My doctor tells me I may have a probable MI but not to worry about it

Question: 

I am a 43 y/o female, 68 in, 145 lbs. Heathy, do not smoke. Chol normal except LDL 114. HDL 52. Recently had an ECG as part of a physical and the printout read Probable Anteroseptal MI, age indeterminate. The internal medicine MD said this is a normal variation for tall, thin females. He recommends no further follow up. I do exercise 4-5 times weekly, either run or walk. Do not ever recall having chest pain. Do you agree? Or should I ask to have an echocardiogram?

Most likely your doctor used an automated machine that generates a "diagnosis". There are reasons why you might have "Q waves in V1-V3" that may include incorrect lead placement. However, it is not OK for your doctor to tell you that you have had a probable MI, but not to worry about it. He owes you an explanation!

This is what an Anteroseptal infarct looks like on EKG.

Q, QS, or qrS complexes in leads V1-V3 (V4)
Evolving ST-T changes

Fully evolved anteroseptal MI (note QS waves in V1-2, QRS complex in V3, plus ST-T wave changes)

While it is true that

  • Women may have atypical symptoms,
  • A silent MI may occur (one that didn't produce symptoms and is found incidentally)
  • An incidental EKG may show changes, consistent with an old MI

it is unlikely that any of these occurred in a woman with your background. This is what I would recommend. Ask your doctor to explain. He owes you that! Depending on what he tells you, ask for another EKG where lead placement is not an issue, get a second opinion, or get a stress ECHO,

Hope this helps,

Dr T

http://www.cardiachealth.org/

Comments

My answer to you is the same as above: your doctor owes you an explanation! I cannot judge this EKG from here, but if I were your doctor would feel reponsible to discuss all the lab results with you, and not leave you find answers on the internet!

I recently relocated to another county & requested my med. records mailed to me. During an office visit to the doc (well, I never saw a doctor, only a NP, although every med rec, rpt, tests etc. listed the referring, requesting or treating physician as a male doc I had never met, seen or heard of, to date, I have no clue who he is) I had been feeling lousy, lethargic, experienced numbness down my arms, neck & fingertips, had to sleep sitting up in chair for sometime (this probably due to the mild COPD diagnosed) I had constant insomnia & so tests were ordered. I was also prescribed some medications including High BP medication & Nitroglycerin. My BP was at Stage 2 or whichever is on the top of the scale, which certainly explained some of my anxiety. I had the lab & radiology tests completed the same day. I never saw the results of the ECG test at my f/up ov nor did the NP review it with me. She discussed the other test & findings so I assumed that was it.My ECG report listed my: Rate 86 - Normal sinus rhythm                                              PR 153  -* Probable Anteroseptal MI, age indeterminate*                                          QRSD 81 - Minimal ST elevation, inferior leadsetc. etc.....                                                                    - ABNORMAL ECG -                               PRELIMINARY - MD MUST REVIEW I had to search the web to determine what this outcome meant in patient reality & although I found thedefinitions of the medical words/terminology, I still can't grasp the results or determination of the testing. To complicate this even further for me, someone, I am assuming the "MD MUST REVIEW" person, with a writing instrument -completely lined out the entire explanation of PR 153*, initialed & wrote: "Probably WNL". I am taking random guess "WNL" means: "within normal limits"? I can't decide what is more disturbing to me at this point, the "diagnosis" as per the tech's original entry, the fact it is then basically determined to be inaccurate or ? & scratched off...or, the word "Probably" used as a final word. Is this type of non-definitive, non-committed & rather unresolved statement common terminology in the medical field? Is a medical practitioner allowed to determine such an issue to be a "probable" or "maybe" - at some point in time must there happen to be a definitive answer either way? I really am rather puzzled by the entire report - but I'm not clear as to what portion or aspect of these results I should actually be challenged by, if any - or how to interpret the evasive wording & lack of resolution (or so it seems to me). It's a shame I have to first find this out in a review of my med records, research this after the fact rather than have the medical facility staff mention the results at the appropriate time & review with me particularly with the knowledge my mother died some years earlier of congestive heart failure & 8 yrs previous she had triple bypass surgery. Perhaps you can clarify some part of it? I appreciate your time/patience in reading this. thx.

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