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ST curve in the ECG, low vitamin D levels. Have to go for nuclear test. What are my chances of stroke in the future?

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Cardiologist, Interventional
Practicing since : 1996
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I had an ecg done and was told that it showed a depressed ST curve (everything else looked normal). What does this mean? I was told that depressed ST can be a normal condition in some people - Is that true? Could this put me at higher risk for heart disease or stroke in the future? What are possible causes of the depressed ST? I was told that I should get a nuclear stress test to investigate further - (I am hesitant to expose myself to the radiation as small as it may be) Are there any other tests that can be done instead? I am 40 years old female 130 lbs 5' 3". I was also told I had low vitamin D levels - the tests showed an 18 ( sorry I don't remember what units). Can high doses like 10,000 IU once per week of vitamin D to treat the condition be bad for your heart? Sorry it sounds like a lot of questions, but I am a little worried. Thanks, XXXXXXX
Posted Fri, 20 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 4 hours later

Thank you for your query.

ST depression on the ECG usually signifies a relative lack of blood supply to the muscle of the heart. This could happen due to some blockages in the coronary arteries. A few other conditions where we can have a depressed ST curve are:
- When there is an increase in the thickness of the walls of the heart due to hypertension or other causes.
- Due to changes in some electrolytes like potassium.
- Effect of some drugs.
- Other conditions like myocarditis, cardiomyopathy, etc.

Is it possible for you to upload a scanned copy of the ECG to this website so that I can see the ECG for myself and analyze the changes better?

The next step is usually a stress test to detect ischemia. If you are worried about a nuclear imaging test, you can opt for a ‘dobutamine stress echo’. Here, an increasing dose of intravenous dobutamine is injected and echocardiography of the heart is done to detect changes. The stress is produced by the drug. It is a safe test and gives reasonably specific results.

If the stress test comes positive, it would be better to do coronary angiography and plan further management depending on the anatomy seen.

Vitamin D can be used to overcome the deficiency. It has not been shown to be bad for the heart. There are recent studies have revealed that Vitamins D in low doses along with ‘statins’ are beneficial.

I hope this answers your query. Feel free to contact me for any further clarifications. If you can upload the ECG, I can give you my analysis/interpretation of the ECG.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: ST curve in the ECG, low vitamin D levels. Have to go for nuclear test. What are my chances of stroke in the future? 17 hours later
Are there cases where ST depression is a normal condition for some people?

Also if ST depression is a baseline condition for me how could this affect my long term health?
Answered by Dr. Raja Sekhar Varma 5 hours later

Thank you for your reply.

ST depression can be considered as a normal variant only after excluding all other pathologic causes. One does not want to miss out on treatable causes of heart disease.

If it is indeed a normal variant (after all extensive testing), it will not have any impact on your long term health. The only problem would be that it might be difficult to detect new changes (as a result of new disease) if there are baseline changes.

If the ST depression is due to some disease process, the prognosis would depend on the cause.

I hope this answers your query.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
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