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What does the stress test report indicate?

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Posted on Sat, 23 May 2015
Question: Is S T elevation & depression a normal variant on a stress test? Even if it is below the threshold of 1.5?

The machine print out stated "2nd degree AV block mobitz type II & septal MI & Q wave 40+" my symptoms were consistent with MI and post MI but cardiologist didn't want to discuss my symptoms stating i was too young and it was most likely a machine error. Do machines often get it wrong? I can see the q wave on activity...so i don't know what part is the error - the machines interpretation or the fact that it is unlikely to be there?
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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I advice to discuss with your doctor, facing the following opinions.

Detailed Answer:

Hello!

Thank you for asking on HCM!

I understand your concern, and would like to explain that judging on a stress test result, first, the indications for undergoing such a test must be appropriate.

Generally, highly suspicious ischemic chest pain (or its equivalents) must be present, in addition to any coronary risk factors (at least an intermediate pretest probability for coronary heart disease must be present).

Regarding your question about ST elevation or depression, they must be judged on concrete grounds, facing patients medical history, complains, and pretest probability for coronary artery disease.

Generally speaking, when these ST deviations (greater than 1-1.5 mm) are present in addition to inducible exertional ischemia clinics (chest pain, or its equivalents), an important pretest probability of CAD, complex arrhythmia, or AV conductance disturbances, as well as hemodynamic abnormalities (like hypotension), then ST deviation is considered abnormal and contributes to a positive results of the stress test (CAD evidence).

If stress test is performed in a patient with prior MI, then ventricular repolarization abnormalities on the ECG leads facing MI location, may not be considered as any current myocardial ischemia (in the absence of an evident clinical symptomatology and other co-indicators mentioned above). In this case it may be considered a sign of dyskinetics anomaly.

Regarding your concern about AV bock and septal MI, I would rely on the doctor decision to draw the final conclusion (as there are special cases where a septal Q wave doesn't reflect a MI presence, and the machine sometimes conclude false results as well).

To conclude about a MI presence, a resting ECG is very helpful. If you own such a recording, please upload it for an expert opinion.

Feel free to ask me whenever you need.

Hope to have been helpful to you. Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ilir Sharka (2 hours later)
That was very helpful thank you. I wondered how or if my cardiologist could make a diagnosis without obtaining all the history or if it would be just his interpretation versus the machine. There is a strong family history of MI and sudden death, cardiovascular disease evident at age 40, my dad passed at 53 after a 10+ year history of very high blood pressure & elevated cholesterol (treated with medication). 2 weeks prior to his MI his cholesterol, BP, heart rate were perfect but then he developed MI symptoms, avoided 3 GP apts & died at the gym.

I had a 12 mth history of bradycardia and pre syncope & 2x syncope when walking around. I felt as though my brain was a bit sluggish. Until I had this sudden illness??? I never had heart burn before, initially i thought it was a gastric type virus, i felt tired, extreme fatigue, coming down with something, short of breath, then i had severe chest pain when walking, like squeezing (that scared me and i began to think maybe it's not heartburn), as I f my heart stopped and tingling sensation went to my feet then remained in my arms, back & shoulder pain & throat sensation, sweating, nausea and trying to vomit but had not eaten for a few hours. I lay down, which made it hard to breathe, not sure if i passed out or went to sleep. I had told my partner to check on me just in just in case it wasn't a virus. When i woke 3 hrs later i felt like i was heavily sedated. Chest pain again but less intense. I had to sleep most of the next 48 hrs. I drank fluids but hardly pee'd. I felt like there was something wrong with my brain, i couldn't remember things, i couldn't do complex report writing, extreme fatigue. I got pressure headaches daily. The dizzy spells were several times per day with at least 2 episodes of pre syncope /day (vision disturbance, weakness but not complete loss of consciousness)..hands swelled, lost my appetite, nausea & tight chest & hot flushes, intolerant of alcohol (1 glass made me feel ill) sense of smell is heightened.,
things are almost back to before this illness, it's been 9 week since it happened.
my gp referred me based on my 12 mth history of pre syncope, & bradycardia (at week 3- i had thought it was a nasty virus as some other people had felt unwell but none had chest pain) . I actually didn't remember the episode at this time, life was a blurr. My ecg was abnormal & that triggered my memory. I can upoad my Ecg, resting from that appointment. Cardiologist said everything was normal but before i met with him the nurse said there were ectopics in my halter test, heart rate range of 49bpm-150bpm. I just worry i don't know what happened or why? And i worry about driving with my family in the car. Maybe he's right but i don't feel like he had all the info or was even interested because i'm "too young" and i "probably just pulled a muscle" his advice was to eat more salt & drink more water?? I drink 2-3 litres a day??
doctor
Answered by Dr. Ilir Sharka (9 hours later)
Brief Answer:
A neurological opinion would be necessary during the differential diagnosis

Detailed Answer:

Hi again!

