Your Exercise ECG Report: Key Insights and Next Steps

Q: Your Exercise ECG Report: Key Insights and Next Steps

Hello, based on your exercise electrocardiogram records, your clinical symptoms mainly include exertional wheezing (New York Heart Association classification) and exertional chest discomfort? Typical? (Canadian Cardiovascular Society classification). <br>Angina pectoris is actual

Exercise Electrocardiogram Report

Hello: The exercise electrocardiogram report is as follows.
No additional tests were performed, and the doctor recommends continuing aspirin therapy.
I would like to seek a second opinion regarding the necessity of continuing this medication.

Conclusion: Borderline (suspected positive) Duke Treadmill Score: +2 (Low risk: +5; Intermediate risk: +4 to -10; High risk: < -10).
Pre-exercise condition NYHA Class: Class II.
Chest pain: Typical angina CCS Class: Class II.
Resting ECG: normal.
Vital Signs:
Resting: 136/94 (HR: 81)
Exercise Stage 1: 165/102 (HR: 112)
Exercise Stage 2: 185/81 (HR: 132)
Exercise Stage 3: 171/71 (HR: 153)
Recovery 0 min: 175/70 (HR: 144)
Recovery 1 min: 170/74 (HR: 117)
Recovery 3 min: 152/82 (HR: 107)
Recovery 5 min: 151/92 (HR: 100)
Reason for termination: Dyspnea, Target HR, unable to continue due to shortness of breath.

Exercise time: 07 min 40 sec
Maximal HR: 86% (153/178)
ST changes:
II: -1.0 (Upslope)
III: -1.0 (Horizontal)
aVF: -1.0 (Upslope)
Arrhythmia: none
Event: BP drop (-); Chest pain (-)
Note: Uneven baseline.

Xiao Yu, 40~49 year old female. Ask Date: 2024/01/18

Dr. Li Han reply Cardiology

Hello, based on your exercise electrocardiogram records, your clinical symptoms mainly include exertional wheezing (New York Heart Association classification) and exertional chest discomfort? Typical? (Canadian Cardiovascular Society classification).
Angina pectoris is actually a clinical diagnosis.
Generally, when a physician assesses that the likelihood is between 50% to 80% based on clinical presentation, they will recommend the use of aspirin, an antiplatelet medication, to prevent the occurrence of acute coronary syndrome or myocardial infarction.
At the same time, appropriate medications will be provided to control your risk factors and alleviate symptoms.
The exercise electrocardiogram utilizes a treadmill exercise to impose increased workload on the heart, thereby inducing clinical angina and changes in the electrocardiogram.
This aims to achieve a more definitive clinical diagnosis and, more importantly, to provide a semi-quantitative, functional risk assessment, which indicates the risk of acute events and mortality in patients with coronary artery disease.
The Duke score serves as a reference indicator to exclude certain clinical management biases that may arise from medical inertia (for example, I might feel that your clinical symptoms do not seem severe, and therefore you might not be that unfortunate, or I might intentionally avoid risks or unfavorable factors leading to passive management or recommendations, etc.).
I apologize for not being able to provide you with a straightforward yes or no recommendation, but you can focus on lifestyle changes and controlling your modifiable risk factors to reduce or delay the progression of atherosclerosis.
Take care from Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2024/01/18

More Info

Understanding your exercise ECG report is crucial for assessing your heart health and determining the appropriate next steps in your treatment plan. Based on the information provided, your report indicates a borderline result with a Duke Treadmill Score of +2, which places you in the intermediate risk category. This means that while you are not at high risk for cardiovascular events, there are still some concerns that warrant further evaluation.

Key Insights from Your Report
1. Duke Treadmill Score: A score of +2 suggests that you have a moderate risk of cardiac events. This score is derived from your exercise capacity, symptoms during the test, and any ECG changes observed. In your case, the presence of typical angina (chest pain) classified as CCS Class 2 indicates that you experience some limitations in physical activity due to your heart condition.

2. Vital Signs: Your resting blood pressure was recorded at 136/94 mmHg, which is considered elevated. During exercise, your blood pressure increased significantly, reaching 185/81 mmHg at Stage 2. This response is not uncommon during physical exertion, but the high resting blood pressure could be a risk factor for cardiovascular issues.

3. Heart Rate Response: You achieved a maximal heart rate of 153 bpm, which is approximately 86% of your predicted maximum heart rate. This indicates that your heart is responding appropriately to exercise, but the fact that you experienced dyspnea (shortness of breath) and had to terminate the test early is concerning.

4. ST Segment Changes: The report notes ST segment changes in leads II, III, and aVF, which could indicate myocardial ischemia (reduced blood flow to the heart muscle). While these changes are not definitive for a heart attack, they do suggest that there may be some underlying issues that need to be addressed.

5. Recovery: Your recovery heart rates indicate that your heart is gradually returning to baseline, which is a positive sign. However, the presence of dyspnea during exercise suggests that your heart may be under stress.

Next Steps and Recommendations
Given the borderline results and your symptoms, it is essential to consider the following steps:
1. Medication Adherence: Continuing with aspirin as prescribed by your doctor is important, as it can help reduce the risk of blood clots and cardiovascular events. However, it is crucial to discuss any concerns about long-term use with your healthcare provider, especially if you experience side effects.

2. Further Evaluation: Since your exercise ECG showed borderline results, it may be beneficial to undergo additional testing, such as a myocardial perfusion scan or a coronary angiogram. These tests can provide more detailed information about blood flow to your heart and help identify any significant blockages in the coronary arteries.

3. Lifestyle Modifications: Focus on maintaining a heart-healthy lifestyle. This includes regular physical activity, a balanced diet low in saturated fats and cholesterol, weight management, and smoking cessation if applicable. These changes can significantly impact your cardiovascular health.

4. Regular Monitoring: Keep track of your blood pressure and heart rate, and schedule regular follow-ups with your healthcare provider to monitor your condition. If you experience any new or worsening symptoms, such as increased chest pain or shortness of breath, seek medical attention promptly.

5. Consider a Second Opinion: If you have concerns about your current treatment plan or the necessity of continuing aspirin, seeking a second opinion from a cardiologist may provide additional insights and reassurance.

In conclusion, while your exercise ECG report indicates some areas of concern, it is essential to approach this situation with a comprehensive plan that includes medication adherence, further testing, lifestyle changes, and regular monitoring. Engaging in open communication with your healthcare provider will help ensure that you receive the best possible care tailored to your individual needs.

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