Should You Consider Further Imaging After an Exercise ECG?

Exercise Electrocardiogram (Exercise ECG)

My exercise electrocardiogram results are as follows.
Is there a need for further imaging scans? Thank you.
Conclusions:
1.
Target HR = 160 bpm; Max HR = 162 bpm (101%)
2.
Exercise stopped at stage 4 (METs: 10.9), no angina
3.
Duke score: Low risk
4.
Resting EKG: Normal sinus rhythm
5.
Exercise EKG: Upsloping ST segment depression in leads II, III, aVF, V3-V6 up to 2 mm since stage 3 (relatively wider in V4-V6)
6.
Recovery EKG: ST-T returned to baseline in less than one minute
7.
Conclusion: probably negative test

Mr. Wang, 60~69 year old female. Ask Date: 2022/12/17

Dr. Cai Guiqin reply Cardiology

We recommend that you discuss the above situation further with your attending physician, focusing on symptomatic treatment or determining if further examinations are necessary.
Thank you, and wish you good health!

Reply Date: 2022/12/17

More Info

Based on the information provided from your exercise ECG report, it appears that you have experienced some degree of ST segment depression during the test, particularly in leads II, III, aVF, and V3-V6. This finding can be indicative of myocardial ischemia, especially if it occurs during exercise. However, it is important to note that the recovery EKG returned to baseline in less than one minute, which is a positive sign and suggests that the ischemic response was transient.

Given the context of your results, the decision to pursue further imaging, such as a CT coronary angiogram (CTCA), should be based on several factors:
1. Symptomatology: If you have experienced symptoms such as chest pain, shortness of breath, or any other concerning signs, further imaging may be warranted to assess the coronary arteries for any significant blockages or abnormalities.

2. Risk Factors: Consider your personal and family history of cardiovascular disease, as well as any risk factors such as hypertension, diabetes, hyperlipidemia, or smoking. If you have multiple risk factors, further imaging may be more strongly indicated.

3. Exercise Capacity: Your exercise capacity appears to be good, as indicated by the Duke score being low risk and the ability to achieve a target heart rate. This is a positive aspect and may suggest that your cardiovascular system is functioning adequately under stress.

4. ST Segment Changes: The presence of ST segment depression during exercise can be a red flag, but the degree and duration of the depression, as well as the recovery time, are critical in determining the significance. Since your ST segment returned to baseline quickly, this may suggest that the ischemic response was not severe.

5. Consultation with a Cardiologist: Ultimately, the best course of action is to consult with a cardiologist who can interpret your results in the context of your overall health, symptoms, and risk factors. They may recommend further imaging if they believe it is necessary to rule out significant coronary artery disease.

In summary, while your exercise ECG shows some concerning changes, the transient nature of the ST segment depression and the quick recovery are reassuring. However, the decision to proceed with further imaging should be made in consultation with a healthcare provider who can evaluate your specific situation comprehensively. If you have any ongoing symptoms or concerns, it is advisable to seek medical attention sooner rather than later.

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