DEAR DR. GOTT:
Could you kindly explain the results of my recent electrocardiogram? My family doctor does not respond to my questions.
The following is from the letter I got from the imaging center: “Baseline electrocardiogram shows first degree atrioventricular block, non specific ST-T changes, prominent left ventricular voltage. There were no significant dysrhythmias induced by exercise. There are diffuse ST changes on the electrocardiogram, particularly in inferior limb leads, but these changes were primarily upsloping and did not meet definite criteria for ischemia. Immediate recovery phase was unremarkable. The remainder of the recovery phase was unremarkable.”
What is your take on all this? I am a healthy 66-year-old male.
DEAR READER:
I will break down the results so that they are easier to understand.
First, you have first degree atrioventricular (AV) block. This means that when the impulses from the atrial chambers of your heart go off, there is a delay before they signal the ventricles to beat. A normal heart beat goes lub, dub, lub, dub. In your case it sounds like lub, (space), dub, etc. The good news is that this is fairly common and not necessarily a sign of heart disease.
Second, you have non-specific ST-T changes. ST and T refers to certain waves on the EKG. These changes are very common but may indicate heart ischemia (restriction of blood supply and oxygen to the heart).
Third, you have prominent left ventricular voltage. This is often caused when the muscle of the left ventricle thickens, usually because of a hypertension.
Fourth, during the exercise portion you had no significant rhythm abnormalities. Diffuse ST changes were present but did not meet certain criteria for a positive diagnosis of ischemia.
Finally, the recovery phases were normal.
The end result is that you had a “normal” test with no significant abnormalities. However, because there was a baseline EKG, exercise phase and recovery phase, I believe that you had a stress test which evaluates the health of the heart while at rest and during exercise. This provides a more accurate picture than a standard EKG which is given during rest only.
Now to my opinion. You say that you are a healthy 66-year-old male, but it is my experience that stress tests are not given routinely. Therefore, you must have had some symptoms, such as shortness of breath, chest pain or pressure or chronic or uncontrolled high blood pressure that concerned your physician enough to order testing. Without knowing those symptoms I cannot give any specifics but I feel that you should be seen by a cardiologist without delay. On paper your testing was normal but when it is put together (even without knowing the reason for the testing), you have what appear to be the beginning signs of ischemic heart disease.
Ischemic heart disease is often the result of coronary artery disease (blockage of the arteries to the heart). A cardiologist would be able to examine and order further testing to rule this out. If you do indeed have heart disease it is most likely in an early stage and can easily treated with diet, exercise and medication. In such a case, the outlook can be very good. I am not a cardiologist but I feel you really need to be followed up by one.
I am very disappointed at your family doctor’s response, or in this case, lack of response. As physicians we are here to take care of our patients and help them take care of themselves. That includes involving them in their own health. You need to sit down with your physician and explain your disappointment and concerns. Perhaps he or she was having an off day when you asked. If you have asked several times but still have received nothing in response, then it is probably time to find another family doctor. If this is the case, you should also explain why you are leaving his or her care. Maybe your effort to inform the physician will change his or her attitude and allow other patients to benefit. Remember, there is no need to be rude. Often it is the soft spoken patient who expresses concern who makes the greatest change in physicians; attitudes.
To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Medical Specialists”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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