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Suggest Treatment For Severe Chest Pain, GERD And Gastritis
Question: Hello I have been having on and off chest pains since mid december. Family doctor sent me to a gastro doctor who has since diagnosed me with esophgeal spasms, GERD and gastritis. Prior to the upper endoscopy, the gastro doctor ordered a EKG to help rule out heart issues. The gastro doctor interpreted the EKG as WPW type b. This scared me greatly as i had a week to wait until a cardiologist appointment that was preciously scheduled to also rule out heart issues due to the chest pain. Last week i uploaded the EKG that my gastro doctor said showed the WPW and had one of your cardiologists interpret it as normal. Yesterday i had the cardiologist appointment and he did another EKG and stress test and neither showed WPW, although he said that the EKG my gastro doctor ran actually was WPW. I am now very confused and extremely anxious. He is sending me to a heart rythmn specialist but it may be over 4 weeks before i can get in to see him.
1. Please take another look at the gastro doctor's EKG and let me know if this is indeed WPW. I have uploaded it for review.
2. The EKG the cardiologist ran yesterday came back with "borderline RAD repol abnrm suggests ischemia, diffuse leads". He started to tell me this result then stopped once he saw i had a ct scan a few weeks ago and my calcium score was 0. Inhad to insist on a stress test. Once he did the stress test and it came back clinically and electrically negative, he said the chest pain is not my heart. Please let me know if i should be concerned with this finding on the EKG. I do not have a copy of this EKG.
3. I wasnt expecting to do a stress test yesterday so i had a cup of coffee an hour prior. Could this have affected it or EKG? I also was extremely anxious/stressed and heart started racing as soon as he told me i had WPW based on the EKG the gastro doctor ran. The tech also couldnt get the leads to stick to my skin because i had used lotion and they kept sliding and falling off as he perfromed the EKG.
4. Lastly he said my heart rate recovery was slow with stress test and i need to condition. Is this benign? I exercised this morning and got my heart rate up to 176 and within 2 minutes of cool down it was at 135. Im female 44 years old otherwise healthy.
Thank you in advance. I am cery anxious about all of this and cardiologist doctor seemed to rush me through yesterday.
1. Please take another look at the gastro doctor's EKG and let me know if this is indeed WPW. I have uploaded it for review.
2. The EKG the cardiologist ran yesterday came back with "borderline RAD repol abnrm suggests ischemia, diffuse leads". He started to tell me this result then stopped once he saw i had a ct scan a few weeks ago and my calcium score was 0. Inhad to insist on a stress test. Once he did the stress test and it came back clinically and electrically negative, he said the chest pain is not my heart. Please let me know if i should be concerned with this finding on the EKG. I do not have a copy of this EKG.
3. I wasnt expecting to do a stress test yesterday so i had a cup of coffee an hour prior. Could this have affected it or EKG? I also was extremely anxious/stressed and heart started racing as soon as he told me i had WPW based on the EKG the gastro doctor ran. The tech also couldnt get the leads to stick to my skin because i had used lotion and they kept sliding and falling off as he perfromed the EKG.
4. Lastly he said my heart rate recovery was slow with stress test and i need to condition. Is this benign? I exercised this morning and got my heart rate up to 176 and within 2 minutes of cool down it was at 135. Im female 44 years old otherwise healthy.
Thank you in advance. I am cery anxious about all of this and cardiologist doctor seemed to rush me through yesterday.
Brief Answer:
Yes it is WPW
Detailed Answer:
Hi,
Welcome.
This is Dr Sameer, cardiologist.
Yes your ECG shows features of WPW syndrome (delta waves, short PR). It is actually a congenital presence of extra conducting pathway in heart in addition to normal circuit.
It generally remains asymptomatic but can sometimes precipitate tachycardia.
It is said that, If an individual's XXXXXXX waves disappear with increases in the heart rate, he or she is considered to be at lower risk. This is because the loss of the XXXXXXX wave shows that the accessory pathway cannot conduct electrical impulses at a high rate.
Risk stratification is best performed via programmed electrical stimulation (PES) in the cardiac electrophysiology laboratory. This is an invasive but generally low-risk procedure during which the atria are stimulated to try to induce tachycardia. If a tachycardia involving the accessory pathway can be triggered, the cardiologist can then assess how rapidly the accessory pathway is able to conduct. The faster it can conduct, the higher the likelihood the accessory pathway can conduct fast enough to trigger a tachycardia.
