Positive Exercise Test

Report:

Early ST segment depression consistent with severe ischæmia

Comment:

The peak exercise attained a rate of 152/min just before the end of Stage 1 (Bruce protocol); the diastolic pressure rose from 100 to 105 mmHg; most importantly, the patient reported anginal pain.

The ST segment depression is the electrocardiographic criterion for a positive test: the minimum requirement is 1 mm depression from the isoelectric line (T-P segment if possible, but cropped off in this sheet) 0.08” from the J point. Early (three minutes here) depression connotes more severe ischæmia.

Hypertensive response – rise instead of fall in diastolic pressure with exercise – also correlates with ischæmia, but is not diagnostic. Anginal symptoms are not diagnostic either, but support the positive predictive value of the test; the female sex does not.

Angiography showed 80% proximal LAD artery stenosis and a 50% left circumflex stenosis; the ventricle was normal. Her 12-lead ECG when she was admitted, pain-free at the time, is shown below. It is consistent with Wellens’ syndrome – unstable angina and right precordial T inversion with normal V5-6.