Abnormal Exercise ECG Results: Insights and Recommendations - Cardiology

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Understanding abnormal exercise ECG results can be a complex process, especially when previous tests have shown normal results. In your case, it appears that you have a history of tachycardia, which has been managed with medication, and you have undergone multiple cardiac evaluations over the years, including exercise ECGs and echocardiograms. Recently, however, your latest exercise ECG indicated a positive response, suggesting myocardial ischemia, which can be concerning.

Firstly, it’s important to understand that exercise ECGs are designed to assess how your heart responds to physical stress. They can reveal issues that may not be apparent at rest, such as ischemia, which is a condition where the heart muscle does not receive enough blood and oxygen. The fact that your previous tests were normal but this one was not could indicate a progression of your condition or that the stress level during this test was sufficient to reveal underlying issues that were previously masked.

The accuracy of exercise ECGs can vary. They are generally reliable for detecting significant coronary artery disease (CAD), but they can produce false positives and negatives. Factors such as your fitness level, the presence of arrhythmias, and even technical aspects of the test can influence the results. In your case, the presence of symptoms like chest discomfort during heavy lifting may correlate with the findings of ischemia on the ECG.

Your physician's recommendation for a coronary angiogram (heart catheterization) is a common next step when there is a suspicion of significant coronary artery disease, especially given your symptoms and the recent test results. This procedure allows for direct visualization of the coronary arteries and can provide definitive information about blockages or other issues.

Regarding your question about myocardial perfusion scanning, this test is often used to assess blood flow to the heart muscle and can provide additional information about the presence and extent of ischemia. It is generally considered to be more sensitive than an exercise ECG in detecting ischemia, particularly in patients with atypical symptoms or those who may not reach their target heart rate during exercise. If you are considering this test, it could provide valuable information that complements the findings from your exercise ECG.

As for the medications prescribed, aspirin is commonly used to reduce the risk of heart attacks by preventing blood clots, while your current medication (康肯) is likely aimed at controlling your heart rate and rhythm. It is essential to adhere to your medication regimen and follow up with your healthcare provider regularly to monitor your condition.

In summary, the abnormal exercise ECG results warrant further investigation, and your physician's recommendations are appropriate given your symptoms and history. If you have concerns about the accuracy of the tests or the management plan, seeking a second opinion or discussing the possibility of additional tests like myocardial perfusion scanning is a reasonable approach. Always communicate openly with your healthcare provider about your symptoms and any changes you experience, as this will help guide your treatment effectively.