Heart & Cardiology/Abnormal ECG


Dear Doctor,

Thank you for considering my problem.  I had recently visited my general practitioner (gp) regarding some mild chest pain that I was attributing to gastric reflux or the arthritis in my neck.  My gp thought it may be worthwhile having a cardiac ultrasound and a stress test.  The ultrasound showed that all was well but the ECG was abnormal while resting and markedly abnormal with the stress test - ST wave depression and T wave inversion.  I had no chest pain during the stress test.  A couple of hours later I did experience some chest pain and took myself to the hospital where I had a chest X-ray, CT angiogram, d-dimer and triponin levels tested - all was clear but ECG remains abnormal.  I subsequently found out that a stress test I had 5 years ago showed the same abnormalities (although at the time I was just told I had no cardiac problems and not told about the abnormalities).

In the last few days I had a 24 blood pressure monitor that shows mild hypertension (average 140/90 but 188/100 in morning) so I have commenced raking Coversyl 2.5mg.  The only other medication I took was Yaz (OCP) but have been now changed to Loette a week ago.  I had a hysterectomy approx 6 years ago but continue to get ovarian cysts if not on the OCP.  Blood test also showed mildly elevated ESR and ANA levels.  I am 49 years old and aprox 10% over my ideal body weight.

My main question is why would my ECG be abnormal if everything else appears normal?  I have lost my confidence as I live alone and I am in constant fear of a cardiac event.  The cardiologist at the hospital didn't explain and my gp doesn't know how this can happen.  Could you shed any light on this?

Thanking you in advance of your response,


Hi Sandra,
A positive stress test such as yours usually (but not always) indicates coronary artery disease (CAD), which has been excluded in your case.

Exercise testing has a sensitivity of 78% and a specificity of 70% for detection of coronary artery disease, which means that in most patients a positive test result indicates CAD.
However and for instance, in a low risk population, such as men aged under 30 years and women aged under 40, a positive test result is more likely to be a false positive than true, and negative results add little new information. In a high risk population, such as those aged over 50 with typical angina symptoms, a negative result cannot rule out CAD, though the results may be of some prognostic value.
You should be comforted by the fact your previous stress test was similar and nothing has occurred during since!

Hope this helps,
Dr T

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