Brief Answer:
I would recommend as follows

Detailed Answer:

Hello,

Regarding your concern I would like to explain that if an exercise cardiac stress test is performed in a person with low pre test probability, it is very likely to have false positive results. This means that there may be some abnormal ECG findings but not correlated with the presence of cardiac ischemia (coronary artery disease).

I would like to reassure you that there is no evidence of any heart attack in the past. Besides, ST elevation in an exercise cardiac stress is a rare finding and usually is not very typical of cardiac ischemia response.

Although, in order to definitely rule in or out the presence of coronary artery disease, I would recommend performing any of the following cardiac tests:

- a nuclear perfusion cardiac stress test
- a coronary angio CT scan
- a dobutamine cardiac stress echo

I would also like to review your ECG recordings during your exercise cardiac stress test and your cardiac ultrasound. Can you upload them for a second opinion?

Hope I have answered your query. I remain at your disposal for any further questions whenever you need!

Regards,
Dr. Ilir Sharka,
Cardiologist

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Brief Answer:
My opinion is as follows

Detailed Answer:

Hello,

I have reviewed your uploaded exercise cardiac stress test report. I would prefer to directly review also the ECG strips during the test. Meanwhile, if you have any available cardiac ultrasound report I would be interested to review to give a more appropriate professional opinion.

As I said before ST elevation during exercise cardiac stress test is not a common finding of cardiac ischemia, especially in a patient not having experienced myocardial infarction. In rare cases, ST elevation may be a marker of a proximal (left main coronary artery) vessel stenosis, a coronary spasm or left ventricular wall motion abnormalities. Nevertheless, it cannot conclude any firm suspicion of coronary artery disease, especially when you don't have any known coronary risk factors since all your previous cardiac stress tests have resulted normal.

The best strategy to follow for definitely clarifying this issue is to discuss with your attending doctor on the possibility of performing any of the above mentioned cardiac tests.

Hope I have answered your query. Please, let me know if you have any further questions.

Regards,
Dr. Ilir Sharka,
Cardiologist

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Brief Answer:
I explain below

Detailed Answer:

Hello,

Considering your blood lipid profile, if you are normotensive (no history of high blood pressure, no diabetes, and if you are a non smoker) then your 10 years risk for a fatal cardiovascular event is around 1%, so practically low. However, accounting for your actual chest pain symptomatology and your suspicious cardiac stress test conclusion, it is necessary to proceed to further cardiac investigation workup.

It is true that cardiac catheterization is the best and most reliable test to get the right medical evidence of coronary artery disease (stenosis) presence. Non-invasive cardiac tests like coronary angio CT scan or nuclear perfusional cardiac stress test seem to be rational alternatives for detecting coronary stenosis and myocardial ischemia presence, but if you want to get directly to the end of the story, you could promptly direct to coronary angiography (catheterization).

You have to discuss this with your cardiologist on the above mentioned issues.

Hope I have answered your query.

Regards,
Dr. Ilir Sharka,
Cardiologist

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