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2023 March 31

Stress echocardiogram

I have previously reported on my PVCs (premature ventricular complexes) mysteriously turning into SVT (superventricular tachycardia) in Holter monitor results. But when I had an echocardiogram done in January 2023, there were no SVT episodes. The reuslts were that things were pretty much normal:

The patient was in normal sinus rhythm during the exam. The patient had occasional PACs during the exam. The patient had occasional PVCs during the exam.
Left Ventricle: The left ventricle is normal in size. There is mild concentric left ventricular hypertrophy. The left ventricular ejection fraction is normal. The left ventricular ejection fraction calculated by 3D echo is 65%. The left ventricular wall motion is normal. Assessment of diastolic parameters suggests a pseudonormalization pattern, consistent with elevated filling pressures.
Right Ventricle: The right ventricle is normal in size and function.
Atria: The left atrium is mildly dilated. 3D LAVI: 36 ml/m2.
Mitral Valve: The mitral valve leaflets appear to be normal, and opens well. There is no mitral valve stenosis. There is trivial mitral regurgitation.
Aortic Valve: The aortic valve is trileaflet. The aortic valve is sclerotic, but shows no functional abnormality. There is no aortic valve stenosis. No aortic regurgitation is present.
Tricuspid Valve: The tricuspid valve leaflets are thin and pliable. There is no tricuspid stenosis. There is trace tricuspid regurgitation. Unable to estimate PA systolic pressure due to poor TR signal.
Pulmonic Valve: The pulmonic valve is normal in structure and function. There is no pulmonic valvular stenosis. There is no pulmonic valvular regurgitation.
Great Vessels: The aortic root is normal size. The ascending aorta is normal in size. Atherosclerotic changes can be seen in the abdominal aorta. The inferior vena cava appeared normal.
Pericardium/ Pleural: There is no pericardial effusion. There is no pleural effusion.

In discussing the results with the cardiologist, I pointed out that the Zio monitor results (with 2161 SVT episodes in 329 hours, about 6.66/hour) showed clusters of episodes when my heart rate was high, suggesting that they were triggered by exercise.  The cardiologist ordered a stress echocardiogram, to see whether we could catch the SVTs that way.

Today I had the stress echocardiogram test. Here are the stress results:

Protocol Name BRUCE
Max Work Load (METS*10) 165
Time In Exercise Phase 00:13:38
Max. Systolic BP 196 mmHg
Max Diastolic BP 72 mmHg
Max Heart Rate 166 BPM
Max Predicted Heart Rate 152 BPM

The resting blood pressure was 122/70 mmHg.

We stopped the test because they wanted only about 80% effort, not maximum effort, as they didn’t want me breathing too hard for the echocardiogram at the end of the test. They reported the termination condition as “dyspnea (shortness of breath)”, but I was still able to talk fairly comfortably when we stopped, so it definitely wasn’t maximum effort. When I was wearing the Zio monitor, I got up to 176bpm (though that was with an SVT episode—my highest sinus rate was only 160 bpm). Still, 16.5 METS is not too shabby for a 68-year-old man.  If I do another stress test in future, I’ll probably push for a higher level of exertion.

Here are the main observations from the test:

No ischemia with good tolerance and normal LVEF
PVCs, PACs, short runs of SVT


Normal BP response to exercise.
Resting ECG Sinus rhythm @ 56 bpm.
Stress ECG: No ischemic ST changes. Rare PVCs during stress. Rare PACs during exercise and recovery. Short runs of PAT.
Left Ventricle: Normal global systolic function. There are no wall motion abnormalities.
Immediate Post Stress Echocardiogram: There is appropriate exercise augmentation of the ejection fraction. There are no exercise-induced wall-motion abnormalities.

Note: PAT stands for paroxysmal atrial tachycardia—a type of paroxysmal supraventricular tachycardia (PSVT). So we did manage to trigger an SVT episode, but there doesn’t seem to be much more information—everything looks pretty normal. 

I guess in cardiology, having arrhythmias be hard to catch is probably good news, but I don’t know why they were so common when I had the Zio monitor on, but so rare now, just a few months later.

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