Q. Does my ECG look like I have ever had a heart attack?

Answered by
Dr. Rishu
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 14, 2016 and last reviewed on: Jan 12, 2021

Hi doctor,

I am a 34 year old man. My weight is 22 stone, but I am pretty active despite my weight. I am neither easily fatigued from being active nor do I ever feel breathless other than normal. There is no history of peripheral artery disease in my family or coronary artery disease and to my knowledge; there has been no heart attack in my family or episodes of sudden cardiac death. I am a non-smoker and I do not drink alcohol.

My concern is that I suffer regularly with aches and pains in my legs, soles of feet, arms, shoulders and my chest. I do suffer costochondritis. The pain is never severe; it is more of a dull ache or a pulling sensation. If I had to rate the pain out of 10, I would say the discomfort is not more than 1 or 2 and maybe 3 at the worst. I feel that I have severe health anxiety and I do regularly check my pulse, blood oxygen and blood pressure. I have had numerous ECGs and of which, I will attach three for your reference. I have also had a coronary calcium score before 5 years, which was zero. I have had every blood test, including cardiac enzymes a number of times and my blood work is always normal except for borderline low testosterone. My cholesterol also in borderline and I am managing it through diet.

Initially, I had chest pain before six years. I had a consultation with my GP and he organized a coronary calcium score due to a dramatically elevated cholesterol level. CCS was normal and I began a treatment of Atorvastatin. There was no further issue for the next three years. Then, when I was involved in moving a disabled person from a high rise apartment and was lugging furniture and other household items up and down five flights of stairs, I felt unwell, chest discomfort and pain in the arms. Also, I felt dizzy and fast pulse. I attended A and E promptly and they performed an ECG. But, it showed nothing and cardiac enzymes were also normal. The only thing there was an inverted T-wave, which the cardiologist was not concerned with as it was only in one lead.

Two years ago, I attended A and E again with chest pain. Another ECG was performed along with a chest x-ray and all of which were normal. I was kept in overnight for routine observation and in the morning I was visited by a cardiologist. He felt that the issue was muscular and not cardiac in origin and I was subsequently sent home. Before 10 months, I attended my GP surgery to discuss my past and was told that it was a likely anxiety disorder. To settle my mind, I asked my GP to perform an ECG and the machine autogenerated a diagnosis of possible peri-infarction age undetermined. This subsequently triggered a panic episode. My GP checked it and said if I had been presented this ECG without the autogenerated diagnosis then he would say it was a perfectly normal ECG. As I asked for a second opinion, he sent my diagnosis to a cardiologist. The reply sent was I find it highly unlikely that this gentleman has ever had an MI. However, if he is still concerned, then consider a referral for stress echocardiogram.

I opted for the stress echo. When I met with the consultant cardiologist, he told me that it was not anything to worry about as everything appeared normal and was basically an anxiety based. He advised no further tests necessary and discharged me as healthy with a diagnosis of GAD. Before three months, I attended A and E with chest pain and discomfort following a stressful day. Another ECG was taken and everything was normal apart from Q waves in lead 3. A and E consultant examined ECG and reported no change from earlier ECGs. A month later, I had an ambulance call out to the home address. Two ECGs were taken in one hour difference. The first again showed inferior infarction, age undetermined and QRS duration (corrected) 491 ms. Ambulance crew said it is fine and otherwise a normal ECG. All other observations are normal with oxygen 99% and somewhat high BP. It was likely anxiety again. The second ECG showed a normal QRS duration and no other issues. I was advised to see GP for anxiety medicines

I visited my GP last month. He repeated ECG again and it was normal. He gave me Sertraline and said based on my entire history that it is definitely not a cardiac chest pain. From last month, I started a new job at the hospital. Due to shoulder pain and leg pain, I attended A and E and an ECG was performed allegedly and it did not show any of the previous Q waves from earlier ECG's and appeared completely normal. The cardiac enzymes were taken and were reported normal. The final diagnosis was anxiety. Yet, again, I attended A and E in the last month as my fitbit showed that my pulse was elevated to 159. When I rushed to A and E, my pulse was 144. On arrival at A and E, I had my BP taken 154/94 mmHg. My spo2 was 100% and pulse was 114. Another ECG was performed and the nurse informed me that everything normal except QTC. So, I was asked to repeat an ECG by the consultant there. The second one was reported to be normal. In the meantime, I had panicked and checked on the internet regarding QTc durations and learnt about sudden cardiac death due to the long QTc syndrome. The nurse very bluntly told me that it was very highly unlikely to happen to me as I had no other symptom. Again, I was just diagnosed with anxiety.

I have still been getting the pain in the back of my leg, around the sole of my foot, shoulder and a very slight ache in my jaw. Also, I feel some chest pain, but I relate this to my costochondritis. Please be aware that all the pain mentioned above is the same that I have presented with for a number of weeks or months and have attended A and E. Is it true that all this can be due to anxiety? Should I worry about QTc? Does my ECG look like I have ever had a heart attack? What could be causing the other pains? Sometimes, while taking a rest, my fitbit reports my pulse to be as low as 54 and when walking my pulse tends to be around 114 to 120 bpm. When it is around 120, I can feel my heart beat.

One thing that is new and has recently nerved me is the ability to hear my pulse most often after running up my flight of stairs from living room to bedroom. The heartbeat can be heard externally for only a few seconds, maybe 10 at the most and then settles back to normal. This incidence occurs when I am highly anxious, during pre-anxiety attacks and only when I have done something like running upstairs. Recorded pulse during this audible heart beat is usually 120, but then within 2 minutes again that will drop to normal range. In fact, I have clocked my pulse at 136 and after 30 seconds it has dropped to 96. I am just concerned about the actual audible heartbeat. Please help me.

#

Hi,

Welcome to icliniq.com.

It is good to see your detailed history for which I have asked for.

Firstly, your ECG is perfectly normal. For anything to be wrong in case of ECG, the changes should be present in at least two consecutive leads at a time. In your case whether it is a T-wave or Q, it is always there in one lead, which does not signify anything.

As your stress echo and all cardiac enzymes are normal (far superior to ECG in diagnosing a problem) you are cleared from cardiac side.

Secondly, you say that you were prescribed statins (Atorvastatin). One of the most common side effects of statins is myalgia (pain in a muscle or group of muscles).

The generalized body ache and dull aching in nature is a characteristic feature of myalgia. I request you to consult your doctor and immediately stop Atorvastatin. Also, get your liver function test done.

  • Kindly ask your doctor to shift you either on Niacin or Fenofibrate if you are intolerant to statin.
  • ECG is always interpreted by a doctor. The machine most of the times provide us with artifacts. Do not worry; your ECG is perfectly alright.
  • From your history, you have severe anxiety levels and attacks called panic attacks. Every attack of panic disorder presents with same symptoms as you have mentioned.
  • I can feel that you are obsessed by the thought that you are having any sort of a cardiac ailment. Try to overcome your obsession.
  • If you smoke or drink, then stop it. Try meditation for at least 30 minutes a day and do regular exercise.
  • I suggest tablet Paroxetine 12.5 mg once daily for 21 days and tablet Clonazepam 0.5 mg once daily for 21 days for anxiety. Consult your doctor, discuss with him or her and take the medicine with consent.

The Probable causes:

1. Myalgia induced by statins.
2. Panic disorders.
3. Obsession induced anxiety.

Investigations to be done:

Liver function test.

Regarding follow up:

For further information consult a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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