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Introduction
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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ST elevation myocardial infarction during head-up tilt testing.

Lucas Simonetto Faganello1,2, Mauricio Pimentel1,2, Ana Paula Arbo Magalhães2

  • 1Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Journal of Cardiovascular and Thoracic Research
|March 27, 2020
PubMed
Summary

A man experienced ST elevation myocardial infarction (STEMI) during head-up tilt testing (HUTT). This cardiac event occurred despite normal initial tests, revealing significant coronary artery disease.

Keywords:
Head-up Tilt Testing (HUTT)ST Elevation Myocardial InfarctionSyncope

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Area of Science:

  • Cardiology
  • Diagnostic Testing
  • Interventional Cardiology

Background:

  • Syncope is a common clinical presentation requiring thorough investigation.
  • Head-up tilt testing (HUTT) is a valuable tool for diagnosing autonomic dysfunction and syncope.
  • Standard diagnostic workups, including treadmill tests and electrophysiological studies, can sometimes be inconclusive.

Observation:

  • A 54-year-old male presented with recurrent syncope.
  • Initial investigations, including treadmill testing and electrophysiological study, yielded normal results.
  • During passive head-up tilt testing (HUTT), the patient developed inferolateral ST elevation on the electrocardiogram.

Findings:

  • The ST elevation observed during HUTT was indicative of acute myocardial ischemia.
  • Coronary angiography revealed critical stenoses in the right coronary artery and the circumflex artery.
  • This case highlights a rare presentation of ST elevation myocardial infarction (STEMI) triggered by HUTT.

Implications:

  • Head-up tilt testing may unmask underlying coronary artery disease in patients with unexplained syncope.
  • This finding underscores the importance of considering ischemic heart disease in the differential diagnosis of syncope, even with negative initial cardiac evaluations.
  • Clinicians should be vigilant for electrocardiographic changes during provocative testing and consider urgent coronary angiography if STEMI is suspected.