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What Does My Treadmill Stress Test Indicate About My Heart Condition?

Posted on Tue, 6 May 2014

Question: Hi. I recently performed a treadmill stress test (Bruce Protocol, non nuclear) with the following results. 11.5 minutes, 11.8 vo2, normal beginning HR and blood pressure. Normal increases of both HR and BP with exercise, normal decreases of each after cessation. Normal ECG in beginning, throughout test, and during recovery, UNTIL THE LAST MINUTE OF RECOVERY, where a 1-2 mm depression was noted. I am leaning towards repeating the test but with contrast, which is one of 3 options given to me by my PCF, who also gave me options of doing nothing, or getting a heart catheritization. I am 55 years old, in very good health but with history of high triglycerides which are treated with Lovaza, and family history of CAD. Your thoughts and suggestions are welcome. XXXX

Answered by Dr. Anantharamakrishnan (2 hours later)

Brief Answer: Go for Thallium stress EKG Detailed Answer: Dear friend, Welcome to Health Care Magic You have an excellent effort tolerance indeed. However ST depression 1mm or more (Horizontal or down-sloping / 80 milliseconds rom J point) is suggests ischemia and is an indication for further work up. At times, there may be false positive or false negatives too. The next step is TMT with thallium isotope. It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle. If there is a suggestion, the next step is to see the ANATOMY (structure) – undergo catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is invasive but it is the gold standard for this. CT angio is non-invasive study for the anatomy. If positive, you will need catheterisation, anyway. At this stage, you start with aspirin and statin… Aspirin in small doses – 75 to 150 mg – is a routine. It acts on the platelets and helps to reduce clot formation. There are others too… Statins have actions beyond cholesterol – like anti-oxidant and plaque stabilising effects… and given even if the cholesterol is normal... Your treating doctor will prescribe appropriately. The aim of any investigation is to modify the treatment, based on the result. With a positive family history and Dyslipidaemia, it is wiser and safer to do the test and see / rather than wait and watch Take care Wishing all well God bless

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (11 hours later)

Sounds like good advice and is consistent with PCF recommendation. Just wondering what would result in the depression so late in the recovery vs. during the exercise portion of the test or shortly thereafter in beginning of recovery? Thanks, XXXX

Answered by Dr. Anantharamakrishnan (9 hours later)

Brief Answer: time for compensation - Detailed Answer: Hi Obstruction limits the quantum of flow… The increased demand puts a strain leading to maximum adjustments – physical and physiological The demand continues into early recovery – And it needs time for mechanical and metabolic measures to settle down… Hence changes are at times obvious or more prominent during recovery Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar