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VINRAY posted:
Hi, recently I underwent TMT as advised by doctor. I am 59 and have controlled BP and diabetis type 2. The Results as mentioned in TMT report are: Protocol: BRUCE, BHR 74 bpm, MHR 160 bpm 99% of max predicted 161 bpm in Exercise 3, Max time on Exer= 09:41, Case BP: 160/90mm Hg, Max BP: 190/90mm Hg, Max workload: 10.7 Mets, Total dist Cov :0.69 Km, Termination: fatuge.

Impressions: Good Excer tolerance, No Angina, Baseline ECG showed T wave inversioin in lead 3. At 3 mins of rec patient had 1mm horizontal ST depression in leads V4-V6 which lasted upto 10 mts, Multifocal VPCs seen during Ex & rec., Normal HR and BP response.

Test Positive for exercise induced Ischemia (may be false positive in v/o ECHO findings)
Stress ECHO: No RWMA , mild conetric LV cypertrophy.

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cardiostarusa1 responded:
Hi:


As ALWAYS, the patient's doctor(s) are obligated to fully-explain (of course, in a way that they can understand) the test results/findings from any diagnostics.

Because of those two specific electrocardiogram (ECG) abnormalities (T wave inversion and ST depression), this indicated ischemia.

Ischemia = cardiac or myocardial ischemia. This is an Insufficient amount of blood flow to an area/areas (regions, regional) of the heart muscle (myocardium), which can occur only when the heart is stressed (such as during exercise, aka exercise-induced) or at rest and stress, due to a narrowing (blockage) in one or more coronary arteries, coronary artery disease (CAD).

However, sometimes, during a standard/routine treadmill test, for various reasons, there may/can be a false-positive result, indicating there is a problem when there actually isn't. Further testing can usually confirm or rule this out.

On a stress echocardiogram diagnostic report, to confirm this, it may say something such as: At peak stress, new regional systolic dysfunction noted with wall (examples being, anterior/front, inferior/lower, posterior/back, lateral/side) **hypokinesis.

**Hypokinesis = low motion, low heart wall motion (**wall motion abnormality, WMA), which can occur due to conditions such coronary artery disease (CAD), cardiomyopathy (heart muscle disease), and heart failure (systolic dysfunction).

With the general focus on the stress echo results -

No RWMA

RWMA = Regional Wall Motion Abnormailty

As reported, this is usually applied with regards to abnormalities of motion (or kinesis) of the heart's left ventricle (LV), a lower pumping chamber.

No RWMA is good news, as it simply means that all segments of the LV are contracting (pumping) normally.

However, mild concentric LV hypertrophy (LVH) is not good news. As reported, the normal thickness range of the LV is from 0.6 to 1.1 cm, measured at the very end of diastole (the heart's resting/relaxation phase). If more than 1.1 cm thick, a diagnosis of LVH can be made.

Several patterns of LVH have been described, such as concentric and eccentric. Concentric LVH is defined as an increase in LV thickness (all over) and LV mass with increased LV diastolic pressure and volume, commonly seen in those with high blood pressure (BP, hypertension). As applicable to the patient, concentric LVH is a marker/indicator of poor prognosis in the presence of high BP.

Health Central

Cardiac Enlargement: A Patient Guide

There are two types of cardiac enlargement: Hypertrophy and dilation....

With the exception of exercise-induced enlargement, all forms of cardiac enlargement are abnormal and associated with further...

http://www.healthcentral.com/heart-disease/patient-guide-44614-6.html

Take care,

CardioStar*

WebMD member (since 8/99)



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