心肌缺氧與心臟血管專科相關問題-心臟血管專科

心肌缺氧？

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醫生您好 6月份抽血飯前血糖132總膽固醇230低膽固醇129三酸甘油脂452目前有在吃血糖與降血脂藥，日前胸悶心悸呼吸不順與胸痛與刺痛
先後安排1.心臟超音波2.極度踏車運動試驗再來是3.24小時超音波檢查，因為24小時超音波檢查有心肌缺氧但醫生說之前做的運動心電圖沒有所以不用擔心，請問是這樣嗎？再麻煩醫生幫我查看，有什麼需要注意的，另外
Sinus rhythm with rate 54-131/min and mean 75/min.這樣正常嗎？
There were intermittent wandering atrial pacemakers.(心房起搏器間歇性遊走)與There were intermittent T wave inversions.(有間歇性T波倒置)是什麼意思，謝謝
檢查日期順序如下
6/20超音波心臟圖(包括單面、雙面)
□ Abnormal spetal motion Echo window □ good ■ fair ■ poor Tape No: IVSt: 7 mm(6-12) LVEDD: mm(36-52) EF: 60 %(49-76) LVPWt: 7 mm(5-11) LVESD: mm(20-36) SV: 38 cc(32-95) LAD: 25 mm(18-38) LVEDV: 63 cc(46-138) ASAO: mm(23-37) Ao Root: 25 mm(23-37) LVESV: 25 cc(10-54) RAD: 33 mm(18-38) Clinical Impression: DM , tachycardia ASSESSMENT: 1.Heart size: ■ normal; □ dilatation of ;□ thickening of ; □ LV mass index gm/㎡ □ LA volume index mL/㎡ ;□ RA volume index mL/㎡ 2.Pericardial effusion: ■ nil; □ small(＜100ml); □ mod(100-300ml); □ large(300ml); □ tamponade 3.LV systolic function: ■ good; □ fair; □ borderline; □ slightly impaired; □ poor; 4.LV diastolic function: ■ normal; □ impaired relaxation; □ pseudonormal; □ restrictive; □reversible restrictive; □ fixed restrictive 5.Valvular lesion: ■ yes; □ no; MS □ trivial; □ mild; □ mod; □severe;(Vmax: m/s;PG max; mmHg;PG mean: mmHg) (Amv(Doppler): cm2;Amv(2D): cm2) MR □ trivial; □ mild; □ mod; □severe; AS □ trivial; □ mild; □ mod; □severe; (Vav: m/s;Vlvot: m/s;Alvot: ;Aav: ) AR □ trivial; □ mild; □ mod; □severe; TS □ trivial; □ mild; □ mod; □severe; (Vmax: m/s) TR ■ trivial; □ mild; □ mod; □severe; (Vmax: m/s:PG: 16 mmHg,RVSP: 19 mmHg) PS □ trivial; □ mild; □ mod; □severe; (Vmax: m/s:PG: mmHg) PR □ trivial; □ mild; □ mod; □severe; 6.Congenital: ■ Nil; □ ASD; □ VSD; □ PDA; □ T/F; □ others; 7.Asynergy: ■ Nil; □ hypokinesis □ akinesis of segments □ dyskinesis of segments 8.RV systolic function:■ normal, □ impaired; IVC 13 mm 9.Additional findings IMPRESSION: Trivial TR, PG:16mmHg, estimated RVSP about 19mmHg No chamber dilation No regional wall motion abnormality Good LV systolic function EF of 60%

7/12 極度踏車運動試驗
Finding：機器判讀內容: The patient exercised according to the BRUCE for 5:33 min:s, achieving a work level of Max. METS: 7.00. The resting heart rate of 110 bpm rose to a maximal heart rate of 153 bpm. This value represents 87 % of the maximal, age-predicted heart rate. The resting blood pressure of 122/94 mmHg , rose to a maximum blood pressure of 172/94 mmHg. The exercise test was stopped due to Target heart rate achieved. Interpretation -- Conclusions --；Impression：醫師確認報告: The patient exercised according to the BRUCE for 5:33 min:s, achieving a work level of Max. METS: 7.00. The resting heart rate of 110 bpm rose to a maximal heart rate of 153 bpm. This value represents 87 % of the maximal, age-predicted heart rate. The resting blood pressure of 122/94 mmHg , rose to a maximum blood pressure of 172/94 mmHg. The exercise test was stopped due to Target heart rate achieved. Interpretation -- Conclusions --Negative

7/21 24小時心電圖
Finding：機器判讀內容: COMMENTS : 1. Sinus rhythm with rate 54-131/min and mean 75/min. 2. There were intermittent wandering atrial pacemakers. 3. No APCs. 4. One VPC. 5. No pauses. 6. There were intermittent T wave inversions. 7. No entries of symptoms were made in the patient diary. Note: Three Channels (MV5, MV1, Lead III)；Impression：醫師確認報告: COMMENTS : 1. Sinus rhythm with rate 54-131/min and mean 75/min. 2. There were intermittent wandering atrial pacemakers. 3. No APCs. 4. One VPC. 5. No pauses. 6. There were intermittent T wave inversions. 7. No entries of symptoms were made in the patient diary. Note: Three Channels (MV5, MV1, Lead III)

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小蘋，40~49歲女性，詢問日期：2023/08/04