Poor Man’s Exercise Test

Report:

Sinus rhythm

VEBs, multiform, some interpolated

Post-ectopic repolarisation changes

ST segment depression

Post-ectopic depolarisation changes

Rate-dependent right bundle branch block

Comment:

The presence of intermittent RBBB somewhat spoils the test: the ST segment would be expected to shift opposite the late QRS forces and at least some of the depression seen after long pauses would be abolished if the RBBB stayed.

The interpolated VEBs do not cause post-ectopic changes, but they do not abolish the RBBB either.

A more valid example, from another patient’s Holter monitor, is shown below (Fig 201a). T wave inversion is the commonest post-ectopic change.

The repolarisation changes are due to the pause induced by the ectopic beat (or any other mechanism). The ‘poor man’s exercise test’ is, in reality, a poor test: it does not occur any more frequently in subjects with coronary artery disease than in normal people137.

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