STdepression during stress test

Posted By  CCF CARDIO MD-APS on October 27, 1997 at 16:44:24:

In Reply to: STdepression during stress test posted by Bonnie Kirkpatrck on October 24, 1997 at 08:45:16:

: I am a 59 yr old female with at present what the cardiologist calls *stable* CAD... my stress tests are  not Thallium, but one where they work you then do an ultrasound.  The dr is not a *board certified* cardiologist.  I have ST depression and -1.0 in leads II III, and aVF with my last testing.. I had angioplasty 7 yr ago..with 2 large blockages that were too long to do by angio.
  My questions are what does the ST depression etc mean... Also, woul I be better off seeing a *board certified* cardiologist rather than waiting for this Dr to *send me on*, and would a thallium stress test be of more value in keeping watch on what is happening?
  Sorry for the long question, but as you can see it is rather complex, and I am confused as to what I should do now...
  Many thanks...
  Bonnie

[CCF CARDIO MD APS]

Dear Bonnie,
     I can tell you that a board certified cardiologist is someone who has taken the rigorous board certification exam, which one can not sit for unless one has completed a certified cardiology fellowship so to speak, and to make this more interesting, one can not sit for the cardiology board examination unless one is a board certified internist, i.e. the test that you sit for after
finishing a certified internal medicine residency. I will not bore you with any further criteria as the list of prerequisites goes on and on.  The American College of Cardiology and the American Board of Internal Medicine give these Board examinations for a fee, but only in an attempt to have physicians in the community that are appropriately trained in their field or subspecialty to provide
the standard of care.  Please note that I do not know why your physician is not board certified.  It is completely up to you as the patient to stay, inquire further, or seek care elsewhere.
     As for your stress echocardiogram which I presume is the test you speak of, there are two parts to it: (1)stress ecg, and (2)imaging of the heart(you had echo, but other imaging modalities include thallium,and P.E.T.)  Your ecg portion was abnormal (the 1.0mm ST depression you mentioned) but if the imaging modality did not show a coresponding abnormality the test is negative
i.e. not worrisome for significant coronary artery blockages that require further study with a cardiac catheterization. As you can see the imaging modality makes a better test since the ecg by itself can be misleading or 'false positive' as said by physicians.  The care of a patient with known coronary artery disease is complex and involves following their course not only with stress tests
but also with careful attention to their symptoms and medication list.  If you want to be evaluated at the Cleveland Clinic Foundation you can call 1-800-CCF-CARE and make an appointment with any one of our many board certified cardiologists at desk F25.  
     Information provided in the Heart Forum is intended for general informational purposes only.  Actual diagnosis and treatment can only be made by your physician(s).