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Old 05-25-2006, 02:27 PM   #1
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Nuclear Stress Test Interpretation??

Can someone please help...

Female 50

Ejection Fraction
LVEF 71%

treadmill: patient excercised 10 minutes, maximum heart rate of 160 bpm and maximum blood pressure of 150/80 mmHg. Test was stopped due to fatigue. The patient reached 94% of predicted maxiumum heart rate. Don't understand this at all: The patient achieved an estimated workload of 11.7 METS

Patient experienced exertion dyspynea mild. Patient had sinus rhythm and PAC rare. STsegment changes of 1.0mm upsloping ST drpression in inferolateral leads beginning in stage 1.

Thanks in advance for any help with what the EF (71%) indicates and METS workload means...

Brenlee

 
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Old 05-25-2006, 08:39 PM   #2
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Re: Nuclear Stress Test Interpretation??

You did well Brenlee,

exertion dyspnea mild = slight breathlessness
11.7 METS is a measure of high output approximately equal to 11.7 times you'd exhibit when resting.
EF is ejectiion fraction and roughly 71% of the blood in your left ventricle is pumped oput into the aorta...good value/

Not too sure about the ST segment stuff.

Pretty normal rhythm with an occasional pre-atrtial contraction...like a beat skip.

Maximum heart rate is usually something like 120- age (or sometimes a slight variation) and you got 94% of that or 160 BPM...good!

Did you have any pain or chest discomfort or burn at all?

 
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Old 05-26-2006, 12:22 AM   #3
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Re: Nuclear Stress Test Interpretation??

Quote:
Originally Posted by Lenin
You did well Brenlee,

exertion dyspnea mild = slight breathlessness
11.7 METS is a measure of high output approximately equal to 11.7 times you'd exhibit when resting.
EF is ejectiion fraction and roughly 71% of the blood in your left ventricle is pumped oput into the aorta...good value/

Not too sure about the ST segment stuff.

Pretty normal rhythm with an occasional pre-atrtial contraction...like a beat skip.

Maximum heart rate is usually something like 120- age (or sometimes a slight variation) and you got 94% of that or 160 BPM...good!

Did you have any pain or chest discomfort or burn at all?
Thank you for your help Lenin. No chest pain, burn or discomfort. I quit when I became breathless after 10 minutes.

I'm researching the STsegment stuff and it's confusing. Everything I read says ST depression of 1.0mm and > indicates further testing, e.g. angiogram because of MI probability. Why would they miss that?

Again, thanks a bunch! You're always a great help.

 
Old 05-26-2006, 04:31 AM   #4
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Re: Nuclear Stress Test Interpretation??

If you had suffered some pain, or been unable to achieve good oxygen utilization, then they'd have made more of the 1 mm ST-depression. Also it's the DOWNSLOPING ST segment that's more worrisome and predictive of angina than the UPSLOPING ones.
Don't worry about MI, rather it's angina that the usual culprit.

(I glossed over the ST segment in my first post because I didn't want to SCARE you needlessly...IT didn't work )

They MAY suggest a perfusion scan and get you back on the treadmill to check for "silent ischemia," but there's no pressing need for you to do it unless you start to feel some chest discomfort.

 
Old 05-26-2006, 09:27 AM   #5
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Re: Nuclear Stress Test Interpretation??

Quote:
Originally Posted by Lenin
If you had suffered some pain, or been unable to achieve good oxygen utilization, then they'd have made more of the 1 mm ST-depression. Also it's the DOWNSLOPING ST segment that's more worrisome and predictive of angina than the UPSLOPING ones.
Don't worry about MI, rather it's angina that the usual culprit.

(I glossed over the ST segment in my first post because I didn't want to SCARE you needlessly...IT didn't work )

They MAY suggest a perfusion scan and get you back on the treadmill to check for "silent ischemia," but there's no pressing need for you to do it unless you start to feel some chest discomfort.
Months of chest pain is what brought me here. I just don't see how they can ignore this test comment as if it's normal when all evidence points otherwise...

