Abnormal EKG?

I was in the hospital Sunday night because I had a really, really bad panic attack (I thought it was the big one)... anyway, they ran the normal tests like blood work, EKG, CT scan, blah, blah, blah and they suggested I follow up with my general practitioner which I did today. Everything was normal at the hospital. They did another EKG in the doctor's office and it came up abnormal. The doctor didn't seem too worried and didn't do much explaining. She says it's not 100% normal but not 100% abnormal either and she thinks it's related to my anxiety. She said she didn't think it had anything to do with heart disease but then they don't have anything to compare it to since they normally don't run these tests on someone as young as me.

So I'm a little confused and worried despite her assurance that it's nothing to worry about. I don't know, should I consult a cardiologist? Has this happened to anyone else here?

The last time I had an EKG at the doctor's office I seem to remember the nurse putting the leads on completely different places on my body. The nurse did do it a couple times to see if the same reading came up.

To Nick F:

I'll be 26 in December and both my grandmother and father have had heart attacks. My father also has an arrythmia (sp?). My aunt had a hole in her heart that was fixed with surgery (can't remember the name of it..)

The EKGs were done about 4 days apart. I'm going to call my doctor's office on Tuesday to find out results from blood tests so I will try and have the nurse or doctor explain a little more to me then. At this point, I think I will schedule an appointment with a cardiologist.

Seeing new patient consults in a cardiologists office on a regular basis, from your discussion I have a strong suspicion that you fit the "worried well" catagory. Unfortunately in our ligitious society rather that TELL someone that, we are compelled to do testing to PROVE it to everybody. The thing about the tests is that they probably cover the cardiologist's rear more than the patient's.

So before you sign up for a battery of needless tests - let's review - you had suspicious symptoms and were admitted (to be cautious) to the hospital for overnight observation. All of your tests were negative. A follow up EKG was done in your GP's office and while not absolutely normal it was not abnormal either. Do you think if there was something to be concerned about, your GP would not want to investigate it further? The answer is definitely yes, of course. If there is a question then get the patient to someone who can provide an answer.

Further - let's have a reality check - the big five risk factors for heart disease are high cholesterol, high blood pressure, smoking, diabetes, strong family history for premature heart disease. At age 26 you would have to have every single risk factor to be at risk for heart disease - especially as a woman. Women's hormones provide a protective effect for coronary disease until after menopause.

Next - are you having symptoms? To heck with the test results and EKG's - what symptoms are you having? Are you having angina - chest tightness or fullness with activity and improved with rest. (Not random chest pain) This is often coupled with extreme shortness of breath with light activity.

If you are not having symptoms consistent with angina and you do not have every or nearly every risk factor on the list - save yourself the trouble and the health system a few dollars. If you do have every risk factor then there is no time like the present to stop smoking, eat a healthier diet, exercise, get decent rest, cut back or eliminate the caffiene, and generally clean up your act. The problem is that the health system has already treated you with ultra caution and I think this has fed into your anxiety. Be well, my friend.

Good luck.

Depending on your age and family history a second opinion from a cardiologist might not be a bad idea. I myself have had an abnormal EKG. Because of the fact that I was having other forms of chest pain I went ahead and had an Echocardiogram, a stress test, and a nuclear stress test. End result? My heart was fine. So an abnormal EKG doesn't necessarily mean you do in fact have a heart condition. But your peace of mind is the most important thing so if can afford to and really would prefer to have a cardiologist check you over then go ahead. And the question about the leads. How far apart were your EKGs? New lead placement protocols are put into place all the time. It also may differ from one medical center to another where they place the leads. This is actually part of the reason I discovered I had an abnormal EKG. I had been having chest pains fairly frequently and mentioned this to a couple nurses at the V.A. where I was a Clerk. They decided that it'd be a good oppurtunity to try the new lead placement and to our suprise: My abnormal EKG. Hope this helps. Good luck.

Addition:
Since you intend to return again just make sure your Doctor knows your history and ask all the questions that you want answered. If you aren't satisfied with everything then I wouldn't think that your Doctor would have a problem referring you.

I am not a doctor but I have had similar experience. I have been diagnosed with a panic disorder and I have an abnormal EKG. I have taken multiple tests to determine the cause of my inverted t-wave. I have also experienced palpitations that make me very light headed. Obviously, over the years this had brought on more anxiety in my life. Please don't jump to any conclusions as panic or anxiety problems can lead to catastrophic thinking... which can cause irregular heart patterns... which cause panic, etc... viscious cycle. I have learned that the EKG is only a basic screening of the electrical and rythymic patterns of your heart. If an abnormality is flagged it does not mean there is a problem. This test does not isolate a problem, it's only a basic screening. Problems will show up however so an abnormality is shown as a flag for further investigation to a doctor. If the doctor let you leave the hospital I would not worry at all!! Just do what you are doing and have your primary physician tell you what he/she recommends. Tell your doctor that you also are dealing with anxiety issues and have learned that your anxiety can breed in the unknown so you would appreciate a detailed explanation of their thoughts and opinion. Most likely everything is ok so I wouldn't worry. Good luck and try and get into a cognitive behavioral therapy program for your anxiety. Ask your doctor about these before attempting a medication program... or at least in combination if needed. Mention these things to your doctor and you will get some good information I'm sure. Peace be with you.

First of all EKGs can be very complicated. There are different parts of an EKG complex. The PR interval which if prolonged usually means that the patient has a 1st degree AV block. The QRS complex can be wide or narrow. If it is wide that usually means the patient has a bundle branch block. The ST segment is what is usually abnormal if the person if having a heart attack. The ST segment will be depressed or the T wave will be elevated if there is decreased blood flow to an area of the heart. You can have a "regular" irregularity which is normal for you. Everyone has occasional PVCs (premature ventricular contracts) and PACs (premature atrial contractions). This is perfectly normal. If you have an arrhythmia, such as atrial fibrillation, you would most likely have symptoms, such as shortness of breath or a rapid heart rate (130-180 beats per minute). You are young and otherwise healthy, so I would probably just check again with my family doctor first. Panic attacks can simulate a heart attack, without the damage. Some irregularity can be normal. As far as lead placement, the white lead goes on the right upper chest or shoulder blade, the black lead goes on the left upper chest or shoulder blade, the red lead goes on the left lower chest, the green lead goes on the right lower chest and the brown lead goes on the middle of the chest. The red and green leads can go on the upper thigh. These don't change.

This is a very common problem in every day practice of medicine. Some people have EKGs that are not perfect. Unfortunately, these people may have to undergo thousands of dollars worth of unnecessary tests. There are tips to avoid that in this audio piece at
http://drchander.com/differenttests.html

An ECG should not be done by untrained personnel in a GP's office, and he is not trained to read them. I would forget it. She may have put the electrodes on wrong.