't have any major problems with it. Youre case is worse than mine but dont worry.My cardiologist said that running and volleyball and other activities with low resistance but that was for me and my specific case of MVP. However if they say your potassium is low eat a banana or 2 a day. Double up on your fruits and vegetables also get rid of all the caffene you take in, coffee or chocolate or anything else with it.

 

[Aidensmom]

Thank you for your replies.

I haven't had the stress test yet - getting sick and the holidays got in the way - I have it next week.

An echocardiogram was not done.

The anti-inflammatory does seem to be helping the pain, and the tenormin was a one time dose.

Like I said in my first post, I do have appointments scheduled and am following up on this, I just am feeling a bit stressed in not really knowing a definitive answer to things and had some questions. My PCP is fairly knowledgable in this area, and she is also very good at covering all the bases with tests/referrals to appropriate sources, so I feel I am in good hands.

 

[MScott1851]

I was just checking back this morning to see how you were doing. I'm glad you're following up. I know ER patients get frustrated sometimes because we can't always tell you exactly what's wrong, but you can take comfort in knowing what it WASN'T (massive heart attack, pulmonary embolism - I'm assuming they did the chest CT to rule that out.) But I know going home with a diagnosis of atypical chest pain doesn't make you feel any better...you already KNEW you had that!!

BTW...someone on here is a cardiologist. LionKing or something like that. I wonder if he still posts, although, like most of us have said, he'd really need both EKG's, all labs and radiology and YOU to examine before he could form an opinion. This isn't like looking at a skin rash, this is your heart.

I really hope you feel better, please keep us updated, and try not to be so stressed...I know it's difficult.

 

[The Mystery Machine]

OK...I will add my 2 cents...

My dd was born with a heart defect so in 15yrs. I have learned many things....

#1...Not all cardiologists are the same. Some are fantastic and smart and some are awful. Your primary GP needs to be bumped from this and you need to find GOOD specialists to help you.

#2...Stress tests are crap...Yes, you should have one but honestly they do not tell you much. I had a Thallium test and still was not impressed.

#3...Insist on the ECHOcardiogram. A good cardiologist will be able to see any serious issues right away. I would do this BEFORE you do a stress test.
Frankly to do a stress test first is STUPID since you are having some serious symptoms.

Good Luck...take charge of your health. It isn't easy but you have to do it.

 

[Christine]

OK...I will add my 2 cents...

My dd was born with a heart defect so in 15yrs. I have learned many things....

#1...Not all cardiologists are the same. Some are fantastic and smart and some are awful. Your primary GP needs to be bumped from this and you need to find GOOD specialists to help you.

#2...Stress tests are crap...Yes, you should have one but honestly they do not tell you much. I had a Thallium test and still was not impressed.

#3...Insist on the ECHOcardiogram. A good cardiologist will be able to see any serious issues right away. I would do this BEFORE you do a stress test.
Frankly to do a stress test first is STUPID since you are having some serious symptoms.

Good Luck...take charge of your health. It isn't easy but you have to do it.

I agree with everything said here.

Earlier this year, I was having some "minor" heart issues. My GP immediately sent me out for an echo just to rule out some structural abnormalities. He told me the second step would have been a stress test. The echo is very easy--I'm just not quite sure why you haven't had one?

Anyway, I agree with getting to a cardiologist for this. I know a lot of GPs will try to "handle" stuff and that's great, but I think you need a specialist here.

 

[Missy Mouse]

Just want to start this off with the disclaimer that I do have doctor's appointments scheduled and have been seeking help, I just have some questions that I am hoping some medical people or people with heart problems might be able to give me insight into....

Let me start by saying that 20 years ago I was told I have a Mitral Valve Prolapse with regurgitation when I had a physical to get into the Coast Guard Academy (I was denied because of that finding). Over the years the murmur comes and goes as being detectable, so it apparantly isn't too severe, though I do take antibiotics before going to the dentist as recommended. I have for as long as I remember gotten occassional fleeting sharp pains in my chest.

About 10 years ago, I had some trouble where I would get dizzy and have some tachycardia on occassion, and often ran a low grade fever for no determinable reason, and so was sent to a cardiologist. I had several tests done and had to wear a Holter monitor for a day or two and nothing was found....

Then again about 5 years ago I went through all the same stuff. All tests were still normal. The cardiologist at that time told me to cut out all caffiene (I only had 2 cups of coffee a day at the most), and that did seem to help. I have gone back to a cup of coffee a day over the last 6 months however.

Well, a few weeks ago I woke up in the morning with some moderate chest pains. They got worse through the day, and started radiating to my arm. My face become numb and I had trouble breathing, and I called my DH at work to come take me to the ER. I have asthma, and the triage people thought I was having an asthma attack, but believe me, that is not what it was. They did an EKG and the doctor's exact words were "Wow, we expect to see an EKG like this on someone much older that has had a few heart attacks." I had something called an incomplete right bundle block or something very similar, but after doing some more research on the net and talking to some people, I have found that it is not necessarily a bad thing, though it can be a sign of a problem. They did other tests, including a chest xray, catscan, and blood tests. Everything came back OK except it was found that my potassium was quite low. I was given potassium and told to follow up with my primary care physician.

I went to my doctor, who is quite confused as to why my postassium is low because there is no obvious reason. She tested me again to make sure that it was back up from what they gave me in the ER and it was OK. She referred me for a stress test. A couple days after that, I caught my son's flu, and the whole time I was sick my heart rate stayed above 100. It scared me a bit because of the whole ER thing earlier in the week, but the doctor said it was due to my fever. Once the fever went down, so did my heartrate so I am sure that was probably true.

Then comes Christmas Eve. I was extremely fatigued all day, and in the evening I felt very sick and was so weak I could hardly walk. I took my temperature and was amazed to find it was normal, I was sure I was sick again. Well, I started feeling really bad and started getting chest pains again so DH insisted I go back to the ER. They did an EKG again, and it indicated inverted T waves and eschemia (sp?). I was given IV fluids and a medication called Tenormin and also some Xanax, and was told I was dehydrated from my earlier sickness and had chest wall inflammation. I was sent home with prescriptions for Naprosyn (for the inflammation) and Xanax, and again told to follow up with my doctor. I already have an appointment next week to follow up for my previous ER follow up, so I haven't gone back yet. However, I looked up the inverted T waves and eschemia stuff on the net, and it is kind of scary. I do realize that reading med sites can make things sound scarier than it should, which brings me to the whole point of my post.

What do all these EKG findings mean? Incomplete right bundle block, inverted T waves, eschemia??? I am not overweight, I have great cholesterol levels, my blood pressure is towards the low side....but from what I am reading all of these things in the EKG can be signs of problems...or not. It is so confusing. Now I know why they gave me Xanax at the ER, it was so I'd not stress so much over this stuff! The ER doctors are just very vague in what they tell you, I guess because they don't want to be making diagnoses, but it is stressful not knowing what is going on.

Hello from a fellow congenital hearter....Tell your cardiologist you want to be on a loop monitor for a month. All an inverted T wave means is that the blood flow to that area is turbulent or interrupted (hence the ischemia). I also have a bundle block. The reason why they're concerned is because an inverted T wave and a bundle branch block is generally indicative of damage from a heart attack. HOWEVER, if your potassium is low it can cause all kinds of pseudosymptoms. Normal potassium levels fall between 3.5-5.3....a low potassium can send you into cardiac arrest. You've already been diagnosed with MVP (which I also have), so it may be time for some medication. I'm 22 and have been on and off meds for the past year. I've been trying to avoid them as long as possible, but I think it's finally time to face it. You'd be surprised what 25 mg of anything can do for your heart. I get bouts of tachycardia into the 140s and my normally very low (92/60) blood pressure shoots up to 150/96. I hope this helps, and if you have any questions feel free to ask.

 

[Pea-n-Me]

Keep in mind that beta blockers would not be the drug of choice for you with your history of asthma.

 

[luvdzny]

My DD had some of the same symptoms you are describing, plus a lot more. She has been sick since she was a baby, she is now 17 years old and was just diagnosed with Dysautonomia. She is very sick right now, has been out of school for over a month and we are working with a neurologist to develop a treatment plan. She had been seeing a cardiologist for many years and they never really could figure out all of her problems. Turns out everything comes from Dysautonomia. Anyway here is a link to a site her doctor recommended, it is for kids but it has a good list of the symptoms, check it out and see if any of it fits for you. Good luck! I know how frustrating it can be. Keep us posted.


www.dynakids.org/Documents/quadfold.pdf

 

[Keli]

I asked my dh about this (NOT a DR but does a lot of work with patients and EKG's) and he was typically vague in his answers, but most of the questions he asked were regarding your potassium levels.
I guess he had a lot of concern for that specifically and indicated that much of the heart issues could stem from the fluctuating potassium. He did say many things can cause your potassium to drop and some of them are very, very serious.

 

[MScott1851]

My DD had some of the same symptoms you are describing, plus a lot more. She has been sick since she was a baby, she is now 17 years old and was just diagnosed with Dysautonomia. She is very sick right now, has been out of school for over a month and we are working with a neurologist to develop a treatment plan. She had been seeing a cardiologist for many years and they never really could figure out all of her problems. Turns out everything comes from Dysautonomia. Anyway here is a link to a site her doctor recommended, it is for kids but it has a good list of the symptoms, check it out and see if any of it fits for you. Good luck! I know how frustrating it can be. Keep us posted.


www.dynakids.org/Documents/quadfold.pdf

It's interesting that you say that, because I've been researching this a lot at work lately. It seems A LOT of the MVP patients we see usually have a myriad of other complaints along with their chest pain, usually vague and nothing that can be clinically confirmed or explained, so doctors poo-poo them and write them off as psychosomatic.

But dysautonomia as a primary diagnosis makes much more sense to me. MVP in and of itself is usually benign, doesn't worsen over time, and certainly doesn't cause the symptoms that I see many patients complaining of.

I found out that there are centers all over dedicated just to researching and treating patients with MVP. I know there is one in Birmingham, AL, and I think the nearest one near Aidensmom is in Hollywood, FL.

