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Pain in chest, breast and armpit area. Test showed no acute cardiopulmonary disease. Concerned

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Cardiologist, Interventional
Practicing since : 1998
Answered : 401 Questions
26 year old male, been suffering from minor chest pains and aches in left breast and armpit area. Intermittent and often relieved by burping. Has had 3 ekgs, first normal than 1 year later markedly abnormal followed by borderline 24 hrs later. (details below) Exercises regularly about 6 miles a day @ 160-180bpm, has lost approx. 50lbs. in last 2 years. Was about 325lbs. now 275. 6'2".

No family history of heart disease. Grandparents all still alive and in their 80's. Both Male grandparents have heart issues but not until they were in their 70's.

Have cardiology appointment in a month. Should I push for a stress test? Should I stop exercising until the appointment? Should I be worried? How abnormal is the 2nd ecg test? Is there any significance that it demonstrates?

EKG 1 - Normal 08/31/10
Heart Rate: 78bpm
PR Int: 164ms
QRS Dur: 86ms
QT/QTc: 380/445ms
P-R-T axes 57 0 36

Computer Analysis:
Normal sinus Rhythm
Normal Axis
Incomplete Right Bundle Branch Block
[normal ekg]

EKG 2 - Abnormal 12/19/11
Hear Rate: 64bpm
PR Int: 162ms
QRS Dur: 96ms
QT/QTc: 404/409ms
P-R-T axes -126 -72-98

Computer Analysis:
(possible) normal sinus rhythm
Left Axis Deviation
Possible Anteroseptal MI
Inferior ME
[Markedly Abnormal ECG]

Doctor's notes: Normal sinus rhythm. Left axis deviation. The patient had RSR prime with early right bundle-branch block, but no other abnormalities. Nonspecific bundle branch associated changes were seen.

EKG 3 - Normal 12/20/11 @ Baylor
Vent. rate : 88bpm
PR interval: 150ms
QRS duration: 94ms
QT/QTc: 390/471ms
P-R-T axis 59 -18 36

Computer analysis:
Normal sinus rhythm
Incomplete right bundle branch block
Borderline ECG

Had CBC done @ Baylor
Troponin I was <0.02 (not sure what else is relevant)
Chest X-Ray Findings: Mediastinal and hilar contours are within normal limits. The cardiac silhouette is normal in transverse diameter. The lungs are grossly clear without pleural effusion or infiltrate.
No acute cardiopulmonary disease.
Posted Thu, 23 Aug 2012 in Hypertension and Heart Disease
Answered by Dr. Prabhakar C Koregol 1 hour later
Thanks for writing in.
Thanks for detailed description. Neither your symptoms nor your ECGs are suggestive of any cardiac problem. Many a times computers give wrong interpretation and we don't attach too much of significance to it. The doctors description matches the findings in first and third ECG, meaning essential all three ECGs show some iRBBB which is inconsequential. In my opinion you can continue exercise, have your cardiac consultation as scheduled and regarding need for any further testing let your cardiologist take call.
At this stage, I dont see any thing that you need to be worried about.
Let me know if you have any more questions
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