Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Could One Have A Normal Stress Test And Still Have A Problem With The Heart?
Question: Could you have a normal stress test and still have problems with your heart? I have had a few episodes of cardiac symptoms but had a normal stress test. I had another episode and just ignored it. Then a couple weeks later I had to get clearance for surgery and my ekg showed new t wave inversion in anterior leads. But cardiology said my stress test was fine and that was it. While I know there can't be anything really serious or I'd be dead but could i still have some issues with my heart that don't show on stress test? I'm 36, normal weight. Only risk factor is high cholesterol .
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello,
A standard cardiac stress test can exclude major cardiac ischemic disorders.
But, its sensitivity and specificity are not 100%.
In other words, you may have a normal cardiac stress test even when there are underlying cardiac issues, as well as abnormal findings in a cardiac stress test could be present in normal and healthy individuals.
The latter alternative is especially in women.
Now, returning to your case, considering your age and results of cardiac stress test, it may be concluded with a high probability that no major ischemic disorders are present.
Anyway, I would explain that the result of the exercise cardiac stress test should be also considered based on the clinical symptomatology.
In case of coronary risk factor present and a suspicious symptomatology (suspicious chest pain, etc.) a rational diagnostic alternative would be a coronary angio CT scan.
You should discuss with your doctor on the above test.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello,
A standard cardiac stress test can exclude major cardiac ischemic disorders.
But, its sensitivity and specificity are not 100%.
In other words, you may have a normal cardiac stress test even when there are underlying cardiac issues, as well as abnormal findings in a cardiac stress test could be present in normal and healthy individuals.
The latter alternative is especially in women.
Now, returning to your case, considering your age and results of cardiac stress test, it may be concluded with a high probability that no major ischemic disorders are present.
Anyway, I would explain that the result of the exercise cardiac stress test should be also considered based on the clinical symptomatology.
In case of coronary risk factor present and a suspicious symptomatology (suspicious chest pain, etc.) a rational diagnostic alternative would be a coronary angio CT scan.
You should discuss with your doctor on the above test.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I uploaded the last two EKGs I had. The one that the cardiologist read said that I now had t wave inversion in anterior leads. Do you agree and does that mean anything? And can the t wave inversion come and go?
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello,
I reviewed your uploaded ECG recordings and would explain that those T wave inversion in the anterior leads (V1-V3) doesn't seem to be related to any cardiac ischemia issue, but instead are part of a certain QRS pattern (rSr'), which in fact does not fulfill the criteria of right bundle branch block.
Instead it is more likely to be related to J wave syndrome and the fact QRS pattern is slightly altered between the two ECGs is explained by changing the electrode positioning on the chest surface.
So, cardiac ischemia is excluded, but it is necessary to go further and investigate potential J wave syndrome.
Hope to have have explained your uncertainties.
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello,
I reviewed your uploaded ECG recordings and would explain that those T wave inversion in the anterior leads (V1-V3) doesn't seem to be related to any cardiac ischemia issue, but instead are part of a certain QRS pattern (rSr'), which in fact does not fulfill the criteria of right bundle branch block.
Instead it is more likely to be related to J wave syndrome and the fact QRS pattern is slightly altered between the two ECGs is explained by changing the electrode positioning on the chest surface.
So, cardiac ischemia is excluded, but it is necessary to go further and investigate potential J wave syndrome.
Hope to have have explained your uncertainties.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What do they do for J wave syndrome? How do they test for it or treat it? Or is it just something that is not a big deal?
Brief Answer:
Explanation as follows:
Detailed Answer:
I would explain that inside J wave syndromes are included two subgroups:
1) Brugada syndrome,
2) Early repolarisation syndrome
These syndromes are associated with increased risk of dangerous arrhythmia and hence need to be correctly excluded.
In your case, Brugada syndrome needs to be excluded and the test of choice is the provocative Ajmaline test.
You should discuss with your doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Iliri
Explanation as follows:
Detailed Answer:
I would explain that inside J wave syndromes are included two subgroups:
1) Brugada syndrome,
2) Early repolarisation syndrome
These syndromes are associated with increased risk of dangerous arrhythmia and hence need to be correctly excluded.
In your case, Brugada syndrome needs to be excluded and the test of choice is the provocative Ajmaline test.
You should discuss with your doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
