The Tests Say Intervene, but the Patient Feels Fine

The following case, with a response by Dr. James Fang, was published in CardioExchange, an online forum for cardiology news and discussion. The case prompted a lively conversation, which you can access and join by registering for CardioExchange.

A 58-year-old asymptomatic man with hypertension and hyperlipidemia had an abnormal electrocardiogram (ECG) during routine annual physical examination. His primary care physician ordered a treadmill stress test.

The patient exercised for 6 minutes and 39 seconds of a standard Bruce protocol, achieving 8.1 metabolic equivalents. He stopped because of dyspnea. His heart rate increased from 63 beats per minute (bpm) at rest to 133 bpm at peak exercise, and his blood pressure changed from 176/86 mm Hg to 164/90 mm Hg. An ECG showed 3.5-mm horizontal ST-segment depressions in leads I, II, III, aVF, and V₃ through V₆ that began 5 minutes into the test and resolved 8 minutes into recovery. During exercise, the patient had isolated premature ventric…

Author

Anju Nohria, MD