Exercise-Induced Dyspnea and Chest Tightness: Key Insights

Chest tightness and increased shortness of breath after exercise compared to before?

The exam was terminated at Stage 4 (10:09) due to dyspnea with angina.
Max workload = 11.9 METs.
Max HR: 157 bpm, 92% of MPHR.
ST depression: 1.35 mm over V6 (horizontal).
Hypotension: No.
Other: No.
Conclusion: Possible positive.
Dear Doctor, the above is my exercise electrocardiogram report.
After exercising, I experienced more shortness of breath than before.
Following the exercise ECG, I underwent a myocardial perfusion scan, and the results are as follows:
HISTORY AND INDICATIONS:
1.
Exertional chest tightness/dyspnea/chest pain, relief after resting, rule out coronary artery disease (CAD), for functional evaluation and risk stratification.
2.
Cardiac echocardiogram: Left ventricular (LV) function (preserved); LV dilation (-); LV hypertrophy (-); valvular heart disease (VHD) (-); pulmonary hypertension (-).
3.
Baseline ECG: sinus rhythm.
RISK FACTORS:
Hypertension (+); Diabetes Mellitus (-); Hyperlipidemia (+); Smoking (-); Family History (-).
PROCEDURES:
1.
A gated myocardial perfusion scan was performed with intravenous infusion of 15 mCi and 30 mCi of Tc-99m MIBI at peak stress and rest.
2.
Stress was induced by vasodilator stress with intravenous infusion of persantin.
3.
No significant discomfort was noted during persantine stress.
4.
Blood Pressure (basal to peak): 149/90 -→ 141/88; Heart Rate: 78 -→ 86.
5.
CT-based attenuation correction was also performed.
FINDINGS:
1.
Stress/rest perfusion abnormalities: positive - Grade: mild - Size: small - Reversibility: partial - Segments: inferolateral.
2.
Semi-quantitative perfusion scores: SSS = 2, SRS = 0, SDS = 2.
3.
Echocardiogram findings: Systolic Blood Pressure: 140 mmHg, Diastolic Blood Pressure: 86 mmHg, Heart Rate: 58 BPM, Model: A70C.
Clinical diagnosis: Hypertensive heart disease without heart failure.
INDICATION: Cardiomyopathy or ischemic heart disease.
CARDIOLOGIST’S COMMENTS: [Details not provided]
IMPRESSION: [Details not provided]
SUGGESTION: [Details not provided]
CHAMBER SIZE:
Aortic Diameter (AOD): 41.0 mm (normal range: 16-40)
Left Atrial Diameter (LAD): 40.0 mm (normal range: 18-40)
Right Ventricular Diameter (RVD): 16.0 mm (normal range: 10-20)
Interventricular Septal Thickness at end-diastole (IVSd): 10.1 mm (normal range: 6-12)
Posterior Wall Thickness at end-diastole (PWTd): 10.1 mm (normal range: 7-12)
Left Ventricular Diameter at end-diastole (LVDd): 56.3 mm (normal range: 45-55)
Left Ventricular Diameter at end-systole (LVDs): 37.1 mm (normal range: 30-45)
Left Ventricular End-Diastolic Volume (LVEDV): 156.0 mL (normal range: 14-140)
Left Ventricular End-Systolic Volume (LVESV): 58.5 mL (normal range: 27-95)
Right Atrial Diameter (RAD): mm (normal range: 18-40)
Ejection Fraction (EF): 62.5% (normal range: 50-80)
Fractional Shortening (FS): 34.1% (normal range: 25-44)
VALVULAR ABNORMALITY: Redundant mitral valve.
Thickened mitral valve (TMV).
Nothing particular on pulmonary valve (PV) and tricuspid valve (TV).
PROSTHETIC VALVE: No prosthetic valve present.
REGIONAL WALL MOTION ABNORMALITY: SCORE: 1 = Normal; 2 = Hypokinesis; 3 = Akinesis; 4 = Dyskinesis; 5 = Aneurysm.
(01) Basal AnteroSeptum: 1.
I would like to ask the doctor what my main heart issues are, as I am experiencing chest tightness and increased shortness of breath during exercise.
Thank you for your response, and I wish you peace and joy.

Afa, 50~59 year old female. Ask Date: 2023/10/10

Dr. Wu Xueming reply Cardiology

The myocardial perfusion scan shows evidence of myocardial hypoxia; it is recommended to discuss treatment options with the outpatient physician.

Reply Date: 2023/10/10

More Info

Understanding exercise-induced dyspnea and chest tightness is crucial for evaluating cardiovascular health, especially in individuals who experience symptoms during physical activity. Based on the information provided, it appears that you have undergone a comprehensive evaluation, including an exercise electrocardiogram (ECG) and a myocardial perfusion scan, due to symptoms of exertional chest tightness and dyspnea.

Key Insights into Exercise-Induced Dyspnea and Chest Tightness
1. Definition and Causes: Exercise-induced dyspnea refers to shortness of breath that occurs during physical activity. It can be caused by various factors, including cardiovascular issues, respiratory conditions, or even anxiety. In your case, the presence of chest tightness and dyspnea during exercise raises concerns about potential underlying coronary artery disease (CAD) or other cardiac conditions.

2. Exercise ECG Findings: Your exercise ECG report indicates that the test was terminated due to dyspnea and angina at a workload of 11.9 METs, with a maximum heart rate of 157 bpm. The horizontal ST depression of 1.35 mm over V6 suggests possible ischemia, which is a condition where the heart muscle does not receive enough blood and oxygen, particularly during exertion.

3. Myocardial Perfusion Scan Results: The findings from your myocardial perfusion scan indicate mild stress/rest perfusion abnormalities with partial reversibility in the inferolateral segments. This suggests that there may be some degree of ischemia present, which could be contributing to your symptoms. The semi-quantitative perfusion scores further support the notion of mild ischemic changes.

4. Risk Factors: Your history of hypertension and hyperlipidemia are significant risk factors for cardiovascular disease. These conditions can lead to the development of atherosclerosis, which narrows the coronary arteries and can result in symptoms like chest tightness and dyspnea during exertion.

5. Cardiac Function: The echocardiogram results indicate preserved left ventricular function, which is a positive sign. However, the presence of hypertensive heart disease without heart failure suggests that your heart is under stress due to high blood pressure, which can affect its overall performance over time.

6. Recommendations: Given your symptoms and the findings from your tests, it is essential to follow up with your cardiologist for a thorough discussion of your results. They may recommend lifestyle modifications, such as dietary changes, increased physical activity tailored to your condition, and strict management of your blood pressure and cholesterol levels. Medication adherence is also crucial in managing your risk factors.

7. Further Evaluation: If your symptoms persist or worsen, further evaluation may be warranted. This could include additional imaging studies, such as a cardiac catheterization, to assess the coronary arteries directly. This procedure can help determine if there are significant blockages that may require intervention.

Conclusion
In summary, your symptoms of chest tightness and dyspnea during exercise are concerning and warrant careful evaluation. The combination of your exercise ECG and myocardial perfusion scan results suggests that there may be underlying ischemic heart disease. It is essential to work closely with your healthcare provider to manage your risk factors and monitor your heart health. Regular follow-ups and adherence to treatment plans can significantly improve your quality of life and reduce the risk of serious cardiovascular events. Always prioritize open communication with your healthcare team regarding any new or worsening symptoms.

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