Questions on my Stress Echo Test

[jerry1978]

I am a 44 year old male, and had a StressEcho Test (asymptomatic-just wanted one to check for CHD and before starting an exercise program.)

I reached Stage 3 of the Bruce Protocol, and stopped due to sciatic leg pain.  I reached a Peak HR of 169 (96 % of Max)

Here is what the report says:

BASELINE EKG: Normal sinus rhythm.  Possible anteroseptal MI of
              indeterminite age.  Diffuse non-specific ST-T wave
              changes.

EKG CHANGES:  No ischemic ECG changes.

ARRHYTHMIA:  Occasional VPD's.

HR AND BR RESPONSE:  Normal.

ECHO STUDY:  Normal left ventricular internal dimensions and
             wall thickness.
            Normal left ventricular systolic function.

STRESS ECHO REVEALS:  Normal augmentation in left ventricular
                      function.

SUMMARY:  Normal stress echocardiogram, without clinical, ECG,
          or echocardiographic evidence of inducible ischemia.

I was told by the attending MD and my Cardiologist that this is a normal test; and told not to be concerned about the baseline EKG finding of a possible past MI.

My Questions:

(1)  Can a baseline EKG give a false interpretation of a past MI, as my Doctor suggests?

(2)  What does non-specific ST-T wave changes mean?

(3) What about the "Occasional VPD's?"  What are they, and are they dangerous to me?

(4) Is a Stress Echo as good as a nuclear stress test?

p.s.:  I am on Hydrochlorothiazide,Zoloft,Klonopin, and Toprol XL (with-held the Toprol for the test)-can any of these meds be the cause for the abnormal EKG?

Thanks-Jerry

[Cleveland Clinic]

(1) Can a baseline EKG give a false interpretation of a past MI, as my Doctor suggests?

The ecg diagnosis of MI can vary in some people and must be interpreted in the context of all a patients data.  The best marker form your data was your echo which showed no evidence of abnormal wall motion which would occur from damage from an MI.  Position and body habitus can effect the readings on an ecg.  In some patients we see minor variations of ecgs done during stress and ecgs done routinely due to changes in heart position during stress.

(2) What does non-specific ST-T wave changes mean?

Exactly that.  There are changes in the area between your QRS and T wave. In the context of the data you mention, they probably mean nothing. Frank drepression and elevation are specific markers for ischemia, minor variations of this portion of the ecg are seen commonly and reported.

(3) What about the "Occasional VPD's?" What are they, and are they dangerous to me?

They are occasional extra heart beats. In the context of the rest of yoru study they don't mean too much.  An increase in the frequency of these beats in patients with structural heart disease can be associated with an increased mortality risk.

(4) Is a Stress Echo as good as a nuclear stress test?

It depends. There are factors that can cause problems with interpreting the images in each one.  However, if they are able to get good quality images in both studies then they are essentially equivalent.



good luck

[Barbarella]

I had an EKG done one time which showed a "previous heart attack" which I never had because all my follow up EKG's did not show a "previous heart attack" neither did the echo.  One out of three heart attacks can be silent I was told by my Cardiologist, but ALL EKG's would show this following the one who stated the previous heart attack.  My Cardiologist told me that so many EKG's show "previous heart attacks" that he doesn't even take these results serious anymore until he did further testing.

[Barbarella]

Getting your medical test results has its pros and cons.  I never lived in the UK, but I'm sure should you have a serious problem indicating on one of your tests your doctor would call you in for further follow up.  In the U.S. we can request a copy of our test results, but as a layman we understand very little.  Our doctors spend only so much time with a patient, sometimes only 5 minutes when its supposed to be 15 minutes, and we are told "don't worry you are o.k." or we are given the result, the doctor explains it to us, but some of us still worry.  Some of us go to the Internet and research.  When bringing a copy of what we researched to our doctors some doctors still deny what we found out and researched from the internet i.e. about side effects in my case.  Some doctors get mad for doing the research and accuse us of not trusting them and believe in them with their diagnosis.

To be honest with you I'd rather not have the oppertunity to get a copy of my results because I'd have less to worry about.  I wish the Internet were never invented because of tons of pages about medical stuff which in return most doctors don't want to hear about and get mad for not trusting them (happened to me), and yes, they can refuse to treat you over stuff like that, happened to a friend of mine.

The bottom line as you can see we are allowed to get copies of our tests, but most of us still worry because most doctors just don't have enough time to sit down with us and answer all our questions and our concerns and worries.  This might be the case with people who have high priced insurances or private patients with lots of money, but the average people who have an HMO insurance get a few minutes to cover the basic problem maybe get an answer or two while the doctor is showing you the door saying "see you in 6 weeks."

[Barbarella]

I can understand people getting upset when somebody breaks the rule, but I get a lot out of just reading peoples posts, read that other people have/had the same problems I have.  Some people are worst off, I read what some people did/do about their problems.  I highly respect the doctors who take the time out to answer our questions, but they cannot really give a 100% diagnosis without seing you, examaning you and so forth.  They also will not question another doctor's diagnosis without seing and examine us in person. If most of our doctors could afford to take the time out and answer all our questions we would not need to go on the Internet, would not need to log on sites like these and ask questions.  But the times of the "country doctors" are over where the doctor leans back in his chair and answers ALL your questions, puts your mind at ease,  and after all that talks about the weather and asks how the rest of your family is doing.