EKG and Stress test results

[janne]

I posted a few weeks ago. MI 2 months ago, LAD stented. 39 yr old female, no risk factors, but I am an ex-smoker.  Vague lingering symptoms, not necessarily activity related.
EKG showed nonspecific abnormal T waves(?).
Treadmill stress test:
resting ECG sinus rhythm, rate 53bpm, possible old anterior myocardial infarction. 9 mins on TMT ramp protocol (stage 8)(what is that?), max heart rate 164bpm  (86%). Abnormal ST segment depression 1st apparent at 4:5mins in lead II , reached max 1.3mm. Also abnormal ST depression in leads III, AVF and V5.  Occasional PVCs which disappreared at higher levels of exercise. Peaked was 158/82(resting bp 130/80) at 7:30mins.
Recovery: ST depression but not exceed 0.9mm.
Conclusion: positive ekg response for myocardial ischemia

I would appreciate this info in layman's terms.  Are the leads that show ischemia related to where my heart attack was? One cardiologist strongly suggests angio again (? restenosis of stent), another cardiologist insists it is not necessary says abnormal ekg because of previous MI and stress test could be false positive.  I realize angio is the only definitive way to find out if stent is blocked, but I do not want to have angio again unless their is strong evidence pointing to this.
What is your take on this information?  Would stress test be abnormal anyway because I had an MI 2 months ago.  A nurse was concerned last week because resting hr was 36, is this why I find I am more tired? Does this treadmill test show I am deconditioned/out of shape?

Thank you so much in advance for any info.
Jann
  

[CCF-M.D.-RCJ]

Jann,

Thanks for the post.  Sorry to read of your troubles.

Interpreting stress tests is as much an exercise in faith as it is a scientific process.  The bottom line is that (1) you have a good functional capacity, and (2) without any signs of danger.

Functional capacity is more strongly related to mortality than any other factor from the test.  This is a simple concept: the longer you can go on a treadmill, the more likely you are to live.  You performed at least average for someone your age, and certainly did fine for someone so soon after a heart attack.

Danger signs during a treadmill test include a significant drop in blood pressure, very early or extensive ST segment depression, and dangerous arrythmias.  You had none of these.

Interpreting ST segment changes in women is notoriously difficult, and is even more so in women who have EKG changes from a heart attack.  The odds are that these changes are totally non-specific, but please remember that I am basing this statement without having actually seen the strips.

Acute in-stent restenosis just weeks after a cath would be exceedingly uncommon, but so is a heart attack in a 39 yo woman.  One reasonable approach would be to undergo a stress test with imaging.  If the imaging shows signs of ischemia, then a cath could be pursued.

As to your other direct questions ...
(1) I have never heard of the ramp stage 8.
(2) A heart rate of 36 may indicate over-beta-blockade, which certainly could cause fatigue.

[janne]

Thank you so much for responding. You have put my mind at ease. I think I'll pass on the angiogram unless my symptoms become more pronounced.
Thanks again,
Jann

[ska781]

A related discussion, Inverted t waves in EkG normal nuclear stress was started.