Abnormal Exercise ECG Results: What You Need to Know

Abnormal results in exercise electrocardiogram (ECG)?

Hello Doctor,
I am 30 years old and have been experiencing intermittent chest tightness, especially during emotional stress.
I do not smoke or drink alcohol, and my comprehensive health check last November showed no signs of hypertension, hyperlipidemia, or high cholesterol; all my blood pressure, lipid, and cholesterol levels were normal.
I underwent an ultrasound at a large hospital, which revealed symptoms of mitral valve prolapse.
However, due to the persistent chest pain, the doctor arranged for an exercise electrocardiogram (ECG).
After reviewing the report today, I felt lost and unsure of what to do.
The doctor mentioned that during exercise, there appeared to be signs of myocardial ischemia, and I noticed some values in the report like -1.4, -1.8, and -1.0.
The doctor said it is uncertain whether I have coronary artery disease, but it is quite possible.
He believes that since I am still young, the likelihood of coronary artery disease is low.

I would like to know if there is a possibility of misinterpretation with the exercise ECG.
The doctor mentioned that if further investigation is needed, I would require a coronary CT angiography or cardiac catheterization.
According to the doctor, catheterization is invasive, so I prefer to undergo the coronary CT angiography.
Could you please tell me if there are any discomforts associated with the coronary CT angiography? This result has left me feeling very depressed and unsure of what to do.
Thank you, Doctor.

Xiao Z, 30~39 year old female. Ask Date: 2017/04/23

Dr. He Dongjin reply Cardiology

Hello, please don't be anxious.

1.
There will be no discomfort during the cardiac CT scan, so don't worry.

2.
It is recommended to print out the exercise electrocardiogram and consult with other cardiologists.

3.
The exercise electrocardiogram may have false positives, which does not necessarily indicate a problem.
It still sounds like symptoms of mitral valve prolapse.

Changhua Hospital cares about you.

Reply Date: 2017/04/23

More Info

Understanding abnormal exercise ECG results can indeed be a source of anxiety, especially when symptoms like chest discomfort are present. It’s important to approach this situation with a clear understanding of what the results mean and the next steps you can take.

From your description, it appears that you have undergone a series of tests due to episodes of chest discomfort, particularly during emotional stress. The exercise ECG (also known as a treadmill test) is designed to assess how your heart performs under physical stress. The results indicating potential myocardial ischemia (reduced blood flow to the heart muscle) can be concerning, but they are not definitive for coronary artery disease (CAD).

The values you mentioned, such as -1.4, -1.8, and -1.0, likely refer to the degree of ST segment depression observed during the exercise test. ST segment depression can indicate that the heart is not receiving enough oxygen during exertion, which can be a sign of ischemia. However, it’s crucial to understand that these results can be influenced by various factors, including technical aspects of the test, individual variations in heart response, and even the presence of conditions like mitral valve prolapse, which you mentioned was noted in your echocardiogram.

Your doctor’s assessment that the likelihood of significant coronary artery disease is low due to your age and overall health is reassuring. It’s also important to note that false positives can occur in exercise ECGs, meaning that the test may suggest ischemia when it is not present. This is why further testing, such as a coronary CT angiogram or cardiac catheterization, is often recommended to clarify the situation.

A coronary CT angiogram is a non-invasive imaging test that provides detailed pictures of the heart and blood vessels. It can help identify any blockages or narrowing in the coronary arteries. During the procedure, you may experience some discomfort from lying still on the table and the intravenous contrast dye may cause a warm sensation or a brief feeling of flushing. However, most patients tolerate the procedure well, and it is generally considered safe.

If you are feeling overwhelmed by the results, it’s important to communicate openly with your healthcare provider. They can help explain the findings in detail, discuss the implications, and guide you through the next steps. It’s also beneficial to address any emotional distress you may be experiencing. Consider seeking support from friends, family, or even a mental health professional if you find the anxiety is affecting your daily life.

In summary, while abnormal exercise ECG results can indicate potential heart issues, they are not definitive. Further testing is often necessary to clarify the diagnosis. A coronary CT angiogram is a reasonable next step that can provide more information without the invasiveness of catheterization. Remember to take care of your mental health during this process, and don’t hesitate to reach out for support.

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