# Abnormal Electrocardiogram???



## ElvisMerckx (Oct 11, 2002)

Got an EKG this morning as part of a routine physical. The result was 'abnormal' -- "Possible Septal Infarction -- Age Undetermined." 

My Dr's not concerned. She thinks it's probably due to my height, fitness, and the placement of the diodes or somesuch; but she scheduled me for an Echocardiogram, just to be sure.

A quick online search (though not necessarily medically sound) indicates that a strong, healthy heart (the result of 25+ years of regular bicycling) could easily trigger this diagnosis.

Anyone here experienced this? Should I be worried? How much sleep should I lose over the next week awaiting the heart echo? Or, is this a typical misdiagnosis among us cycling types?

Any advice appreciated. Medical advice would be very appreciated.


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## crazyc (Jun 5, 2008)

it would be good to know what that diagnosis is being based on. i would guess
most likely on q waves. these waves in the septal leads are normal but can be
absent in a percentage of the population. I don't agree with the enlarged heart part.
you can have a strong heart but an enlarged heart is usually a sign of other
problems. I would be sure to have a cardiologist review the ecg and getting an echo
certainly won't hurt and will pick up an motion abnormailites or lack of motion associated
with infarcted heart tissue. don't lose sleep over it. if you are an avid cyclist you
are giving yourself exercise stress tests everytime you ride, so as long as you have not 
been experiencing chest pain i would not sweat it. but do continue with the testing.


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## ElvisMerckx (Oct 11, 2002)

crazyc said:


> I don't agree with the enlarged heart part.


Concur. "Enlarged" was a poor choice of words on my part and not part of my diagnosis. I've removed the term from the original post. Thanks.


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## spade2you (May 12, 2009)

If you're feeling fine, I wouldn't worry too much until you get the followup exam. Unless in an autopsy, it's hard to get a 100% perfect diagnosis and analysis of the heart.


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## ElvisMerckx (Oct 11, 2002)

*Diagnosis Info*



crazyc said:


> it would be good to know what that diagnosis is being based on. i would guess most likely on q waves. these waves in the septal leads are normal but can be
> absent in a percentage of the population.


On the ECG print-out they gave me, it states: 
"Possible Ectopic Atrial Bradycardia 
Q wave in septal lead
ST elevation also present
Possible Septal Infarction -- Age Undetermined"

And, yes, I've already scheduled the Echo.


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## Don Duende (Sep 13, 2007)

That is probably an automated computer generated result, not a true diagnosis which should be made by a cardiologist. An echocardiogram (an ultrasound test) would probably settle the issue, as well as providing further important information about your heart. I would insist upon it. Tell them you will sue, if they refuse to do the test and consequently miss the diagnosis.

An enlarged heart may be due to an underlying medical condition and unlikely to be present in a recreational cyclist. Some forms of heart enlargement may subject you to a risk of sudden death.

That will get them sufficiently motivated to do the right thing. After all you are a cyclist and this is a cycling forum. Your doctor is probably not a cyclist and therefore, insensitive to issues that affect us. DO NOT LET THEM BRUSH YOU OFF.


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## EDUC8-or (Jan 2, 2009)

I am 36 years old in the best shape of my life but required to pass a yearly physical with the FAA for my job. Once I hit 35 I had to get an my first EKG, and what ensued gave me quite a scare. The EKG machines make their own little electronic diagnosis without taking much into consideration. I see you have an ST elevation which is very common for endurance athletes. This could be a sign of Athlete's Heart. The machine will look at this and other items from your EKG and make a diagnosis. 

For me the machine said to consider pericarditis, which is the inflammation of the lining around your heart. The doctor said there was nothing to worry because I showed absolutely no symptoms and I was in such great shape. He knew a very small amount about Athlete's Heart and said to wait to see if I get a letter in the mail before scheduling any other tests. We have a 19 month old at home and I am the primary breadwinner and I felt a little uneasy so I began to schedule some tests, at about the same time I got a nastygram from the FAA saying I needed to prove my fitness to continue to work. 

I had to go to my primary care physician, not the FAA doc to begin the tests. I had another EKG there and was sent on to the cardiologist. They scheduled me for an echocardiogram. It took about 2 weeks to get in for the echo and about another 7-10 days for the results to get to my primary care physician. During this time NONE of these doctors outside of the FAA doc asked me about the amount and intensity of my exercise. I never even met with cardiologist, I just went to the office to have the test performed by a tech. Instead an intern simply read my echo, looked at my EKG, and diagnosed me with 3-4 very serious ailments. I then was scheduled for a stress test and they even considered doing a non-exercise stress test due to the results of my EKG and echo. 

