心肌缺血與心電圖檢查結果判讀-心臟血管專科

心肌缺血、運動心電圖？

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醫生您好，在一家診所及一家大醫院做的檢查差異頗大，希望請醫生協助判讀，謝謝！

【A診所】
1. 24小時心電圖：
402.10 HYPERTENSIVE HEART DISEASE, BENIGN WITHOUT CONGEStive heart 414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE 427.9 CARDIAC DYSRHYTHMIA, UNSPECIFIED 4270-2 PAT 790.6 OTHER ABNORMAL BLOOD CHEMISTRY 424.0 MITRAL VALVE DISORDERS Recording from:15 August 2022 12:28:49 Duration :24 hours 00 mins Recorder type:FD4(3 chan) S/N=AR4-0001600 Analysed :Analysed retrospectively S/W version :V4.2(f569.5ale) Analyst : Release :12.0 Preference :CCH ＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿ 1. Sinus rhythm. 2. Total 24 hours HR of 117143 beats. 3. Intermittent ST depression, T wave inversion, myocardial ischemia.

2.心臟超音波
診斷及檢查目的: 402.10 HYPERTENSIVE HEART DISEASE, BENIGN WITHOUT CONGEStive heart 414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE 427.9 CARDIAC DYSRHYTHMIA, UNSPECIFIED 786.50 CHEST PAIN,UNSPECIFIED 424.0 MITRAL VALVE DISORDERS 780.50 SLEEP DISTURBANCES,UNSPECIFIED M-Mode, TWO DIMENSIONAL ＆ DOPPLER STUDIES RVD 1.9 (0.7-2.3) Mitral valve Structure REGURG VELOCITY STENOSIS LVDD 4.5 (3.5-5.5) EF slope (80-370mm/s) Grading m/sec Gradient mmHg LVSD 3.0(1.9-3.9) Excursion (15-30mm) Max/Mean Peak/Mean IVS 1.0(0.5-1.2) Ao 3.0 (1.7-4.0) □ MV + /3 / / LVPW 0.9 (0.5-1.1) LA 3.2 (2.0-4.0) □ AV � /3 / / Pericardial □ TV + /4 / / effusion(-) □ PV � /4 / / N ABN Description Regional Wall Motion □ □ Mitral Valve □ □ Aortic Valve □ □ Tricuspid Valve □ ■ RVSP= 30.2 mmHg Pulmonary Valve □ □ Left Ventricular Function: Dias. vol Syst. vol. EF. 57 %(50-70) Others: 判讀: 1. Normal chamber size ＆ wall thickness. 2. TMV with Mild MR. 3. Mild TR ; Trivial AR ＆ PR. 4. E/A ＞ 1. 5. Estimated PAP= 30.2 mmHg. 6. Mild to moderate Hypokinesia : IVS, Anterior wall Mild Hypokinesia : Inferior wall ＆ LV apex 7. Normal LV systolic ＆ Diastolic function, LVEF= 57 %.

【B大醫院】
1.運動心電圖
The patient exercised according to the BRUCE for 10:43 min:s, achieving a work level of Max. METS: 12.90. The resting heart rate of 86 bpm rose to a maximal heart rate of 190 bpm. This value represents 100 % of the maximal, age-predicted heart rate. The resting blood pressure of 108/72 mmHg , rose to a maximum blood pressure of 152/52 mmHg. The exercise test was stopped due to Fatigue. Interpretation -- Conclusions --；Impression：醫師確認報告: The patient exercised according to the BRUCE for 10:43 min:s, achieving a work level of Max. METS: 12.90. The resting heart rate of 86 bpm rose to a maximal heart rate of 190 bpm. This value represents 100 % of the maximal, age-predicted heart rate. The resting blood pressure of 108/72 mmHg , rose to a maximum blood pressure of 152/52 mmHg. The exercise test was stopped due to Fatigue. Interpretation --Adequate BP response without angina and no ST change during exercise test. Conclusions --Negative

