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What Does This TMT Report Indicate?
Question: My wife got a regular Health checkup done. Her TMT showed mildly positive. The TMT report says : Normal heart rate and BP response. Developed asymptomatic 1-1.5 mm upsloping ST Depression in the leads II,III, avF, V3-V6 during stage 3 at heart rate of 166 bpm, which reverted to basal pattern within 1 minute of recovery period.After 3 minute recovery period patient developed T wave inversion in leads II, III,avF and V5-V6 which persisted till late recovery. No symptons of anginal/chest pain during the test. No significant arrhythmia during the test. No S3/S4 Gallop during the test. My wife is 48 rs old, her weight is 65 kg and her height is 158 cm. Kindly advise what next step should be taken?
Brief Answer:
stress thallium test to be done as soon as possible
Detailed Answer:
Hi,
Firstly thank for choosing health care magic for your query!
As per the details given by you there is approx 1 to 1.5 mm ST depression in your wife,s TMT .
The depression is present in leads II,III, avF(inferior leads) and leads V5-V6 (Lateral leads).
According to the latest criteria laid down by XXXXXXX college of cardiology,
Minor changes; less then 2mm ST depression in inferior leads can be neglected , But even 1 mm of ST depression in lateral leads specially V5 and V6 is highly significant and should not be neglected.
Inferior leads represents the inferior wall of heart and a change more then 2mm is significant in TMT, v5-v6 represents the lateral wall of heart and TMT is highly sensitive to rule out ischemia in this region,as T wave inversion persisted in lead v5 and v6 till late recovery ,it can be ischemia,and this has to be taken seriously!
Angiography is a invasive procedure ;and mildly positive TMT is never a indication of angiogram.
-Recommendations for Coronary Angiography in Patients With Suspected CAD Who Are Currently Asymptomatic (YOUR CASE SUSPECTED CAD);
1) High-risk criteria on noninvasive testing (stress thallium).
2)Patients who have been successfully resuscitated from sudden cardiac death or have sustained (>30 seconds) monomorphic ventricular tachycardia or nonsustained (<30 seconds) polymorphic ventricular tachycardia.
Neither of two are there in your wife ,
I would suggest you to go for a test called STRESS THALLIUM;
A thallium stress test is a nuclear imaging test that shows how well blood flows into the heart while you’re exercising or at rest. This test is also called a cardiac or nuclear stress test.
During the procedure, a radioisotope (nuclear liquid) is administered through an IV. The radioisotope will flow through your blood stream and end up in your heart. Once the radiation is in your heart, a special camera called a gamma camera can detect the radiation and reveal any issues your heart muscle is having.
Sensitivity of the test is almost 97% as compared to angiogram 99%,and being a noninvasive test the risk associated are far less then angiography..
So my suggestion is go for Stress thallium ,if any thing is wrong in stress thallium then angiogram is indicated.
Advised
Stress thallium test
In case you want more details or you have any other query,feel free to ask.
Thank you,
Dr Rishu Saxena
Cardiologist
stress thallium test to be done as soon as possible
Detailed Answer:
Hi,
Firstly thank for choosing health care magic for your query!
As per the details given by you there is approx 1 to 1.5 mm ST depression in your wife,s TMT .
The depression is present in leads II,III, avF(inferior leads) and leads V5-V6 (Lateral leads).
According to the latest criteria laid down by XXXXXXX college of cardiology,
Minor changes; less then 2mm ST depression in inferior leads can be neglected , But even 1 mm of ST depression in lateral leads specially V5 and V6 is highly significant and should not be neglected.
Inferior leads represents the inferior wall of heart and a change more then 2mm is significant in TMT, v5-v6 represents the lateral wall of heart and TMT is highly sensitive to rule out ischemia in this region,as T wave inversion persisted in lead v5 and v6 till late recovery ,it can be ischemia,and this has to be taken seriously!
Angiography is a invasive procedure ;and mildly positive TMT is never a indication of angiogram.
-Recommendations for Coronary Angiography in Patients With Suspected CAD Who Are Currently Asymptomatic (YOUR CASE SUSPECTED CAD);
1) High-risk criteria on noninvasive testing (stress thallium).
2)Patients who have been successfully resuscitated from sudden cardiac death or have sustained (>30 seconds) monomorphic ventricular tachycardia or nonsustained (<30 seconds) polymorphic ventricular tachycardia.
Neither of two are there in your wife ,
I would suggest you to go for a test called STRESS THALLIUM;
A thallium stress test is a nuclear imaging test that shows how well blood flows into the heart while you’re exercising or at rest. This test is also called a cardiac or nuclear stress test.
During the procedure, a radioisotope (nuclear liquid) is administered through an IV. The radioisotope will flow through your blood stream and end up in your heart. Once the radiation is in your heart, a special camera called a gamma camera can detect the radiation and reveal any issues your heart muscle is having.
Sensitivity of the test is almost 97% as compared to angiogram 99%,and being a noninvasive test the risk associated are far less then angiography..
So my suggestion is go for Stress thallium ,if any thing is wrong in stress thallium then angiogram is indicated.
Advised
Stress thallium test
In case you want more details or you have any other query,feel free to ask.
Thank you,
Dr Rishu Saxena
Cardiologist
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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