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What Does Chest Pain With Abnormal ECG Results Indicate?

Posted on Thu, 26 Apr 2018

Question: I have been diagnosed with very frequent premature ventricular complex. I have had 4 ECG all borderline or abnormal with different automated messages:
1. probable anteroseptal infarct old
2. negative T wave anterior
3. minimal ST depression.

All the cardiologist that I have shown them just brushed it off and said there are no pathological Q,R,S,T waves and only abnormality is PVC. Otherwise they said ECG is normal.

I have also done 1 - 24HR HOLTER and results of this are 11,787 PVC in 24 HRS (11% of total heart beat) and the PVC is isolated and monomorphic.

I have also done 2 - echo cardiogram and these are also normal. Only ectopics are noted in the echo cardiogram.

I have also done 1 - tread mill test and this is also normal except for some PVC. No ST deviation and test is negative for inducible ischemia.

Chest X Ray and abdominal ultrasound results are also normal.

I continue to have palpitations and dull chest pains only on the left side. I also have a very brief burning sensation in the upper back for a few seconds that comes and goes and does not appear muscular in nature. These chest pains have been on and off for the past 5 months. I am also curious to know if the chest pain that I have is characteristic of cardiac pain - let me explain:

1. Chest pain is not present when sleeping - I do not notice while sleeping
2. When I exercise - pain characteristics do not change. I run about 2KMS every other day during which my heart rate monitor shows my heart beat in upper 150 and still no changes in pain.
3. The pain is dull and constant at times - sometime for the entire day
4. Only the palpitations make me think the pain is cardiac related.
5. Pain is more on left side. Nothing directly under sternum and nothing on the right side.

What is your advice? Should I follow up with a CT angiogram or do a Cardiac MRI. Is this necessary and will it provide an alternate confirmed diagnosis. I am concerned that these PVCs may be caused due to underlying cardiac problems.

How is a benign PVC identified from a malignant one?

All relevant reports are attached.

Answered by Dr. Bhanu Partap (41 minutes later)

Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello

After thoroughly studying your case history and considering your age along with a negative Traedmil Trst for inducible is chemist the possibility of having coronary artery disease is almost negligible.

Above that if you don't have habit of smoking then you are quite safe from coronary artery disease prospective.

Now as you are having frequent palpitations which are bothering you in your day to day life and also your Holter monitoring shows multiple number of VPCs, so we are left with two options

1. Medical therapy in the form of Beta Blockers
2. EP study

Now you can start with medical therapy for at least one month and see if you get benefit from that, but if that doesn't favour you or suits you then you should consult an Electrophysiologist and discuss with him regarding EPS and RFA as treatment options.

Hope to have been helpful.

Kind Regards
Dr. Bhanu Partap

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Bhanu Partap (1 hour later)

Hello doctor - thanks for the response. I am curious to know if the tests that have been done so far are enough to diagnose benign palpitations. Is there anything else that needs to be checked?

I am worried that these could be caused by some reason that is not picked up on these tests.

Answered by Dr. Bhanu Partap (1 hour later)

Brief Answer:
follow-up answer

Detailed Answer:
Hello again,
No these will be sufficient. These all are the basic cardiac tests which are needed.

If anything else is needed to make a proper diagnosis that will be an EP study only. But that too is only required if palpitations are troubling you a lot.

Hope this will answer your query. If you have any more doubts you can ask me back or else you can close the discussion and rate the answer.

Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Bhanu Partap (37 hours later)

Thanks for you response doctor. Your answer is reassuring.

Answered by Dr. Bhanu Partap (23 minutes later)

Brief Answer:
Hello again

Detailed Answer:
It's a pleasure helping you.

Kindly close the discussion and rate the answer.

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Bhanu Partap (45 hours later)

Hi Doctor - just one more quick question. I have added one more attachment to the question - TMT_HISTORICAL_Saba.pdf

This includes cover page of stress test from 2014 and more recently from 2017. I have used a red arrow to indicate PVC column. Is my understanding correct that this is the indicator of PVC's?

If yes - then these have been recorded for me on a routine medical check up in 2014 and again now in 2017. My question is there any significance to having PVC over such a long term? Should I be concerned if there is any increase in frequency over this period.

I am trying to understand if there is any significance to these from before and now?

Thanks and appreciate your time on these questions.

Answered by Dr. Bhanu Partap (1 hour later)

Brief Answer:
Hello Again

Detailed Answer:
Yes that's an indicator of VPC's.

Although the amount of VPC which you had during the TMT test is not significant. The only difference from past and now is the VPC's are occurring at rest also.

You can continue with the prescribed medicine for a month and see if it helps and if even after a month palpitations keep on bothering you then you can discuss with your treating cardiologist regarding EP study.

Kind Regards
Dr Bhanu Partap

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Nagamani Ng