ST depression- Any Cardiologists here?

Anyone?

with no symptoms, you are worrying about nothing ( albeit get your lipids checked & i assume you have no family history )

if you are abnormally worried & have the cashola, you can go for a follow up scan ( they used to be thallium scans, but CT angiography is current popular method )

btw, ventricular hypertrophy doesn't cause ST depression - it causes enlargements of the QRS complex

Be patient. The cardiologists are at work now. They come to this site in the evening and will post then.

I got some very good advice on here last spring when I was going through some cardiology work trying to get to the bottom of some issues I was having with general fatigue and poor performance. While I got some good specific advice, a primary theme from the folks who seemed to know what they were talking about was to be patient and wait to hear directly from your cardiologist. He/she is the one looking directly at your clinical data, and really the only one in a position to give you a straight, unqualified answer.

In my case, the doc dismissed any concerns completely out of hand. I have an enlarged heart from training, and some other minor characteristics that are out of "normal" spec, but in my case, given his physical exam and my history, absolutely no concern. He went so far as to ORDER me back to running (I had not been running due to the family doc's recommendation pending the cardiologist consult), which was music to my ears. :-)

Good luck!

Thanks-

So being asymptomatic and a runner with ST depression is fairly common?

My cholesteral isn't great. Level is 205 last time measured, ratio was HDL 43/LDL 139. My diet is very good, must be genetic.

Father had arthesclorosis, but he was a heavy smoker, drinker, overweight and NO excercise.

Not a cardiologist, but a physiologist.

Cardiac hypertrophy due to exercise should not cause an ST segment depression. It will change the electrical axis of the heart more toward the left since the left ventricle is undergoing more hypertrophy than the right from long-term endurance exercise. This would show in the V1-V6 single leads and the QRS will be larger in the Lead I vs. Lead II.

I'm going off the top of my head here without my EKG interpretation book around, but ST segment depression USUALLY indicates mild ischemia or ischemic damage of the myocardium.

T waves themselves are a bit funny. By that I mean, usually T waves deviate upward like P waves and the R of the QRS complex. However, some people have biphasic T waves and others even have T waves that deviate downward. My dad's does this and EVERY other variable indicates he is perfectly healthy.

So, what lead were you looking at? The "standard" that most people see is a Lead II. When EKGs are shown in movies of patients, you are almost always seeing a Lead II. Usually, the T wave on Lead II should be upward deviating, but again, see above.

So, I'm wondering if you may have a biphasic T wave that is appearing as a depression of the ST segment. Of course, this is no diagnosis, and you should go back to your Dr. But worrying about it at this point, is, in my very humble opinion, not worth it based on the other information you've given.

I'll see if I can find my EKG interpretation book and give you a little more.

Stache-

Thanks so much!

Titan wrote:So being asymptomatic and a runner with ST depression is fairly common?

yes

it just means your heart is under strain, but if you're running hard on a treadmill, of course your heart is under strain !

My cholesteral isn't great. Level is 205 last time measured, ratio was HDL 43/LDL 139. My diet is very good, must be genetic

yes, cholesterol is up a bit, but not much : you need more aerobic exercise ( go cycling if your knees are bad ) & check your diet

Let me just add that "ventolin" chimed in last spring when I made my public inquiry on here, and among those who appeared to know something, I found his/her input to be the most hare-brained, and least relevent or useful. I gather the guy/gal claims to be some kind of doctor, but I've never found his postings to be particularly credible. Granted, I am not a physician. Maybe others do not share my opinion and trust him. You're obviously free to form your own opinion.

Stache is on the money according to what i've been taught, which is admittedly limited. Yes, listen to your cardiologist, best advice that's been given. Sounds like this did happen but I'd make sure the 12-lead was done: at FULL rest (no prior excercise), in the middle of easy running (brief stop to get a clear tracing), and right at the end of a solid effort (1-2min HARD on the mill, then stop for a good tracing), then again at 5min into a VERY EASY cool down. compare those 4 tracings and see the morphology of the ST segment and, assuming no significant variations, as has been mentioned, no need to be concerned.

best of luck.

cheers, dude-

ps, simply a no brained paramedic so take it w/ grain of salt

hmmm...

iirc correctly that was your

"what can i do about my 2" dick ?" query

& i suggested you date a midget...

I'm not a cardiologist, but am a 4th year med student who recently took my EKG class. ST depression in general means subendocardial ischemia, meaning mild ischemia. However, it can also be due to changes in repolarization due to left ventricular hypertrophy depending on which EKG leads the ST depression in found in. So it is plausible that you have some left ventricular hypertrophy as a result of exercise and that is resulting in ST depression. However, I agree with some of the other comments that the most important thing is to follow the guidelines of your cardiologist as they have a much more complete picture (as well as more experience than I).

Thanks again, since my OP I have done a little research and it looks as though ahletes who have years of aerobic training under thier belts have about a 10% incidence of ST depression. (not sure if false positives were included)

ST depression that was not present prior to exercise but appeared while exercising is suggestive of ischemia. If due to LVH, I would expect it to be present all the time. There are a lot of other variables in deciding if the changes represent coronary aretery disease. My guess is since you have good exercise tolerance that you don't have significant occlusions in your cononary arteries. In any event, I or anyone else will not be able to tell you much of value regaring your case. I would listen to your cardiologist.

I doubt you would find cardiologists on this site, but if there were I wouldn't be too surprised. Stache is probably referring to to Dale Dubin's "Rapid Interpretations of ECG" book. It would give you a straight answer. The above post sounds right to me, but I'm only a second year med student. That said you can throw away the rest of the staches comments because this is just the very bare bones physical basis of how an ecg works. You would do better to google this, or see if dubin's book is on google books.

hence why i suggested the 3-4 tracings, prior to , during, during hard, and post excercise. that will tell you MUCH more than just one particular tracing. really need to get that whole picture of what the stress variable does to your 12-lead, otherwise it's not worth that much.

cheers, dude-

exactly what we use. great book and pretty much everything one needs to know in the field. not to a true cardiologists level but good enough to get a start on things. only 15-20 bucks on amazon if you want your own copy....

dude-

So a doc tells you to have a follow up done and you come post on a message board? I hope you did not get the job.

ST depression can be "nothing", but are you willing to take the risk?

I have had the job for may years, the stress test is a part of my biannual physical. The doctor who administered the test is not at liberty to discuss results with me, but did mention ST depression. He will send to my Company Doctor which will be at least two weeks. So...,in the mean time I thought I would get some insight here as Ive seen th etopic discuused before. I actually know that of several doctors who post here.

No, Im not willing to take th erisk and will get more thorough exam.