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What does high-risk exercise treadmill test mean?

I finally obtained a copy of my EP report about my last treadmill test. Can someone please help me with this? I am very concerned. The report says:

In stage II of the Bruce protocol at approximately 3 minutes, the patient began to experience frequent PVCs, followed by a run of polymorphic nonsustained VT. Next the patient had a 12-beat run of monomorphic nonsustained VT (I was told on the phone that the 12-beat run was the longer of the two). At that point, the procedure was terminated and the patient remained in sinus rhythm with occasional PVCs that resolved throughout recovery. (this is not all of report)

IMPRESSION:
1. High-risk exercise treadmill test with 2 runs of nonsustained ventricular tachycardia seen in stage II of the Bruce protocol, accompanied by frequent premature ventricular contractions that resolved in recovery.

This is the first time I have gone into polymorphic VT on a treadmill test (usually monomorphic), and the first time the report said "high-risk treadmill". Can someone help me decipher this report? I don't know if this means I am at high-risk only during treadmill testing or high-risk overall because of the findings. I can't find anything on line.

The doctor did not explain at the time, he just mentioned that my v-tach is adrenaline dependent, and he prescribed beta-blockers and another treadmill in a month. I couldn't tolerate the beta-blockers because of chest pain, then he prescribed flecainide with a treadmill in two weeks. I decided against taking the flecainide until I can speak with him in his office because of my concerns with that medication. I have an appointment in two weeks.

I would appreciate any help with this.
Best Answer
1423357 tn?1511085442
I believe there are a number of factors used in conjunction with a formula that is used to classify a patient who has completed a treadmill test ; high risk, moderate risk, low risk.  From your post, it sounds like you had some problems early on it the test, enough so that your score data placed you in the high-risk category.  I trust that your cardiologist knows that you've delayed taking th flecainide?  If not, you should inform him immediately.  Not taking it could put you at more risk than following your physician's orders.
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Avatar universal
Thank you both for your response.  

Tom, I did not realize electrolyte imbalance or drug toxicity could be a cause of v-tach.  I will ask the doctor about that.  He did mention last year that my v-tach originates in the lower part of the right ventricle.  At that time the v-tach was monomorphic with a few PVCs that were polymorphic in nature.

Is something wrong, the report said "No symptoms or ST changes indicative of ischemia during this exam,"  so the VT didn't occur because of that.  I am very concerned that part of the VT was polymorphic.  Last year the EP told me not to worry, my heart function was good, and short runs of monomorphic VT were benign. I received no treatment at that time.  He did mention the word catecholamineric after a treadmill test last year and he mentioned adrenaline dependent after this treadmill test.  That would indicate it is brought on with exercise, but I have caught two short runs while sitting at the computer.
  
All year long I was looking at heart conditions that would cause monomorphic VT, now I find I have both.  I did read on line tonight that with ARVD, you can have both monomorphic and polymorphic VT.  Because I had the PVCs that were polymorphic in nature, I have also looked into CPVT and a few others that are predominantly polymorphic VT, and some of them inherited.  I don't know of anyone in my family that had SCA, but I don't know my mother's side of the family very well, and have no contact with any of them.  I do know that her mother supposedly had epilepsy (it was thought she did at that time) and died at a young age.  I had a grand mal seizure in my early 20s in which the cause was never determined.  My first EP said it was possible that it could have been v-tach.  I may try to contact my mother's side of the family to get more information.

I definitely hope the doctor can determine what is causing my v-tach very soon.  I have 3 grand-children that run cross-country, and if this is inherited, I need to find out.




Helpful - 0
1124887 tn?1313754891
It would be interesting to know which type of polymorphic VT you did have. A few of them are fairly easy to recognize.

One is "Torsades de pointes" which usually happens in the setting of a prolonged QT. I would assume your doctor would notice if you had a prolonged QT interval (regardless whether it's genetic or caused by electrolyte disturbances, the QT is prolonged in both cases)

ARVD does not manifest with polymorphic VT as far as I know. It will manifest with monomorphic VT that origin from the RV, usually near the outflow tract. Often it's close to impossible to distinguish benign RVOT-VT from malignant ARVD arrhythmias just to look at the arrhythmia.

Polymorphic VT can occur with ischemic episodes, but from your test results you don't have that. I assume you didn't have severe ST depression during the test.

Last, there is a genetic condition which is known for causing polymorphic VT during exercise. The arrhythmia is known as bidirectional VT, and is often preceded by lots of PVCs. The condition is a genetic disturbance of the calcium channels, and it's known as catecholaminergic polymorphic VT. Not saying you're having that condition, but it could be worth mentioning to your doctor. Treatment is beta blockers.
Helpful - 0
1423357 tn?1511085442
Well...here's the thing.  You have the heart's structural status in the left hand, and the heart's electrical conduction system status in the right hand; two different things.  People die everyday with structurally perfect hearts, but defective electrical systems.  You mention the occurance of the polymorphic VT, This is often a problem associated with electrolyte imbalance and long QT interval.  If you acquired this problem, it can be related to drug toxicity.  Has your physician explored this?  Examined your electrolytes?  I hope you can find a resolution, and good luck.
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Avatar universal
Thank you for your reply.
I did let his nurse know I wanted to wait to talk to him before taking it.  The side effects of that medication makes me too concerned to take it.
I forgot to mention in my post that I have good heart function, only about 10% blockage, and all my tests, including heart MRI, have come back negative.  My problems with v-tach started last year during a treadmill test.  I have worn heart monitors during the year which showed nothing, so I was hoping my treadmill test would be OK this time.  But the polymorphic VT popping up is new.  Last year the doc was looking for ARVD with the heart MRI.  I have heard it sometimes takes a long time to diagnose that.  I hope I don't end up with that.
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