Heart & Cardiology/stress test question


Hello Doctor, I am a 61 year old woman who is normal weight, exercise every day and a breast cancer survivor of 12 years. I am on metropolol XL 25mg twice a day for fast heart rate. I recently had a stress test that my general doctor said was of no concern, but the interpreting cardiologist wrote " resting ekg shows non specific ST wave changes. Pt exercised for 10 minutes on Bruce protocol, achieved 11.7 metabolic equivalents. Heart rate increased from 89 to 171, representative of 106% maximal  age predicted heart rate. The patient had 2 mm upsloping ST depression in leads V4, V5 and V6 diagnostic for ischemia by EKG criteria, a sensitive but non specific finding. ..." " No evidence of inducible ischemia by stress echocardiographic criteria" "diastolic dysfunction is present". My questions are these:
1) With abnormal EKG, but normal echo how concerned should I be about the upsloping ST segment depression?
2) What exactly is diastolic dysfunction?
As I mentioned earlier, my generaldoctor is not concerned, but reading this report has concerned me. What is your opinion?
I should mention that I have had lung scarring from my cancer treatment radiation which will periodically cause chest pains and some shortness of breath. Thank you for your time and consideration.

Hi, http://myheart.net/articles/diastolic-heart-failure/

1) The up sloping ST depression is often rate related and is not as much of a concern as down sloping ST depression. What is very reassuring is that you went to 10 minutes and 11 METS which basically puts you in a low risk group. With the normal echo, and the level achieved, i wouldn't worry about the EKG changes unless you have been told otherwise.

2) I have linked you a post about diastolic dysfunction above, basically it means the heart doesn't relax as well as it could.

From your tests it doesn't seem you have much to worry about in terms of your cardiovascular health. I would recommend simply paying attention to risk factors, such as lifestyle, exercise, blood pressure, cholesterol etc..

Hope that was helpful.  

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Mustafa Ahmed MD


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


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


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

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

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