Also the mere fact that my report states the changes of 1.0mm upsloping ST depression occurred right after test began in stage one is and indicatior for more serious and significant predictor of ischaemia.

for example and starters

2.2. Exercise ECG in CAD detection

The most prominent abnormal response in ECG during the exercise test is an ST-segment deviation, mostly depression caused by subendocardial ischemia. ST-segment elevation is less common and has been associated with reciprocal changes for the ST depression, transmural or epicardial injury, and also coronary spasm. In addition to ST-segment deviation a deep T-wave inversion, an increase in R-wave, Q-waves, QRS changes and QT interval are considered to be sensitive in the detection of CAD8. However, there are also several studies yielding discrepant results, which would suggest that ST-segment deviation is still the most accurate exercise ECG variable for CAD detection.

It is generally assumed that early onset of ST-segment depression and its prolonged recovery after exercise signify more severe CAD9. Observation of the time course of ST depression during and after exercise was found to add significantly to the information gained during exercise testing. Other researchers have also stressed the importance of relating ST-T changes to the time of their occurrence during and after exercise. In addition ischemic ST changes developing during recovery has shown to have similar prognostic significance than changes appearing during exercise10.

Previous studies have suggested that ST-segment depression with adenosine myocardial perfusion imaging (MPI) may be a marker of significant coronary artery disease. It is unclear if the significance of ST depression differs between men and women. We investigated the diagnostic accuracy of ST-segment depression with adenosine radionuclide MPI as a marker of significant CAD in men and women. Consecutive patients who had angina or suspected CAD and underwent an adenosine stress test and subsequent angiography were retrospectively analyzed. The inclusion criteria were met by 959 patients. Mean age was 64 +/- 11 years, and 43% were women. ST depression occurred in 7.6% of the cohort and more often in women (64% women vs 36% men, p <0.001). Among men and women, patients with ST-segment depression had a significantly higher peak rate-pressure product, more chest pain, and a higher ejection fraction in response to the adenosine infusion compared with those without ST-segment depression. ST-segment depression occurred more often in the presence of stenotic lesions (>/=50% and >/=70%), and left main or 3-vessel disease, regardless of gender. Transient ischemic dilation occurred more often in men with ST-segment depression. The logistic regression analysis demonstrated that the only significant predictors of left main or 3-vessel CAD were gender, an abnormal result on MPI, transient ischemic dilation, and ST-segment depression. In conclusion, ST-segment depression during adenosine MPI is an important marker of angiographically significant CAD in men and women. The presence of ST-segment depression is associated with left main disease and 3-vessel CAD.-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The only research I could find perhaps supporting their lack of concern:

BACKGROUND: ST segment depression on the electrocardiogram during the exercise treadmill test (ETT) is used as a predictor of coronary artery disease (CAD), although it is recognised that both false-positive and false-negative results limit the value of this procedure. Although adenosine does not produce an inotropic or chronotropic effect upon the myocardium it may cause ST depression during infusion. METHODS: The 12-lead ECG recordings obtained during 825 adenosine stress and 425 ETT procedures, performed as part of a 2-day Tc-MIBI protocol, were retained for examination and comparison with the appearances at subsequent myocardial perfusion imaging (MPI). RESULTS: ST depression was associated with 44 (4.9%) of the adenosine stress and 44 (10.4%) of the ETT procedures. Both 1 and 2 mm ST depression during adenosine stress were significant predictors of reversible ischaemia (p < 0.01; p < 0.01). However, even though 2 mm ST depression on ETT was significant as a predictor of reversible ischaemia (p < 0.01), 1 mm ST depression on ETT was not (p = 0.4). There were more female cases with false positive ECG changes in both the adenosine stress (63.6%) group and the ETT (66.7%) group. There was no significant correlation between the territory of the ischaemic changes seen on the ECG with the location of defects developing on MPI in both the adenosine stress and ETT groups. CONCLUSIONS: ST depression of 1 mm occurring with adenosine stress, unlike with the ETT, is a significant predictor of ischaemia!

