ECG - Abnormal- ST Elevation

[7gcbc]

Just had an ECG, two infact last week, due to go for stress testing next week.

summary as below:

Left Atrial Enlargment, ST Elevation, possible infract *** acute MI ***

Now, having spent the last 24 hours scaring myself to death looking this stuff up on the internet, and having seen the results of the 2nd ECG which say possible normal variation, and the GP says that I'm tall and thin (thus elongated heart) bmi of 18.9, resting pulse 62-64bpm - so marginal bradycardia, so I'm either incredibly fit or about to drop dead.

All other Class I tests are within limits, Good Cholestrol is about 1.9, bad cholesterol is about 3, blood pressure normal, etc etc, Eyesight/Urine fine.

anybody got any opnions or similar experiences ?

I have had two CAA class I's (97/98) and one JAA Class I (2001), last ECG was 2001, current one(CASA) is last week, and have just had class 2 reissued whilst we wait for the result of the jogging test.

cheers

7gcbc

[andystear]

7gcbc

Im an emergency dept doctor

I would guess what you are reading is the computer generated report
at the top right of the ECG
We wish people would get rid of these as most of the time they
are just completely wrong
we see a fair number of young, well people rushed up to emergency
in an ambulance , when this sort of thing comes out on a routine ecg.
When the ecg is looked at by a real doctor not the computer software
most of the time the ecg is normal .

hope this helps

andy

[7gcbc]

andy,

Thanks for that, you are correct that it is a computer generated report.

I recall the ecg operator had to move the leads more than once to get a proper reading, and in the end gave up on trying to get a reading from my legs as they are more than one timezone away from my heart

The Anxiety (fear of people in white coats and ecg reports) is another factor entirely.......not entirely a relaxing wait of two weeks before I do the stress test, If it was something serious one would hope the gp would send me packing down to the cardiologist ?

cheers

7gcbc

[slim_slag]

"summary as below:

Left Atrial Enlargment, ST Elevation, possible infract *** acute MI ***"


Well, what a palava. You need to look at the ECG as part of the big picture. I'm guessing you are a fit healthy young male who can run a marathon if you wanted to and you've never had chest pain in your life except from broken ribs from playing rugby. I'd be far more impressed with that than a single test which has dubious predictive value anyway. ECG's are useful at telling whether something has happened and you haev a previous ECG, not too good at telling what is going to happen, nicely demonstrated by the report you have been given.

1) ECG's are pretty poor at picking up left atrial enlargment. You would need an echo to tell that and I wouldn't waste your money.
2) ST elevation is only really a worry if it wasn't there before - or the guy is in his fifties with crushing central chest pain brought on by exercise. With you it's probably just early repolarisation which is nothing to get concerned about.
3) The possibility of you having had an MI is ridiculously remote. Computer has really got it's knickers in a twist with that one.

So yes, googling can throw up some scary stuff, but as you are otherwise healthy they really don't apply.

Sending you for an exercise ECG is just somebody covering their back.

Probably :)

[7gcbc]

Slim,

Thanks for the reply, since seeing the report I've had a consious "feeling" about my chest, and so went for a brisk 5 minute jog last night, just to wake myself up or else :uhoh: , fine, pulse woke up, no ill feeling whatsoever, infact if anything my breathing was much more deeper and relaxed after the jog, I think I may need to see a shrink.....

ps: age 39, used to excercise (run/cycle/weights) regularly until 2002, when kid monsters arrived.. since then mostly walking is main excercise.

cheers

7g

[slim_slag]

7gcbc,

Seems like I guessed wrong :) Most people asking about ECG's on here are twenty years younger than you and having their initial Class 1 at Gatwick.

Do have you any previous ECGs to compare this last one with? What caused you to have your first ECG at 39?

People do stress about what doctors tell them about their hearts. You get nightmare cases when somebody was diagnosed with heart disease at a young age, spend the next twenty years as a self imposed cardiac cripple, then find out the initial diagnosis was incorrect and there's nothing wrong with them. Bit of a bummer.

[7gcbc]

Slim,

I did my initial Class I over 11 years ago 1995 (ECG) (aged 29), at Gatwick which was fine, renewed 96, went o/seas, 97, 98, came back, class II for a while, renewed JAR in 2001 (with ECG), did class II (CASA) in 2002, decided to take CPL recently hence the class I this week.

FYI, just spoke to the Doc, he has submitted the second ECG with the "within limits variant" and he is comfortable with it., however he still wants a stress test to be sure, he's 90% sure that there is nothing up, but wants the check anyway.

You guessed right about the ribs tho :) , I has a badly bruised rib from a tackle when I did the class I at gatwick, and so had difficulty doing the chest expansion without pain :)

[7gcbc]

Thanks for all your replies, did the stress ECG today , all fine, well all fine and good to get an Echo, did the Echo, all good. No Issues. :)

Repolarization apparently, Heart is not where you'd normally expect to find it, don't care where, as long as they don't lose the records and report back to my DAME (who should now know that my ECG is nothing to worry about)

still cost me 500 south pac pesos tho' :uhoh:

[got caught]

Glad to hear your ok.

