— Bonnie, Minnesota I am happy to say that usually, Bonnie, for a person like you, who has a normal heart structure and a normal exercise stress test with good exercise tolerance, the prognosis is excellent, even with inverted T-waves. T-waves are a part of a normal electrocardiogram (EKG), representing the electrical recovery (or repolarization) of the ventricles, the lower chambers of the heart, after a contraction, or heartbeat. There are many reasons why T-waves can be inverted. We can see inverted T-waves, for instance, in the midst of a heart attack and in structural heart disease, such as coronary ischemia or left ventricular hypertrophy. On the other hand, we also may see inverted T-waves in people whose tests are completely normal, and we simply don’t know why they occur. I have followed some patients like this for years that have never had a problem. They are asymptomatic and have otherwise normal hearts. So, my advice to you is not to worry. Inverted T-waves are not uncommon, and you don’t need to be overly anxious about them as long as you continue to feel well and have normal echocardiograms and stress tests. On the other hand, if your internist has concerns and you feel more information could be helpful, make an appointment with another cardiologist and get a second opinion. That way, everyone will feel reassured going forward. Q2. My gynecologist ordered an electrocardiogram (EKG) for me prior to my upcoming surgery. It came back abnormal. Should I be going to a cardiologist for further testing? — Ann, Connecticut Yes, Ann, a cardiologist should interpret an abnormal EKG, a recording of the electrical activity of the heart, taking into account your overall health. An abnormal EKG does not necessarily indicate life-threatening heart disease or any heart disease at all, for that matter. In fact, EKGs can be abnormal for many reasons, and a cardiologist is most qualified to figure out why. Moreover, the anesthesiologist and surgeon will want a letter from the cardiologist saying that you are okay to undergo surgery. This is called a pre-operative clearance. If it turns out your original EKG is truly abnormal, then you may need a nuclear exercise stress test to see if there is any blockage in one or more of your coronary arteries as well as another echocardiogram to look for underlying structural disease of the heart muscle or valves, or a congenital abnormality. Even if these tests show that there is an underlying heart problem, it’s possible you could still have the surgery if the cardiologist determines you are at low or moderate risk and if the surgery is critical to your long-term health. If there is heart risk and the surgery is necessary, I would suggest that your cardiologist monitor you during the surgery or make sure you have medications to help protect your heart during the procedure. And of course the cardiologist should also make sure that the anesthesiologist and surgeon are aware of your risk. Learn more in the Everyday Health Heart Health Center.
