A mentally retarded woman has ACS. Kindly explain her ECG.

Hello doctor,

I try to help a mentally limited woman of 36 with ACS complaint from which the ECG is not clear. I have a photograph of her ECG. It seems inferior wall ischemia or NSTEMI. I tried to get her examined, but difficult to explain to her. Can you please help in reading the ECG?

Thank you doctor,

Your answer is very useful. Can you tell me some more, please?

Summary:

A 36-year-old woman, awaking at night with chest pain, pressure and fullness on the left side from the belly up to shoulders and left arm with tingling. It got repeated in the afternoon, so went to the ER, where this ECG is from.

Lateral and inferior ischemia can be seen in this. There are R losses, R reductions, QT widenings, ST deviations, high declines, invertive T waves, biphasic T waves, hyperacute T waves, elevation II and aVF in this ECG.

You wrote lateral and inferior seeming two separated areas affected, or one bigger or smaller on the border of lateral and inferior? What does this indicate in the sense of broader or double ACS incident? Also, the complaint is coming in the night and afternoon. Further examination is needed of course but I do not succeed to convince the woman to do so. I try to help this mentally limited woman.

Thank you doctor,

The only question left is blood clot, narrowing or spasm. Her mental state could cause spasm, so I must be careful. Anyway, thanks again I have to solve it from here. She was not taken to the hospital, I think they considered spasm. Over one hour on the monitor at home they left saying stress. Please get back to me if you agree that this is the total picture.

Hi doctor,

Could you please go over the ECG (photo attached in the above query) once again to see that we did not overlook anything and summarize what is implies. The complaints are waking up in the night with chest pain only left side with pressure and tingling from belly upto shoulder and left arm. It happened again in the afternoon, which ended up calling ambulance and this is where the ECG is from. There are R losses, R reductions, QT widenings, ST deviations, high declines, inverted T waves, biphasic T waves, hyperacute T waves, elevation II and aVF, as goog as I know in this ECG. I think you were right that the lateral area is affected too but small.

Please summarize implications after the extra check of the ECG please, not how to treat as you did that already, unless you want to add something of course. Can you indicate the seriousness? I have to make decision to put her under stress of treatment being mentally limited which stress also affects loosening bloodcloths or cause spams. Thank you.

Dear dr., Thanks again. I come to write all this to You because nothing is done uptill now. 2nd October 2019 ambulance people stayed one hour and a half (!?) having her on Corpuls3 monitor where ECG is from. Advice; referred to homephysician leaving note and cardiogram only description complaints on note, but she did not take anything with her to the home physician, who listened to her heart and took bloodpressure, said nothing. So I could get the cardiogram and sended this to her homephysician with description what happened. Homephysician called her and put message on her voicemail and she did not react to that. So uptill now she is not aware it is a heart attack though she thought that and let her mother call ambulance which arrived by priority. I asked some people also professor Ken Grauer ecg specialist who stated "Worrisome ecg" and further people I asked stated one cannot leave a woman with an ecg like that at home. And warnings from people to do things, but they don't now her mental state, I told YOU about her mental state. THAT IS WHY I ASKED YOU THOROUGHLY WHAT YOU CAN SEE IN IT. So I have to challenge her mental condition to put her from the relaxing idea "Everything is alright, no heart infarctation or heart attack" to "Goodness there is something with my heart" and the physical affect of that on plaque and more. But if I understand You there is too much in the ecg to choose for relax and do nothing. It is really a problem to use a big understatement to deal with this for her. What You think? (I understand that You see the same as I above here and still can see the ECG here?). Maybe I can support THE PSYCHOLOGICAL PICTURE by a photo of her, Biblical system to ask a question (Biblical oracle) gives the same answers, BUT I HAVE A MATTER TO TRUST MY INTERPRETATION OF THE BIBLICAL ORACLE ANSWER.

Dear dr., THANKS FOR YOUR GOOD WORK. I need to convince her to do things and the homephysician calls her and she does'nt call back after his voicemail to her. Could You please summarize that treatment is needed and why (the implications You see in the ECG and complaints, I will explane what ischemia and NSTEMI etc. is) and if treated prevents problems. Also please don't weaken things then she will not do anything. I can copy this text and show her if You allow. (Maybe address text to Ilona). THANK YOU SO MUCH for things uptill now, I have to save this woman... Greetings regards Hans Michael, BLESS YOU.

