Q:
I am a 43 y/o female, 68 in, 145 lbs. Heathy, do not smoke. Chol normal except LDL 114. HDL 52. Recently had an ECG as part of a physical and the printout read Probable Anteroseptal MI, age indeterminate. The internal medicine MD said this is a normal variation for tall, thin females. He recommends no further follow up. I do exercise 4-5 times weekly, either run or walk. Do not ever recall having chest pain. Do you agree? Or should I ask to have an echocardiogram?
A:
Most likely your doctor used an automated machine that generates a “diagnosis”. There are reasons why you might have “Q waves in V1-V3” that may include incorrect lead placement. However, it is not OK for your doctor to tell you that you have had a probable MI, but not to worry about it. He owes you an explanation!
This is what an Anteroseptal infarct looks like on EKG.
Q, QS, or qrS complexes in leads V1-V3 (V4)
Evolving ST-T changes
Fully evolved anteroseptal MI (note QS waves in V1-2, QRS complex in V3, plus ST-T wave changes)
While it is true that
- Women may have atypical symptoms,
- A silent MI may occur (one that didn’t produce symptoms and is found incidentally)
- An incidental EKG may show changes, consistent with an old MI
it is unlikely that any of these occurred in a woman with your background. This is what I would recommend. Ask your doctor to explain. He owes you that! Depending on what he tells you, ask for another EKG where lead placement is not an issue, get a second opinion, or get a stress ECHO,
Hope this helps,
Dr T