Do I Need a Heart Catheterization After Abnormal Exercise ECG Results?

Hello, Doctor He. I would like to ask if it is necessary to perform a cardiac catheterization based on the data from an exercise electrocardiogram?

Hello Doctor,
At the beginning of November, I went to the emergency room due to chest tightness and difficulty breathing.
The initial examination showed only an electrocardiogram (ECG) indicating sinus bradycardia and ST segment elevation.
I was hospitalized for four days; during that time, two days showed normal ECG results, while the other two days still indicated sinus bradycardia and ST segment elevation.
Throughout the process, I underwent blood tests, blood cultures, echocardiograms of the heart, liver, kidneys, pancreas, and spleen, among other ultrasounds, and the doctors said everything was fine! However, the chest tightness, dizziness, and feelings of weakness have not subsided.
I have been enduring it and have somewhat gotten used to it.
The doctors mentioned that if the exercise ECG does not reveal any issues, I might be referred to a psychiatrist, suggesting that it could be due to psychological factors.
Therefore, I told myself that my physical discomfort was caused by psychological factors.

After the exercise ECG report came out, the doctor said I need to undergo a cardiac catheterization to check for any blockages in the vessels.
I found it hard to accept that everything was initially fine, and now I suddenly need a catheterization.
I would like to ask the doctor about the data in Recovery Stage 1, where the ST segment is -2.00 mm.
What level of myocardial ischemia does this indicate? (My attending physician has many patients and does not have much time to clarify my doubts, so I am seeking help online.) Is there a real necessity for the cardiac catheterization? I will be going abroad for half a month soon, and I need to engage in high-intensity training while I am there.
I am concerned about any potential risks.
Additionally, the medication Entresto that the doctor prescribed has not improved my chest tightness; however, it has alleviated some neck and back pain.

Thank you very much for your guidance!

Yuan Yuan, 30~39 year old female. Ask Date: 2019/11/23

Dr. He Dongjin reply Cardiology

Hello, in Recovery Stage 1, the data shows ST -2.00 mm.
What level of myocardial ischemia does this indicate? It's hard to say; it depends on how long you have been exercising.
Given your situation, I recommend getting evaluated, especially since you are traveling abroad.
Medical care is not as convenient as in Taiwan, and considering you need to engage in high-intensity training, it's important to understand your cardiac condition in advance.
This way, everyone can feel reassured.
If there are any issues, addressing them beforehand would be better for your safety.
Changhua Hospital cares about you.

Reply Date: 2019/11/23

More Info

Based on the details you provided regarding your abnormal exercise ECG results and the subsequent recommendation for a heart catheterization, it is essential to understand the implications of your findings and the rationale behind further testing.

Understanding Your Exercise ECG Results
Your exercise ECG indicated a significant ST segment depression of -2.00 mm during the recovery phase. This finding is concerning as it suggests possible myocardial ischemia, which is a condition where the heart muscle does not receive enough blood flow and oxygen. ST segment changes during exercise testing are critical indicators of the heart's response to stress and can reveal underlying coronary artery disease (CAD).

Why Heart Catheterization?
Heart catheterization, or coronary angiography, is a procedure used to visualize the coronary arteries and assess for blockages or narrowing. Given your symptoms of chest discomfort, shortness of breath, and the abnormal findings on your exercise ECG, your physician is likely considering this procedure to determine if there are any significant blockages in your coronary arteries that could be contributing to your symptoms.

1. Risk Assessment: The presence of ST segment depression during exercise suggests that your heart may not be receiving adequate blood supply during physical stress. This could lead to angina (chest pain) or even more severe complications, such as a heart attack, especially if you engage in high-intensity activities.

2. Symptom Correlation: Your ongoing symptoms of chest discomfort, dizziness, and weakness, despite normal results from other tests (like echocardiograms and blood tests), further support the need for a more invasive investigation. It is crucial to rule out any significant coronary artery disease that might not have been evident in previous assessments.

Is There a Need for Urgency?
Given that you plan to engage in high-intensity exercise while abroad, it is vital to address these concerns before proceeding. Engaging in strenuous activities without understanding the underlying cause of your symptoms could pose risks, especially if there is an undiagnosed blockage.

Conclusion and Recommendations
1. Consult Your Cardiologist: It is essential to discuss your exercise ECG findings and the recommendation for catheterization with your cardiologist. They can provide clarity on the necessity of the procedure based on your specific situation and symptoms.

2. Consider the Risks of High-Intensity Exercise: If your physician confirms that catheterization is necessary, it may be prudent to postpone any high-intensity training until you have a clearer understanding of your heart health.

3. Follow-Up on Symptoms: If you experience worsening symptoms, such as increased chest pain, shortness of breath, or any new symptoms, seek medical attention immediately.

4. Mental Health Consideration: While psychological factors can contribute to physical symptoms, it is crucial to ensure that any potential physiological causes are thoroughly investigated before attributing your symptoms solely to anxiety or stress.

In summary, the recommendation for heart catheterization is a precautionary measure to ensure your safety and health, especially in light of your abnormal exercise ECG results and ongoing symptoms. It is always better to err on the side of caution when it comes to heart health.

Similar Q&A

Is Cardiac Catheterization Necessary After Abnormal Exercise ECG?

Hello Dr. He: I am 29 years old. Last year, I had a health check-up, and my total cholesterol and triglycerides were around 230. After starting to jog, I experienced chest tightness and went to the hospital for an examination. The exercise electrocardiogram showed signs of hypoxi...

Dr. He Dongjin reply Cardiology
Hello, both options are possible. If you are concerned about the risks of cardiac catheterization, you may consider undergoing a cardiac CT scan first to assess the degree of blockage before deciding whether to proceed with the catheterization. Ping An Changhua Hospital cares abo...

Understanding Abnormal Exercise ECG: Risks and Next Steps for Heart Health

Hello Doctor: Regarding the question from the other day about the abnormal exercise electrocardiogram showing a positive hypoxic response, does this necessarily indicate vascular sclerosis and stenosis? Is there no possibility of a false positive? Why did you directly recommend a...

Dr. He Dongjin reply Cardiology
Hello, an abnormal exercise electrocardiogram showing a positive hypoxic response does not necessarily indicate vascular sclerosis or stenosis, and there is a possibility of false positives. Cardiac catheterization is a general term that includes procedures such as coronary angio...

Understanding Exercise ECG: Insights on Heart Palpitations and Risks

Hello Doctor, I have recently experienced occasional palpitations. I underwent an echocardiogram and a 24-hour Holter monitor, both of which showed no significant abnormalities. I then arranged for a stress test, and the report is as follows. I would like to know if this situatio...

Dr. Wu Xueming reply Cardiology
The results of the exercise electrocardiogram (ECG) are positive. If you continue to experience symptoms of chest tightness or chest pain, please visit the outpatient clinic to discuss with your physician whether further testing is necessary.

Understanding Exercise ECG Results: What to Expect After Testing

Hello, I have an issue with arrhythmia. Recently, I fainted suddenly, so I underwent an exercise electrocardiogram and blood tests. Aside from a cholesterol level of 190 and a fasting blood glucose level of 101, there don't seem to be any other problems. Here are the report ...

Dr. Wu Xueming reply Cardiology
The results of the exercise electrocardiogram need to be interpreted in conjunction with clinical symptoms indicative of cardiovascular disease, and the positive predictive value is approximately 60 to 70 percent. Therefore, additional tests are still required to determine if you...