Stress Echo Results questions

[maria694]

I am a 54 yr. old female who recently went to the ER with chest pressure, shortness of breath and tachycardia . All lab tests were normal, including troponin.  I was told that the stress echo was normal, but reading the results, I have 2 areas that concern me:
1) "The patient had 1-2mm ST segment depression, upsloping in inferior leads 2, 3 and AVF. Resolution in less than one minute   and
2) The pt. has evidence of deconditioning with heart rate of close to 130 within 40 sec. of activity and 150 at the first stage of the Bruce protocol, could use increased beta blockers as resting heart rate in the 90's

So, my questions are:
1) Should I be concerned about the st segment depression? Is this a sign of ischemia and/or an indication for additional tests such as a cardiac cath? (which I would like to avoid)
2) What is deconditioning? I take toprol 25mgxl qd.

I have intermittently experienced what I believe is inappropriate sinus tachycardia and chest pains ever since being treated for breast cancer with chemo and radiation 5 years ago.  I walk 5 miles a day, go to the gym 3x/week, do tai chi , never eat red meat and only rarely dairy. When things are "normal" my heart rate is in the 70s and goes into the 120s with physical exercise. When I experience the sinus tach and chest pains, resting heart rate is in the 90's and goes up to the 140s with exercise, very uncomfortable acc with the shortness of breath.

I would appreciate any insights. Thank you

[Michael J. McWilliams, M.D.]

1. Stress tests are not always black and white, there can be shades of grey in how they are interpreted.  Your doctor probably felt that your heart walls were moving normally and that is why he told you that it was ok.  ST depression can be a sign of ischemia, but is not always a sign of ischemia.  Whether you not you would need or if they would recommend a heart catheterization is a tough decision.  If you doctor thinks your chest pains are not from you heart, you do not need a cath.  If they are not sure and the chest pain continues despite beta blockers, a cath might be a good idea.

2. Deconditioning means that you are not in good physical shape and exercise may improve your symptoms/energy.  Inappropriate sinus tachycardia and deconditioning often look the same on a stress test.  That is a pretty low dose of beta blocker -- there is lots of room for increasing it.

I hope this helps.