Stress EKG Results

[mf1970]

Hi
I'm a 37 year old male, slightly high BP, reasonably fit

I've just had a stress EKG as part of a works medical insurance assessment. No symptoms to date It was conducted using modified bruce protocol.
My initial ECG at rest was fine.
The test lasted 10 minutes until 95% MHR was achieved. I was exercising at this rate for 1 minute without an increase in heart rate.
The MP reviewed the traces and was a little confused .
All traces were good up to 8minutes, some minor deviations but one offs (not three in a row etc.)
Between 8 and 9 minutes (HR=172, 16.8 METS) there were and i quote "significant ST depressions leads v3-v6".
The traces returned to normal when exercising from 9 minutes through to the end of the test.

Do you have any explanation for why a test can start normal , go through an abnormal patch and return to normal as resistance level increases?

I have been referred for an exercise stress echo as a follow up

Thanks
Mark

[mf1970]

Hi
Any comments on the results above?
Thanks
Mark

[mf1970]

Hi
Results are back but a little help in interpreting may help. My doctor has signed me off as normal but i'm not too sure what it means.

Resting 12 Lead ECG = widespread non-specific ST Segment change / incomplete right bundle branch block
Exercise Stress ECG = 13.3 mets , 166 bpm, 2mm inferior horizontal st depression at peak although this resolved within first 50 seconds of recovery. Pulse maximal, systolic bp response appropriate, recovery phase otherwise normal
Resting Echocardiogram = Normal LV function
Immediate post exercise Echocardiogram = Normal augmentation of function in all segments
Recovery echo = no change

Conclusions
1. Maximal sympton limited to moderate load
2. No induced chest pain
3. Inferolateral ST depression
4. appropriate pulse and bp response
5. No induced wall motion abnormalities
6. No specific evidence of induced myocardial ischaemia.

Thanks in advance if you could translate into some plain english
Cheers
M

[Michael J. McWilliams, M.D.]

I thought there might have been family history involved for them to ask for the test.  I hope the next test clears things up for you.  good luck.

[mf1970]

Thanks for that.
I believe they were insisting on a test since my father suddenly died at the age of 50 from a heart attack (MI) so family history is not on my side.
An earlier (circa 5 years ago) ECG(resting) result showed a strange trace (again at the request of a medical insurer) so i chose to visit a cardiologist in the UK. He advised that the trace had been carried out incorrectly but decided to do an echocardiogram(at rest) to "check". Nothing was noted at the time and i was discharged without further treatment other than to insist on 40mg statin to keep cholesterol in check. This is now low when compared to the average.
Cheers
Mark

[Michael J. McWilliams, M.D.]

Mark,
I don't have a good explanation for that.  The trick is that you should not order tests on people that don't need the tests because you may end up with a result that confuse you.  If you aren't having any cardiac symptoms (chest pain, shortness of breath, normal EKG, etc), I don't see a good reason for a stress test.  Unfortunately life insurance companies sometimes see that differently. You had excellent exercise capacity and you are young.  If there is any question, having a cardiologist look at the stress test results may be helpful (if not already done).

The stress echo will help clarify if there are any wall motion abnormalities (walls of the heart don't beat very well if they aren't getting enough blood).  It should help answer the question.

I hope this helps and try not to worry.