I passed carefully through you medical history, and I would conclude that your complains doesn't seem specific for any cardiac disorders.

(a) You have experienced a very prolonged and migrating chest pain; it doesn't seem to be heart related at all. A cardiac ultrasound and cardiac enzymes lab test during those complains would have ruled out possible cardiac implications. Even the most careless cardiologist would have noticed that.

(b) A special point to consider is your pre syncope and syncope history. A possible cardiac rhythm and conductance disturbance could be hardly found responsible, facing concomitantly your extreme fatigue, prolonged weakness and your normal Holter report.

(c) Regarding those dizzy spells, pre syncope, unexplained memory loss, inability to perform complex procedures (writing, etc) not associated by a hemodynamic disorder, should be addressed by a neurologist, as they are more compatible with the nervous system involvement. Probable digestive type of epilepsy aurea should be considered during differential diagnosis.

(d) At the end, I would suggest to consider a Head up Tilt table testing and some blood tests (CBC, PCR, ,etc) and to visit your neurologist for a comprehensive differential diagnosis of your complains.

If you have available cardiac tests results (ECG, cardiac ultrasound, Holter monitoring, stress test, etc), you could send them for a final review of opinions.

Best Regards! Dr. Iliri
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Ilir Sharka (1 hour later)
thank you for your time and reassurance.
doctor
Answered by Dr. Ilir Sharka (6 hours later)
Brief Answer:
You are welcome!

Detailed Answer:

You are welcome!
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ilir Sharka (1 hour later)
attached are my ecgs...black & white are from my stress test. red from GP - i guess the gp one is what made me think it might be cardiac...i don't have copies of the other reports - echo and halter but apparently there were a few ectopic beats and a heart murmur.
doctor
Answered by Dr. Ilir Sharka (56 minutes later)
Brief Answer:
Please, try to send them again!

Detailed Answer:

Hi!

I am sorry, but I couldn't find any attached files on my follow up screen.

Please, could you try once more the attachments! Alternatively, you can mail it to me at YYYY@YYYY with subject line as 'attention to Dr. Iliri Sharka'.

Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Ilir Sharka (2 hours later)
Hi, I have provided some attachments. Please review them.
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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
Everything looks normal from your reports.

Detailed Answer:

Hi Katrina!

I looked carefully your attached reports, and I am glad to confirm you that they are all normal.

(1) Your resting ECG is normal (sinus rhythm, no arrhythmia presence, no conductance and repolarization disorders).

(2) Your stress test is considered normal (those up-sloping depressions are not considered pathological, as they are normal ECG findings during sinus tachycardia. You have also a normal blood pressure response to physical exertion.

So, to conclude, there is not any elements from all these recordings, that could raise relevant suspicions about any heart problem issues.

Hope to have been helpful to you.

My best wishes! Dr. Iliri

Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Dr. Ilir Sharka

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What does the stress test report indicate?

Brief Answer: I advice to discuss with your doctor, facing the following opinions. Detailed Answer: Hello! Thank you for asking on HCM! I understand your concern, and would like to explain that judging on a stress test result, first, the indications for undergoing such a test must be appropriate. Generally, highly suspicious ischemic chest pain (or its equivalents) must be present, in addition to any coronary risk factors (at least an intermediate pretest probability for coronary heart disease must be present). Regarding your question about ST elevation or depression, they must be judged on concrete grounds, facing patients medical history, complains, and pretest probability for coronary artery disease. Generally speaking, when these ST deviations (greater than 1-1.5 mm) are present in addition to inducible exertional ischemia clinics (chest pain, or its equivalents), an important pretest probability of CAD, complex arrhythmia, or AV conductance disturbances, as well as hemodynamic abnormalities (like hypotension), then ST deviation is considered abnormal and contributes to a positive results of the stress test (CAD evidence). If stress test is performed in a patient with prior MI, then ventricular repolarization abnormalities on the ECG leads facing MI location, may not be considered as any current myocardial ischemia (in the absence of an evident clinical symptomatology and other co-indicators mentioned above). In this case it may be considered a sign of dyskinetics anomaly. Regarding your concern about AV bock and septal MI, I would rely on the doctor decision to draw the final conclusion (as there are special cases where a septal Q wave doesn't reflect a MI presence, and the machine sometimes conclude false results as well). To conclude about a MI presence, a resting ECG is very helpful. If you own such a recording, please upload it for an expert opinion. Feel free to ask me whenever you need. Hope to have been helpful to you. Greetings! Dr. Iliri