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Forum Name: Ischemic Heart Disease

Question: Stress Test Results confusion


 rfisher - Wed May 04, 2005 9:26 am

Hello, I had previously posted regarding chest pain and ischemia and have further information now that has only served to confuse me more. I am hoping someone can give me some further information.

I am 29 years old, obese, and a smoker. I do not have a family history of early heart disease; my grandfather died at the age of 85 of a heart attack and that is about it. My total cholesterol is 182, LDLs are 108, triglycerides are 42. Blood pressure runs around 116/62. I have prediabetes. Blood enzyme tests taken twice over a three day period after chest pains were "totally normal" according to the doctor. I have been diagnosed with GERD in the past as a cause for some chest pains, but recent chest pains have been different in nature than the GERD chest pains I have had in the past. Have been told I have "esophageal sludge" in my gallbladder. Was told that my ECG had an inverted T wave in V1. Took a thallium stress test. Was told at that time that the ECG readings were normal, although when I went from a resting to a standing position my T waves inverted again, then flipped themselves upright. The results of the stress test indicated "suspected mild ischemia", but then went on to say that it could be an "artifact" as a result of the position of my breast between the resting and stress testing. Results noted that the computer analysis did not note any ischemia. My doctor wants to treat me "aggressively" with Crestor, Aspirin, Glucophage. However, I am very prone to side effects from medication and would like to avoid taking any if at all possible. Based upon the information given above, I have no idea if I actually have ischemia because the information conflicts between the stress test pictures and computer analysis and what my doctor is telling me. Should I pump a bunch of drugs in my system? Given the other information about my cholesterol, heart disease, blood pressure, etc, am I a "walking heart attack at any moment" the way my doctor is telling me or is she just trying to scare me? I should note that my doctor is a BIG proponent of gastric bypass surgery and keeps telling me that I'm going to die within the next five years if I don't get it. I am overweight, indeed, but would like to avoid that type of major surgery if at all possible and think that, with a few lifestyle changes I'll be okay. I am also planning to begin taking Zyban within the next week to quit smoking, as I know that is something I very much need to do. However, if I do have heart disease and/or ischemia and am going to "die soon" as I keep getting told then I'm willing to reconsider my position on that surgery as well.

Thank you very much for your time!

R
 shehperpk - Fri May 06, 2005 1:26 pm

:)
hi there...
i have some happy news for u....
my limited experience of cardiology tells me that having MI / angina at your age is a rare phenomena. the information you have provided us doesnt give a hard clue to start medication for ischaemic heart disease. and we need some harder evidence to go for it. why not try the treadmill test ie, exertion tolerance tests.. to confirm whether u have some thing wrong with your coronaries or not.
now your ldl levels are pretty ok... they should be around 100 for the best. u didnt mention hdl levels.
u have to understand the difference between primary and secondary prevention... primary is the one which u do to prevent a disease to attack u..while the secondary prevention means to soften the blow of a disease who has already attacked u and to prevent its complications..
now u r at a high risk as u have a positive family history, u r a smoker, and obese if i remember correctly. so whether u have heart disease or not ,, u will have to do something good to prevent it...
1----- change the lifestyle
stop smoking it will help in dilating the coronaries and raise your hdl levels
increase the physical excercise
take low fat and low salt diet
better to consult a dietician
2-----start some of the medicine.....
aspirin ... take low dose and enteric coated variety... it has hell of a role in primary and secondary prevention against ischaemic heart disease
consult a lipid physician for adjustments.. and may start atorvastatin or ezitimibe as per requirment.

3-----take a good record of your
blood pressure
blood sugar levels
fasting lipid profile
renal function tests


..... and take good care of yourself
 shehperpk - Fri May 06, 2005 1:38 pm

hi
i forgot to tell u that t wave is normally inverted or biphasic in v1.... so if in confusion, ask your consultant to do the same test with posterior leads and right sided leads in place as well. but believe me its just headache.. just go for exertion tolerance test.
 Shannon Morgan, CMA - Fri May 06, 2005 9:39 pm

User avatar
shehperpk wrote::)
hi there...
i have some happy news for u....
my limited experience of cardiology tells me that having MI / angina at your age is a rare phenomena. the information you have provided us doesnt give a hard clue to start medication for ischaemic heart disease. and we need some harder evidence to go for it. why not try the treadmill test ie, exertion tolerance tests.. to confirm whether u have some thing wrong with your coronaries or not.
now your ldl levels are pretty ok... they should be around 100 for the best. u didnt mention hdl levels.


If he had a thallium stress, then he already had a treadmill, unless he is too obese to walk fast enough to get an accurate result. Thallium images show (not as well as angiograms) possible blockage in an artery. If there was evidence of a blockage, they would have scheduled an angiogram.

T-waves can flip, V1 only is nothing to get to upset about, it was very likely artifact. ECGs are not always as accurate on obese persons because there is too much density between the electrode and the electrical current it is measuring, allowing for more artifact.

Amazingly, your choleststerol/HDL levels are fine. HDL under 135 is ideal.

You definitely are a ticking time bomb with the smoking, lack of excercise, obesity and now prediabetes. Actually, you are either diabetic or you're not. It would be a very good idea for you to take the Glucophage, it will keep your glucose levels around normal BUT you still have to follow a diabetic diet and EXCERCISE! Lose the weight and quite smoking or you will die young, guaranteed. Average age for developing Diabetes type II is mid 40's. You are 29!!!! Take this as a wake up call.

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