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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Do my abnormal EKG results and chest pain indicate a blockage while on medication for GERD and arrhythmia?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6324 Questions

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Posted on Thu, 15 Nov 2018 in Hypertension and Heart Disease
Question: I recently had an ekg done and the results were abnormal. I have been on flecainide for almost 20 years for arrhythmia. I see my EP every 6 months and all my tests from echo, hotter, event, stress tests have been normal until now. Had my last echo 3 years ago. I see my EP on Monday but am anxious as to what my results mean. I have been having chest pains now on and off for a few weeks, however, I think it may be from GERD as I suffer from that as well. My chest pains is constant all day long and does not get better with rest. Can someone please let me know if my tests indicates a blockage and does the ST elevation mean that I have had a heart attack?
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows

Detailed Answer:

Hello,

Regarding your concern I would like to explain that if an exercise cardiac stress test is performed in a person with low pre test probability, it is very likely to have false positive results. This means that there may be some abnormal ECG findings but not correlated with the presence of cardiac ischemia (coronary artery disease).

I would like to reassure you that there is no evidence of any heart attack in the past. Besides, ST elevation in an exercise cardiac stress is a rare finding and usually is not very typical of cardiac ischemia response.

Although, in order to definitely rule in or out the presence of coronary artery disease, I would recommend performing any of the following cardiac tests:

- a nuclear perfusion cardiac stress test
- a coronary angio CT scan
- a dobutamine cardiac stress echo

I would also like to review your ECG recordings during your exercise cardiac stress test and your cardiac ultrasound. Can you upload them for a second opinion?

Hope I have answered your query. I remain at your disposal for any further questions whenever you need!

Regards,
Dr. Ilir Sharka,
Cardiologist
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ilir Sharka 33 minutes later
Hello and thank you so much for your prompt response. The stress test results were uploaded in the initial email. Let me know if you need me to upload it again. I did a treadmill stress test and not nuclear. They found a complete right bundle branch block and a significant ST elevation. I just attached the results again.

Thanks.
doctor
Answered by Dr. Ilir Sharka 6 hours later
Brief Answer:
My opinion is as follows

Detailed Answer:

Hello,

I have reviewed your uploaded exercise cardiac stress test report. I would prefer to directly review also the ECG strips during the test. Meanwhile, if you have any available cardiac ultrasound report I would be interested to review to give a more appropriate professional opinion.

As I said before ST elevation during exercise cardiac stress test is not a common finding of cardiac ischemia, especially in a patient not having experienced myocardial infarction. In rare cases, ST elevation may be a marker of a proximal (left main coronary artery) vessel stenosis, a coronary spasm or left ventricular wall motion abnormalities. Nevertheless, it cannot conclude any firm suspicion of coronary artery disease, especially when you don't have any known coronary risk factors since all your previous cardiac stress tests have resulted normal.

The best strategy to follow for definitely clarifying this issue is to discuss with your attending doctor on the possibility of performing any of the above mentioned cardiac tests.

Hope I have answered your query. Please, let me know if you have any further questions.

Regards,
Dr. Ilir Sharka,
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Dr Sharka,

I don’t have access to the ecg strips or an ultrasound report. What I uploaded is all I was given. EP thinks there might be some blockage and wants me to get a heart XXXXXXX done. I think that is too invasive and am thinking of asking for a heart scan first....what are your thoughts? Just so you know my cholesterol numbers are high:
Total cholesterol is 260
Triglycerides 130
HDL 69
VLDL 26
LDL 165

Thanks
doctor
Answered by Dr. Ilir Sharka 13 hours later
Brief Answer:
I explain below

Detailed Answer:

Hello,

Considering your blood lipid profile, if you are normotensive (no history of high blood pressure, no diabetes, and if you are a non smoker) then your 10 years risk for a fatal cardiovascular event is around 1%, so practically low. However, accounting for your actual chest pain symptomatology and your suspicious cardiac stress test conclusion, it is necessary to proceed to further cardiac investigation workup.

It is true that cardiac catheterization is the best and most reliable test to get the right medical evidence of coronary artery disease (stenosis) presence. Non-invasive cardiac tests like coronary angio CT scan or nuclear perfusional cardiac stress test seem to be rational alternatives for detecting coronary stenosis and myocardial ischemia presence, but if you want to get directly to the end of the story, you could promptly direct to coronary angiography (catheterization).

You have to discuss this with your cardiologist on the above mentioned issues.

Hope I have answered your query.

Regards,
Dr. Ilir Sharka,
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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