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Medical Forum / General / Cardiology / January 2007Stress Echo Results
I had aortic valve replacement and aneurysm repair in 1999 - take coumadin, Tegretol (for complex partial seizures) and Crestor. I was sent for a stress echo last week following two episodes of near syncope, which my primary care doctor said was probably vasovagal syncope. I have been dealing with some pretty bad fatigue for over a year now but all blood work is fine. Cholesterol is slightly elevated but my "good cholesterol" is 105. I check my BP on ocassion and it's almost always fine. The first part of the echo was normal, though the doctor noted "borderline left atrium enlargement." I was confused by this as the LA measurement was 3.1 and normal size should be less than 4.0. The doctor also commented that there was "no evidence of exercise induced myocardial ischemia." The treadmill part, however, noted this abnormality: "Patient reached adequate heart rate. She developed 0.5mm horizontal ST depression and T-wave inversion in leads II,III,aVF and V4,5,6. In these leads there is baseline ST/T abnormality." I understand that a diagnosis can't be given over the net but nothing was really explained to me about what this meant and I can't get an appointment to see the cardio until late next month. Can someone tell me what this might mean? Everything else looked so good I don't understand why the doctor concluded that the test was "abnormal." Thanks in advance for any info. > I had aortic valve replacement and aneurysm repair in 1999 - take > coumadin, Tegretol (for complex partial seizures) and Crestor. [quoted text clipped - 9 lines] > "borderline left atrium enlargement." I was confused by this as the > LA measurement was 3.1 and normal size should be less than 4.0. It is possible that by the cardiologist's eye your left atrium looked bigger than what the tech measured. > The > doctor also commented that there was "no evidence of exercise induced > myocardial ischemia." That should be reassuring. > The treadmill part, however, noted this abnormality: "Patient reached > adequate heart rate. She developed 0.5mm horizontal ST depression and > T-wave inversion in leads II,III,aVF and V4,5,6. In these leads there > is baseline ST/T abnormality." This suggests that there might be some ischemia. > I understand that a diagnosis can't be given over the net but nothing > was really explained to me about what this meant and I can't get an > appointment to see the cardio until late next month. Can someone tell > me what this might mean? Everything else looked so good I don't > understand why the doctor concluded that the test was "abnormal." The EKG part was abnormal. > Thanks in advance for any info. You are welcome. Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com >> The treadmill part, however, noted this abnormality: "Patient reached >> adequate heart rate. She developed 0.5mm horizontal ST depression and [quoted text clipped - 10 lines] > >The EKG part was abnormal. Thanks for the info. What is the chance of a stress test being wrong? I do have a mechanical aortic valve and wonder if that could be a factor in this showing up as abnormal. However, with the fatigue and weakness I've been feeling ischemia would somehow make sense. However, there are a billion causes for fatigue. Thanks again. neighbor mtstr...@mchsi.dot.com wrote: > Andrew, in the Holy Spirit, boldly wrote: > [quoted text clipped - 14 lines] > > Thanks for the info. You are welcome :-) > What is the chance of a stress test being wrong? There is a possibility. Determining how probable would require knowing the rest of your history and examining you. > I do have a mechanical aortic valve and wonder if that could be a > factor in this showing up as abnormal. It would not cause the change with exercise stress. > However, with the fatigue and > weakness I've been feeling ischemia would somehow make sense. > However, there are a billion causes for fatigue. Medicine remains an art. > Thanks again. Again, you are welcome. Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com mtstreet wrote: >What is the chance of a stress test being wrong? I'm not a doctor. But here's my experience. When my Angina symptoms appeared (classic textbook symptoms I might add), my Primary doc did an EKG, which was normal, but sent me to a Cardiologist anyway. The Cardio guy did a Stress Echo which turned out completely "Normal". I asked for a Cath but, due to the S/E test results plus my complete lack of "CVD risk factors", I was advised against it. I got a second opinion (2nd Cardiologist) which agreed with the first and was told that the Stress Echo was 98% accurate and, in my case, there was no question that my pain had to be muscular or skeletal and definitely NOT heart related. The advice from all three docs (Primary & 2 Cardiologists) was to maintain my lifestyle running, biking, etc and I'd never have to worry about heart probs. So for three years, that's what I did, ignoring the pain (and asking for a Cath at each annual Physical). Finally, after a 30 mile bike ride in May '05, I couldn't take it any more. I went to my Primary guy and deMANded a Cath. He did an EKG that was a little "different" than before and sent me to a 3rd Cardiologist who, after much arm twisting, agreed to do the Cath. That Cath showed up numerous blockages and resulted in a CABGx5 the next day. A few days later, in the hospital hallway, I bumped into my Primary Physician. He was pretty sheepish and his first words were "Well, that's the last time I'll trust one of those damn Stress Echos". LoL! Moral of the story: A Stress Echo CAN be wrong. If you feel in your gut something's not right, stay on your doc's butt until you get an answer that makes sense to YOU. Just remember, NObody is as concerned about your health as YOU are. Port > mtstreet wrote: > >What is the chance of a stress test being wrong? [quoted text clipped - 30 lines] > > Port Actually, the moral to your story is that neither athleticism nor being physical fit will keep you from developing occlusive coronary disease. However, eating the optimal amount thereby staying optimally healthy sans VAT will prevent CV disease: http://groups.google.com/group/sci.med.cardiology/msg/352546a7bf4a81ee? Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com > mtstreet wrote: >>What is the chance of a stress test being wrong >Moral of the story: A Stress Echo CAN be wrong. If you feel in your >gut something's not right, stay on your doc's butt until you get an >answer that makes sense to YOU. Just remember, NObody is as concerned >about your health as YOU are. > >Port My gut feeling is indeed that something's wrong. However, the main symptom I'm having is bad fatigue, which can also be caused by any number of non-cardiac reasons. I don't show any signs of a blood sugar or thyroid problem, though. Still, fatigue was the only reason I went to the doctor back in 1999 and I ended up with aortic valve replacement/aneurysm repair just three or four months later. I had no idea anything was wrong. Since I'm dealing with fatigue again I immediately worry that something's wrong with my heart. I do get SOB every so often but that might be an allergy I'm unaware of or sinus problems. I walk every day so yeah, just because you keep active doesn't mean that your heart is going to be fine. Anyway, I'm determined to get to the bottom of this. Cheers! > fatigue Myopathy is the most common side effect with symptoms ranging from fatigue, weakness, and pain to symptoms associated with rhabdomyolysis which is a life-threatening condition. ......................... 1: Am J Physiol Cell Physiol. 2006 Dec;291(6):C1208-12. Epub 2006 Aug 2. Links Statin-induced apoptosis and skeletal myopathy. ? Dirks AJ, Jones KM. Wingate University School of Pharmacy, Wingate, North Carolina 28174, USA. adirks@wingate.edu Over 100 million prescriptions were filled for statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) in 2004. Statins were originally developed to lower plasma cholesterol in patients with hypercholesterolemia and are the most effective drugs on the market in doing so. Because of the discovered pleiotropic effects of statins, the use has expanded to the treatment of many other conditions, including ventricular arrythmias, idiopathic dilated cardiomyopathy, cancer, osteoporosis, and diabetes. The elderly population is growing. Therefore, it is estimated that the number of statin users will also increase. Fortunately, the use of statins is relatively safe with few side effects. Myopathy is the most common side effect with symptoms ranging from fatigue, weakness, and pain to symptoms associated with rhabdomyolysis which is a life-threatening condition. The development of statin-induced rhabdomyolysis is rare occurring in approximately 0.1% of patients; however, the occurrence of less severe symptoms is underreported and may be 1-5% or more. Physical exercise appears to increase the likelihood for the development of myopathy in patients taking statins. It is thought that as many as 25% of statin users who exercise may experience muscle fatigue, weakness, aches, and cramping due to statin therapy and potentially dismissed by the patient and physician. The mechanisms causing statin-induced myopathy have not been elucidated; however, research efforts suggest that apoptosis of myofibers may contribute. The mitochondrion is considered a regulatory center of apoptosis, and therefore its role in the induction of apoptosis will be discussed as well as the mechanism of statin-induced apoptosis and myopathy. PMID: 16885396 [PubMed - in process]  SignatureS Jersey USA Zone 5 Shade http://www.ocutech.com/ High tech Vison aid This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. > > neighbor mtstreet wrote: > [quoted text clipped - 23 lines] > > Anyway, I'm determined to get to the bottom of this. You will be in my prayers. Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com Andrew B. Chung, MD/PhD felt the need to share this: >> Anyway, I'm determined to get to the bottom of this. > > You will be in my prayers. Mine too: Oh Jesus, you smelly old hippie, stop twisting your hair and gazing at nude men for a few seconds and come help out this guy with a bad heart. Take all his problems and give them to Chung. Nobody cares if Chung has a bad heart. After all, he's a cardiologist so he can just fix his problems himself, right? Right. Thanks Jesus. You f.cking suck, but we'd never say that to your face because we love you. Amen. > Andrew B. Chung, MD/PhD felt the need to share this: > [quoted text clipped - 7 lines] > Chung has a bad heart. After all, he's a cardiologist so he can just fix > his problems himself, right? Right. He'll use a kitten as a stent, and everything will be just fine. > Thanks Jesus. You f.cking suck, but > we'd never say that to your face because we love you. Amen. I would. If there WAS a jesus. >> Andrew B. Chung, MD/PhD felt the need to share this: >> [quoted text clipped - 15 lines] > > I would. If there WAS a jesus. Does the jesus soap on a rope count? |
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