False-positive electrocardiographic changes during exercise test in a patient with pectus excavatum
Andrea Sonaglioni1, Gian Luigi Nicolosi2, Michele Lombardo1
1Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy.
Journal of Clinical Ultrasound : JCU
|April 7, 2020
Summary
Exercise stress tests can show false ischemia in some individuals. A narrow chest diameter, like in pectus excavatum, may cause these pseudo-ischemic changes without heart disease.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Exercise stress testing is a common diagnostic tool.
- ST-segment changes during exercise can indicate myocardial ischemia.
- Hyperventilation in healthy individuals can sometimes mimic ischemic changes.
Observation:
- A 60-year-old man with pectus excavatum presented with significant "pseudo-ischaemic" ST-segment changes during exercise.
- The patient had no evidence of coronary artery disease.
- Anxiety-induced hyperventilation was ruled out as a cause.
Findings:
- This case highlights exercise-induced ST-segment changes in a patient with pectus excavatum.
- No prior literature reports a link between narrow antero-posterior chest diameter and pseudo-ischemic changes during exercise stress tests.
- Pectus excavatum may contribute to false-positive results on exercise stress tests.
Implications:
- Clinicians should consider chest wall abnormalities like pectus excavatum when interpreting exercise stress tests.
- Further research is needed to understand the mechanism linking pectus excavatum to pseudo-ischemic changes.
- This finding may refine diagnostic protocols for exercise-induced ST-segment changes.
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