Cardiovascular Disease Prevention Expert Forum
Conflicting cardio test results
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Questions in the Cardiovascular Disease Prevention forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine.

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Conflicting cardio test results

Age 69, Wt 143,ht5'4", I went for routine cardio evaluation which I do due to poor family history, high cholesterol225-(now258without meds, HDL 90), &mvp.
An echo stress with definity showed abnormal EKG with St-depression consistent with anterior ischemia. MD said he could treat me medically (I can't take statins & was just taken off zetia & NIASPAN after over 7 years, due to generalized pain) or do a cath which he'd prefer. Echo showed abnormal wall movement. Had slight dizziness & s.o.a. But no pain. Report stated "slow", walked 7:14
Stage 1...3 min- HR 101 &bp 140/80
Stage 2...3 min.-HR 122.    160/80
Stage 3....1:14 min..HR 146

Had a 1mm depressed ST, got a headache , soa
Called a tecnically difficult exam w/ 1.5 ml Definity. Described it as moderate work load.
Then in Cleveland....,
2weeks later a stage 3 Bruce protocol stress EKG in cleveland , was called normal, with 91% of predicted max HR, univocal pac's& pvc's during test. Function capacity at 9 METS. Ejection faction 60%. am on no meds.
To cath or not to cath? What am I to think?
What am I to conclude?
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In summary you are asymptomatic with conflicting stress test results. Im not clear if a repeat echo was normal as well. A cath would be the most direct path to certainty for you while in many cases your clinicians, certainly the ones in cleveland who received normal results of studies, would suggest that medical risk factor management is sufficient without subjecting you to the risks of cath. Its largely dependent upon your state of mind and how aggressive you want to be
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