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Dr. Andrew Rynne

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What does this ST elevation of 2 mm during stress test indicate?

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Dr. Anantharamakrishnan

Cardiologist

Practicing since :1966

Answered : 4506 Questions

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Posted on Tue, 3 Nov 2015 in Hypertension and Heart Disease
Question: Good evening--
This is a cardiology question concerning a 2 mm elevated ST segment that was picked up on my /stress stress test today. I am a very healthy active 66 post menopausal woman. I am treated for hypertension which is controlled with Altace 5 mg everyday. I have very low cholesterol levels and a high HDL. Non-smoker, not overweight (125# - 5-8). The major concern by the PCP who is a B/C Cardiologist is that my dad had a major MI and died from it at age 56. My Mom is 93 and recently had a DDD pacemaker implant. MD suggested a Holter monitor study next month and then possibly a nuclear study. Five days per week I work out at the gym, on weights, bike and general machines. I have never experienced shortness of breath or chest pain/discomfort. On today's stress test--I reached 140 heartrate with ease and no problems. MD mentioned that the echo showed that the heart emptied and filled nicely but the elevated St was his only concern. Does this mean I have to cut back on my gym routine? I hope I am not a walking time bomb!!
doctor
Answered by Dr. Anantharamakrishnan 1 hour later
Brief Answer:
Treat as CAD until proved otherwise

Detailed Answer:
Hi friend
Welcome to Health Care Magic

You are in good hands…
Your PCP’s concern is appropriate
You need to be investigated further for Coronary Artery Disease (CAD)… irrespective of all other factors

     The TMT (Treadmill Exercise ECG) has suggested ischemia. It is an indication for further work up – because at times, there may be false positive or false negatives. The next step is TMT with thallium isotope (nuclear study). It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle.
     If there is a suggestion, the next step is to see the ANATOMY (structure) – undergo catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is invasive but it is the gold standard for this. CT angio is non-invasive study for the anatomy. If positive, she will need catheterisation, anyway.

The aim of any investigation is to modify the treatment, based on the result. In such situations, we will cut down strenuous physical and mental stress / treat as CAD, until the investigations are completed…

Good luck
God bless you
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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