Abnormal ECG - Septal Infarct Age Undetermined

[MikeO]

Had a abnormal ECG with my latest trip to the ER (Septal Infarct Age Undetermined) does bother me a bit. This is not the first time i have seen this on an ECG (twice in 2019). Back in 2019 i had an uptick in syncope episodes as well as pre-syncope events. In between 2020 and just now the 3 ECG's i had were normal.

I know that the ECG machines can produce false positives but the ECG's are always human read as well so i would think they could pick out if the lead placement was incorrect and note that on the report.

I am just wondering if i might just stressing the heart during my events a bit and subsequently clears up?

Just wondering if anyone else has had off and on abnormal ECGs like this or has any other input.

My care team is aware of the ECG report and i am sure there would be more action taken if it was needed. In the meantime just seeing what anyone else thinks while i wait to hear from my team next week. 

 

 

[Nelson G.]

From what I read if such thing appears in a ECG, a second one must be done to ensure it was placed the right way,  did you got a second one?

[MikeO]

1 hour ago, Nelson G. said:

From what I read if such thing appears in a ECG, a second one must be done to ensure it was placed the right way,  did you got a second one?

No. I did read that the same thing. First two times i was urged to discuss with cardiology and was picked up by the ECG machine. but no second test to see if it was a false positive.

This time in the ER the attending Doc said the ECG looked good (so it was not picked up by the machine?) but again the data is human read and came back as (Septal Infarct Age Undetermined). 

[Pistol]

@MikeO - I worked many, many years as a cardiology nurse before POTS, and I used to interpret telemetry monitors and EKG's. It happened more often than I can even recall that the EKG machine would state something serious ( usually old MI's ), but what actually was going on was nothing at all worth mentioning. An EKG - as you know - picks up the electrical current through the heart muscle. If there is an MI that means a part of the muscle has died, so there will not be electricity going through the dead muscle. That shows on an EKG as a certain wave pattern in certain leads ( Each lead shows a different part of the heart, a different angle of the heart muscle ). So, for example, if you have an inverted T-wave in a certain lead that could mean that there is dead muscle. But - in my case - I have an inverted T-wave in EVERY EKG, in the same lead. So my EKG's often interpret this as an MI, but in reality the cardiologist will compare it with old EKG's and see that this is normal for me. 

Another scenario is that there may be an abnormality in the EKG that is ( possibly due to lead placement ) very obvious and recognizable to the interpreter but can prompt the machine to declare an MI. In both scenarios the doctor will know that there is nothing wrong and does not necessarily have to do another EKG. IF there is any chance of the MI prediction being true then further action would be taken. 

Did you have the EKG done when you were in the ER for your head injury? If so - the ER doctor, who is certainly well experienced in interpreting EKG's - would have most likely done at least cardiac enzymes to see if you are having an MI at that time. I also have seen patients that had changes in their EKG's that showed OLD Mi's and in those cases the doctor often does nothing or may order a stresstest, depending on the patients symptoms. 

I understand your concerns, and they are valid concerns. However - if I were in your shoes I would address your worries with either your PCP or your cardiologist. You can call their office and tell them, they should have received a report from the ER. They will either do another EKG ( even just to ease your fear ) or tell you not to worry. 

I think you are OK, I am sure that the ER doc would have taken the necessary action of the EKG showed a real problem. 

[MikeO]

4 hours ago, Pistol said:

It happened more often than I can even recall that the EKG machine would state something serious ( usually old MI's ), but what actually was going on was nothing at all worth mentioning

I have to admit the first time i saw an old MI show up on a ECG i did panic a bit (like more than a bit) It's good to know that false positives happen more frequently than one would expect. Do you know if the septal leads are V1 and V2?

4 hours ago, Pistol said:

I also have seen patients that had changes in their EKG's that showed OLD Mi's and in those cases the doctor often does nothing or may order a stresstest, depending on the patients symptoms.

I know my current Cardiologist has struggled trying to determine the current health of my heart ( I think all is well ) even with the last stress test it took the head of Cardiology teaching at UWM and one other Cardiologist to come up with a Promising result. I have given my previous Cardiologist a run for his money as well when trying to access my stress tests.

