Stress Test/Thallium Stress Test

  I am a 48 year old male, non-smoker, good cholesterol, 6'2'', ~230 lbs, with no family history of heart problems and no symptoms.  As part of a regular physical exam, my doctor recommended a stress test.  I was informed that this test was "positive"  with an indication of possible diminished blood flow to the "rear" portion of the heart.  A thallium stress test was then done.  I have the results of that test with the following comments:
  PRE-STRESS EKG:  Rhythm is sinus.  Rate, 63/min. PR, 0.20. QRS 0.08. Axis +80
  IMPRESSION:  Incomplete right bundle branch block.
  STRESS TEST:  No chest discomfort.  Blood pressure was slightly hypertensive on the baseline, and there was also a slight hypertensive response to exercise.  There was no drop in systolic blood pressure at peak exercise.  There were no arrhythmias.  There was significant ST segment depression noted in the inferior leads, with -2.2 mm of ST segment depression, horizontal, and -1.0 mm of ST segment depression, minimally upsloping, in the lateral leads.
  IMPRESSION:  Clinically, negative stress electrocardiogram with no symptoms of chest discomfort.  There were no arrhythmias.  Blood pressure was hypertensive.  Electrocardiographically, there was significant ST segment depression noted in the inferior and lateral leads, compatible with ischemia.
  MYOCARDIAL PERFUSION SCAN:  The multiple images show a normal perfusion pattern in the left ventricle.  No perfusion defects are detected.
  IMPRESSION:  Normal myocardial perfusion scan.
  I am scheduled to see a cardiologist in August, but have some questions:
  Should I be concerned?  The 2 tests seem to contradict each other?
  Workplace stress has been significantly higher than the norm since May, could this be a factor?
  How might this impact my access to health insurance?
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Dear Gary:
I think it is fine to see a cardiologist as you are scheduled to do.  My overall interpretation of your stress test results as you have listed them is that it was a "normal" test.  Sometimes the EKG part of a stress test says there is a problem when there isn't one; the myocardial perfusion scan increases the accuracy of the stress test, and yours is reported as normal.  If you have hypertension (high blood pressure), this will need to be treated with lifestyle modification, and potentially medicines.
Workplace stress had nothing to do with the test results.
This test result will not affect your insurance.
I hope this is the info you were looking for.
If you wish to be evaluated here at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at desk F15.  Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your doctor.