Exercise ECG Reports: Assessing Heart Health Risks

Exercise electrocardiogram-related issues?

I would like to inquire whether this report indicates any heart-related issues and if they are severe.
Attached are the relevant cardiac examination results.
Purpose:
1.
(V) Diagnosis
2.
( ) PTCA
3.
( ) PTMV
4.
( ) Drugs
5.
( ) CABG
6.
( ) Rehabilitation
7.
( ) Arrhythmia
8.
( ) Screening
9.
( ) Others
Pre-exercise ECG:
Blood Pressure: 117/79
Medications: ( ) Yes, (V) No
Patient Fasting: ( ) Yes, (V) No
Stage:
Speed/Grade (MPH/Grade):
(1.7/10) (2.5/12) (3.4/14) (4.2/16) (5./18)
Minutes: 2’ 5’ 8’ R2’ R5’
Blood Pressure: 149/80 186/78 175/76 155/60 140/61
Minutes: Blood Pressure: / / / / /
Exercise Terminated Because of:
A.
( ) Maximal Effort
F.
(V) Dyspnea
K.
( ) Chest tightness
B.
(V) 90% Maximal Heart Rate Obtained
G.
( ) Arrhythmia
L.
( ) Can’t catch-up speed
C.
( ) ST Segment Shift
H.
( ) Leg Pain
M.
( ) Exercise intolerance
D.
( ) Chest Pain
I.
( ) Hypotension
N.
( ) Vasovagal Response
E.
( ) Fatigue
J.
( ) Dizziness
O.
Total Time: 9’11’’
MHR X MSBP: 179 X 186 = 33294
Maximal Achieved Rate: 179
Maximal Predicted Rate: 197
90% Predicted Rate: 177
Prepared by: F104246 Zhang Wei-Han
INTERPRETATION OF EXERCISE ECG
1.
( ) Normal ECG at maximal effort
2.
( ) Normal ECG at submaximal (90%) predicted heart rate
3.
( ) Normal ECG at “inadequate” heart rate of
4.
( ) Abnormal ST junction and segment elevation
5.
(V) Abnormal ST segment depression:
A.
Downsloping mm
B.
Flat 1 mm V5
C.
Upsloping mm (from j point to at least 0.08 seconds)
6.
( ) Other (Specify)
Comment:
1.
( ) Positive
2.
(V) Negative
3.
( ) Inconclusive (specify)
4.
( ) Complication (specify)
5.
Other
Stress and Redistribution Myocardial Perfusion Scan Report:
The Tl-201 myocardial perfusion SPECT study was performed with dipyridamole pharmacologic stress.
Intravenous dipyridamole was administered at a rate of 0.142 mg/kg/min for 4 minutes.
The administered dose was 8.2 ml (5 mg/ml).
The patient experienced headache/dizziness during the stress test, which was relieved by aminophylline.
The Tl-201 myocardial perfusion SPECT study performed 5 minutes after intravenous injection of Tl-201 and 4 hours later revealed homogeneous distribution of radioactivity in the myocardium of the left ventricle in each study.
The EKG-gated functional study showed: Stress LVEF = 72%, Rest LVEF = 68%.
Stress defect: 12% of total myocardium.
Reversibility: 78% of total (LAD: 50%, LCX: 70%, RCA: 0%).

Impression:
- No evidence of myocardial infarction or ischemia.

Memo:
Preparation by Xu Chao-Ying | Draft by Zhang Si-Han
Doppler Color Flow Imaging Report:
Echo machine:
Patient source:
[Atrium and Aortic Root]
AO (mm) = 29
LA (mm) = 31
[Left Ventricle]
IVS (mm) = 9
PW (mm) = 9
EDD (mm) = 50
ESD (mm) = 29
EDV (ml) =
ESV (ml) =
LV mass (g) =
LVEF: by M-mode measurement: 71%
LV Wall motion: Normal wall motion
[Right Ventricle]
TAPSE = mm
[Diastolic function]
Mitral inflow E/A: ? (E/A ratio:)
Septal E/e: ;
Lateral E/e: ;
[Valve]
MS: nil;
MR: nil;
AS: nil;
AR: nil;
TS: nil;
TR: nil;
PS: nil;
PR: nil;
[Other findings]
IVC diameter: mm with sniff collapse > 50%
Intracardiac vegetation: None
Intracardiac thrombus: No
Congenital lesions: None
Conclusion:
1.
No cardiac chamber dilation
2.
Normal LV systolic function with normal wall motion
3.
Normal RV systolic function
4.
Equivocal MV prolapse

