I have severe chest pain with ST elevation and normal P axis. Please explain.

Hello,

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Firstly, the probability of heart attack is less at this age. Now severe chest pain would usually mean a heart attack, wherein troponin would be positive and ECG (electrocardiography) is expected to show changes. As troponin remains positive for 10 to 14 days after a heart attack, it at least was not a major heart attack. You should attach your ECG tracings over here for opinion over it. Now if we go with the written ECG report, it says a likely possibility of early repolarization pattern, which is an ECG variant and not worrisome. So probably, it was not a heart attack. However, further evaluation with echo and if normal, then stress test or CT (computerized tomography) coronary angiography should be done to be sure. Now coming to symptoms, you should describe those with points like, how long did it persist, for few minutes, or seconds, or an hour, or was it intermittent persisting episodes for few seconds? Did you have any gastric symptoms or reflux symptoms? Was there any local tenderness associated with the pain or did you think it was a deep inside pain? Was it increasing on deep breathing or any fever, cough, running nose, etc? Any addiction, family history of heart disease? Now the presence of soreness afterward points toward the local musculoskeletal pain rather than deep cardiac pain. So, the possibility of noncardiac causes should also be considered like musculoskeletal pain, gastric reflux, or esophageal spasm, or pleuritic chest pain. However, a complete cardiac evaluation should also be done to be sure. I hope this helps you and get back if you have more information to share.

Hello,

Welcome back to icliniq.com.

Regarding ECG interpretation, they were not sure of diagnosis while interpreting an ECG. However, they mentioned it probably an early repolarization pattern, which is not worrisome. So, probably there was no anterior wall injury based on the ECG report. Now if we consider a negative troponin test, then you need not be concerned about it. Because with anterior wall injury, we would expect the troponin to be positive. So, unlikely to be a matter of concern. However, as I mentioned, small probability of heart issues should be ruled out with further investigations and echo also because you have a family history of premature heart disease. Now considering the pain was deep inside and there was discomfort during taking pills, the probability is of acid reflux or esophageal spasm even if there were no obvious symptoms for it. Also, you would get breathlessness and chest pain on exertion, if it was a cardiac pain. In my opinion, it is important to request them for tracing, continue to have antacids before breakfast, avoid spicy, oily food and there is no harm in continuing low dose Aspirin until further evaluation is done.