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Stress Treadmill Test Results Interpretation?
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Anon_233249 posted:
Hi,


I had some chest pains off and on over the past few months (sometimes just momentary stabbing pain that makes me gasp and say, "Ow!", sometimes just an uncomfortable feeling of squeezing or tightness. It may last a few minutes, sometimes only a few seconds and go away. I let my doctor know and she ordered a stress echo treadmill test. I had an appointment with the doctor after the test & she asked what they told me. Well, the hospital sent the results to a cardiologist out of town and they sent the results to my doctor, who was supposed to explain the results to me. I'm not sure if it's something serious or not? She scared me, asking if I wanted a follow-up with a cardiologist, saying they'd probably do an angiogram (I think?). I wasn't sure what to tell her or ask.


The following were the results...if someone knows what it all means, please let me know.


The patient is a 54 year old female with chest pain & hypertension.


Findings from the exercise treadmill test:
She was able to exercise for 6:41 on a Bruce protocol (8 METs), stopping secondary to dyspnea. She denied any chest discomfort with exercise or in recovery.


Baseline ECG: sinus rhythm. Poor R wave progression in leads V2 to V5. No significant Q waves or ST segment changes.


ECG during exercise and recovery: No significant ST segment changes developed during exercise or in recovery.


Heart rate: changed from 72 to 155 (93% maximum predicted heart rate).


Blood pressure: changed from 151/74 to 208/89.


Findings from the echocardiogram:


Resting LVEF: Approx. 70%


Baseline wall motion: No left ventricular regional wall motion abnormalities. Moderate concentric left ventricular hypertrophy was present at rest. Normal chamber sizes and valvular structures. No thrombus, vegetations or pericardial effusion.


Wall motion after exercise: The base to mid inferior wall became hypokinetic following exercise. The remaining segments of the left ventricle showed improved wall motion.


Doppler: Physiologic tricuspid regurgitation was present at rest.


Conclusion: Echocardiographic evidence of inferior wall cardiac ischemia developed at a moderate workload. No typical angina or significant ECG changes developed to confirm the echocardiographic findings.


Discussion: The new left ventricular regional wall motion abnormalities following exercise suggested cardiac ischemia in the distribution of the right coronary artery. Systolic hypertension and moderate concentric left ventricular hypertrophy were noted at rest. The severe hypertension that developed near the peak exercise may result in false positive findings. No typical angina or significant ECG changes were noted during the study. The Duke Treadmill Score is 6.5 (Low Risk, 24% probability of a significant coronary stenosis and 16% five-year mortality).


"Translation", please! Was my blood pressure during exercise very abnormal and something to be concerned about? Anything else from the above, I should be concerned about? Cardiac ischemia, hypertrophy, hypokinetic, tricuspid regurgitation, etc., etc.??!!!


Thank You,
Debbie
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cardiostarusa1 responded:
Hi:

"Poor R wave progression in leads V2 to V5"

In general, as reported, a number of conditions may/can be associated with poor R wave progression, which includes left ventricular hypertrophy (LVH, thickening of the wall of the left ventricle), right ventricular hypertrophy (RVH, thickening of the wall of the right ventricle), lung disease, anterior (front wall) or anteroseptal (front/septum) infarction (heart attack), electrical conduction abnormalities, cardiomyopathy (heart muscle disease), chest wall deformity, normal variant, and ECG lead misplacement.

"Resting LVEF: Approx. 70%"

Normal resting range is 55%-70%.

Understanding Your Ejection Fraction

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

"Moderate concentric left ventricular hypertrophy was present at rest."

As reported, the normal thickness range of the left ventricle (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 left ventricular hypertrophy (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). As applicable, concentric LVH is a marker/indicator of poor prognosis in the presence of high BP.

"The base to mid inferior wall became hypokinetic following exercise."

Hypokinetic or hypokinesis = low motion, low heart wall motion, which can occur due to conditions such coronary artery disease (CAD), cardiomyopathy (heart muscle disease), and heart failure (systolic dysfunction).

"Doppler: Physiologic tricuspid regurgitation was present at rest."

Valvular regurgitation (leakage) levels goes from trace or physiologic (aka minimal or trivial, found in many otherwise heart-healthy people, and can typically be safely ignored), to mild (should be monitored) to moderate (should be monitored closely to see what overall effect it's having on the heart) to severe (when it gets to this point, valve repair or replacement is usually dictated).

