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DIABETIC, past CVA with abnormal ECG. MYOCARDIAL INFARCTION?

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Hi,my mother is 68 years old patientold.She is diabetic,HTN and has suffered from CVA brain around 4 years old patientback.She is on medicines (Atorva, Ecosprin, Seloken XL 50, Nicardia R 20, Gluformin XL500 AND half diamicron XR30)
Today morning she suddenly woke up in the morning with sweating which went after 5 minutes.She was under stress for something.Today in the afternoon we went to the doctor and we have done ecg which showed probably Myocardial Infarction (Reports attached) but doctor said ecg is ok and he ordered trop I test also which came up as negative (0.01) and then he said we should continue the medication and there is nothing to worry.please check the ecg and please tell whether this is normal or not and if it is normal then why it has shown as Probably Myocardial infarction. PLEASE REPLY AS FAST AS POSSIBLE

Category: Cardiologist

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Category: Cardiologist
 31 Doctors Online

Hello,
Thank you for your query at DoctorSpring.Com

The ECG at present doesn't show any major abnormality. There is slight ST segment elevation less than 0.5 mm in leads 2 3 and avf . However it may be just a minor artefact. Or minor electrical abnormalities. The pain of myocardial infarction doesn't disappear in 5 minutes.

Trop I is negative. However done within 6 hours of chest pain it can be negative. So whereas I feel that the chest pain may not have been a myocardial infarction you could still get a repeat ecg done along with a repeat trop I done.
If both are again normal then it is not a myocardial infarction.
Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

Sir,thanks for replying back so early.However I would like to clarify few points. There was no chest pain and there was only sweating 2) This episode occurred at5 am in the morning and we did Trop I at 3:10pm in the afternoon 3)I will do ecg and trop I again 2mrw as per your suggestions and will send you the report. Also,request you to please let me know why ecg interpreted it wrong


Hello,

If there is no chest pain it becomes more unlikely that it is a MI.
The machine may interpret mild defects as pathological. Human diagnosis and interpretation is more important.

Trop I after so long is good enough
I don't think its a mi
Still you could repeat these tests tomorrow and let me know,
Regards
Dr Vivek Mahajan


Patient replied :

Sir,we have done ecg and trop t tests today.The trop T came as negative and ecg has been attached for your reference. Please revert accordingly.Also,her sugar levels were around 60 and doctor suggested that the episode could have been due to low sugar.


Hello,
The repeat ecg doesn't show any fresh changes. So it is not a myocardial infarction. As your doctor says it could very well be hypoglycaemia. So good news it is not a heart attack. You could get a treadmill test done after 2 days to be sure that she has not got any coronary artery disease
Regards
Dr Vivek Mahajan


Patient replied :

Thanks Sir ....Stress test at her age....is it ok..or do we have any other option


Hello,
Stress test is possible at 68 years old patientage. only issues that may come are knee pain which may prevent her from walking fast.
other tests are dobutamine stress test or coronary angiography. alternatively if she never had pain you could just manage her with medicines and that is quite ok for her.

Regards
Dr Vivek Mahajan
DM Cardiology Fellow (PGIMER)
MD Medicine (AIIMS)


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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