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Treatment for MINOR ST DEPRESSION in EKG.

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I recently visited ER for chest pain, and 10 days prior to that a slightly abnormal EKG.

My latest 7 EKGs within a year showed normal, except one slightly abnormal (as I mentioned). I had a stress test done last week that was borderline. I am 53. My troponin last week at ER visit was 0.01. All blood tests are normal. Last year in April, I went to another ER and they monitored my heart all night, and all results were normal.
My cholesterol has varied 160-240 over the years.
I take Lipitor (40 mg once every few days).
6 EKGs normal in the last year.
1 recent EKG is abnormal = Minimal ST Depression (0.025 MV ST Depression)
Latest Blood Test (ER visit):
Troponin = 0.01
Myoglobin = 24.0
CK-MB (CK-2) = 1.1
Borderline Stress Test

Attached, all my results on heart in the last 10 years, with emphasis in the last year.
What do you recommend? How bad (if any) is my condition, you think.

Category: Cardiologist

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 22 Doctors Online

Hello,
Thank you for your query.
I understand your concerns.
I have seen all your reports being shared by you, and considering the troponin levels and the normal EKG, your heart is fine as of now. One isolated abnormal EKG can be ignored, as there can be minor electrical disturbances. ST depression is mainly because you're obese, and that causes atherosclerosis, causing ischemia. Your main goal should be to reduce weight and bring your BMI below 25. If your weight does not come down, chances of MI/ Stroke increases in the future.
Also, why do you take Lipitor once in a few days? It has to be taken regularly.
Have you consulted any cardiologist before?
Regards.


Patient replied :

Thanks so much Doctor for your kind, caring, and prompt reply, and taking careful time to look at the results: 1). Since Lipitor intake has been a lifelong thing for me, I am afraid that Liver may be damaged, and that is why I only take 40 mg every few days. 2). I have seen a cardiologist in 2005-2006. I have included his report with my previous inquiry (see Kiledjian_2005.pdf). The rest of the time I am seen by family doctor. 3). Having presented you with results, do you advise if I do strenuous exercises, like swimming, jogging? How about sex? 4). How about drinking two cups of coffee? 5). Let us hypothetically say I need angioplasty/stents, and as a result I go on healthy lifestyle, what are my chances to live a good and long life? 6). Attached, I am also sending you the results of my ER visit in April of last year (2014) complaining of tingling in neck and arms. CT scan of the head was normal. They did blood work and Troponin was 0.06 and as a result they admitted me to the Hospital for all night check. The subsequent 3 Troponin results were 0.01. And heart monitoring/blood work was normal. Please look at the results. Thanks much in advance for all your help.


Hello,
1) Lipitor has to be taken daily. It is a very commonly prescribed drug and does not damage liver like that. It damages liver more for people who are already cirrhotic or drink regularly. This has been the problem, if you took medicines daily your levels would have been normal by now. Please take it daily.
2) I have reviewed the reports you sent in support, and they are fine except for high cholesterol once again. Troponin levels are fine.
3) I won't advise strenuous exercise till your cholesterol levels are normal, and I will advise brisk walking for 30-45 minutes daily.
4) Sex can be normal.
5) You can drink 2 cups of coffee.
6) Hypothetically, if you reduce your weight, your heart is fine till now. Please work on reducing weight.
Regards.


Patient replied :

Thanks Dr. Garg so much for the detailed review and great feedback.

So between taking Lipitor of 20 mg/day, and 40 mg/day, or 80 mg/day, which is good?
Also, is 40 mg every two days equivalent to 20 mg every day?


I will advise 20 mg/ day as of now, and repeat the values in 3 months with adequate diet control.
No 40 mg every 2 days is not equivalent to 20 mg everyday.
Please follow 20 mg/ day as advised.
Regards.


Patient replied :

Few more questions if please:

1). Do you think I need to also have imaging done on my heart SOON, like EKG, or nuclear stress test, especially that I have some sternum area pain that comes and goes?
2). I am taking 1 tablet of 325 mg Aspirin a day now, should I do that for some time?
3). Does the stress test take into acount the age of a person?


Hello,
- You can repeat the ECG after 3 months, now nothing is required.
- Yes continue taking Aspirin, it prevents against terminal health events like MI/ Stroke.
- Yes stress test considers the age too.
Regards.


Dr. Hemant Kumar Garg
Category: Cardiologist
Experience: 
Post Doctorate: DM, Cardiology, Institute of Post Graduate Medical Education and Research, Kolkata, 2008
Post Graduation: MD, N.S.C.B Medical College, Jabalpur, 2004
Fellowship in Interventional Cardiology, France, 2001
Internship: N.S.C.B Medical College, Jabalpur, 2001
Medical School: M.B.B.S, N.S.C.B medical college Jabalpur, 2000.
Dr. Hemant Kumar Garg and 4 other Medical Specialists are ready to help you

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