As you had a stress testing done(which is not influenced by coffee intake) which is actually a test to see of their is any associated coronary disease. It has 70-80% sensitivity. If it is negative, than chances are very low.
It is also used to see if their is any stress induced tachycardia.
In your case, as you said it is normal, than you are not in that risk category.
Finally, i just want to say that it is better to get a PES(also said as EPS- electro physiological study) which can access exactly the risks.
Till than, relax. Avoid exertions, avoid excess coffee (things that increase heart rate).
Thanks a lot.
Take care.
Yes it is WPW
Detailed Answer:
Hi,
Welcome.
This is Dr Sameer, cardiologist.
Yes your ECG shows features of WPW syndrome (delta waves, short PR). It is actually a congenital presence of extra conducting pathway in heart in addition to normal circuit.
It generally remains asymptomatic but can sometimes precipitate tachycardia.
It is said that, If an individual's XXXXXXX waves disappear with increases in the heart rate, he or she is considered to be at lower risk. This is because the loss of the XXXXXXX wave shows that the accessory pathway cannot conduct electrical impulses at a high rate.
Risk stratification is best performed via programmed electrical stimulation (PES) in the cardiac electrophysiology laboratory. This is an invasive but generally low-risk procedure during which the atria are stimulated to try to induce tachycardia. If a tachycardia involving the accessory pathway can be triggered, the cardiologist can then assess how rapidly the accessory pathway is able to conduct. The faster it can conduct, the higher the likelihood the accessory pathway can conduct fast enough to trigger a tachycardia.
As you had a stress testing done(which is not influenced by coffee intake) which is actually a test to see of their is any associated coronary disease. It has 70-80% sensitivity. If it is negative, than chances are very low.
It is also used to see if their is any stress induced tachycardia.
In your case, as you said it is normal, than you are not in that risk category.
Finally, i just want to say that it is better to get a PES(also said as EPS- electro physiological study) which can access exactly the risks.
Till than, relax. Avoid exertions, avoid excess coffee (things that increase heart rate).
Thanks a lot.
Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you, is there a reason why WPW doesnt show up on every EKG? I had a complete cardiac workup by an EP 18yrs ago after a friend of mine had postpardem cardiomyopathy and i got acared because my heart skipped beats alot. 18yrs ago the EP did EKG, echo and holter monitor and said i had PVCs that were benign. I guess that's why i am so taken back that i was born with this and all the EKGs ive had in my lifetime it has never been seen. Thank you in advance.
Brief Answer:
Please see detailed answer
Detailed Answer:
Hi,
Welcome again.
WPW will always show on the ECG as the abnormal pathway is always present but it is not conducting the impulse. Its actually how you interpret the ECG.
Postpartum cardiomyopathy is completely different thing where heart weakens because of pregnancy.
Echo will always be normal in peoples who have WPW. Holter will also not show anything significant if any arrhythmia or palpitation does not occur during the 24 hr time.
You could be normal throughout your life if no such arrhythmia occurs which can not be predicted.
So to remove all doubts & discrepancies go to your electrophsiologist & plan for a EP study. If that comes fine, you can be assured & than their will be nothing to worry.
And i must say that doing EP study is not an emergency & you can plan it as per your convenience & availability of doctor.
Thanks
Take care
Please see detailed answer
Detailed Answer:
Hi,
Welcome again.
WPW will always show on the ECG as the abnormal pathway is always present but it is not conducting the impulse. Its actually how you interpret the ECG.
Postpartum cardiomyopathy is completely different thing where heart weakens because of pregnancy.
Echo will always be normal in peoples who have WPW. Holter will also not show anything significant if any arrhythmia or palpitation does not occur during the 24 hr time.
You could be normal throughout your life if no such arrhythmia occurs which can not be predicted.
So to remove all doubts & discrepancies go to your electrophsiologist & plan for a EP study. If that comes fine, you can be assured & than their will be nothing to worry.
And i must say that doing EP study is not an emergency & you can plan it as per your convenience & availability of doctor.
Thanks
Take care
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Prasad
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