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When should a stress test be considered?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

My mother, who is 62 years old, has been hospitalized for two days due to sudden sweating, chest pain, and pain in her left hand. When she was admitted, her blood pressure was 190/110 mmHg. She is also diabetic (with blood sugar levels of 150 to 270) and has been under tremendous stress due to a recent personal loss. She underwent an ECG and a 2D echo. I have attached the reports here. Her doctor mentioned that she was on the verge of a heart attack when she was admitted. Her ECG is reported to be abnormal, and the 2D echo shows signs of CAD (coronary artery disease) and diastolic dysfunction.

Currently, she is being treated to lower her blood pressure. Her doctor has advised a TMT (treadmill test) and angiography if the TMT results are positive. Could you please review the reports and let me know how serious her condition is? I would also like to know the next steps in terms of tests and treatment options.
Answered by Dr. Danej Mangesh Baliram

Education:

MBBS

Professional Bio:

Dr. Danej Mangesh Baliram is a certified Cardiologist. He completed his MBBS from Maharastra University of Health Sciences in 2007. He studied MD in General Medicine from Maharastra University of Health Sciences in 2010. Later, he studied DNB in Cardiology from the National Board of Examinations, New Delhi in 2015. He is well-trained in diagnosing, treating, and preventing diseases of the blood vessels and heart. He is currently practicing at Jupiter Hospital in Pune and has 17 years of clinical experience.

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Hi,

Welcome to icliniq.com.

I have reviewed her reports (attachment removed to protect patient identity). It could be unstable angina or a myocardial infarction (MI). Please let me know her troponin I level. If it is repeatedly negative, a stress test is advisable. If it is positive, then a coronary angiography should be done directly. Perform a troponin I or troponin T test and repeat it 12 hours after the onset of pain if the initial value is negative. If positive, proceed with angiography. If still negative, then a stress test should be considered.

I hope this helps.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

She was admitted for three days. Should I ask my healthcare provider to perform a troponin I test now if it has not already been done? I have attached my mother's complete file, with the ECG records arranged from newest to oldest. My doctor advised waiting two or three days before conducting any further tests. When she is on Nicorandil at 12 drops per minute, her blood pressure stabilizes at 120/80 mmHg, but without it, it rises to 150/80 mmHg.

Is this a sign of a more serious issue that needs further investigation? Her doctor mentioned that it might take about 15 days to bring her blood pressure back to normal. Her ECG shows clear ST-segment depression. Should I be concerned about this? Will it normalize with medication? I am worried about not wasting time if there is any possibility of CAD or significant heart damage that requires immediate attention.

Please help.

Answered by Dr. Danej Mangesh Baliram

Education:

MBBS

Professional Bio:

Dr. Danej Mangesh Baliram is a certified Cardiologist. He completed his MBBS from Maharastra University of Health Sciences in 2007. He studied MD in General Medicine from Maharastra University of Health Sciences in 2010. Later, he studied DNB in Cardiology from the National Board of Examinations, New Delhi in 2015. He is well-trained in diagnosing, treating, and preventing diseases of the blood vessels and heart. He is currently practicing at Jupiter Hospital in Pune and has 17 years of clinical experience.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Hi,

Welcome back to icliniq.com.

Based on the reports you provided (attachment removed to protect patient identity), if the ECGs (electrocardiograms) were taken on different days, they do not show any progressive or regressive changes. The changes present are fixed. Therefore, if the first and last ECG were not taken on the same day, there is no immediate cause for concern.

However, after confirming that the repeat troponin I or troponin T test is negative, she should undergo a stress test to reach 10 METS (metabolic equivalent of task, one of the stress test parameters) without experiencing any chest discomfort or additional ECG changes. Only then can we conclude that her discomfort is likely non-cardiac.

I hope this helps.

Thank you.

Medically reviewed by Dr. K. Shobana
Published At September 22, 2016
Reviewed At September 26, 2024

Education:

MBBS

Professional Bio:

Dr. Danej Mangesh Baliram is a certified Cardiologist. He completed his MBBS from Maharastra University of Health Sciences in 2007. He studied MD in General Medicine from Maharastra University of Health Sciences in 2010. Later, he studied DNB in Cardiology from the National Board of Examinations, New Delhi in 2015. He is well-trained in diagnosing, treating, and preventing diseases of the blood vessels and heart. He is currently practicing at Jupiter Hospital in Pune and has 17 years of clinical experience.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Education:

BDS

Professional Bio:

Dr. K. Shobana is a Dental Surgeon specializing in oral health and dental care. She is skilled in preventive dentistry and provides oral hygiene education. She can do restorative treatments such as fillings and crowns. She can handle periodontal problems such as gum diseases and periodontitis. She can do root canal treatment.

This doctor is not available for online consultations on the platform anymore.

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When should a cardiac stress test be considered?

Five quick questions help you understand when a cardiac stress test is typically advised, when to mention concerns to your doctor, and when to seek immediate attention.

This tool provides educational information only and does not diagnose, treat, or replace professional medical advice. Consult a qualified healthcare professional for personalized medical guidance.
Dr. Danej Mangesh Baliram
Dr. Danej Mangesh Baliram

Cardiology

Consult this doctor

Education:

MBBS

Professional Bio:

Dr. Danej Mangesh Baliram is a certified Cardiologist. He completed his MBBS from Maharastra University of Health Sciences in 2007. He studied MD in General Medicine from Maharastra University of Health Sciences in 2010. Later, he studied DNB in Cardiology from the National Board of Examinations, New Delhi in 2015. He is well-trained in diagnosing, treating, and preventing diseases of the blood vessels and heart. He is currently practicing at Jupiter Hospital in Pune and has 17 years of clinical experience.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality
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