Question

I've had chest discomfort that started 1 month ago and has consistently got worse. I had an EKG, stress test, and ultrasound that didn't show any ischemic changes. I am 39, female, with no heart risks in my family, and very low cholesterol. The stress test was 9 minutes long. My heart rate rose from a resting 90 to 190 beats-per-minute during the test, but didn't want to go down after the test. It finally got down to 144 and I could leave. Is anything seriously wrong?

Answer

No test is perfect. In good hands, a stress echocardiogram has about 80-90% accuracy - it all depends on the quality of the images and the skill of the cardiologist reading the images. Presuming yours was of good quality, the physician was skilled in interpreting it, you had no discomfort on the treadmill, walked a decent distance, and the echo images were normal, it is likely that the discomfort is coming from something other than your heart.

Your main concern seems to be about the heart rates. It is normal for the blood pressure and heart rate to rise during a stress test. It is possible that you were worked much harder than you are accustomed to and it took longer for your heart rate to come down. I would presume you didn't have an abnormal heart rhythm during the test, or the doctor would have said something. Also, presuming the functioning of your heart was normal, it is unlikely that any shortness of breath or increased heart rates that are now occurring have anything to do with a weakened heart/abnormal valves. Other factors which can make the heart rate go up out of the ordinary (but not related to abnormal heart rhythms) include dehydration, too active thyroid (which can also make the blood pressure increase), anemia, other endocrinological abnormalities, and, of course, anxiety. A simple thing would be to have a blood count, chemistry panel, and thyroid blood test to be sure none of things are "out of whack." If they are all unremarkable, then there is a simple 24-hour monitor (Holter) that can be worn to see what your heart rate/rhythm does during a typical day. If something shows up, then it can be acted on. Finally, any type of stimulants (i.e. caffeine, etc) can certainly increase the heart rate/etc.