Heart & Cardiology/Abnormal ECG

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Question
Hello,
   I had a rotator cuff surgery on the 24th of July. The anesthesiologist tried to put a nerve block in my neck but he had a problem with only getting 1/4 of the medicine in the nerve. Right when he did this, I had a horrible heavy feeling in my chest. Like the urge to cough but nothing was there.  Then it was gone. Came out of the surgery fine. That night I had a cough and it felt like my lungs were full. I waited two days. By this time my whole right side was so sore in my lungs.
So I went to my ER. When I came in my blood pressure was  101/54. This was very unusual as I am on blood pressure meds and I have never had that low before. The dr rans some test a complete blood count with differential. The only thing that was off was the MPV which was 6.00 with the normal being 8- 12. ( I assume surgery was the cause of this)?
C- Reactive Protein was high 1.6  normal being 0.0 -.9 . ( again surgery)?
Nt-pro-b-type-natriuretic peptide 167 normal 0-125. I do not know what this is?
Troponin 1 less then <0.017 which was low 0.017- 0.056. Do not know what that is  either
Ct of chest without contrast normal.
The Dr came in and did a ECG. She did it twice.
Results are inferior myocardial infraction 140+ ms Q Wave and/or St/t abnormality in II/aVF1, of  indeterminate age,   Abnormal ECG.
Ok she said I probably had pleurisy, to go in to your regular Dr. In two days if it got worse. Which I will as it is now on both sides of my lungs and I can not breath. My question for you given my scant history would you be concerned about my heart?  I understand that you could never diagnose on the internet but what questions do I ask? I am a female 5'10 weighing 155 pounds. Never had a problem before?  
Thank you so much for your help.

Answer
Hi, some on several of these issues is available at http://blog.myheart.net

There is a lot of information there and to be honest, in order to give you sound advice i'd need to know and see a lot more! But let me comment on the following.

The crp of 1.6 in this setting is neither here nor there, and i wouldn't be concerned about such a minor elevation, it is not likely of any significance and i'm not sure why they measured it.

The BNP is a marker released by the cells of the heart and elevated levels may (but not always) signify some heart failure. This needs to be in conjunction with signs and symptoms such as swelling and shortness of breath etc. Yours is somewhat elevated suggesting there may have been some strain on the heart during this whole episode.

The troponin is a marker released by the cells of the heart and elevated levels may mean heart damage such as a heart attack. your troponin was normal which is good!

The EKG showed q waves in the inferior leads, which may signify a previous old heart attack in that region. its important to realize that the machine may often get this wrong and that we as cardiologists often have to correct this. Its difficult to say without seeing the EKG.

Although you were told you may have pleurisy, it seems your ct scan of the chest was normal. This is certainly reassuring. I would certainly follow up with a Dr and have this looked in to, the differential is wide and honestly without me writing a large essay and knowing a lot more information it is difficult to comment on.

Finally in terms of your heart, i would say that given the symptoms of shortness of breath, an EKG that showed possible prior damage, and an elevated BNP level, that you should at least have an echocardiogram to ensure no underlying heart dysfunction. If its normal you can likely be reassured. Other things such as pneumonia need to be ruled out also.

Do follow up with a Dr as suggested and get to the bottom of all these things!

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

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Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

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Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

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MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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