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How accurate is an ekg that repeatedly comes back with anterior or anteroseptal infarct ?

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Cardiologist, Interventional
Practicing since : 1996
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How accurate is an ekg that repeatedly comes back with anterior infarct or anteroseptal infarct in combination with a failed stress test, abnormal CAT coronary, have documented runs of SVT, and runs of PVC's. Off and on chest discomfort, severe left arm pain that's sporadic w/ or w/o cp, sob and bp that keeps climbing higher even on meds. Where would a this infarct be located at if there is one? And can an electrical problem between the SA an the AV node as one cardiologist suggested cause all these symptoms? As of late my bp climbed as high as 227/119. I am a 42 yr old female, not obese but have quite a family cardiac history. This all started when I was 39 yrs old, was resting when all the sudden I had sudden intense pressure/ pain to left side of my chest, became diaphoretic, pale, sob, nauseated and the dry heaving. My pulse was so fast that couldn't count it, but then it would stop and start again. My husband took me to a military base and they treated me with XXXXXXX it helped but still didn't feel well. Was then told that I has something going on cardiac wise but they didnt have a cardiologist on so unless I had that doom and gloom feeling they were going to release me but if I had that feeling they would transfer to another hospital. Disgusted, I left. My husband tried taking to another hospital on the way home but I was tired of all the tests and just went home. After being up all night sick and my heart racing he took me the hospital where I worked bc he said I looked like death. They admitted me with SVT . I have been on a battle since. Was told by last cardiologist that I had a number of things wrong and he wasn't sure what to do, couldn't give me any answers. As a er nurse this was unacceptable and I fired him. But as a bad pt I have not seen a cardiologist in over a yr because I lost faith but because my symptoms have gotten increasingly worse I finally went to one that I was told was very good. Unfortunately he told me what I knew he was going to say and that was I needed a card XXXXXXX Also doing a renal angio at same time. Is this the new standard? Worried
Posted Tue, 24 Apr 2012 in Valvular Heart Disease
Answered by Dr. Raja Sekhar Varma 19 hours later
Hello Mrs Lokelani,

Thank you for your query.

I would like to know some more specific details from you.
1) Can you upload the scanned ECG using the file upload feature of this site? A scanned ECG with the rhythm strip showing the SVT will also be useful.
2) What did the stress test show exactly? What test was done - TMT? or a Stress thallium scan or a dobutamine stress echo? What were the abnormalities shown?

It appears from your history that you suffered a heart attack when you were 39 yrs old, probably an anterior wall MI. This is most likely due to a blockage of the Left anterior descending artery. Whether that is the only blockage or whether there are other blockages will be answered by the coronary angiogram. Since you have had some treatment, it is also possible that at least part of the blockage might have regressed. But, since you do have chest pain on and off, it is likely that there is persisting blockage.

The shortness of breath is probably due to a reduction in the ejection fraction after the MI.

The presence of ischemia and/or scar due to the MI can produce ventricular arrhythmias like PVCs, NSVT VT and someimes even VF. These PVCs can trigger SVT in a person with "dual AV nodal pathway" or if you have accessory pathways (manifest WPW syndrome or concealed accessory pathways). The timing of the PVC with respect to the normal cardiac cycle is critical in inducing the arrhythmia. The SVT can also cause chest pain, dyspnea and palpitations.

The uncontrolled BP is not helping matters much. The high BP puts an additional strain on your heart that is already weakened by the MI. The levels of 227/119 are quite high. A possibility is that there may be obstructions of the renal arteries (symptoms, the presence of a past MI, hypertension, abnormal stress test and abnormal CT angio, it is definitely advisable to undergo coronary angiogram and renal angiogram. Further treatment can be planned according to the results of the angio. If there are significant blocks, and if there is significant "viability" of the affected areas, it is worthwhile to do revascularization (CABG vs angioplasty, depending on the anatomy and feasibility). If the blocks are <70% in severity, or subserve non-viable areas, medical management can be optimized.

You will also need drugs to control your arrhythmias. Many of these may be controlled with medicines. Revascularization also will produce a beneficial effect. In case of persistence of arrhythmias despite adequate revascularization and optimal medicines, you should undergo an EP study and RF ablation, as indicated.

I hope this answers your query. Please feel free to get back to me for further clarifications.
With regards,
Dr RS Varma
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