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What Do These Following Echocardiogram And TMT Test Reports Indicate?
Question: today i underwent eco and tmt test. eco test shows heart rate 78bpm NSR
No left ventricular regional wall motion abnormality, LVEF 60%
Concentric LV hypertrophy present
Trace MR.
Trace TR (PASP Normal)
Grade I diastolic dysunction
E/E<12 S/o Bormal LVEDP
Normal right ventricular systolic function
IVC S/o normal RAP
No intracardiac clot/vegetation/ pericardial effusion seen
TMT Test report shows:
On XXXXXXX protocol of workload of 7.60Mets whcih is 91/5 of maximum predicted HR.
Significant ST-T changes were observed durig excerise test. Developed 1.0 to 1.5mm HZ ST depression in leads II, III aVF during stage II, progress to 1.5 to 2.0mm HZ & DS ST depression in leads II, III , aVF and V6 at peak exercise. These ST-T changes reverted to basal pattern at 1 minute of recovery period
No significant arrhythmia was observed during stree test
Normal HR & BP response to exercise
Final Impression: TMT test is positive for reversible myocardial ischemia
I am Hypo thyrodism for past 20 years in controlled condition having 100mg eltroxin medicine, non smoker, non-vegiterian. My weight is 105 Kg with height 5ft 10 inch. I am having BP as normal before, but last one week it is 140/90 to 144/70 today. Kindly suggest treatment, i want to be healthy without any surgery based on eating habits and medicine.
No left ventricular regional wall motion abnormality, LVEF 60%
Concentric LV hypertrophy present
Trace MR.
Trace TR (PASP Normal)
Grade I diastolic dysunction
E/E<12 S/o Bormal LVEDP
Normal right ventricular systolic function
IVC S/o normal RAP
No intracardiac clot/vegetation/ pericardial effusion seen
TMT Test report shows:
On XXXXXXX protocol of workload of 7.60Mets whcih is 91/5 of maximum predicted HR.
Significant ST-T changes were observed durig excerise test. Developed 1.0 to 1.5mm HZ ST depression in leads II, III aVF during stage II, progress to 1.5 to 2.0mm HZ & DS ST depression in leads II, III , aVF and V6 at peak exercise. These ST-T changes reverted to basal pattern at 1 minute of recovery period
No significant arrhythmia was observed during stree test
Normal HR & BP response to exercise
Final Impression: TMT test is positive for reversible myocardial ischemia
I am Hypo thyrodism for past 20 years in controlled condition having 100mg eltroxin medicine, non smoker, non-vegiterian. My weight is 105 Kg with height 5ft 10 inch. I am having BP as normal before, but last one week it is 140/90 to 144/70 today. Kindly suggest treatment, i want to be healthy without any surgery based on eating habits and medicine.
Brief Answer:
Keep a check on blood pressure. Evaluate for underlying heart disease
Detailed Answer:
Hello ,
I am Dr. Mody and I would be addressing your concern.
I went through the information you have provided .
Now the echocardiography is nomral except concentric hypertrophy, which may be secondary to increased pressure . Though you say that blood pressure is on higher side since a week only , but for concentric hypertrophy to develop it must be longer in duration . So keep a tab on the blood pressure reading and smart medication if needed .
Cut salt in your diet and 35 mins of aerobic exercise daily. This should reverse the echo finding .
Now coming to the TMT report , considering your age and TMT becoming positive in stage 2 itself , I strongly suggest that you undergo further cardiac evaluation. A conventional coronary angiography may the the next step depending on detailed examination.
An angiography doesn't mean surgery, but it will help you to quantify the extent of underlying problem and nd based on that optimum medication may be started .
So I would sincerely advice you that instead of getting frightened of the consequences atleast get a complete diagnosis and take a call based on the objective results rather than speculate . There may a chance where the TMT ais falsely positive and there might not be any blockages .
So get your evaluated and keep a at rich check on the blood pressure. Lose weight , get your lipids and sugars checked too .
Let me know if any clarification needed
Regards Dr Priyank Mody
Keep a check on blood pressure. Evaluate for underlying heart disease
Detailed Answer:
Hello ,
I am Dr. Mody and I would be addressing your concern.
I went through the information you have provided .
Now the echocardiography is nomral except concentric hypertrophy, which may be secondary to increased pressure . Though you say that blood pressure is on higher side since a week only , but for concentric hypertrophy to develop it must be longer in duration . So keep a tab on the blood pressure reading and smart medication if needed .
Cut salt in your diet and 35 mins of aerobic exercise daily. This should reverse the echo finding .
Now coming to the TMT report , considering your age and TMT becoming positive in stage 2 itself , I strongly suggest that you undergo further cardiac evaluation. A conventional coronary angiography may the the next step depending on detailed examination.
An angiography doesn't mean surgery, but it will help you to quantify the extent of underlying problem and nd based on that optimum medication may be started .
So I would sincerely advice you that instead of getting frightened of the consequences atleast get a complete diagnosis and take a call based on the objective results rather than speculate . There may a chance where the TMT ais falsely positive and there might not be any blockages .
So get your evaluated and keep a at rich check on the blood pressure. Lose weight , get your lipids and sugars checked too .
Let me know if any clarification needed
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Raju A.T
Doctor is it possible that. Present problem can be reversed with some medicine for few weeks and I can reduce weight and again go for tmt look I am a ca in practice and has lot of responsibilities if I follow above plan and try to reverse the problem with my weight reduced and vo check and some reqd medicine for 3 weeks if problem remains I can then go for test of angiogram or pl suggest me any other thing also some alternative
Brief Answer:
Start medications and lifestyle changes , if no symptoms you may wait for 3 weeks
Detailed Answer:
Hello Sir ,
TMT being positive is just an investigation which points to a maybe underlying heart condition . We don't know the extent of it . Considering it became positive in stage 2 itself and your age , obesity and other risk factors, it's safer to evaluate it further .
If you are scared of undergoing a conventional angiography ( though a better option ) , you may have a CT coronary angiogram done , which is just a CT scan , depending on its result at least you can be started on medicines for the heart plus we will have a better idea about the urgency of further treatment.
Even if we investigate as we have discussed, loosing weigh and bringing necessary modification in the diet and lifestyle should be your priorities by all means .
If there are symptoms waiting for 3 weeks is not a problem , but repeating a stress test after 3 weeks makes no sense as nothing is going to change there in 3 weeks , so rather a furthur investigation is justified.
The above discussion would be the most ideal and safer way ahead .
Hoping I could help .
Regards
Dr Priyank Mody
Start medications and lifestyle changes , if no symptoms you may wait for 3 weeks
Detailed Answer:
Hello Sir ,
TMT being positive is just an investigation which points to a maybe underlying heart condition . We don't know the extent of it . Considering it became positive in stage 2 itself and your age , obesity and other risk factors, it's safer to evaluate it further .
If you are scared of undergoing a conventional angiography ( though a better option ) , you may have a CT coronary angiogram done , which is just a CT scan , depending on its result at least you can be started on medicines for the heart plus we will have a better idea about the urgency of further treatment.
Even if we investigate as we have discussed, loosing weigh and bringing necessary modification in the diet and lifestyle should be your priorities by all means .
If there are symptoms waiting for 3 weeks is not a problem , but repeating a stress test after 3 weeks makes no sense as nothing is going to change there in 3 weeks , so rather a furthur investigation is justified.
The above discussion would be the most ideal and safer way ahead .
Hoping I could help .
Regards
Dr Priyank Mody
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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