Rex, 20~29 year old female. Ask Date: 2022/12/09

Dr. Wu Xueming reply Cardiology

All three test results show normal findings.

Reply Date: 2022/12/09

More Info

Understanding exercise ECG reports is crucial for assessing heart health and identifying potential cardiovascular risks. Based on the provided report, several key points can be highlighted regarding the patient's heart health status.

Summary of the Report Findings
1. Pre-Exercise ECG and Blood Pressure: The pre-exercise ECG shows a resting blood pressure of 117/79 mmHg, which is within the normal range. This indicates that the patient does not have hypertension at rest.

2. Exercise Protocol: The exercise was conducted using a Bruce protocol, which is a common treadmill exercise test that progressively increases in intensity. The patient achieved a maximal heart rate (MHR) of 179 BPM, which is 90% of the predicted maximum heart rate (197 BPM). This suggests that the patient was able to reach a significant level of exertion during the test.

3. Termination of Exercise: The exercise was terminated due to dyspnea (shortness of breath), which is a common symptom during high-intensity exercise, especially if the individual is not accustomed to such levels of exertion.
4. Blood Pressure Response: The maximal blood pressure recorded during exercise was 186/78 mmHg. While the systolic pressure is elevated, the diastolic pressure remains relatively stable, which is a typical response during exercise.

5. ECG Interpretation: The ECG during exercise showed sinus tachycardia with premature atrial contractions (PACs) and non-specific ST-T changes. The presence of PACs is not uncommon and can occur in healthy individuals, especially during exertion. However, the non-specific ST-T changes warrant further investigation, as they may indicate underlying issues.

6. Overall Conclusion: The report concludes with a negative result, indicating no significant ischemic changes during the exercise test. This is a positive outcome, suggesting that there are no immediate signs of coronary artery disease (CAD) or significant heart dysfunction.

Risk Assessment for Heart Disease
The risk factors for coronary artery disease (CAD) include hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of heart disease. In this case, the patient does not have hypertension, diabetes, or a history of smoking, which are positive indicators. However, the report does mention hyperlipidemia and a family history of heart disease, which are significant risk factors.

Recommendations for Further Evaluation
1. Monitoring and Follow-Up: Given the presence of non-specific ST-T changes and PACs, it is advisable for the patient to undergo further monitoring. This could include a Holter monitor to assess heart rhythm over a 24-hour period or additional stress testing to evaluate the heart's response under different conditions.

2. Lifestyle Modifications: The patient should be encouraged to adopt a heart-healthy lifestyle, including regular exercise, a balanced diet low in saturated fats and cholesterol, and maintaining a healthy weight. These changes can help manage hyperlipidemia and reduce overall cardiovascular risk.

3. Regular Check-Ups: Regular follow-ups with a healthcare provider are essential to monitor heart health, especially considering the family history of heart disease. Lipid profiles and other cardiovascular risk assessments should be conducted periodically.

4. Consideration of Medications: If hyperlipidemia is significant, the healthcare provider may consider discussing the initiation of statin therapy or other lipid-lowering medications to manage cholesterol levels effectively.

Conclusion
In summary, while the exercise ECG report indicates a generally positive outcome with no significant ischemic changes, the presence of PACs and non-specific ST-T changes suggests that further evaluation may be warranted. The patient's risk factors for CAD should be managed proactively through lifestyle changes and regular monitoring. Engaging in discussions with a healthcare provider about these findings will be crucial for maintaining heart health and preventing potential cardiovascular issues in the future.

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