Anyway, steering a bit off topic, back to wishing Beth good health!!

 

[LiLIrishChick63]

Just want to start this off with the disclaimer that I do have doctor's appointments scheduled and have been seeking help, I just have some questions that I am hoping some medical people or people with heart problems might be able to give me insight into....

Let me start by saying that 20 years ago I was told I have a Mitral Valve Prolapse with regurgitation when I had a physical to get into the Coast Guard Academy (I was denied because of that finding). Over the years the murmur comes and goes as being detectable, so it apparantly isn't too severe, though I do take antibiotics before going to the dentist as recommended. I have for as long as I remember gotten occassional fleeting sharp pains in my chest.

About 10 years ago, I had some trouble where I would get dizzy and have some tachycardia on occassion, and often ran a low grade fever for no determinable reason, and so was sent to a cardiologist. I had several tests done and had to wear a Holter monitor for a day or two and nothing was found....

Then again about 5 years ago I went through all the same stuff. All tests were still normal. The cardiologist at that time told me to cut out all caffiene (I only had 2 cups of coffee a day at the most), and that did seem to help. I have gone back to a cup of coffee a day over the last 6 months however.

Well, a few weeks ago I woke up in the morning with some moderate chest pains. They got worse through the day, and started radiating to my arm. My face become numb and I had trouble breathing, and I called my DH at work to come take me to the ER. I have asthma, and the triage people thought I was having an asthma attack, but believe me, that is not what it was. They did an EKG and the doctor's exact words were "Wow, we expect to see an EKG like this on someone much older that has had a few heart attacks." I had something called an incomplete right bundle block or something very similar, but after doing some more research on the net and talking to some people, I have found that it is not necessarily a bad thing, though it can be a sign of a problem. They did other tests, including a chest xray, catscan, and blood tests. Everything came back OK except it was found that my potassium was quite low. I was given potassium and told to follow up with my primary care physician.

I went to my doctor, who is quite confused as to why my postassium is low because there is no obvious reason. She tested me again to make sure that it was back up from what they gave me in the ER and it was OK. She referred me for a stress test. A couple days after that, I caught my son's flu, and the whole time I was sick my heart rate stayed above 100. It scared me a bit because of the whole ER thing earlier in the week, but the doctor said it was due to my fever. Once the fever went down, so did my heartrate so I am sure that was probably true.

Then comes Christmas Eve. I was extremely fatigued all day, and in the evening I felt very sick and was so weak I could hardly walk. I took my temperature and was amazed to find it was normal, I was sure I was sick again. Well, I started feeling really bad and started getting chest pains again so DH insisted I go back to the ER. They did an EKG again, and it indicated inverted T waves and eschemia (sp?). I was given IV fluids and a medication called Tenormin and also some Xanax, and was told I was dehydrated from my earlier sickness and had chest wall inflammation. I was sent home with prescriptions for Naprosyn (for the inflammation) and Xanax, and again told to follow up with my doctor. I already have an appointment next week to follow up for my previous ER follow up, so I haven't gone back yet. However, I looked up the inverted T waves and eschemia stuff on the net, and it is kind of scary. I do realize that reading med sites can make things sound scarier than it should, which brings me to the whole point of my post.

What do all these EKG findings mean? Incomplete right bundle block, inverted T waves, eschemia??? I am not overweight, I have great cholesterol levels, my blood pressure is towards the low side....but from what I am reading all of these things in the EKG can be signs of problems...or not. It is so confusing. Now I know why they gave me Xanax at the ER, it was so I'd not stress so much over this stuff! The ER doctors are just very vague in what they tell you, I guess because they don't want to be making diagnoses, but it is stressful not knowing what is going on.

you know, i'm really not quite sure what they mean, but i have a lot of the same symptoms that you have.

i was diagnosed with asthma just a few years ago(which is always odd, because asthma is almost always diagnosed when you're a child) and i get rapid heart beats for no reason. usually they last for a few seconds to a minute. once it lasted 15 minutes and i went to the hospital and they found absoutly nothing. i've gotten chest pains before, and was told it was just "chest wall pains"........***?? what the heck does that mean!? obviously something is causing the pain in my left side of my chest, no?? i've gotten very fatigued for no reason at times as well. i was also told to cut out all caffiene, which i have done a really good job at doing. but i still get the rapid heart pounding.

so i've had all kinds of tests. stress test, a 24 hour holter monitor, a 30-day event monitor(which i had to stop wearing after a week because i got a reaction to the stickem thingys), EKGs, a tilt table test......everything. and they all came back "normal".

it drives me nuts because i know something's wrong, but the doctor's don't believe me. and it's also a problem because of my age. i'm 22 and everytime i go in for a test or a check up with the cardiologist i hear "you're too young to be here!" and it kind of bothers me, because i feel like they're not looking for anything important because they think that it couldn't possibly happen to me.

you should go to your cardiologist and ask them what exactly your test results mean. and ask them what you can do about it. i hope that they find out what's wrong, and can treat it. good luck, and let us know what they say