Poor (Man’s Exercise) Test

Report:

Sinus rhythm 56 – 66/min

VEB

SVEBs, blocked

Post-ectopic T wave inversion

Comment:

The Holter strips are a continuous recording.

Post-VEB beat (top strip) has inverted T wave – what some call a post-extrasystolic repolarisation change. Similar change is seen in the first beat of the bottom strip, which follows a blocked SVEB sharply etched just after the last T wave in the third strip.

Another blocked SVEB causes the pause at the beginning of the bottom strip, but this time the next beat’s T wave remains normal. This is because of the pause caused by the first blocked SVEB – the heart has adapted to the slower rate. It is a fast learner.

Below (Fig 35a) there are two conducted SVEBs, a VEB and a run of VT, all causing pauses and T wave changes following them. It is now known that the repolarisation change is due to the pause itself, rather than, in some way, the preceding premature beat30. It was once believed to reflect ischæmia and called poor man’s exercise test31. It’s just a poor test.

On a related note, post-ectopic (or pause-induced) U wave changes may be of some diagnostic value, but for arrhythmia rather than ischæmia32.

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