What is the significance of an EF of 85%? Patient is male, 53 years old, 5-2", approx. 135 pounds with a previous triple bypass (3 years ago). He was admitted to the hospital with chest pains. The electrocardiogram showed very minor nonspecific ST segment straightening. Exercised according to a standard Bruce protocol, completing Stage 4 and achieving heart rate of 164 BPM. Blood pressure response acceptable. No exercise-induced arryhthmias. Monitoring of the electrocardiogram during exercise revealed no ischemic change, however, in late recovery, there did appear to be evidence of some ST segment depression in the inferolateral leads. (about 1 mm of horizontal ST segment depression). Nuclear medicine gated myocardial perfusion spect study showed an LV EF of 85% and no evidence for ventricular wall motion abnormality. It noted that there is ventricular wall thickening. Nothing to suggest reversible perfusion abnormalities. (I think the last item means he didn't have a heart attack.) Do we need to be concerned about the high EF? Is the horizontal ST segment depression of concern?
The horizontal ST depression is non-specific so probably doesn't carry much significance. The fact that he exercised up to the 4th stage and had no perfusion defects on the scan (no low blood flow, not necessarily a heart attack) portends a better prognosis. Nuclear tests aren't good at estimating ejection fraction, so I would recommend an echocardiogram to get a better sense. High ejection fraction may be a sign of hypertensive heart disease, beta blocker withdrawal, poor volume status, etc.
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