: : : : I am a 40 year old female with a history of hypertension dating back to the age of 24. I have been on several meds,each of which has had some effect in reducing my BP but has worked consistently. My average BP is 140/92, on meds. I have had a history of chest tightness and palpitations off and on for the past 3 years. Previous doctors attributed it sstress
: : : : and did no tests. I just changed MDs and a stress test ,echo(for heart murmur)and 24 hr Holter were ordered. Results: Echo normal. Holter-sinus tachycardia. Stress- Resting ECG showed normal sinus rhtyum, rightward axis and poor R wave progression. Per Bruce protocal I lasted 6 min. until stopped due to BP
: : : : of 220/118 and SOB. No chest pain. Random PVCs. ST upsloping depression 0.5mm. Whatis poor R wave progression and do any further studies need to be ordered? Palpitations and chest pressure continue.THANKS!
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: : : Dear bnt
: : : Poor R wave progression is a finding on an EKG that can reflect either an artifact of the way that the EKG leads are placed or reflect a previous heart attack. It is unlikely to represent an old heart attack, given that your echo was normal. However, your symptoms could still be from coronary artery disease; the only way to know for sure would be a cardiac catheterization. The stress test was terminated too early (though appropriately) to be definitive.
: : : I hope this has been useful. I wish you the best of luck. Feel free to write back.
: : : Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
: : I wrote to you previously about my results of cardiac tests. My internist sent me for a cardiology consult due to continued symptoms. She felt electrophysiology studies might be in order.
: : I just returned from the cardiologist and I'm confused. He said all my tests were within normal limits according to my verbal report ( my PCP's office failed to fax all current results and recent notes; only an abbreviated result of my Holter
: : results).His opnion was that 6 minutes was adequate enough on the stress test to be conclusive.. My Pcp wasn"t sure. He said that since the Holter only showed 20 ectopic beats (and of course I wasn't symptomatic during my 24h Holter) and that was normal. I recently began to walk for exercise again after stopping one year ago due to rheumatic symptoms related to my Sjorgren syndrome. When I resumed walking, I expercienced chest pain and tightness on minimal exertion.
: : Previously I had no chest discomfort with exercise. I told the cardiologist this and he shrugged it off.He did say that he didn't think it was pericarditis since he couldn't hear a rub. I mentioned my PCP's suggestion of the electro physiology and he said he saw no need for any further studies at all despite a strong family history of CAD. My father has had bilateral carotid endarterectomies, one previous angioplasty and another scheduled
: : for next week. My mother who is hypertensive like my father, has had a mitral valve replacement. All of her immediate family members have died of MIs. My father's family all suffered CVAs.
: : I briefly spoke with my PCP and she seemed surprised that the cardiologist suggested no further studies but said she would wait for his report. I wasn't thrilled at the prospect of a cardiac cath but two opinions (yours and my PCP) suggested this.In your opinion, is a cardiac cath indicated considering my history? My other concern was my BP. It was 160/102 in his office and he didn't think this was too high. He commented that in Great Britain 150/100 is considered normal.
: : I was under the impression that the borderline norm was 140/90. Opinion...is this an accurate assessment by the cardiologist? I'm not sure insurance will pay for a second opinion, is it worth paying out of pocket? Once again, thank you for your help!!
Both a stress echo and a stress thallium are useful for detecting coronary artery disease. I do not feel that one is better than the other - they are just different ways of obtaining the pictures. If you can exercise safely and adequately, an exercise stress test is more useful than a chemical stress test, assuming your blood pressure is under control at the time of the test.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
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