185ST depression limited to recovery after combined adenosine and low-level exercise

Abstract

Introduction ST-segment depression limited to the recovery phase is reported in about 10% of patients undergoing treadmill exercise and its prognostic significance is similar to that occurring during exercise. Case A 58-year-old male with type II diabetes mellitus, hip osteoarthritis and typical angina was referred for SPECT MPI. The stress protocol was adenosine combined with low-level treadmill exercise. The patient experienced typical chest pain that resolved at the end of exercise. There was no ECG evidence of ischemia at baseline (a) or during exercise (b). At one minute into the recovery phase the ECG showed downsloping ST-segment depression (c) progressing further at minute 4 (d) and lasting until minute 12. SPECT MPI revealed reversible perfusion defects in the anterior, anterolateral and inferolateral walls (e) . Coronary angiography identified severe lesions in the LAD (f) and obtuse marginal (g) arteries. Two-vessel percutaneous revascularization was performed with good angiographic results. Questions ST-segment depression is less common with pharmacologic stress compared to treadmill exercise testing, however once present it has a high positive predictive value for coronary heart disease in patients with abnormal MPI. Conclusions The finding emphasizes the importance of ECG monitorization during the recovery phase after the end of exercise or pharmacologic intervention. The recovery phase should last for at least 5 minutes or until the heart rate recovers to less than 100 bpm. The recovery phase shall be longer as needed for ECG changes and/or symptoms to resolve. (Figure Presented).