Dear dr., I don't have much progress with my friend to take action. Maybe I need her to contact You, would You agree to answer her? She is limited but not stupid. So if you agree tell me. Is it so that message below means that I give her this link and through HER telephone she uses the link and ends up with You?? So please tell me if You agree and then how to reach You via the link. I wrote back to iClinic to first ask You what You agree to. *!* She may respond to medicine so scaring her off with bypass etc. I would avoid but at the same time not weaken necessaty please. I told her already about NSTEMI so no need to avoid that; we need her to convince too and we cannot weaken things so that she does'nt go forth. THANK YOU FOR EVERYTHING UPTILL NOW!!! BLESS YOU. I received this link in a message from iClinic; Hello Hans Michael Chi, ​ Please click on the below link to chat with the doctor unlimited for the next 100 hours ​ -> https://www.icliniq.com/ask-a-doctor-online/icq100 Thanks & Regards, Team - iCliniq On Wed, 19 Feb at 9:22 AM , Hans Michael Chi wrote: Hello iCliniq, Below is an enquiry posted by a visitor from your website (http://www.icliniq.com) Name: Hans Michael Chi E-mail: blessyouchn@getblessed.cn Phone: +31-0614140115 Message "Dear, I want a friend to chat with a doctor. How do I pay You for her so that she can chat? Greetings Hans Michael Chi" -- This is a website notification sent from your website (http://www.icliniq.com).

Dear dr., I hope she uses the link. There are suggestions of heartfailure also since long (before attack October 2nd) because of dizziness stays at home at certain days because doesn't dare to go out being dizzy. Also the shortness of breath "I really need a house streetlevel" she says. "I almost cannot stand on my legs if I am upstairs third floor and first level with bag too". Heartpalpitations "Scary that was" she says, happened I don't know how often. To pee often even every hour sometimes. SHE DOES NOT TELL EVERYTHING AT FIRST, LATER I DISCOVER MORE COMPLAINTS. Fatigue, quickly heartpalpitations because of something. Well you are informed. So only leave out that CABG could be necessary but don't weaken necessaty to go to doctor. I don't underestimate Your diplomacy but it is to inform You about her mental state. Regards and esteem, Hans Michael Chi.

Dear dr., I sended an email to iCliniq if they could remove 'retarded', she is mentally limited but not retarded. She may read all this and the use of Your link will get spoiled and I cannot get the help for her. Greetings and THANKS AGAIN for everything, bless You, Hans Michael Chi.

Dear dr., Something keeps lingering on my mind, how are You so sure that she had an NSTEMI? You wrote "i will definitely commit and say that this lady has suffered an NSTEMI". The complaints always vary from person to person. Repeating her acute complaints; She awoke at night with chestpain and fullness/stiffness left side chest from belly/hip uptill shoulder + tingling/stinging , and left arm so and dizzy, calling ambulance in afternoon. They kept her +/_ 75 minutes on monitor and left with leaving form with complaints and ecg for homephysician. Complaints lasted still for some time after they left. The day after tomorrow April 2nd she goes to hospital for exam. But please tell me what You made sure about NSTEMI. Greetings and esteem, Hans Michael Chi. THANKS again for things.

Dear dr., Complaints vary, there are even infarctions without pain. So as I understand it is that the ECG deviations go further than only ischemia. Ken Grauer EKG specialist writer of more than 40 books wrote a.o. to me "There is a lot of ST-T wave depression. This is most marked in leads V3, V4, V5 with the T wave being surprisingly tall in these leads = look HYPERACUTE". Rest of the 5 cardiologists/ECG specialists say the same as You. A.o.; irresponsible to leave a woman with a cardiogram like this at home. Only You are CERTAIN that it is NSTEMI. The answers in my Biblical answer where I prayed for say that too. But I have to support arguments for cardiologist-visit here. She did not go yesterday so I have work to do to get her there. So please tell me do I understand correctly that the ischemic changes I mentioned above and which You of course also see, ARE MORE THAN ONLY ISCHEMIA, because of the bigger deviation and/or counted together? So; because of that the deviations are bigger or because of putting them together or both? So please elucidate details because I have problems convincing also her mother who needs to help getting her with the cardiologist. So thanks again so far and bless You, greetings and esteem, Hans Michael.

Dear dr., Hereby I send You a new cardiogram what is made of her. It is totaly different from the old one of October 2nd 2019 what You have here on top. What You think of it. I see upsloping J-S en very tall T waves also which I associate with the problem she may still have. In V2 and V3 lifted start of the T. S-T elevation actually. Also we can think about the enormous difference of this ECG with the old. So the interpretation of the old is right and the same as others I asked like I told You, BUT WHAT HAVE WE LEFT YOU THINK??? She has chestpain too, also influenced by excitement. On top of the lot of heart failure alike complaints. But let's see first what You say about her ECG compaired with the old ECG. Hope all well with You there where You live and best wishes for You and Yours in this crazy time.

