Stress Echo

[bmdgsd]

57 F w hx of CMV & EBV cadiomyop on mio biopsy. EF inc from 40% - 60%.  Hx: AI , Hyperlipids, SOB on exerti and CFS.  Rare CP w exertion.  Menopause 28 yrs.

stress echo  6-26-08. Results:

   Stopped due to SOB & sys HTN.  Aerobic capacity not obtainable.  EKG at rest NSR  poor R wave progression. T Wave inversion in lead III with 1-1.5mm ST depres in leads V4-5 with exercise.  

Stress IMP:  Ischemic GTX with symptoms of HA and SOB  a sys hypertensive response to exercise.

Resting image.  There is  sm seg of the basal inferior wall & inferseptal hypokineses.  (This was not present on echo of 6-3-08)  Overall there is still probably norm LV sys function.
Post stress :   basal inferior  & basal inferoseptum may remain hypokinetic.  There is an appro incr in LV wall thickening in the remaining wall & no LV dil.

IMP: prob normal , non ischemic stress echo, but possible small area of persistent hypokinesis at the base of the inferoseptum and inferior walls.

     Max heart rate          152
     % pred. max               93
     Peak sys BP           220
     peak prp                  334
     Pred norm vo2       25ml/kg/min
     calc vo2 max                18
     MET achieved                5  

BP supi      140/80    HR  82
     stand    124/72         87
     stage 1  220/80        141
              2                     152
     Recove 1 min          123
                   2   200/70    113
                   4   170/88     105
                    6   150/88     98

EKG's  were  norm until 2002 then  showed NSR  Pos. L atrial enlargement; anteroseptal infarct, age undeter (computer)  Cardio"s reading:  slow R wave progression. counter clockwise rotation.

... is the EKG a normal variant?  what is slow R waveand rotation caused by after having norm ekg's

...  recommend?   currently on Toprol XL 50mg  Crestor Tricor Zetia Midodrine Florinef celebrex  plaquenil

... should I be concerned about stress echo results ?

[Lee Kirksey, MD]

Hello
There is quite a bit of information in that comment. Ill focus on your question which I understand to be is your ekg a normal variant. Your history suggest cardiomyopathy which is symptomatic with sob on exertion and occasional angina. Also aortic insufficiency. I would not expect your ekg to be normal. It looks like you have evidence of LV thickening and a question of inferior ischemia all of which are "concerning"... yes but currently being treated appropriately by your doctors. The echo is one indicator of your overall clinical picture and should be repeated at some interval for comparison or sooner if your symptoms change

[Lee Kirksey, MD]

Perhaps swimming would provide a better form of exercise. I would speak to your cardiologist or the doctor covering in his absence and see if based on your clinical picture, your toprol is optimized or another agent should be added

[bmdgsd]

Thank you so much for the advice.  I had a gut feeling the med should be adjusted, but needed the confidence boost you provided.  This site is a great way to learn and see how other people deal with things.  It also helps diminish the "pity parties".  The posts re children and their parents really puts things into perspective.

Thank you again

[bmdgsd]

Sorry for all the info at once.  What, if anything can I do about the sys hypertension with activity.  It is severely limiting what little walking or exercising I could do. My cardiologist is on vacation and Toprol is the only BP med I am on.  There must be some kind of activity I can do that will not affect me so quickly and severely.  I was told to stay away from isometrics.

Thank you.