Which tests can rule out heart-related problems?

Question

Hi doctor,

During a routine medical checkup, I had an abnormal finding on my resting ECG (electrocardiogram) and was recommended to undergo a 2D echo and a treadmill test (TMT). I do not have any chest pain. My 2D echo report is normal; however, the TMT results are as follows: significant ST depression of 0.1 mm in leads V4-V6 at peak exercise, which did not persist during recovery. The TMT was mildly positive for RMI. The Bruce test parameters were Bruce stage 3, exercise time of 8.09 minutes, METS of 10.2, and a THR of 173 bpm attained. My BP was 120/80 mmHg during rest and recovery, with a maximum BP of 140/80 mmHg during exercise. I did not experience any problems during my TMT. I consulted a doctor to understand the implications.

The doctor informed me that the TMT result is incorrect and should not be mildly positive, as it does not match the parameters indicated in the report. Rather, it should be negative for TMT. As a result, I was advised to undergo the TMT again for my peace of mind, which I did six days after the first test. I am enclosing a copy of the report. According to this report, the doctor has stated that it is negative for RMI. However, another doctor has told me that this analysis is incorrect and that this report also reflects mildly positive results for RMI. Consequently, I am confused about the authenticity of the report and its interpretation by the doctors.

I kindly request that you review the 11 pages of the report I am enclosing and let me know whether the report can be declared negative for TMT. Please inform me if I need to provide any additional information. Additionally, please advise me on the next steps I should take. Is there any test that can confirm or rule out the possibility of a heart-related problem?

Thank you for your help.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for providing a detailed case history. I have reviewed all aspects of the case materials provided here (attachments removed to protect the patient's identity) and understand your concerns.

Based on these reports, we cannot conclude that you have coronary artery disease or occlusion of 75 percent or more in the heart's arteries. Since you do not experience chest pain, either at rest or during exertion, I do not believe you need angiography at this time. The best next step is to maintain regular physical activity. Your body mass index should remain within the normal range of 18 to 24.

Additionally, please follow a healthy and balanced diet and monitor your cholesterol and blood pressure levels. You are currently in good shape concerning these parameters. Most importantly, you should have a regular cardiac checkup every six months. You do not need angiography immediately. However, if you experience chest pain in the future that is confirmed to be cardiac in origin, your cardiologist may need to proceed directly to angiography to determine the cause of this pain.

I hope this helps.

Thank you.