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Experiencing pre-syncope. ECG showed moderate voltage for LVH and T wave abnormality. What does this mean?

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Hi, i've been experiencing pre-syncope for a while now and the doc referred me to get an ECG, which I did, the results stated that I had normal sinus rhthym, moderate voltage for LVH and T wave abnormality, consider anterior infarct. WHat does this mean? I'm 35, female, I'm overweight, though not all my life and my father had a heart attack two years ago at 62, which they stated was down to genes, rather than environment. What do you think? Thanks
Posted Wed, 5 Dec 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 2 hours later
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
Assuming that you did have then medical events supporting your history might have been:
1. You have family history, obesity and possible not investigated therefore not detected hypertension producing borderline LVH with T wave abnormality. If a lipidogram has not been done it is quite possible that you have high bad cholesterol (Total Cholesterol, LDL, Triglycerides) and low good cholesterol (HDL). These are risk factors for coronary artery disease.
2. Your pre syncope could have been been because of transient arrhythmia (not uncommon in onset of acute coronary artery disease.
These facts can go in favor of at least suspecting Acute Coronary Syndrome, non ST elevation, non q Myocardial Infarction (MI that is Heart Attack).

However, according to world health organisation diagnosis of MI in your case anterior infarct should satisfy 2 out 3 of the following crieria:
1. Typical Retro sternal pain, XXXXXXX squeezing, central going towards jaws or radiating towards left arm associated with shortness of breath and symptoms like sweating. Pain, unless treated, ought to continue for >20 minutes. You did not have this.
2. Elevation of cardiac enzymes, serum myoglobin, Serum Creatine Phospho Kinase MB fraction (CPK-MB) or Troponin T or Troponin I levels elevation. Reports of these must have been awaited.
3. Typical EKG changes where ST elevation suggests ischemia, initially tall T waves occur in hyper acute stage later on these get inverted and q wave suggests necrosis (which can occur in absence of q wave also). Therefore, you have a borderline EKG.
In cardiology we are trained to keep our threshold of diagnosing heart attack in emergency, low. For cost of missing an heart attack is far too high. That is why I would go with suspicion of heart attack and treat you for the same: no harm, it will be confirmed or excluded sooner. Though personally, with the limitation of not able to assess you, I do not feel you have one. Good Luck.

With Best Wishes

Dr Anil Grover
MBBS, MD (Medicine), DM(Cardiology)
Above answer was peer-reviewed by
Follow-up: Experiencing pre-syncope. ECG showed moderate voltage for LVH and T wave abnormality. What does this mean? 20 hours later
Thanks for your answer.
What course of action would you recommend?
My own doctor is being very slow to determine the next steps and im worried because I don't know whats happening and if there is anything wrong, I would want to start treatment as soon as possible. As it is I delivered my ECG results to her three days ago and she has not yet contacted me. She is not a cardiologist, but a GP. Will she know what to look for? OR should it be normal practice for her to review my ECG and refer to me a specialist like yourself?

Kindest regards

Answered by Dr. Anil Grover 1 hour later
If you are not feeling any physical discomfort like chest heaviness or pain, aggravated shortness of breath or any similar symptoms; then it is unlikely that your EKG was showing much and enzymes (if sent) must have been normal. So, your doctor must have put you lower down on sick patient priority. That should be good news. Nonetheless, without being confrontational, if I were you, I will ask the doctor that should not you be subjected to further tests like coronary angiography even if elective, but sooner. For the gold standard of ruling out or confirming coronary artery disease and its extent. That is something for which we are concerned about. You did have at least one serious symptom -pre syncope- and other serious sign -dubious ECG-, therefore, you do merit to consult a cardiologist who would eventually take the final call.
Meanwhile, please do not stress your self, as stress is also a risk factor and you still have to find about other risk factors for coronary artery disease and start saving yourself from a potential heart attack. Therefore, specific treatment which it seems can start only after you see a specialist. I am sure you can handle the situation diplomatically. If you have a question for me I will be only too pleased to answer. Good Luck.

With Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
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