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Heart & Cardiology/stress echocardiogram question

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I recently had a stress echocardiogram done to evaluate chest pain I have been having for many years. I am 60 year old female who is normal weight, in good physical shape and exercise daily.No family cardiac history. I had radiation therapy 11 years ago for breast cancer which gave me radiation pneumonitis and subsequent some lung fibrosis. I suspect my chest pain is pulmonary rather than cardiac.
I was suprised that no physician was present at the stress test. Here are the results that concern me: "Nonspecific ST-T wave changes on baseline EKG. On stress EKG the patients had 2mm of upsloping ST depression in leads V4, V5 and V6 which is diagnostic for ischemia ". Echocardiogram was completely normal.
6 years ago I had a stress echo which read "1-2mm ST segment depression, upsloping in leads 2,3,AVF with resolution of EKG changes 1 minute into recover. No evidence of stress induced ischemia".
My question is this, for a diagnosis of ischemia shouldn't the report have mentioned whether there was recovery from the ST segment depression? And since it was upsloping, isn't this considered not really diagnostic for ischemia? Why would the first test be read as no ischemia and the second test as ischemic when both tests showed ST segment depression? I will see my family physician next week to discuss this test, but I am very reluctant to pursue this any further (ie a cardiac cath)
Thank you for your time and consideration

Answer
Hi, http://blog.myheart.net/2014/03/17/do-i-need-a-stress-test/
http://blog.myheart.net/2013/05/12/how-often-should-i-have-a-stress-test/


A stress echocardiogram is a good test to detect the presence of significant coronary artery disease. Of note, in your case, in addition to the radiation affecting your lungs, it can affect your coronary arteries and your valves so another good reason for you to have the stress echo particularly as you have symptoms.

In reference to the ST changes, it is typically down sloping st segment changes that are the most concerning, upward sloping changes can be simply a reflection of the increased heart rate. It would be difficult to comment without seeing the test. I wouldn't worry about the resolution of the changes in recovery as i suspect they would have mentioned this if is was persistent.

Importantly however you had a stress echo, I'm presuming an echocardiogram was performed at the high heart rate as you cam off the exercise machine. The echo part of the test is the much more specific portion here. Yours was normal I'm presuming. This tells us two things. Firstly it puts you in an excellent prognostic group. Secondly it tells us that there were no wall motion abnormalities and therefore it is highly unlikely you have significant obstructive cad. If you had not had the stress echo portion then we could have worried more about the ekg, but now there is no point.

Finally, i think its highly doubtful you will require further testing in the setting of a normal stress echocardiogram.

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

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Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

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Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

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MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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