# I have a septal infarct



## Chief Complaint (Aug 6, 2011)

Im a new medic and am currently going through the hiring process for a couple of counties (volunteer and career).  My physical showed an abnormal EKG, possible septal infarct, and i was told that i need to see a cardiologist for further testing.  I was hoping it was just an issue with lead placement.

Saw the cardiologist today and had another EKG performed, same result as my first.  Going back on Thursday for a stress echo to figure out whats going on.

The Doctor told me that its still possible for the EKG to be incorrect based on lead placement.  Not everyone's heart is situated in the same place inside the chest cavity so the landmarks used for lead placement might not always be appropriate.

*My concern is that if i do have an infarct, and am still cleared for work, would a career department not hire me based on my EKG?  We all know how competitive EMS can be, is an infarction grounds for automatic disqualification in your agency?*

Any advice is greatly appreciated.


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## abckidsmom (Aug 6, 2011)

For fire-based agencies it definitely is.  NFPA has found that people with cardiac history or history of angioplasty in the past have a hugely inflated risk of LODD, and recommended that those people not be hired, or not be cleared for fully duty if they are.

Should a person with an MI history be doing EMS (not fire)?  I guess, but how long can you do CPR?  That's pretty vigorous activity, and combine it with stress hormones it can be risky if your heart is poorly perfused at all.

Best check with your cardiologist about whether it's even a good idea.


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## Chief Complaint (Aug 6, 2011)

abckidsmom said:


> For fire-based agencies it definitely is.  NFPA has found that people with cardiac history or history of angioplasty in the past have a hugely inflated risk of LODD, and recommended that those people not be hired, or not be cleared for fully duty if they are.
> 
> Should a person with an MI history be doing EMS (not fire)?  I guess, but how long can you do CPR?  That's pretty vigorous activity, and combine it with stress hormones it can be risky if your heart is poorly perfused at all.
> 
> Best check with your cardiologist about whether it's even a good idea.



Performing CPR will not/has not been an issue.  I hate to sound vain, but I'm in extremely good health other than this possible infarct.  I am a marathon runner, I work out 4 days/week, and I've been an athlete all of my life.

The first part of your post is kinda what I expected to hear, definitely not what I was hoping for though.  So if this turns out to be legit, what would my options be besides abandoning my dream career?  Work IFT for the rest of my days?  Sigh.


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## the_negro_puppy (Aug 6, 2011)

Do not despair. Abnormal S-T elevation can be caused for a number of reasons other than AMI i.e benign early repolarization. The fact that you are super fit even works to exclude AMI. Wait til you have the stress echo etc.


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## Sandog (Aug 6, 2011)

For a proper diagnosis, more test would need to be performed such as an echocardiogram. I just had one recently and am now scheduled for a treadmill test. EKG by itself is not conclusive, at least that is what my doc told me.


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## Chief Complaint (Aug 6, 2011)

the_negro_puppy said:


> Do not despair. Abnormal S-T elevation can be caused for a number of reasons other than AMI i.e benign early repolarization. The fact that you are super fit even works to exclude AMI. Wait til you have the stress echo etc.



I think the cause for concern was the downward deflection of the Q wave in V1 and V2.  Hopefully its a mistake with lead placement or something else.



Sandog said:


> For a proper diagnosis, more test would need to be performed such as an echocardiogram. I just had one recently and am now scheduled for a treadmill test. EKG by itself is not conclusive, at least that is what my doc told me.



Thanks for the reply, im trying not to worry too much about all of this but its difficult.  Sounds like this is something that would absolutely DQ me from working as a FF/Medic.  We dont have EMS only agencies besides the IFT companies around here so this would definitely change the course of my life/career.


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## usalsfyre (Aug 6, 2011)

They're likely not going to diagnose a previous MI without an echocardiograph. Don't despair just yet.


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## abckidsmom (Aug 6, 2011)

Chief Complaint said:


> I think the cause for concern was the downward deflection of the Q wave in V1 and V2.  Hopefully its a mistake with lead placement or something else.
> 
> 
> 
> Thanks for the reply, im trying not to worry too much about all of this but its difficult.  Sounds like this is something that would absolutely DQ me from working as a FF/Medic.  We dont have EMS only agencies besides the IFT companies around here so this would definitely change the course of my life/career.



I recall you being in VA?  There are still a couple of EMS only agencies, RAA being the only that jumps to mind.  Its early to be panicking, and there are still choices.


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## Chief Complaint (Aug 7, 2011)

abckidsmom said:


> I recall you being in VA?  There are still a couple of EMS only agencies, RAA being the only that jumps to mind.  Its early to be panicking, and there are still choices.



I had never heard of RAA before, thanks.  Yup im in VA, in the Fairfax area.  Richmond isnt that big of a relocation if things dont work out on my physical.  My jaw dropped when i saw their pay scale, but i suppose i cant be too picky.  $15/hr would be a major pay cut for me, but id be willing to do it if thats all i can get.


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## Smash (Aug 7, 2011)

I assume you mean that you have _had_ a septal infarct, rather than you are _having_ a septal infarct...

If you are a fit (if slightly mental) marathon runner, I would imagine that you are more likely looking at either some hypertrophy or early repolarisation.


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## Chief Complaint (Aug 7, 2011)

Smash said:


> I assume you mean that you have _had_ a septal infarct, rather than you are _having_ a septal infarct...
> 
> If you are a fit (if slightly mental) marathon runner, I would imagine that you are more likely looking at either some hypertrophy or early repolarisation.



Correct, it appears that I had an infarct at some point in the past.  Will know more after my stress echo on Thursday.


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## MSDeltaFlt (Aug 7, 2011)

Chief Complaint said:


> Performing CPR will not/has not been an issue.  I hate to sound vain, but I'm in extremely good health other than this possible infarct.  I am a marathon runner, I work out 4 days/week, and I've been an athlete all of my life.
> 
> The first part of your post is kinda what I expected to hear, definitely not what I was hoping for though.  So if this turns out to be legit, what would my options be besides abandoning my dream career?  Work IFT for the rest of my days?  Sigh.



Yeah, you're a marathon runner and workout 4 days/week which means your resting heart rate is probably somewhere around 48.  Which means your stroke volume is phenomenal.

ECG machines are programmed for HR's 60-100.  Anything less is abnormal and the computer's "save your *** circuit" will interpret accordingly. 

I've got $20 saying you never had an infarct.


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## Chief Complaint (Aug 11, 2011)

Just wanted to update.

I had my stress echo today and everything came back normal.  The cardiologist said that I'm in excellent health and that the 2 abnormal EKGs were likely the result of lead placement errors.

Thanks to all who posted.


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