Dear dr., THANKS for Your thorough reply. I thought also about what You write the overall normal but... I associated V2, V3, V4 with something still and also it could represent old infarction, see uploaded image of signs of infarction, first figure is same as with her in V2, V3, V4. So my idea is that in her case it could be left over from 2nd October where old ECG is from where You decided NSTEMI. Professor Ken Grauer which I mentioned to You before as one of those I asked said the T waves are surprisingly tall there in(hyperacute) the old ECG and now they are even much bigger and shaped like I described and You can see. So comparing old and new ECG we may say something next, and about these T's? Greetings and esteem, Hans Michael Chi.

Dear dr., Sorry to keep You occupied with this but I DO see bigger Q's in her ECG than in the FIRST snapshot on the image. And taller they are in hers than in the snapshot. So that is why I thought about old infarction sign. Maybe You misunderstood my question and comparing. Hope You can help me out, sorry. Greetings, Hans Michael.

Dear dr., Thank You again for everything! I just have to help this woman! Considdering her difficult psychological condition I have to put her through tests which are not 100% also considdering the difficulties in women diagnoses. Also if they see a slight hypertrophy because of the scoliosis then we scare her with "overdiagnosis". So what You think about an exhaustive bloodexam, respected doctor? I have this opportunity; https://www.prescan.nl/onderzoeken/hart-en-vaten-extra , just push the translationbutton on Your computer to translate the Dutch language. Can You please elucidate the benefit of this exam -if You agree to do this- and add what You considder necessary, because I have to convince HER. And if this or other (blood)test gives info about PRESENT plaque. In the next message I have some questions about her ECG I think to see some things left. But I don't want to put You at too much work at one time. Greetings and esteem, Hans Michael Chi.

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Dear doctor, Yes of course You are busy. She still has high-chestpain + high chestpain influenced by excitement and the heartfailurecomplaints indeed. I HAVE A BETTER PHOTO HERE. Doctor Makode is only saying that the ECG is, better, in the sense of ischemic changes. He is not so positive about the ECG as You. The marks in the ECG I think to see; slight depression in I elevated J-point in III upsloping depression in aVL elevated and upsloping J-S-T in V2 and V3 slight depression in V5 elevated J in aVR elevation in II and aVF elevation in II and III at photo 29d also little peaks and little depressions on a lot places, 'double T tops' not only horozontal line on T's also for example, in photo 29d. The T's and the Q's we talked about already. Could You please specify what a 48 hour holter can tell, I have an address where I can let her do that. She met a terrible cardiologist who did not listen to or do anything, not one thing, only looked at this ECG and said ECG = alright. And he had the old ECG too! And knew the heartfailure complaints, the chestpain. Reviews about him include for example one year and a half al sorts of examinations and always "No deviations" and that person goes to Turkey on vacantion and got the idea to go to doctor there to see what they say there and two heartvalves were far from good they saw immediatly, they take that report back to here where they choose other hospital which fixed it! SO YOU SEE I HAVE TO STRUGGLE THROUGH THIS ON MY DECISIONS IN THE END! WE HAD THE BLESSING THAT THE HOMEPHYSICIAN WAS WILLING TO ORDER ECG, THIS CARDIOLOGIST I MENTION ABOVE DID NOT WANT TO GIVE ANYTHING, AND THE PLACE WHERE THIS WAS DONE GAVE IT TO HER, SHE ASKED, BUT NOW WE ARE WAITING AND WAITING FOR ECHO AND ANSWER FOR CONCLUSIONS ECG THE HOMEPHYSICIAN PROMISED ABOUT BUT NOTHING YET. Hope work and pray to get solution for this. ANYWAY BLESS YOU FOR THE HELP! Greetings Hans Michael, You take care too! Bless You and Yours.

Dear dr., You left out coronary-angiogram in Your message above like this; Investigations to be done: Echocardiogram Probable diagnosis: Ischemic heart disease Treatment plan: Antiplatets and statins , antianginals Could You please explane as good as possible why not necessary? Apart from rather not putting her through this with her psychological condition I have to evaluate from Your very valued arguments if to do or not. Greeetings and esteem, Hans Michael.

Dear doctor, Hereby I send You the echocardiogram of Ilona. https://wetransfer.com/downloads/1b30748949332a1574068e4425db860b20200716155306/2044028699b6333a6b46cdbcda46870720200716155348/cf7b43 Greetings and esteem, Hans Michael Chi.

Dear doctor, How do I send You the link if this site does change the link because I checked the link and it is good, only this site ads things to it which are originally not in it. Costs are no problem, so tell me how. Greetings.

