Q. My heart rate is 160-170 bpm after exercise. Is ST depression normal after exercise?
Hello doctor,
I recently began doing cardio exercise and noticed that my heart rate would go up to 160 to 170 beats just after a few minutes of exercise. I got some anxiety about it and purchased a portable EKG monitor. Everything showed up normal when taking it while resting. But it shows ST depression after working out. So I consulted my family doctor, he has done an ECG, and nothing showed up. I tried explaining to him it was showing some change after exercise, but he seemed to like it was not a concern and said it is normal to show a change after exercise. But I read something that, showing ST changes after exercise is a bad sign and can be CAD. Is it something I should be concerned about? Or is ST depression normal after exercise?
Hello,
Welcome to icliniq.com.
Heart rate going up might be related to you being unaccustomed to activities. At your age, normally you are expected to attain a heart rate of 180 bpm with exercise. So nothing to worry about it. Some ST depression does occur during exercise, but it is physiological and upsloping, and can only be commented upon after seeing it. However, considering your age and no symptoms while running, it is likely a physiological depression. If you can get tracing, then that would be confirmatory. I hope this helps.
Hi doctor,
I attached the report for your opinion. Thank you.
Hello,
Welcome back to icliniq.com.
Now, in the depression tracing, there is a significant depression in the middle part of the strip for a few beats, but depression in the remaining part is physiological. Similarly, the elevation is significant in the earlier part of tracing while nonsignificant in the later part. Now, this is quite unusual to see that with continuing exercise, some beats show significant changes while rest are physiological. So, there is a possibility that this is artefactual due to unstandardized machines. Also, you do not have any symptoms like chest heaviness, pain or undue breathlessness, dizziness during exercises, supports this possibility. But it is worthwhile to evaluate you. It is unlikely for someone to have ST elevation without symptoms. But, I think routine TMT (treadmill test) should be obtained to clear the doubt. If you have any risk factors like smoking, family history, dyslipidemia, etc., then it better to have TMT.
Hi doctor,
Thank you for the reply, I do not really get what any of that means besides the treadmill test. I do not want to do this because I do not have insurance currently.
Hello,
Welcome back to icliniq.com.
In short, it means there are borderline changes but are not reliable as these are not recorded on standardized machines and in multiple positions. So, to rule out the possibility of any blockages, you should undergo TMT (treadmill test), which records changes from various directions. Now, if you are not able to undergo it, then you should record multiple such tracings at high heart rates. Also, if you have access to some other such portable devices like Alivecor kardia monitor and use that. Also, whenever you are recording, record in different possible positions and mention the position on tracing. So, in a nutshell, tracings show some doubtful changes but not enough to conclude the presence of CAD (coronary artery disease). So, by seeing the multiple tracings, we would be in a better position to comment. Note for symptoms of CAD like chest pain or heaviness, undue breathlessness and dizziness during exercises.
Hi doctor,
Thank you for the reply, So I did some more scans this evening after jogging in place for a few minutes, and here what it is showed up. I labeled in my notes how I took them. I have seen there were a few weird-looking traces, and I do not know if it is the device I am using or what it is. All these were taken in 10 minutes or so span. The VPB bigeminy was the first time. Maybe I moved the device or something while taking it I do not know. Let me know what you think.
Hi,
Welcome back to icliniq.com.
Your scans are absolutely fine. The scan between the right-hand finger and left nipple created some doubts yesterday, but it is fine today. You continue to have some more scans for this lead and those are artefacts.
Hi,
Thank you for the reply, I would like to send you a few more sets of them. I have anxiety over this. Also, how is it possible that one is showing ST depression and another ST elevation within a few minutes like that? Do the waves look completely different? And what is with the curves that show them swooping way down?
Hi,
Welcome back to icliniq.com.
In my opinion, they are all nonsignificant changes. There were some significant changes in a few beats in a single tracing which were likely due to artefacts. So you should not worry about it at present. Get some more tracings reviewed for additional assurance. And importantly, you are asymptomatic, so the probability is extremely low.
Hi doctor,
Thank you for the reply, Here is another set of readings after running on a treadmill for a few minutes today. Let me know if they look good. Thanks.
Hi doctor,
Thank you for the reply, One final question is couple minutes in my heart rate gets to 180 BPM. Do I fight through it and let it get to 200 BPM or do I slow down?
Hi,
Welcome back to icliniq.com.
No, it is fine. But, it is better to gradually increase exercise over a few weeks to avoid excessive stress on the heart. But, in healthy individuals, it is fine. But if you develop any symptoms like dizziness, then better to slow down.
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