Which waves in the treadmill stress test indicate problems?

Question

Hello doctor,

I have attached the results of a treadmill stress test. I would like to obtain technical information regarding these results, particularly concerning the infarction. I would appreciate your assessment of the severity of this infarction and whether it could be due to a machine error. Could you also illustrate in the attached shot which waves and shapes indicate potential problems?

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your report (attachment removed to protect patient identity). It is unlikely that there is a machine error; errors do not display such patterns and are suggestive of an old infarction only. The findings are present in the inferior leads, which indicates that the inferior part of the heart is damaged, and these types of infarctions are relatively less severe. However, an echocardiogram will provide a better understanding of the severity and extent of the damage. Therefore, it is advisable to have an echocardiogram done if it has not been completed yet.

In lead I, you can see a P wave followed by a sharp spike known as the QRS complex, followed by an upright wave called the T wave. In leads II, III, and AVF, which are inferior leads, there is a downward QRS spike instead of an upward spike, and the T wave is also inverted, indicating heart damage. The next step is to perform an echocardiogram to assess the extent of the damage, followed by angiography to evaluate for any blockages. If necessary, revascularization may be required.

I hope this helps, and please reach out if you have any questions.

Answer 2

Hello,

Welcome back to icliniq.com.

The significant changes are present only in leads II, III, and AVF, not in the other leads. Therefore, if the echocardiogram is normal, the severity is not great. Our main priority here is to rule out ischemic changes. An infarction will cause some damage to the heart, which can be clearly seen on the echocardiogram. Given your ECG changes, we were expecting to see some changes in the echo.

Additionally, a normal echo raises the possibility of false positive ECG (electrocardiogram) changes. The CT (computed tomography) scan will help determine whether any blockages are present. Rheumatic fever is an entirely different condition; it causes damage to the heart valves and a normal echo rules out any such damage. It can also sometimes cause ECG changes.

I hope this helps you.

Thank you.