Dear dr. De doctor does not want to give that Ilona only got the cd-rom where the link is from from the centre where they did the echocardiogram. The section 'report' is blanc on the cd-rom. Like the centre gave the ECG, doctor did not give ECG or data ECG. So I copied cd-rom to have two for safety and put it on wetransfer. THE LINK IS RIGHT, UNSCRAMBLED, IN THE EMAIL TO support@iclinicsupport.freshdesk.com. So the possibility we have left is what they emailed me, see below, that they indeed PLEASE want to give that to You. COSTS ARE NO PROBLEM IF YOU HAVE TO LOOK LONGER TO THE CD_ROM TELL ME THE COSTS! (+/_ 20 minutes). They write below here that they give You the link, but uptill now I understand they did not, so what we do? do I type out the link in writing like this -eight-zero-one-six-two etc. etc.??? Message where the link is unscrambled in ORIGINAL below here; Dear dr. It is hopeless, I keep getting this and cannot log in on that link to get the echocardiogram to You; Re: Support Ticket: Dear,=0D=0AI cannot upload an echocardiogramfile for dr. Vivek Pillai, he answered to me to ask You.=0D=0ATh Contactfoto Afzender icliniqAdd contact Datum Vandaag 01:15 Berichtinhoud Hi Hans Michael Chi, ​ You are trying to post a new query. Kindly follow-up the same doctor. Ticket: https://icliniqsupport.freshdesk.com/helpdesk/tickets/13136 Thanks & Regards, Team - iCliniq On Fri, 17 Jul at 3:49 AM , Hans Michael Chi wrote: Dear, If I log in on Your site there is no problem. If I log in on Your link there is mentioned; Login to the support portal Enter the details below The email and password you entered does not match Remember me on this computer Forgot your password? icliniq schreef op 2020-07-16 23:56: Hi Hans Michael Chi, ​ We forward your link to the doctor. Kindly post your follow-up query to the doctor for the doctor answer. Ticket: https://icliniqsupport.freshdesk.com/helpdesk/tickets/13136 Thanks & Regards, Team - iCliniq On Fri, 17 Jul at 2:16 AM , Hans Michael Chi wrote: Dear, I meant that I cannot post the link on my page for dr Pillai because it changes if I put it in, so that dr. Pillai cannot reach wetransfer via the link. My page with You; https://www.icliniq.com/query/view/id/1871207?utm_campaign=answered_email&utm_source=1871207 Regards Hans Michael Chi. icliniq schreef op 2020-07-16 22:03: Hi Hans Michael Chi, ​ You can post the link with your query to the doctor. Ticket: https://icliniqsupport.freshdesk.com/helpdesk/tickets/13136 Thanks & Regards, Team - iCliniq On Fri, 17 Jul at 1:06 AM , Hans Michael Chi wrote: Hello iCliniq, Below is an enquiry posted by a visitor from your website (http://www.icliniq.com) Name: Hans Michael Chi E-mail: blessyouchn@getblessed.cn Phone: +31-0614140115 Message "Dear, I cannot upload an echocardiogramfile for dr. Vivek Pillai, he answered to me to ask You. The file; https://wetransfer.com/downloads/1b30748949332a1574068e4425db860b20200716155306/2044028699b6333a6b46cdbcda46870720200716155348/cf7b43 Thank You, regards, Hans Michael Chi." -- This is a website notification sent from your website (http://www.icliniq.com). 13136:823475 13136:823475 13136:823475

Dear dr., Being where we are now what You think to do? Stress echo, stress ECG, wearing holter and say to her to hit the stairs several times and run on the street till it is too much, angiography, or what? For these we need uptill now -as I told You- uncooperative doctor, holter we can order for ourselfs here. What about her complaints? So tell me Your respected view. Greetings, Hans Michael.

Dear dr., If I cannot persuade for a stress ECG, before they do this they have crazy conditions, don't You think that a 48 hour holter and see that she hits the stairs is an alternative? See if there are ECG changes. Greetings, Hans Michael.

Dear dr., How are You and Yours. Here rather good with the virus. Ilona went to the stress ECG I will send You the stress ECG as soon as I have it. It is already made on 17-9-2020, I already have the rest ECG hereby what they made before the stress ECG on 17-9-2020. If You look at II and III on the photo "Scan" BELOW in the photo, I have my doubts, and please look at the rest of this ECG and also please compare with the ECG before this above (not the first) and also to see the difference in II and III. She had chestpain with pressure again few days ago. Also when she gasps it is with very short inhale-exhale very quickly instead of gasping deeper. And still the dizziness on the stairs too. The rest You know what I wrote above here. Greetings and respect, Hans Michael Chi.