Last edited by Brenlee; 05-26-2006 at 09:34 AM.

 
Old 05-26-2006, 10:59 AM   #6
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Re: Nuclear Stress Test Interpretation??

I just spoke with my dr's office about this concern. I haven't talked to the cardio himself, yet I spoke with his RN. She said that this wasn't of concern. It was the images themselves that told the whole story in the test and that the upsloping ST depression was of little significance. That contradicts everything I've read. And I've read a BUNCH lately.

What to do..

Not comforting. Nope. Clearly keeps me extremely unsettled. I asked that the cardio call me and explain more indepth.

Last edited by Brenlee; 05-26-2006 at 11:00 AM.

 
Old 05-26-2006, 11:12 AM   #7
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Re: Nuclear Stress Test Interpretation??

Please... how do you pronounce "ischemia". It would be prudent to sound half-way intelligent when/if the cardio calls back.. LOL

 
Old 05-28-2006, 08:38 AM   #8
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Re: Nuclear Stress Test Interpretation??

It's: ISS-KEE'-MEE-UH and the adjective is ISS-KEE'-MIC

Hon, I've seen lots of data speaking to the innocuousness of an upsloping ST segment and the relative non-importance of a 1 mm. ST segment.

I even pulled out all my old ECG's...they really require a trained eye. I had PROVEN ischemic angina but I can't find bupkis of any ST depression. Seems the web sites make it SOOO clear but in reality the interpretation is something of an art.
I am getting my dander up with determination to be able to read these things.

Why didn't you get a perfusion nuclear scan as long as you were going through the agro of the stress test? Did you have much chest pain during the test?

Last edited by Lenin; 05-28-2006 at 10:40 AM.

 
Old 05-30-2006, 10:26 AM   #9
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Re: Nuclear Stress Test Interpretation??

I have researched my EKG findings. To focus on the ST segment, its purpose with the 12 lead is to make a distinction between ischemia and necrosis and whether the condition is reversable.

The classic changes with necrosis (Q waves), injury (ST elevation), and ischemia (T wave inversion) may all be seen in acute infarction. In recovery the earliest change is with the ST normalization, then the T wave and Q (abnormal configuration) usually persists. Consequently, the age of the infarction can be roughly sestimated with how the ST segment appears and T wave. The presence of the Q wave in the absence of ST and T wave abnormality indicates prior or healed infarction.

I don't believe result are from an individual's reading of the graphic printout, but the equipments software analyzes. The doctor makes a diagnosis in conjunction with other information from other sources. Relationships of one wave to another, the wave size, polaration, its duration and the different leads, etc. would almost preclude an exact reading from a visual display by a doctor. I would assume!

 
Old 06-06-2006, 08:48 PM   #10
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Re: Nuclear Stress Test Interpretation??

Quote:
Originally Posted by Lenin
It's: ISS-KEE'-MEE-UH and the adjective is ISS-KEE'-MIC

Hon, I've seen lots of data speaking to the innocuousness of an upsloping ST segment and the relative non-importance of a 1 mm. ST segment.

I even pulled out all my old ECG's...they really require a trained eye. I had PROVEN ischemic angina but I can't find bupkis of any ST depression. Seems the web sites make it SOOO clear but in reality the interpretation is something of an art.
I am getting my dander up with determination to be able to read these things.

Why didn't you get a perfusion nuclear scan as long as you were going through the agro of the stress test? Did you have much chest pain during the test?
Lenin, First.. thanks for your response. I've been away from the board.

My final conversation with the cardio ended in (his words...) "Good Luck".

The ST depression is innocuous (says he) in female patients, especially.