Another shining example of why a machine will never replace a doctor. (Or a pilot):cool:

[Pirate]

I've just had a similar experience. Perfectly normal ecgs for donkeys years and this new machine's software now says error or somesuch so my AME can't issue a certificate and the reading has to go to CAA for the cardiologist to read. I posted it off last Tuesday and called CAA today, a week later, to confirm they had received it. A charming lady checked and said it would be read tomorrow and I should get a letter next week. She apologised for the delay, saying "..so many of you are showing anomalies".

To my mind, this is proof enough that the software isn't up to the job. Given the stress that such an occurrence puts on professional pilots, I strongly believe the Authority should abandon this regime and continue to rely on the interpretive skills of the AMEs. Life's tough enough without waiting two weeks to find out whether one still has the wherewithall to earn a living.

I'm old enough to remember the time when the CAA Medical Division ended up with serious egg on its face over ecgs and had to admit the limitations of these tests. I do have tremendous respect for the Aviation Medicine fraternity and I hope that they will take a pragmatic view and pull the plug on this "advance" sooner, rather than later.

[7gcbc]

oddly enough, I think the gatwick ame's did fine when they saw my zig zags', its' the Casa guys here that did a spinner, or maybe its better that they're thorough, but I'm certainly not going to pay for a stress and echo ecg each renewal.......

Pirate, you're correct of course, the computer got it so wrong, its almost a joke, the cardio-conjurer just looked at it an laughed, immediately dismissing it , but the AME still had to play it safe, and in the end I'm just relieved.

could have done sans the stress of the last 10 days tho', just not easy by any means.

[jb5000]

Hi all,

When I went for my initial class one the computer came up with a response that my heart rate was too fast and that there was a problem (sinus tachycardia IIRC), and marked this onto the ECG printout.

The doctor there simply looked at it and knew that it was becuase someone had just whacked twelve sensors all over me, and dismissed it instantly.

Is it different for a doctor 'out in the sticks' to one based at Gatwick? Would a regular AME have had to refer it no matter what his opinion?

[slim_slag]

There are a couple of things going on here.

1) Is an ECG looked at in isolation much good at giving an idea of what is going on.
2) Is a computer much good at interpreting an ECG.

The answer to 1) is sometimes, but not always.
The answer to 2) is yes it is. Probably better than most AME's (and I say most) but not as good as most cardiologists. That is not a critcism of AMEs as they know a lot of stuff that cardiologists wouldn't be very good at.

Determining if a dodgy looking ECG is relevant has to be done by a human. In 7gcbc's case the human looked at the ECG as part of the big picture, thought the ECG wasn't important, but sent him off for further checks to eliminate the possible nasties thrown up by the ECG. As 7gcbc wasn't as young as I thought he was and had earlier normal looking ECG's then that was the correct thing to do.

[flybubba]

I went thru a similar ECG problem a couple of years ago. "Poor R-wave progression". AME sent me to cardiologist, echo and stress test. I'm tall and thin and do a lot of aerobic sports. Cardiologist said I was fine, that "in my case, poor R-wave progression wasn't important". I'm just curious why sometimes the ECG comes up perfectly normal, and other times it shows this feature. One doc said that the "R-wave progression" had to do with the signal transmission thru my chest, and given my fitness and anatomy, it could occur. Anyway, relieved to hear about it being a non-issue.

[7gcbc]

" I'm just curious why sometimes the ECG comes up perfectly normal, and other times it shows this feature."


Hi Bubba (tank you very much, tank u very muh :) )

I'm curious also, I'm similar build, tall, thin, very good enduro, can run/cycle for days, low avg pulse, very safe cardio vasc, yet I get hauled up on a (quite stressful) ECG normal variation, I'm actually happy the DAME played it safe, the expense is well, boo hoo, I can't complain about that, but I just hope my renewal is not going to involve this every 6 months. Slim is absolutely correct of course, the DAME did all correct.

cheers

7g

[Flyin'Dutch']

As others have commented already, the self diagnosing software for ECG machines is notoriously dodgy.

Luckily enough you can switch this feature off.

Makes life a lot easier.

[QDMQDMQDM]

Flyin Dutch,

I didn't know you could switch the bloody computer reporting off on these things. Ours is going to be swiched off first thing Monday morning.

Thanks for that,

David

[planeChef]

I once did an ECG when applying as a train driver and was diagnosed with an atypical ST anomaly of the antorelateral and was disqualified for doing the job.

I went to cardiology right away and also the company doctor kept a very close eye on me at my current job, nothing wrong...

[Jarvy]

Abnormal ECG's not always wrong. Last April I had an abnormal ECG, everyone including AME said dont worry just the new machine. CAA grounded me next day and I'm still grounded and do have a problem. Enlarged left side of heart and signs of ventricular tachycardia.
:(