When I returned for the stress test I asked if I could sit down for a consult with a cardiologist. I had my wife and 13 month old in tow because I was feeling a bit scared. It just turned out one of the senior partners in the practice was there that day. The doctor took one look at me, one at the EKG, and another at the results of the echo and started scratching his head. He said I look like I'm in very good shape and asked if I exercise much. He thought something just didn't add up, left the room to look at my echo, and came back with the good news. He said wrestlers, triathletes, swimmers, and cyclists often have the ST elevation due to the amount of endurance exercise in which we participate. Also, looking at my echo my heart was in very good shape but certain parts were enlarged or thickened because my heart was so efficient. He took care of the problem with the FAA and let me feel better about exercising again. Most importantly he let me know I was healthy and it was great having my family there with me to hear the good news.

While I can't make a diagnosis, I can make a guess and I'd say you probably have an Athlete's Heart. Good for you for scheduling your echocardiogram, you need to know for your own sake if you're healthy. Make sure you sit down with a cardiologist to review the results from your echo, this is extremely important.  I learned the hard way and it gave me a good scare. Also, take the results of your EKG with you and let them know you're a cyclist. Sorry for the long spiel, I just want to prevent you from a similar situation. I know it's unsettling to hear something might be wrong with your heart, please keep us updated and let us know what they find.


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## 180 (Jan 10, 2009)

I had an EKG that caused me to be denied insurance. Even my heart doc didn't understand it. He said my heart was fine. It was a number of years ago so I'm ok now and have been insured since but the lady doc that suggested I get this test done was a whack job. She gave me a list of docs to go see. It was like she was trying to destroy my health history. She was German and kinda mean. I dunno. It was a weird experience. I'd rather not talk about it. lol


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## PJB (Apr 1, 2006)

I had the same thing happen to me . EKG showed a possible enlarged heart or thickening of the walls, so my Dr did a echo cardiogram and the cardiologist got a kick watching me run my ass off on the treadmill, said nothing was wrong. From what I read endurance athletes can show different readings on a EKG.


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## BendBiker (Jul 22, 2006)

Hi-

I am just a medical student, so don't take what I say as medical advice, but as a cyclist I am very interested in your findings. Sinus bradycardia probably just means that you have a low heart rate, which I'm sure you know is a typical finding of somebody who is athletic and does a lot of aerobic activity. I found a pretty good, not too technical description of some changes in athletes hearts. Here is the link:

http://www.merck.com/mmpe/sec07/ch082/ch082c.html#CIHCEGIE
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767992/ (more technical)

It might be helpful to use to ask informed questions at your appointment. ST segment elevation is like an alarm bell phrase for a doctor. While it can be present in athletes, it can also mean there is heart disease. It is definitely worth checking out but hopefully I'm reassuring you that there are physiological (and not necessarily just pathological) explanations. 

In my experience learning about the heart in medical school, it seems like there are a lot things that we look out for as a sign of disease that can also occur in athletes. Hopefully that is why they scheduled the echo for you. That being said nobody is immune to coronary artery disease and I have heard stories of some very fit people needing bypass surgery, you never know. I wouldn't worry too much, but wish you good luck.


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## EDUC8-or (Jan 2, 2009)

BendBiker said:


> It might be helpful to use to ask informed questions at your appointment. ST segment elevation is like an alarm bell phrase for a doctor. While it can be present in athletes, it can also mean there is heart disease. It is definitely worth checking out but hopefully I'm reassuring you that there are physiological (and not necessarily just pathological) explanations.


It also depends on the type of ST elevation, here's another link:

http://note3.blogspot.com/2004/01/what-is-j-point-elevation.html

I have the j-point elevation, my GP didn't know anything about this but the cardiologist took a look at my EKG and said he wouldn't have scheduled me for the additional tests.


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## ElvisMerckx (Oct 11, 2002)

*Echo Result*

Okay, had my echocardiogram this morning. I felt really out of place in the waiting room -- about 12 really old fat people and me. As the tech walked me back for the test, she asked me if I'm an athlete. She'd already looked at my EKG and said that the reading indicated I had an "athletic heart" -- nothing more.

The ultrasound took about 30 minutes. The tech said everything looked great to her. Then the doctor reviewed it and he said everything's perfectly normal.

So, with this experience, that makes about 18 expensive and unnecessary healthcare procedures for my family in only 4 years. No wonder healthcare costs are skyrocketing.


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## Guest (Dec 21, 2009)

I've never had a "normal" one. As I prepared to enter the military I got my first one and it was abnormal, they sent me to see a specialist at Vandy so I could get a waiver for it. Doc had me lay down and hooked me up after looking at my previous test, told me to do flutter kicks while they did the test, passed.


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