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What does EKG showing interior infarct indicate?

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Posted on Fri, 25 Jul 2014
Question: I was hospitalized in early April for high BP and high blood glucose. I am just now finding out that my EKG run continuously in the hospital revealed that I have had an interior infarc. What are the medical implications of this and what are the treatments? I am 63 years old, 5'3", 200 lbs. NOW, my BP is approximately 140/70 with meds and A1c was 7.0 (down from 14.2 in the hospital).

Thank you..
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Answered by Dr. Sukhvinder Singh (2 hours later)
Brief Answer:
please see below.

Detailed Answer:
Dear sir
The implications of inferior infarct now depends upon your symptoms, pumping of heart and risk factors. Please upload your latest ECHO report. Enlist your symptoms and any risk factors like diabetes, high blood pressure, smoking, obesity and family history of heart attack.
Treatment options will depend upon above information. This may include medicines, life style modification and coronary intervention.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Sukhvinder Singh (2 hours later)
As previously stated...63 year old FEMALE, 5'3" 200 lbs.....Type 2 diabetic...insulin dependent. Hosptalized for high A1c....14.2....High BP (220/120),,,severe migraines. IN hospital for one week with continuous EKG. CAT scan, MRI, and MRA done...no Tumors or bleeds. Both BP and A1c now normal with meds, but migraines persist. Was scheduled for a colonoscopy, but GI doc canceled because he saw the hospital report that indicated that the EKG indicated an interior infarc....no one had said anything about it until now. What is prognosis and treatment from here? Family practice doc said nothing about it. I am waiting for a referral to a caridiologist...
doctor
Answered by Dr. Sukhvinder Singh (7 hours later)
Brief Answer:
please see details.

Detailed Answer:
Respected Madam,

First of all I apologize for addressing you as sir in my first answer. It was an inadvertent mistake. I apologize that you have to repeat a part of your question again, but that was just to enumerate all the risk factors for coronary artery disease.

There can be two possibilities in such a scenario. One is that the computerized EKG reported that there was an infarct (heart attack) and indeed there was a heart attack but was somehow missed. Second possibility is that there was no heart attack only computerized EKG reported it (which is many a times incorrect).

In this context, I suggest three sets of action which you can plan accordingly:
1. We need to confirm that you had an attack. If there is a history of prolonged chest discomfort (especially heaviness of chest), lasting from more than 5 minutes to few hours, especially associated with sweating/ nausea/ vomiting/ breathlessness, it favors true infarct. Its absence, does not rule out the same. Currently if you have chest discomfort or heaviness on running/ using stairs/ brisk walk, it again indicates likely presence of anginal heart disease.

2. Second, Your physician may tell looking at EKG that changes are likely to be true or false.

3. Third he may get an ECHO done to look for presence of evidence of infarct. That is best possible thing.
After this much of work-up, if the infarct is proven and you have angina on exertion or moderate to severe loss of pumping of heart, you may be subjected to coronary angiogram.
If there is no definite angina or equivalent, and loss of pumping is mild, you may be subjected to stress testing. The result of stress testing will guide future management.

By now, you must have got it that we are at very beginning of work-up of your cardiac condition. Prognosis will depend upon what we get out of this work-up. If you have no chest pain, I would suggest you try the second plan of action, that is ask your physician to look at the EKG.

From treatment point of view, you need to be on statins, anti-platelets, anti-hypertensives and if you have angina on exertion, some anti-anginals and beta-blockers. You must control your diabetes and high blood pressure meticulously.

You definitely need to lose weight under supervision.

Hope this provides you some insight. Please feel free to discuss further. I will be glad to elaborate more on issue.
sincerely
Sukhvinder

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sukhvinder Singh (5 hours later)
Thank you very much!

Yes, this helps tremendously.

I have been on Lipotor for quite some time and cholesterol is up and down, but marginally, ok, but could be better. BP now OK...140/70 this AM, blood glucose 76 this AM. I am on numerous blood pressure meds including a beta blocker. I have absolutely no chest pain and was shocked when I was told about the interior infarct; however, I seem to have a lot of difficulty keeping stringent BP control even on meds....daily BP seems to fluctuate quite a bit. As far as the weight is concerned, I have tried every diet on the face of the earth with little success. After the hospital, I had severe diarehra for 2 months and was barely eating 300-500 calories/day because everything precipitated runny bowels. I still lost no weight. Now, I am trying to eat basically a Paleo diet with more fish than meat. I am eating very few high glycemic index carbs and try to abide by the 90/10 rule (90% compliance, 10% freedom from the diet). I have been so sick since the hospital that exercising is not possible, but my normally preferred exercise is swimming.

Again, thank you for this detailed reply. This is what I was looking for and needed to know...
doctor
Answered by Dr. Sukhvinder Singh (1 hour later)
Brief Answer:
please see below

Detailed Answer:
Respected Madam
Still, the best bet would be opinion of a seasoned cardiologist and ECHO to rule out an infarct.
All diabetics should receive lipitor like drugs throughout life.
Yes, diabetics do have problems in BP control and ACE inhibitors are best option, if not contraindicated and well tolerated.
Try to resume swimming after your cardiologist consultation & clearance.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sukhvinder Singh (1 hour later)
Thank you very much.

Yes, I am awaiting the referral to the cardiologist. I was just very frightened about this information and wanted an immediate opinion. Knowledge is power! This was a quite serious bit of information and I was concerned that I was not told about it immediately so action could have been taken right away. I appreciate your thorough response...
doctor
Answered by Dr. Sukhvinder Singh (5 hours later)
Brief Answer:
Welcome Madam

Detailed Answer:
Respected madam
You are welcome.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sukhvinder Singh

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What does EKG showing interior infarct indicate?

Brief Answer: please see below. Detailed Answer: Dear sir The implications of inferior infarct now depends upon your symptoms, pumping of heart and risk factors. Please upload your latest ECHO report. Enlist your symptoms and any risk factors like diabetes, high blood pressure, smoking, obesity and family history of heart attack. Treatment options will depend upon above information. This may include medicines, life style modification and coronary intervention. Sincerely Sukhvinder