Exercise ECG: Insights on Heart Palpitations and Risks

Exercise electrocardiogram

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 situation is serious and whether a cardiac catheterization is necessary.
Thank you.
Purpose: 1(V) Dx; 2( ) PTCA; 3( ) PTMV; 4( ) Drugs; 5( ) CABG; 6( ) Rehabilitation; 7( ) Arrhythmia; 8( ) Screening; 9( ) Others
Pre-exercise ECG: Blood Pressure: 136/103
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: 157/84 146/80 -/- 165/96 137/87
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: 9’16’’
MHR X MSBP: 176 X 157 = 27632
Maximal Achieved Rate: 176
Maximal Predicted Rate: 187
90% Predicted Rate: 167
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 elevated
5.
(V) Abnormal ST segment depression:
A.
Downsloping mm
B.
Flat 1.7-3.1 mm II III AVF V4 V5 V6
C.
Upsloping mm (from j point to at least 0.08 seconds)
6.
( ) Other (Specify)
Comment:
1.
(V) Positive
2.
( ) Negative
3.
( ) Inconclusive (specify)
4.
( ) Complication (specify)
5.
Other

Mathis, 30~39 year old female. Ask Date: 2023/01/21

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.

Reply Date: 2023/01/21

More Info

Understanding the results of an exercise ECG (electrocardiogram) is crucial for assessing heart health, especially when symptoms like palpitations arise. Based on the provided report, there are several important factors to consider regarding your heart's condition and the potential need for further investigation, such as coronary angiography.

Overview of Your Exercise ECG Report
1. Pre-Exercise Conditions: Your blood pressure was noted at 136/103 mmHg, which indicates hypertension, particularly the diastolic reading. This could be a contributing factor to your symptoms of palpitations and dyspnea (shortness of breath) during exercise.

2. Exercise Performance: You achieved a maximal heart rate of 176 BPM, which is approximately 94% of your predicted maximal heart rate (187 BPM). This indicates that you were able to exert yourself significantly during the test.

3. Termination of Exercise: The exercise was stopped due to dyspnea, which is an important symptom to note. Dyspnea during exertion can indicate underlying cardiac issues, especially if it occurs alongside palpitations.

4. ECG Interpretation: The report indicates abnormal ST segment depression, which is a key finding. ST segment depression during exercise can suggest myocardial ischemia, meaning that the heart muscle may not be receiving enough blood and oxygen during exertion. This is particularly concerning when combined with your symptoms.

5. Overall Assessment: The exercise ECG was classified as positive, which suggests that there may be underlying coronary artery disease (CAD) or other cardiac issues that warrant further investigation.

Implications of Your Findings
Given the abnormal ST segment changes and your symptoms, it is essential to consider the following:
- Risk of Coronary Artery Disease: The presence of ST segment depression during exercise is often associated with ischemic heart disease. This means that there could be blockages in the coronary arteries that supply blood to the heart muscle.

- Need for Further Testing: While your initial tests (echocardiogram and 24-hour Holter monitor) did not show significant abnormalities, the exercise ECG results suggest that further investigation is warranted. A coronary angiogram (heart catheterization) could provide a clearer picture of the state of your coronary arteries and help determine if there are significant blockages that need to be addressed.

- Management of Symptoms: In the meantime, managing your blood pressure and any other risk factors (such as cholesterol levels) is crucial. Medications may be necessary to help control these factors and reduce the risk of cardiovascular events.

Recommendations
1. Consult Your Cardiologist: It is vital to discuss these findings with your cardiologist. They can provide a comprehensive evaluation and determine whether a coronary angiogram is necessary based on your symptoms and exercise ECG results.

2. Lifestyle Modifications: Consider lifestyle changes that can improve heart health, such as a heart-healthy diet, regular exercise (as tolerated), and stress management techniques.

3. Monitoring: Keep track of any new or worsening symptoms, such as increased frequency of palpitations, chest pain, or worsening dyspnea. Report these to your healthcare provider promptly.

4. Follow-Up Testing: If recommended, undergo further testing such as a myocardial perfusion scan or stress echocardiogram to assess heart function and blood flow more thoroughly.

In conclusion, while your exercise ECG indicates some concerning findings, it is essential to approach this situation with a comprehensive plan involving further evaluation and management. Early intervention can significantly improve outcomes in patients with potential coronary artery disease.

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