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Abnormal Stress Test; Normal SPECT/Imaging
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Abnormal Stress Test; Normal SPECT/Imaging

Hi doc/everyone --

Quick question regarding recent stress test results. I went in for cardiac SPECT imaging where they inject the tracer at rest and gather images, followed by a tress test, then the SPECT imaging again immediately following exercise.

During the stress, I reached 15 minutes and 17 METS with the test ending b/c of fatigue. The findings said at just over 12 minutes of exercise I showed ST segment depression of 2mm in most leads, resolving just 25 seconds into recovery. Also noted were a couple short runs of nonsustained ventricular tachycardia at peak exercise.

The SPECT imaging results were normal both before and following the abnormal stress ekg.

Can I be reasonably assured that the normal SPECT imaging negates the positive stress ekg, and that it was a false positive? Any reason to pursue further testing?

Background: I'm a 38-year-old male with history of AVNRT (ablated in 1995) and frequent PVC's. Currently on a CardioNet monitor to assess recent increase and change in frequency of arrhythmia episodes.  No risk factors for CAD other than family history involving maternal grandfather who died at 42 of MI and paternal grandfather who developed heart disease in his late 40's.

Thanks so much for your answers and insights.
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edgehatfield,

You raise an interesting question regarding the interpretation of stress tests. No test in medicine is completely perfect in the sense that if positive you have a disease and if negative you do not have disease. As a result, all tests are hindered by false positives (test is positive in the absence of disease) and false negatives (test is negative even in the presence of disease) Exercise stress testing is no different. As a result, interpretation of any test depends in part upon the clinical context in which it was ordered and obtained.

Your particular test has many features which are very reassuring and place you at low risk. First, you state that you have no risk factors for coronary artery disease which decreases the overall likelihood that you have coronary artery disease. Secondly, you performed very well on the exercise portion of the stress test. Numerous studies have shown that this significantly decreases the odds of you having a cardiac event over the next 5 years. Finally, the nuclear imaging revealed no evidence of ischemia.
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