Learning new lessons from a stressful “ ST segment ”

This is the Incidental ECG of an apparently healthy 50-year-old businessman, recorded while  applying for health insurance How will you describe this ECG? Let me magnify it for you    Why this big fuss about this ECG?  Such ECGs are so common. Looking at the ST segment, we are supposed to think of significant CAD,, LVH, Aortic stenosis or variants of cardiomyopathy, and sometimes electrolytic shifts. The fact that it is recorded at rest, and the patient is absolutely asymptomatic, it is very unlikely there is ongoing ischemia.It could be a myocardial origin or an unknown repolarisation pattern. But, one thing is clear, we can’t send this guy under the label of non-specific ST/T changes. The Echo was done it was normal. No WMA,  LVH. Aortic valve was perfect.  Is CAG indicated here? Three responses came from three different cardiologists. Everyone agreed, the stress test is not going to be useful, as  baseline  is unstable Absolutely not Indicated, since he is asymptomatic. I believe the history and Echo. Please follow him up A definite yes for CAG. (Being a scientific cardiologist, without excluding CAD, I can’t be at peace. Will do at least a CT angiogram) A third cardiologist said a CT angiogram is waste of time and wanted to do a radial CAG in 10 minutes in his newly opened hi-fi radial lounge. What happened then? Don’t know, whether...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized non specific st segment Source Type: blogs