Valvular regurgitation grading scale by echocardiography is 0-4plus. Valvular regurgitation can cause various symptoms or no symptom(s) at all.

As necessary, prescription drug-therapy treats symptoms, but does not cure the condition. As applicable, corrective treatments include catheter-based or surgical-based valve repair and replacement.

"Echocardiographic evidence of inferior wall cardiac ischemia developed at a moderate workload."

"The severe hypertension that developed near the peak exercise may result in false positive findings."

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.

Most important, communicate/interact well with your doctor(s).

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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Anon_233249 replied to cardiostarusa1's response:
CardioStar,


Thank you so much for a quick reply and for explaining things so much better. I'm not sure what to do. You didn't say if the severe high blood pressure during the test was a concern (when I saw it go up to 190, I commented on it and the guy conducting the test said it's normal for blood pressure to go up during exercise? But what's a normal vs. abnormal level?!!


When I left the doctor's office, I felt she wasn't sure what to tell me. I've had others say perhaps it's because she'd a regular MD, not a cardiologist. Just before I left, we agreed to a follow-up if I continued having the pain. Then over Christmas vacation, I wondered if I should go ahead and get an appointment just so the cardiologist could explain things further. I will stay in touch with my doctor. If you had the above results, what would you do? Also, how often do people get a response from Dr. Beckerman?


Thanks so much.


---Debbie
 
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cardiostarusa1 replied to Anon_233249's response:
You're welcome. :-)

"Then over Christmas vacation, I wondered if I should go ahead and get an appointment just so the cardiologist could explain things further."

Sounds good.

"If you had the above results, what would you do?"

Consult with a cardiologist.

"How often do people get a response from Dr. Beckerman?

Dr. Beckerman often replies on daily basis during the week.


"The severe hypertension that developed near the peak exercise......"

"You didn't say if the severe high blood pressure during the test was a concern."

In general, as reported, systolic blood pressure (SBP, heart's pumping phase) during exercise has been found to predict a future diagnosis of high blood pressure (hypertension), coronary heart disease (CHD), and absolute worst-case scenario, cardiovascular disease death (CDD).

SBP rise during exercise and percent maximum SBP at 2 minutes after exercise are directly and independently associated with the risk of all stroke and ischemic stroke (brain attack).

Take good care,

CardioStar*




 
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djs628 replied to cardiostarusa1's response:
CardioStar,


Thank you again for responding to my questions. I believe I will call the doctor back and tell her I'd like a cardiologist (the one who wrote the test results) to explain things to me.


You said that hbp during exercise can predict future hbp, chd, even cdd. I already have hbp...mostly controlled with lisinopril. I say mostly, because when I get nervous (like at the doctor's, or other times), it will go up, but other times, I could be around 120 over 76.


Thanks again. Have a great weekend.


---Debbie
 
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cardiostarusa1 replied to djs628's response:
You're welcome.

Hope everything works out as well as possible for you

Take extra-good care,

CardioStar*



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Heart-Healthy Foods

Nothing complicated, just plain and simple

AVOID foods high in saturated fat and cholesterol. CHOOSE skim or low-fat milk, low-fat yogurt and reduced-fat cheeses. Eat more fish and poultry. LIMIT servings to five to seven ounces a day. TRIM visible fat. Limit egg yolks. SUBSTITUTE two egg whites for one whole egg or use an egg-substitute. Eat more fruits and vegetables, whole grains, breads and cereals. USE LESS salt and fat. SEASON WITH herbs and spices rather than with sauces, gravies and butter.

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Good to know, for the primary and secondary prevention of heart attack and brain attack/stroke

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, typically affecting the carotid, coronary and peripheral arteries, which includes age, gender, genetics (gene deletion, malfunction or mutation) , diabetes (considered as being the highest risk factor), smoking (includes second and thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), Low HDL (now questionable, according to recent studies) high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).

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Quote!

Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society


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It's your future......be there.
 
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Anon_233249 replied to cardiostarusa1's response:
Cardiostar,


Thanks again.


You take care, too.


---Debbie
 
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cardiostarusa1 replied to Anon_233249's response:






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