I'm 24 female. chest xray result says heart is in normal size. but my ecg remarks says sinus rthythm and anteroseptal wall ischema what does it mean?

Abnl ECG: Although it can be a helpful indicator, chest Xray is never a definitive test for heart size. This is done with an echocardiogram, cardiac CT, or a cardiac MRI. Sinus rhythm is the normal rhythm. Young female with anteroseptal abnormality on ECG- would suspect ECG lead misplacement- sometimes the heart is higher/lower in the chest or breast size differences. If symptoms, see a cardiologist.

Different things: Chest X-ray measures physical dimensions of heart (left-right). ECG measures functioning of heart muscle (like timing of an auto engine). Speak to your doctor for a more detailed explanation. In general, at 24 you should not be having heart issues!