 

4 hours ago, Pistol said:

if I were in your shoes I would address your worries with either your PCP or your cardiologist

They were notified of the recent ER visit so i am sure all is good.     

[deborah c wilkin]

I have had same " Septal-Infarct- age unknown', "Abnormal ECG", then, going back to ER few days later had the "Septal Infarct- Resolved", "Borderline ECG". 3 Years later the exact thing happened, again. Devastating cardiac diagnoses, followed each.

There was nothing wrong with my heart before the first infarct. I wasn't told about either and no second ECG were done nor other testing recommended, and I was assured "Nothing" was wrong with me. When I had first, I was 55 with no health problems, and went to ER for blunt chest injury (subsequently, on 3rd visit, a CT discovered 3 broken ribs in posterior chest. 

When I had second experience with "Septal-Infarct- age unknown', "Abnormal ECG",-  I went to ER by ambulance, with hyperventilation upon waking, and SVT's and AF. I was subsequently referred to Cardiologist only because ambulance staff insisted ER MD acknowledge the SVT- I was in, when the EMS got to my home.

One month after first, I had Echo which discovered LVS (stenosis), Stage 2, followed by "Essential Hypertension" a few days to a weeks later.  I had sought out an Cardiologist on my own, and he recommended an ECHO based on "my concern" over ER records showing infarct (and complimentary- lung pathology). 

One month after second, "Septal-Infarct- age unknown" &, "Abnormal ECG", I had second Echo, and had mysteriously developed Right Atrium Enlargement and Pulmonary Hypertension, to go along with LVS.   

There are no hidden medical facts I'm leaving out, this is my story and now I am 68 and in CHF with PH.  I no longer trust medical diagnoses or advice. Now, I follow up by getting all my medical records (and discs for MRI/CT/Echo's), including nurses notes and do my own research.

[deborah c wilkin]

One must get all their reports, learn to read ECG and question everything until you get reply. I'm afraid we are in charge of our own health, my story and those of many others is eerily similar and alarming.

[deborah c wilkin]

On 1/9/2022 at 6:24 AM, MikeO said:

I have to admit the first time i saw an old MI show up on a ECG i did panic a bit (like more than a bit) It's good to know that false positives happen more frequently than one would expect. Do you know if the septal leads are V1 and V2?

I know my current Cardiologist has struggled trying to determine the current health of my heart ( I think all is well ) even with the last stress test it took the head of Cardiology teaching at UWM and one other Cardiologist to come up with a Promising result. I have given my previous Cardiologist a run for his money as well when trying to access my stress tests.

 

They were notified of the recent ER visit so i am sure all is good.     

NO, NO, PLEASE do not think all is good, all could be very wrong and you are not being told for some reason. i am waiting to see my new cardiologist and am taking my 2-ER "Septic Infarcts" that preceded symptom development- I will be getting a precise explanation and i will let you know.  i now have CHF and right Atrium-something, leaky valves, descending aorta "unable to be be visualized" and more. the new dx of CHF & Pulmonary Hypertension, followed second, "Essential Hypertension" followed first.

[MikeO]

23 minutes ago, deborah c wilkin said:

NO, NO, PLEASE do not think all is good, all could be very wrong and you are not being told for some reason. i am waiting to see my new cardiologist and am taking my 2-ER "Septic Infarcts" that preceded symptom development- I will be getting a precise explanation and i will let you know.  i now have CHF and right Atrium-something, leaky valves, descending aorta "unable to be be visualized" and more. the new dx of CHF & Pulmonary Hypertension, followed second, "Essential Hypertension" followed first.

Please follow up. I would be interested as to the explanation. Since i posted on this my team is sure that the leads were misplaced causing the false reading. I really have not had any symptoms since being put on Ranolazine and my last stay at the hospital in madison the EKG was good and all the strips that were taking during my stay were stellar.

I think what is consistent is that my local providers use techs in training and don't always get the lead placement right more mis than hit.

I have had good echo's and stress tests to back this up.

Best of luck with your upcoming visit