My PCP is more disturbed by ST segement changes and is having another cardio look over my report. By the way, I did indeed have mycardial perfusion imaging at the same time. Is this what you mean by a perfusion nuclear scan? Anyway, the findings are in my nuclear study final report showing an Ejection Fraction of 71%. At no time did I have chest pain, nor do I ever have chest pain during excerise - even to total exhaustion. My angina (if that's what it is) is only at resting, early morning. It's a burning pain in the center of my chest.. not when I go to sleep at night such as acid reflux but early morning 5-6am. Sometimes it awakens me. Sometimes when I get up and walk around it goes away rather quickly. It usually settles in my left breast then is gone. I tried to relate it to hormones at first. This has been going on for a few years.

The disclaimer on the final report is "This test is designed to discover the arteries that are blocked by more than 60-70%. This study cannot determine if there are blockages less than 50%. While the study is reassuring, all tests in medicine have some inherent limitations. This test is not 100% accurate, but is felt to be extremeely reliable" ... you know the drill.

I must say, you are miles ahead of many of us that are clueless on reading an ECG.. Man what a maze. Thanks so much again.. Brenlee

Last edited by Brenlee; 06-06-2006 at 09:33 PM.

 
Old 06-06-2006, 09:03 PM   #11
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Re: Nuclear Stress Test Interpretation??

Quote:
Originally Posted by kenkeith
I have researched my EKG findings. To focus on the ST segment, its purpose with the 12 lead is to make a distinction between ischemia and necrosis and whether the condition is reversable.

The classic changes with necrosis (Q waves), injury (ST elevation), and ischemia (T wave inversion) may all be seen in acute infarction. In recovery the earliest change is with the ST normalization, then the T wave and Q (abnormal configuration) usually persists. Consequently, the age of the infarction can be roughly sestimated with how the ST segment appears and T wave. The presence of the Q wave in the absence of ST and T wave abnormality indicates prior or healed infarction.

I don't believe result are from an individual's reading of the graphic printout, but the equipments software analyzes. The doctor makes a diagnosis in conjunction with other information from other sources. Relationships of one wave to another, the wave size, polaration, its duration and the different leads, etc. would almost preclude an exact reading from a visual display by a doctor. I would assume!
Thanks Ken... this is way over my head. I'm not sure what to do or what to think. My primary care physician asked if I was prepared to have an angiogram and I said "yes, if there's a compelling reason to do so"...

I wish I were more savvy. You guys are wonderful to try to help yet my brain doesn't comprehend the vernacular - I need to educate myself more.

Any recommendations on where to take this with what info I've posted? What would YOU do?

Last edited by Brenlee; 06-06-2006 at 09:14 PM.

 
Old 06-06-2006, 09:11 PM   #12
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Re: Nuclear Stress Test Interpretation??

Quote:
Originally Posted by kenkeith
I have researched my EKG findings. To focus on the ST segment, its purpose with the 12 lead is to make a distinction between ischemia and necrosis and whether the condition is reversable.

The classic changes with necrosis (Q waves), injury (ST elevation), and ischemia (T wave inversion) may all be seen in acute infarction. In recovery the earliest change is with the ST normalization, then the T wave and Q (abnormal configuration) usually persists. Consequently, the age of the infarction can be roughly sestimated with how the ST segment appears and T wave. The presence of the Q wave in the absence of ST and T wave abnormality indicates prior or healed infarction.

I don't believe result are from an individual's reading of the graphic printout, but the equipments software analyzes. The doctor makes a diagnosis in conjunction with other information from other sources. Relationships of one wave to another, the wave size, polaration, its duration and the different leads, etc. would almost preclude an exact reading from a visual display by a doctor. I would assume!
Forgive the double response. I didn't think the first one went through.

Thank you Ken. Unfortunately I'm not savvy when it comes to the ECG reading aspect in the least. I'm ignorant to the vernacular and thus, at the mercy of what the doctor tells me, which goes against my nature as I feel it's important to have more than one opinion. Plus I really WANT to understand. I'm very impressed with the knowledge here.

Last edited by Brenlee; 06-06-2006 at 09:12 PM.

 
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