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Your Good Health: Abnormal infarction on an EKG brings worry of a heart attack

Test patterns anomolies in the septum near electrical wires that attach to the chest unlikely to be an attack 80% of the time
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Dr. Keith Roach

Dear Dr. Roach: I am a 79-year-old man in relatively good health. I don’t take any medications. I recently visited a cardiologist regarding some heart palpitations that I have been experiencing. After a review of my laboratory tests, history and physical exams, and my electrocardiogram (EKG), the doctor told me that everything seemed fine.

A month after this visit, I went into my patient portal and reviewed the EKG, and to my surprise, it stated that there was an infarction in the septum. I read online that this can be a silent heart attack. The cardiologist didn’t mention these results at any time, so I called his office and spoke to his nurse, who relayed my concerns to him.

The nurse replied that the doctor had rereviewed the EKG, and the result was a false positive. He said that there was no reason to be concerned, nor to have the EKG repeated. What do you think?

Anon.

An EKG is a very useful, inexpensive, noninvasive way of finding out information about the heart. Unfortunately, the results are not always definitive.

I reviewed the EKG that you sent me, and you have a pattern called a QS in leads V1 and V2 (the electrical wires that attach to the chest). Although this can indicate a heart attack in the septum (the part of the heart between the ventricles), this is not the case approximately 80% of the time.

I agree with your cardiologist that it is very unlikely to represent a serious condition like a heart attack, especially given your excellent overall health. However, if you were my patient, the next time you came in, I would probably recheck the EKG with very careful attention to the placement of the leads. If the abnormal finding disappeared, you can be 100% certain that this EKG finding does not represent a heart attack.

Dear Dr. Roach: Is there any truth to the belief that there are more hospital admissions or emergency room visits during a full moon?

N.D.G.

As many as 40% of medical staff do believe that the moon affects ER visits and admissions, but the definitive answer is no. Multiple large studies have shown that there is no correlation to the number or type of ER visits during a full moon. One of my ER colleagues tells me that she thinks the ER staff doesn’t really believe it, and it’s just an expression that people say when they are busy. I’m not convinced that’s the case for everyone.

Humans are very good at finding patterns — so good that we often see them even when they aren’t there. I can attest to the fact that during a particularly busy night in the ER, someone will often say that it must be a full moon. The times when there actually was a full moon tend to reinforce the belief, while the times that there wasn’t a full moon tend to be forgotten.

Careful observation with objective endpoints is necessary to prove or disprove this hypothesis. It is ironic that even people who use science all the time can make this mistake.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu