question-icon

What causes pain in right arm and back when diagnosed with notch in v2?

default
Posted on Tue, 17 May 2016
Question: Hi. I asked this question yesterday but I woke up quite worried. I found an old ecg from a couple of years ago and another one that was done in the last month and it is clear that there was no notch in v2 in the first two, but yesterday when i was in the ER with right arm/back pain it came out with something like rsr' in v2. Should such a change occur on an ecg in such short time?
doctor
Answered by Dr. Meriton Siqeca (1 hour later)
Brief Answer:
Nothing to worry about

Detailed Answer:
Hello and thank you for your question.
Welcome to HCM. I understand your concern.

I would recommend you not to worry about this phenomenon. You see, this may easily be an artefact, since there are no pathological phenomena related to non-specific changes in V2. V2 and V3 are problematic derivations, which in our experience are found frequently because there is no standard in placing the electrode in these positions.
Even ignoring all these facts, even if we accept that this change looks like a pathological one, changes in one single derivation, not associated with at least the same changes in the adjacent derivations, are considerend non-pathological and are "ignored" (in the good way) by us.

The greatest comfort to me comes when I add the fact that you are only 34 years of age and cardiac problems at this age are very rare.
I would advise you, once again, not to worry about it. If this keep concerning you, undergo another EKG a week later. As for the right side pain, it probably is a positional problem you assume during sitting/working/sleeping. It will spontaneously go away and, if unbearable, try a 5-day course of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs).

I hope to have been helpful. I am happy to help, should you have follow-up questions.

Kind regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Deepak
doctor
default
Follow up: Dr. Meriton Siqeca (30 minutes later)
What about v6. Does it look like st is slightly elevated?
doctor
Answered by Dr. Meriton Siqeca (20 hours later)
Brief Answer:
Nothing to worry about

Detailed Answer:
Hello again.

Still, it would have to be accompanied with the same changes in the adjacent lead(s), so it could be called pathological. However, if this is worrisome to you, you can undergo a cardiac stress test, to see if this is pathological, although the probability is very very low.

I hope this was of help. Please close the discussion and rate the answer, if you do not have further questions.

Best regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
default
Follow up: Dr. Meriton Siqeca (2 hours later)
Do you not see chages fron ecg 1 to ecg on other leads as well?3
doctor
Answered by Dr. Meriton Siqeca (9 hours later)
Brief Answer:
Yes, I can see the changes. Cardiac stress test

Detailed Answer:
Hi again.

Yes, I can see the changes, and yet I am not worried about it. As I stated earlier, if you are so worried about this, perform a cardiac stress test which is basically an EKG when heart is physically stressed. If these changes have a clinical and pathological significance, the stress test is the only and best way to confirm/exclude them as pathological phenomena.

I hope this helps.

Regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Meriton Siqeca (52 minutes later)
Thank you. I have an appointment w my cardiologist next week. If it is pathological, it wouldnt be a heart attack on this, just ischemia?
doctor
Answered by Dr. Meriton Siqeca (3 minutes later)
Brief Answer:
Yes, my opinion is so

Detailed Answer:
Welcome back and hi again.

It is not a heart attack, I should say. As I mentioned earlier, given your young age, the probability that "something is wrong" is very, very low. I suggested a stress test more to exclude everything so you could be at peace. I think that there is nothing to worry about. But, let us face it, doctors are not Gods,m. That is why there are tests.

I hope to have been of help and I wish you the best.

Kind regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Meriton Siqeca (39 minutes later)
Thank you .
doctor
Answered by Dr. Meriton Siqeca (8 hours later)
Brief Answer:
Not at all

Detailed Answer:
You are welcome to ask anytime.
I hope I was helpful.

Goodbye,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
Answered by
Dr.
Dr. Meriton Siqeca

Cardiologist

Practicing since :2009

Answered : 773 Questions

premium_optimized

The User accepted the expert's answer

Share on
What causes pain in right arm and back when diagnosed with notch in v2?

Brief Answer: Nothing to worry about Detailed Answer: Hello and thank you for your question. Welcome to HCM. I understand your concern. I would recommend you not to worry about this phenomenon. You see, this may easily be an artefact, since there are no pathological phenomena related to non-specific changes in V2. V2 and V3 are problematic derivations, which in our experience are found frequently because there is no standard in placing the electrode in these positions. Even ignoring all these facts, even if we accept that this change looks like a pathological one, changes in one single derivation, not associated with at least the same changes in the adjacent derivations, are considerend non-pathological and are "ignored" (in the good way) by us. The greatest comfort to me comes when I add the fact that you are only 34 years of age and cardiac problems at this age are very rare. I would advise you, once again, not to worry about it. If this keep concerning you, undergo another EKG a week later. As for the right side pain, it probably is a positional problem you assume during sitting/working/sleeping. It will spontaneously go away and, if unbearable, try a 5-day course of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). I hope to have been helpful. I am happy to help, should you have follow-up questions. Kind regards, Dr. Meriton