My husband's heart rate goes up to 200 bpm after vigorous exercise. Is this ventricular ectopy?

Hello doctor,

My husband is 48 years old. He is in good physical shape and healthy, exercises regularly, and takes a healthy diet. During exercise, his heart rate gets to 200 bpm when at maximum exertion, which felt slightly high for his age. In mentioning this to his GP, she suggested a stress test to rule out issues. His medical history and labs are mostly great from a year ago. His last cholesterol panel was normal, and his last homocysteine was 10.5, and his inflammation markers were low. After the stress test (which I was present for and recorded), the cardiologist commented as below: You have excellent exercise performance. You had some extra beats when starting and ending, but these disappeared when exercise level increased, which is a good sign. These are benign in 95% of cases, but we should do an echo to rule out issues. After exercise ended and you were winding down, there was an abnormality as well. These could be from blockages, but the overall pattern does not support this. So it is usually due to bridging, which is your heart muscle squeezing on an artery that is relatively benign. We should do another test to check. After leaving the appointment, his doctor then provided the actual written report (attached below) and has suggested an echo and a CT angiogram. My questions are, can you have a look at the report provided and give your assessment? What is frequent ventricular ectopy at an early stage and recovery? Is this common and most likely benign? What are prolonged ST depression in the inferior and lateral leads in recovery? What could be causing this? Could it be a completely benign finding? Is the CT angiogram truly necessary? I am concerned about the excessive radiation in his chest area and wonder if there are other options here?

Thank you doctor

Could there be benign explanations for these issues as well? And what is the difference in the dye injected between the CT angiogram and the MRI? Would they use the same dye in both instances, so the only difference is CT (which has radiation) and MRI (no radiation)? If it is the same dye, we would definitely want to go with an MRI, but are there any clinical downsides to the MRI? Is this less accurate?