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Exercise induced ST segment depression preceding ST segment elevation.

S R Mittal1, R Saxena, D Garg

  • 1JLN Medical College and Hospital, Ajmer, Rajasthan.

Indian Heart Journal
|March 1, 1990
PubMed
Summary
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Exercise stress tests can reveal complex coronary artery disease. This case highlights ST segment changes suggesting both coronary spasm and significant fixed stenosis.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Clinical Diagnostics

Background:

  • Exercise stress testing is a cornerstone in diagnosing coronary artery disease (CAD).
  • Typical exercise-induced electrocardiographic changes include ST segment depression, indicative of myocardial ischemia.
  • Coronary artery spasm can also manifest during stress testing, presenting unique diagnostic challenges.

Observation:

  • A patient exhibited an unusual exercise-induced electrocardiographic (ECG) response.
  • This response included ST segment depression preceding ST segment elevation in precordial leads.
  • Persistent ST segment depression was noted in the inferior leads post-exercise.

Findings:

  • The observed ECG pattern suggests a dual pathology in the coronary arteries.

Related Experiment Videos

  • This pattern is indicative of significant fixed coronary stenosis.
  • The findings also strongly suggest the presence of concurrent coronary artery spasm.

    • Implications:

    • This case underscores the importance of recognizing atypical ECG responses during exercise stress tests.
    • Such responses may signify complex CAD involving both fixed obstructions and dynamic vasospasm.
    • Accurate interpretation is crucial for appropriate patient management and risk stratification.