Q. I have sporadic chest pressure and there is mild ST depression in stress echo. Is it worrisome?

Answered by
Dr. Isaac Gana
and medically reviewed by iCliniq medical review team.
Published on Nov 05, 2019

Hello doctor,

For many years now, I have sporadic pressure in my chest area, and since I never want to presume it is not heart-related. I usually get it checked out. I do have anxiety and fibromyalgia, so the most likely cause is stress and muscle strain. My last episode was about two weeks ago and after consulting a cardiologist, who suspected it to be muscle-related, I had a stress echo two days ago to make sure.

I am attaching a copy of the report as well as the copy of my last stress test. The current cardiologist told me that the report looks great with a strong heart muscle and no ischemia.

Since I tend to over analyze things, I read the report and it mentions a Duke Treadmill score of 2.5 due to ST depression of 1 mm. I have been told that I have a baseline ST depression forever, and it was present back in my last stress test. I asked the cardiologists about it via a message on my portal and the response was that it is nothing to worry about, and it is not diagnostic. Would you agree that there is nothing worrisome?

Dr. Isaac Gana



Welcome to icliniq.com.

I have seen your reports. (attachment removed to protect patient identity).

I studied through your test results there is absolutely nothing that indicates any serious abnormality. The slight change recorded is not of much significance. From my experience as a physician I frequently see slight variations in test results that are not indicative of any abnormality.

Has there been a change in the way you feel if recent? Did you had any medication in regards to this? Do you have a family history of heart disease? Do you have diabetes or high blood pressure? Any history of stomach ulcer? Do you smoke or drink?

Thank you doctor,

There is no change in how I feel and the chest pressure has subsided. I walk three miles a day with no fatigue or shortness of breath. I do not have diabetes and never smoked and do not drink alcohol. I do have high blood pressure controlled on medication and borderline high cholesterol. I realize I am overweight and need to work on my weight. I am a stress eater.

My father passed from cardiac arrest at the age of 74. He was a chain smoker and had a heart attack and triple bypass ten years before his death. My mom passed from an intestinal blockage at the age of 84. She had CHF and aortic stenosis. She was also a heavy smoker.

So overall, do you feel it is a favorable report? Is there any need to worry about that ST depression and Duke stress test score, given I have had the ST depression at baseline for probably my whole life?

My cardiologist felt that there is no need for further testing or follow. Would you agree?

Dr. Isaac Gana



Welcome back to icliniq.com.

Although there is a family history of heart disease, in your case it is not a cause for worry. Since you do not experience shortness of breath, or chest pain with exercise it is good. You do not need further testing at this moment, there is no indication.

This is what I want you to do. Because of your family history of heart disease and for the fact that you are overweight with a history of high blood pressure,

1. Try to lose more weight at least three to four kilograms in a month by dieting and continuing with your walk.

2. Make sure to check your blood pressure three to four days a week.

3. Do random blood sugar test, lipid profile, ECG (electrocardiography) twice a year as a routine to monitor your cardiovascular health.

Generally, I agree with your cardiologist that there is absolutely no need for further testing. If you are able to lose a few more kilograms, your heart discomfort will get better. It is very common for overweight people to have a feeling of chest discomfort. I am positive that you will be fine.

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