2.心臟超音波
111/08/18
--------------------------------------------- 08/18 Weight 69 kg, Hight 171.00 cm Body surface area 1.81 ㎡ [Clinical Impression:] Chest pain [Aortic root measurement:] Aortic annulus diameter 22.30 mm Sinus valsalva diameter 33.30 mm Sinotubular junction diameter 22.70 mm Ascending aorta diameter 29.80 mm Abdominal aorta diameter 17.50 mm [Left ventricle measurement:] IVSd 9.00 mm LVPWd 7.00 mm IVSd/LVPWd ratio 1.29 LVEDD 50.00 mm LVESD 31.00 mm LVEDV(Teich) 118.00 ml LVESV(Teich) 37.90 ml EF (Teich) 67.90 % SV (Teich) 80.10 ml SVI (Teich) 44.30 ml/㎡ LVEDV(MOD) 74.00 ml LVESV(MOD) 23.00 ml EF (MOD) 68.80 % SV (MOD) 51.10 ml SVI(MOD) 28.20 ml/㎡ LV mass index(Teich) 75.10 g/㎡ LV mass index(2D) g/㎡ RWT 0.30 % [Right ventricle and tricuspid valve measurement:] RV S’ 12.30 cm/s TAPSE 20.00 mm RV area change % TR peak velocity 214.00 cm/s TRPG 18.00 mmHg RVSP 26 mmHg IVC 16.00 mm Basal RV diameter mm mid RV diameter mm base-to-apex length diameter mm Above aortic valve diameter mm above pulmonary valve diameter mm below pulmonary valve diameter mm [Mitral measurement:] MV E point 82.00 cm/s MV A point 63.10 cm/s MV E/A ratio 1.30 MV E/E’ ratio 7.80 MV E’ 10.50 cm/s MV peak velocity cm/s MV mean PG mmHg MVA (Doppler) c㎡ MVA(2D) c㎡ [Aortic measurement:] EOA c㎡ LVOT peak velocity cm/s AV peak velocity 129.00 cm/s AV mean PG 3.00 mmHg AVA (Doppler) c㎡ AVA (2D) c㎡ LVOT diameter 2.23 cm LVOT area 3.91 c㎡ AR pressure half time ms AR peak velocity cm/s [Pulmonary measurement:] MPA diameter mm PV peak velocity 122.00 cm/s PV mean PG 3.00 mmHg Qp/Qs [Left atrium measurement:] LA diameter 26.80 mm LA volume index ml/㎡ [Right atrium measurement:] RA diameter 34.30 mm RA volume index ml/㎡ Impression: Conclusion: 1. No chamber dilatation 2. Good LV systolic function, estimated LVEF: 69% 3. Normal RV systolic function 4. Mild TR, PG: 18mmHg, estimated RVSP: 26mmHg

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由於A診所的醫生一直說我心肌缺氧（血），但我沒有三高（血壓有時候最高到130但其他醫生都認為不算高血壓），A醫生說沒有三高那就是先天血管畸形，要我做心臟640切電腦斷層。

因此我到B大醫院（有心血管中心），B醫生安排運動心電圖和超音波，檢查顯示的跟A診所差異有點大。

因為本身確診有慮病症和僵直性脊椎炎，常常會身體不舒服，最近（在做完這些檢查之後）有時候會感覺心悸、胸有點悶悶，以及常常會不自主深呼吸，戴口罩也常常覺得悶。可是最近搬重物（超過20公斤）上下樓10趟左右除了喘和肌肉痠痛之外沒有其他症狀。

給B大醫院的C醫生看診，也說我心肌缺氧的機率低，並認為我的胸悶心悸比較可能是胃食道逆流（每年都有做胃鏡，每年都是食道口灼傷和鬆弛），但如果狀況持續他也可以安排我進一步檢查，只是他說機率真的不高。

不好意思文有點長，感謝醫生百忙之中耐心閱讀，再麻煩醫生解惑，謝謝醫生！

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西，30~39歲男性，詢問日期：2022/11/01