Cardiac Stress Report, meaning ? what next ?

Cardiac Stress Report, meaning, what next ?
by naturlm, 2 hours ago
Tags: Hypokinesis
I am 64 year old male experiencing no short of breath, pain or other physical heart disease symptoms.  Height 6' 0", weight 210 lbs, 38 in waist, with some belly fat.  I just picked up following results for an echo stress test completed yesterday (stress test ordered because of inverted T on annual EKG physical exam).  At start of test, resting HR was 67 bpm, resting BP 122/82 mmHg.

Test Conclusions:
-Exercise stress test with ECG non diagnostic due to baseline ECG changes
-Abnormal regional wall motion with stress
-Post exercise wall motion shows hypokinesis involving mid septum, apical septum, mid inferior and apical inferior segments
-Visually estimated EF is 60 %, at peak stress EF is normally improved to 65 %.
-There is echocardiographic evidence of ischemia.
-Mild inferior and inferoseptal hypokinesis with stress.

Due to slightly overweight and moderately high blood pressure, I have been on on one daily TiamT/HCTZ 50-25 last two years.  My primary doctor prescribed Simvastatin 40 mg once / day after receiving above stress test results.  What does this stress test mean and what comes next ?  Do I have permanent or non permanent heart muscle loss ?  If unknown, how do we find out ?  Is this treatable with future medications, diet changes. weight loss and exercise and followup echo testing at this point, or is angiogram needed next to determine amount and severity of any blockage, method to remove blockage etc. ?  I am walking an hour each day or bicycling an hour each day and have done this in recent days with no apparent problems, shortness of breath, etc.  Is exercise of this type recommended or do I have to reduce my exercise until further diagnostic testing completed ?  If I must change my exercise, what is recommended ?

[Lee Kirksey, MD]

Hello
Without seeing your test results (the actual test, not the film) I can only comment in general. In addition to the stated information, it would helpful to know if you smoke, your family risk factors, cholesterol panel results

The report suggests that you have ischemia which is a fancy term for living muscle that when stressed by exercise is showing signs of diminished blood flow. This suggests that you have blockages in your blood vessels to some extent. The severity or location is uncertain.  The good thing is that your hearts pumping ability seems good and they dont mention evidence that you have had a silent heart attack in the past

In most cases, your doctor would proceed with a cardiac catheterization. Until you review these results with him, it would probably be prudent to take it easy and avoid exercise and stress. From the medical treatment and prevention aspect, you need aggressive management of your cholesterol and risk factor modification including a low fat <25-30 gm total fat and less than12-15 gm sat fat diet.

You are fortunate to have th opportunity to alter your life style. Most heart attacks occur in people who have had no prior symptoms and 50% of first time events result in death.

Good luck