Is sporadic chest pressure and mild ST depression concerning?

Question

Hello doctor,

For many years, I have experienced sporadic pressure in my chest. Since I never want to assume it is not heart-related, I usually get it checked out. I have anxiety and fibromyalgia, so the most likely causes are stress and muscle strain. My most recent episode occurred about two weeks ago. After consulting a cardiologist, who suspected it was muscle-related, I underwent a stress echocardiogram two days ago to confirm.

I am attaching a copy of the report along with my previous stress test results. The current cardiologist reviewed the findings and said my heart looks strong, with no ischemia. However, because I tend to overanalyze things, I noticed the report mentions a Duke Treadmill Score of 2.5, attributed to a 1 mm ST depression. I have been told in the past that I have a baseline ST depression, which was also present in my prior stress test.

I messaged my cardiologist about this via the patient portal, and they reassured me it is nothing to worry about and not diagnostic. Would you agree that there is no cause for concern?

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your reports (attachments removed to protect patient confidentiality). After thoroughly examining your test results, I can confidently say that there is nothing to indicate any serious abnormality. The slight changes noted are not clinically significant. As a physician, I frequently observe minor variations in test results that do not suggest any underlying issues.

Could you share if there has been any recent change in how you feel? Have you taken any medication for this? Do you have a family history of heart disease? Additionally, do you have diabetes, high blood pressure, or a history of stomach ulcers? Lastly, do you smoke or drink alcohol?

Kindly reply, so I can guide you better.

Answer 2

Hello,

Welcome back to icliniq.com.

Although you have a family history of heart disease, in your case, it is not a cause for concern. The fact that you do not experience shortness of breath or chest pain during exercise is reassuring. There is no indication for further testing at this time.

Here is what I recommend:

Due to your family history of heart disease and your weight, along with your history of high blood pressure, focus on losing six to eight pounds per month through a healthy diet and continuing your regular walking routine.
Monitor your blood pressure three to four times a week to ensure it remains well-controlled.
Perform routine checks, including random blood sugar tests, lipid profiles, and an ECG (electrocardiogram) twice a year, to keep track of your cardiovascular health.

Overall, I agree with your cardiologist that no further testing is necessary at this time. Losing a few more pounds can significantly improve your heart health and reduce any feelings of chest discomfort. It is common for overweight individuals to experience mild chest discomfort, which often improves with weight loss.

I am confident that you will be fine.

Regards.