When should a stress test be considered?

Question

Hi doctor,

My mother, who is 62 years old, has been hospitalized for two days due to sudden sweating, chest pain, and pain in her left hand. When she was admitted, her blood pressure was 190/110 mmHg. She is also diabetic (with blood sugar levels of 150 to 270) and has been under tremendous stress due to a recent personal loss. She underwent an ECG and a 2D echo. I have attached the reports here. Her doctor mentioned that she was on the verge of a heart attack when she was admitted. Her ECG is reported to be abnormal, and the 2D echo shows signs of CAD (coronary artery disease) and diastolic dysfunction.

Currently, she is being treated to lower her blood pressure. Her doctor has advised a TMT (treadmill test) and angiography if the TMT results are positive. Could you please review the reports and let me know how serious her condition is? I would also like to know the next steps in terms of tests and treatment options.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed her reports (attachment removed to protect patient identity). It could be unstable angina or a myocardial infarction (MI). Please let me know her troponin I level. If it is repeatedly negative, a stress test is advisable. If it is positive, then a coronary angiography should be done directly. Perform a troponin I or troponin T test and repeat it 12 hours after the onset of pain if the initial value is negative. If positive, proceed with angiography. If still negative, then a stress test should be considered.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Based on the reports you provided (attachment removed to protect patient identity), if the ECGs (electrocardiograms) were taken on different days, they do not show any progressive or regressive changes. The changes present are fixed. Therefore, if the first and last ECG were not taken on the same day, there is no immediate cause for concern.

However, after confirming that the repeat troponin I or troponin T test is negative, she should undergo a stress test to reach 10 METS (metabolic equivalent of task, one of the stress test parameters) without experiencing any chest discomfort or additional ECG changes. Only then can we conclude that her discomfort is likely non-cardiac.

I hope this helps.

Thank you.