Exercise ECG Results After PSVT Ablation: What to Do Next? - Cardiology

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After undergoing a PSVT (Paroxysmal Supraventricular Tachycardia) ablation, it is concerning to hear that you have been experiencing new and troubling symptoms, including chest heaviness, shortness of breath, dizziness, and episodes of rapid heart rate with minimal exertion. The exercise ECG results you provided indicate some significant findings that warrant further discussion and evaluation.


Understanding Your Exercise ECG Results
1. Maximal Heart Rate and Blood Pressure Response: Your exercise test showed that you achieved a maximal heart rate of 169 bpm, which is 91% of your age-predicted maximal heart rate. This indicates that your heart is capable of reaching a high level of exertion, but the symptoms you describe suggest that your heart may not be handling that exertion well.

2. ST Segment Changes: The presence of horizontal and upsloping ST depression during the recovery phase is noteworthy. ST segment depression can be indicative of myocardial ischemia, which means that the heart muscle may not be receiving enough blood flow during times of increased demand. In your case, the interpretation of "borderline positive for ischemia" suggests that there may be some level of concern regarding the blood supply to your heart muscle.

3. Ventricular Premature Complexes (VPCs): The detection of paired ventricular premature complexes during recovery is also significant. VPCs are extra heartbeats originating from the ventricles and can be a sign of irritability in the heart's electrical system. While occasional VPCs can be benign, their presence, especially in the context of your other symptoms, may require further investigation.


Next Steps
Given your symptoms and the findings from the exercise ECG, here are some recommendations:
1. Consultation with a Cardiologist: It is crucial to follow up with a cardiologist who can interpret these results in the context of your overall health and history. They may recommend further diagnostic testing, such as a cardiac MRI or echocardiogram, to assess the structure and function of your heart more thoroughly.

2. Consider Additional Testing: Depending on your cardiologist's assessment, they may suggest a coronary angiogram or a CT coronary angiography to evaluate for any blockages or significant coronary artery disease, especially given the borderline ischemia noted in your exercise test.

3. Holter Monitor: A 24-hour Holter monitor may be beneficial to capture any arrhythmias or abnormal heart rhythms that occur during your daily activities. This can provide more insight into the frequency and context of your symptoms.

4. Lifestyle Modifications: While awaiting further evaluation, consider lifestyle modifications that may help manage your symptoms. This includes avoiding excessive caffeine, managing stress, and engaging in light, supervised physical activity as tolerated.

5. Medication Review: If you are on any medications, it may be worth reviewing them with your healthcare provider to ensure they are appropriate for your current condition and symptoms.

6. Symptom Diary: Keeping a diary of your symptoms, including when they occur, their duration, and any associated activities, can provide valuable information for your healthcare team.


Conclusion
Your exercise ECG results, combined with your symptoms, suggest that further evaluation is necessary to rule out any significant cardiac issues. It is essential to communicate your concerns and experiences with your healthcare provider, who can guide you through the next steps in your care. Remember, timely intervention can lead to better outcomes, so do not hesitate to seek help.