Stress Echo Results: How much trouble am I in.

[Pax010]

So, I have already spoken to my doctor and she is scheduling me for an appointment with a cardiologist.  There is a bit of a language barrier between her and I so I'm looking for some guidance until I speak with the cardiologist tomorrow morning.

I went in for my annual physical and had an ECG almost as an afterthought.  As I was dressed and leaving the doctor came back in and said that my ECG was abnormal (Incomplete Right Bundle Branch Block) and ordered a stress echo test.  I scheduled that for today, along with a complete blood panel.  

So looking at the results, everything is above average (blood results all totally normal).  Exercise length, target heart rate, response, Duke treadmill score, blood pressure, everything.  However...she called me to say she was immediately referring me to a cardiologist and restricting my activity.  The finding is "Positive for ischemia in left anterior descending distribution after maximal exercise".

I run 3 miles in a day 3 times a week, am at optimal weight, eat well, and am only in my early-40s.  I will absolutely follow my GPs recommendations, but I can already feel the stress building from not having information(probably not good if I have a heart problem).  Can someone give me some high-level insight as to what all this means?  If the initial diagnosis was an IRBBB, how is the new diagnosis in the left anterior?  ANY insight would be appreciated.

[Circa49]

Your METS at 14.2 for about age 42 or so,  is very good.

Your Duke Treadmill score is also good.

If you read around,  you'll find that your odds of dying from a cardiac event in the next 12 months are UNDER 1%.

Regarding METs for a person age 42.5,  your output is about 150% of typical sedentary person your age,  and about 120% of active person your age.  
http://circ.ahajournals.org/content/104/14/1694/F1.expansion.html

Regarding  your diet and cholesterol,  you are young enough and with this brief scare,  such that you should look into taking some more dramatic changes in you diet.   You might want to pick up a book by a well known doctor Dean Ornish,  called The Spectrum.
As the name suggests,  he doesn't insist you jump into the deep end of the pool on day one.  Rather he give you a continuum of steps you can take that will gradually bring you well beyond the normal American Heart Association type of diet which is moderate mostly because they don't believe the average guy will do any more than a modest change.
Don't settle for your cholesterol just being at or around 200 which is called "normal" and "ok" by many docs.
With exercise and diet  you can do better,  even without resorting to statins and such.   Which are OK if really needed.

Let us know the outcome of your doctor visit.

[Pax010]

Thank you.  Although I'm anxiously awaiting my cardiologist appointment confirmation today, this helps ease my mind a little.  That's exactly what I have been stressed about the last 24-hours, dropping dead at my desk or something.

Results (none of which I understand):
Ejection fraction 56%
PA pressure 27mm/hg
METS 14.2
Duke Treadmill score: >5
Peak Double Product: 34780

The summary seems to suggest that those are pretty good which is why I'm further confused.  I was overweight a year ago with bad cholesterol but I've dropped 60 pounds and my cholesterol profile has improved at least 20%.  Still a little high, but improving quickly now.

[Circa49]

Well I can't give you "high level insight",   but if you'll look around, you find that your IRBBB finding is nothing to get excited about.

Leaving you with the ""Positive for ischemia in left anterior descending distribution after maximal exercise"
If there is anything to that,  it certainly isn't something you need to lose sleep over if you aren't feeling any angina during your 3 mile runs.

Of course the cardiologist will give you a more definitive answer about the longer term but if you are concerned about dropping over in the next 24 hours,  I think you can completely relax.

BTW,  what was your Duke treadmill score?  Do you know your METS output.     If you do and you look that up,  you will probably see you have a very low chance of having a "cardiac event" in the next x years.

Good time to perhaps get a temporary fright and re-examine what  you think of as "eating well".    Almost everyone thinks they eat well but that is judging by what is average for Americans.   Is your cholesterol under or over 180?

Please do come back after your visit to the cardiologist and tell us what he/she said regarding the ischemia concern.

I went through much of the same testing last summer including a SPECT perfusion imaging stress test,  the end result of which was my doctor telling me to go "knock myself out"  on my bike rides through the hills where I live.

I still have some questions,  but he wasn't concerned at all after the testing.