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Dr. Andrew Rynne

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What does borderline positive for exercise inducible ischemia indicate?

Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 5760 Questions

Posted on Mon, 23 Apr 2018 in Hypertension and Heart Disease
Question: Hi Doctor,
My TMT Report says: XXXXXXX Protocol.
V. Good effort tolerance.
Achieved % of THR at Mets of workload
Normotensive response.
No Arrythmias / Angina
ST depression of more than 1 mm in L2! V5, V6 and more than 0.5 mm in L3, arF / V2, V3, V4 at peak exercise.
Test is considered as Possible Borderline Positive for exercise inducible ischemia.

What does this Possible Borderline Positive for Excercise inducible Ischemia means for my health.....!!!
Is it something to be worried or can i overcome this by doing some excercise or diet changes.

Please advise

Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:

Welcome on HCM!

After reviewing your uploaded medical tests reports and also your cardiac stress test conclusion, I would like to explain that your lab test are within the normal ranges, except for some slight deviations:

- glycosylated hemoglobin (HbA1c) level which is borderline (5.7%); above this value a prediabetic state (metabolic syndrome) is considered.

- slightly low HDL-cholesterol and increased triglycerides.

Additional efforts are necessary to overcome this condition, including daily physical activity, controlling your body weight and a healthy diet (high in fibers; low in saturated fat and sugar load) as well. Mediterranean diet is highly encouraged.

Regarding your TMT report I would explain that as far as you didn't experience any chest discomfort or pain and no firm and conclusive ECG signs of ischemia were produced, the positive predictive value of the test is not sufficient.

In other words, as you don't have an obvious history of exertion angina and definite coronary risk factors (no history of hypertension, no diabetes, no high cholesterol level, no smoking, etc.), the pretest probability is less than intermediate. So, the test is not enough reliable.

But, if we want to get more inside of this issue, you may need to go through any of the more specific tests like:

- nuclear perfusional cardiac stress test,
-cardiac stress echo,
- coronary angio CT

Meanwhile, I encourage you to continue following a healthy life-style, check periodically your blood pressure values, glucose and lipid blood profile.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri

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

The User accepted the expert's answer

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