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Stress ECG done for chest and neck pain, shows sinus rhythm, poor r wave progression. What does it mean?

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Cardiologist
Practicing since : 1981
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Hi,
I just a stress ECG as I have been getting chest pain and neck pain.
In my report it said with the resting ECG -sinus rhythm, poor r wave progression.
Then it says the resting ECG showed minor T changes also saying I has a good exercise tolerance and exceeded the target heart rate without chest pain. There were no ST changes. The conclusion being a negative test.
What does poor r wave progression mean? And minor t changes mean.
I had a angiogram in 2009 which was clear and suffer from anxiety pretty badly.
I'm on medication for high blood pressure as well.
Cheers
XXXXXX
Posted Sun, 9 Sep 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Anil Grover 4 hours later
Hi XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
To answer your question is simple that in presence of high blood pressure if you have performed normal TMT, poor progression of R wave does not mean much. You have identified stress as one of the risk factors there are 9 others, to give you an objective assessment I need information a) additional information about stress test that is how many METS of exercise you performed? It would been printed on your TMT report. If not ask the technician who was there which protocol was followed and how many minutes you exercised?. Secondly, I want to know about your height and weight. Third, whatever you can add (if information is available with you about the risk factors listed below). Personally and subjectively with not much objectivity, I can safely say that you have underlying stress and high blood pressure but that is incomplete. Therefore, please reply and within hours I will write to you significance of R wave poor progressions and suggestions to prevent any harm to your cardiac health and objective assessment of your current profile. Good Luck. (SKIP A TOPIC IF INFORMATION IS NOT AVAILABLE ABOUT INDIVIDUAL FACTOR).
At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-

A: MODIFIABLE RISK FACTORS
1. Diabetes +/-
2. Hypertension* (How long? What drugs?)
3. Smoking+/-
4. Stress* (What is your personal perception about your anxiety?)
5. Obesity and Sedentary Life Style+/- (How much exercise you do?)
6. High Bad Cholesterol and Lipid Component +/- (State so if you do not know)
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
7. Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
B: NON MODIFIABLE RISK FACTORS
8. Family History 0f Coronary Heart Disease +/- (If any blood relative has it)
9. Increasing age*
10. Being a Man (as opposed to women) till the age 45*
With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
 
Follow-up: Stress ECG done for chest and neck pain, shows sinus rhythm, poor r wave progression. What does it mean? 43 minutes later
Hi Doctor,
Mets was 7.5 and the test took 7 minutes to get to 164 bpm.
I'm 197cms tall and weigh 125 kgs. The cardiologist thinks its all anxiety considering
The. Normal angiogram in september 2009 and normal ecgs and bloods since.
I train pretty hard with Trainer 4 days a week and don't get any chest pain while training. Also after the test my blood pressure went right down to
125/65 where as before it was up. Considerably. Cheers
XXXXXXX
 
 
Answered by Dr. Anil Grover 4 hours later
Hi XXXXXX,
Thanks for getting back to me. Happy to read everything positive. 7.5 Mets is OK for a person with your weight.
If you continue to take care of yourself with personal trainer. I assume that apart from blood pressure you do not have any significant risk factors, you have reasons to cheer for neither poor progression of R wave or T wave minor changes have any meaning. These can be at the best ignored. Good Luck. Take Care.


With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
 
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