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Abnormal EKG with inverted T waves, stress test scheduled. Why do you think I need a stress test?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
hello, and thank you, I had a abnormal EKG with some inverted T waves, my doctor scheduled me to have a echocardiogram and 48 hr monitor , I did those last week, The cardiologist office called today, to schedule me a Stress test, I have not heard anything back about my other tests yet. why do you think he would want me to have a stress test, is it possible they found something in the Echocardiogram or the monitor? Just a little hx, why I had the EKG, when I am in bed at night while dozing off to sleep, I would feel like I would have a pressure come in chest, but it would startled me and I would wake up then it go away. during the day and while I am awake I have no problems, I do have alot of anxiety, and i do take altenol for fast heart rate and have been for 16 years! also i have a normal bp, but my hdl is 36, ldl 109 and over all cholestrol 176
Posted Mon, 21 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 26 minutes later
Thank you for the query.

When the resting ECG shows non-specific changes (like the inverted T waves that you mentioned) or is normal in the presence of chest symptoms, it is good to do a stress test and check if there is any possibility of cardiac ischemia.

Stress is given in the form of exercise (treadmill or bicycle) or with drugs (dobutamine, adenosine, etc). ECG, echo or nuclear imaging may be used to detect abnormalities during the test.

If there are any significant problems, the stress given to the heart helps to bring out the changes and thus, a diagnosis can be made and further tests like angiogram can be scheduled. If the stress test is negative, it usually means that there is no cardiac cause for your chest discomfort.

It would be nice to get the stress test done. If there are any changes, it is an opportunity to find out the presence of any coronary artery blockages and get things remedied before any damage is done. If, on the other hand, everything is normal, you don't need to worry about coronary artery disease being a cause of your problems at present.

If it is feasible, you can also upload the scanned image of your ECG to this website so that I can have a look at it and give you more specific advice.

I hope this clarifies things for you. Feel free to ask me for any further details that you need.
With regards,
Dr Raja Sekhar Varma,
Consultant Cardiologist
Above answer was peer-reviewed by
Follow-up: Abnormal EKG with inverted T waves, stress test scheduled. Why do you think I need a stress test? 11 minutes later
Thank You for your response, I am havng a Stress Test done May 10th,2012, I wish they would not make me wait 3 weeks, but that was the first available appt. if it was a something that showed up on the Echocardiogram or monitor , would they have gotten me in sooner? I am just really worried not knowing any test results. I have not had the pressure inmy chest now for three weeks, I wonder if some of it could be anxiety, my regualr physician who did the EKG stated it could be something from the past Like Lack of Oxygen but what could cause that?
Answered by Dr. Raja Sekhar Varma 22 hours later
Thank you for the reply.

Stress testing is an elective procedure, and usually almost never done on an emergency basis.

If the ECG had shown acute changes in the form of an attack or if blood tests/clinical evaluation had shown any evidence of an unstable process, you would have been posted for an early/immediate diagnostic coronary angiogram followed by appropriate therapy to get rid of the blocks in the coronary arteries.

The fact that you have been asked to come for an elective stress testing indicates that you are probably not at high risk for an acute event, but still needing further evaluation to be sure that everything is alright with the heart.

There are many causes for non-specific T wave changes in the ECG. Sometimes, even drinking a glass of cold water has been shown to produce T wave inversion. As long as the pattern does not fit in with known specific abnormalities, the exact cause of an inverted T wave is difficult to pinpoint.

Coronary arteries provide blood supply to the pumping cardiac muscle. Blockages in these arteries could result in reduced blood flow to the heart muscle. The blood supply is responsible for oxygen transport to these muscles. Thus, when the blood supply is reduced, there could be a relative lack of oxygen to the cardiac muscle, resulting in chest discomfort and ECG changes. I think that this is the message that your physician wanted to convey. However, this is only one of the reasons (although, the most important one) for T wave changes. This is the cause that stress testing will seek to verify or exclude. If the stress test is positive, you will need a coronary angiogram. If the test is negative, you can be reassured that it is unlikely to have significant blockages.

I hope this answers your query. Please accept my answer if there are no follow-up questions.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
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