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ECG results were abnormal. Prescribed appetite suppressant. Having dul pain between right breast and under arm. Suggested biopsy. Guide?

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Practicing since : 1998
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2years ago I went to a cardiologist due to my brother having a heart attack ( my mother had a heart attach at age 38) . I had a echo, stress, EKG and one other that I cannot remember the name of the test( it looked for the presence of an enzyme?). Cardiologist said everything looked perfect and should not expect any heart issues in the future. Fast forward to today. I had an ECG at a medical weight loss clinic. The results were abnormal. Possible anteroseptal infarct. V1. V2. V3. The PA asked if I ever had a heart attack and I said no. She said it could of been due to inaccurate reading from electrodes. She prescribed appetite suppressant. ( I am 5' 9 ". 171 lbs my goal is to lose 25 lbs. 48 yrs old). For the past year or so I have had a constant throbbing low pain in the area between right breast and under arm. Feels like a deep inside pain and cant really push anywhere specific to find out exactly where it is located. I went to my family doctor and she didn't seem concern but said to go have a mammogram. I did and the results said I need a biopsy. Never have had an abnormal mammo. She referred my to a breast surgeon for second opinion. He said the constant throbbing I am experiencing is not from the breast so her referred me to an orthopedic surgeon. The ortho doctor said that the area where I am experiencing discomfort is not within his realm of expertise. I have scheduled a check up again with family doctor but cant get in till mid october. Should I be immediately concern with the abnormal ECG and see a cardiologist right away? Very confused and concerned.

Thank you.
Posted Wed, 9 Oct 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 51 minutes later
Brief Answer:
please see details below.

Detailed Answer:
Dear Ma'm
1. A normal enzyme test, normal ECG, normal stress test or normal ECHO, do not in any way give guarantee that you will not have a heart attack in future. They only tell you the current status.
2. An ECG is best interpreted in light of clinical information and when we see it ourselves. ECG only provide indicators in most of the cases and they are not absolute. If it is feasible for you, please upload your ECG through a facility on right hand top of this page.
3. Yes, incorrect lead placement can give a diagnosis of heart attack because computer gives report on the basis of algorithms which are fed to it at time of installation. Computer generated (abnormal) reports are not correct in ~50% of cases.
4. Pain of angina characteristically comes on exercise/ exertion/ emotional stress/ running/ carrying weights or using stairs. It occurs behind the breastbone. more like a pressure or heaviness and gets relieved by rest. Pain which are sharp, piercing, throbbing, lasting for less than a minute or lasting for hours and days together, increasing on touch or pressure, associated with particular posture or movement, not associated or increased by exertion are less likely to be anginal.
5. Silent heart attacks or unrecognized heart attacks are more common in elderly (>65 years), diabetics, hypertensives, renal failure patients and patients with neuropathies.
6. Hope this provides some insight into your problem. Please upload ECG so that I can detail you more on this. Please also write if there is anything else in your mind.
Above answer was peer-reviewed by
Follow-up: ECG results were abnormal. Prescribed appetite suppressant. Having dul pain between right breast and under arm. Suggested biopsy. Guide? 38 minutes later
Thank you for the informative reply. I have uploaded the ECG and bloodwork results.

What type of doctor would I go to for the constant throbbing pain behind breast?

Answered by Dr. Sukhvinder Singh 24 minutes later
Brief Answer:
Please see details

Detailed Answer:
Dear Ma'm
1. I have seen your ECG. I am afraid that you uploaded same ECG twice (6th September 13). It shows Q waves in V1 and V2 with some "shouldering" in V3. There are no associated ST or T wave changes suggestive of heart attack. There is also abrupt transition from V3 ot V4. These two features, along with definite absence of history of an acute heart related event, indicate that incorrect lead placement is a strong possibility. Still since a doubt has arisen, best would be to get a repeat ECG done with proper lead placement or to go for a cardiac ultrasound (ECHO). I hope that will solve the issue.
2. Your lipid parameters, blood glucose, renal function are within normal limits.
3. If you are taking some kind of steroid/ hormonal pills? If you are diabetic? Do you have any pain or similar pain in chest on walking/ using stairs/ carrying weight? If the answer to all of them is "NO", see an internist (a physician). As a surgeon and an orthopedician, both have ruled out their respective diseases, a good internist can guide you best regarding the origin of pain and further work-up.
Hope this helps.
Feel free to discuss further.
Above answer was peer-reviewed by
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