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Diabetic with irregular EKG and pulse. History of heart attack. Normal BP. Nuclear stress test to be done

I went to the cardiologist last week for an irregular EKG and he said it showed an old heart attack which is common in diabetics. I have been having an irregular phulse on and off and nervous feeling in my chest. That feeling has become more frequent and prevents me from falling asleep at frequently in the past week. I also get the symptoms during the day. My echo was normal and I am waiting on insurance approval for nuclear stress test. I don't know if I should be going to the ER when these symptoms start. My bp is normal at those times.
Asked On : Fri, 19 Apr 2013
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Internal Medicine Specialist 's  Response

Welcome to HCM,

You are diabetic and irregular pulse and your EKG revealed old myocardial infarct which is possible in diabetic what is called silent myocardial infarct.

This abnormality in should be investigated for cause like significant ischemia and coronary lesion.

You're Echo study was normal that is there is no regional wall motion abnormality.

Your nervousness and difficulty in sleep possibly due to anxiety.

It is right approach to get a stress test (Nuclear) if there are evidences of reversible myocardial ischemia than a coronary angiography with PTCA and stent may be required.In case it is negative medical management is to be continued,

Please take care of your diabetes and just relax once your extent of disease is investigated it can be treated.

If you have significant palpitation and any other symptom that needs immediate attention you can visit ER.

Take care

Good Luck

Answered: Fri, 19 Apr 2013
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