Stress Test Analysis & Recommendations (for Dad)

Here’s a plain-English read of your treadmill stress-echo, laid out exactly how we’d explain it to family. I’ll start with a quick walk-through of each screen/photo, then a side-by-side table (doctor vs. guideline-based view), and finish with the good news, things to watch, a practical action plan, and smart questions for your next visit. Citations to official U.S./European sources are included.

⸻

What each photo shows (simple snapshots)

• Photos 1–2 (Pre-test, lying and standing): Heart rhythm steady ~69 bpm; blood pressure ~110/80. Baseline ECG essentially normal.

• Photo 3 (Exercise Stage 1): Comfortable walking; heart rate ~99–111 bpm; blood pressure ~120–130 systolic. ECG still looks fine.

• Photo 4 (Stage 2): Speed and incline up; heart rate rises as expected; ECG shows tiny “dips” (fractions of a millimeter) in some leads—too small to count as “abnormal” by standard rules.

• Photo 5 (Stage 3): Working harder; ECG still shows only small, brief dips. No chest pain.

• Photo 6 (Stage 4 – peak): Top effort. Heart rate peaks ~146 bpm (about 91% of age-predicted max). Blood pressure around 140/80. Small ST-segment dips (about 0.5–0.7 mm) in a few “inferolateral” leads; you still have no symptoms.

• Photos 7–8 (Early & later recovery): Heart rate drops quickly (about 31 beats in the first minute—excellent). Those tiny ECG dips fade and normalize within minutes.

• Photo 9 (Printed report page): Echo images say heart squeeze is good (EF >55%), with no new wall-motion problems during or after exercise. Official conclusion written on the report: “Positive exercise stress echo for ischaemia,” based on the small ECG changes; but the echo pictures themselves do not show stress-induced motion problems.

⸻

“Doctor’s note” vs. what major guidelines say

| Doctor’s report (what it says) | What official sources say (and how your result compares) |

| -------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |

| Final label: “Positive exercise stress echo for ischaemia,” due to minimal ST-segment depression in inferolateral leads during exercise. | Guideline definition of a positive exercise ECG is ≥1.0 mm (0.10 mV) horizontal or down-sloping ST depression measured \~60–80 ms after the J-point. Smaller or up-sloping changes are usually not diagnostic. Your largest change was \~0.5–0.7 mm, so below the threshold → more “borderline/near-normal” than clearly positive. ([AHA Journals]^[1], [PMC]^[2]) |

| Echo images: EF >55%; report does not describe any new wall-motion abnormality. | Stress-echo is called positive when new/worse wall-motion problems appear with stress. If wall motion stays normal, that typically means no significant exercise-induced ischaemia on the imaging part. Your echo section reads as reassuring. ([ASE]^[3], [Online Jase]^[4]) |

| Exercise time/workload: 10:30 minutes, \~13.5 METs (Bruce protocol). | Reaching ≥10 METs is linked to very low risk and often no need for extra imaging when the ECG isn’t clearly abnormal. Your 13.5 METs is excellent and in the low-risk zone. ([AAFP]^[5], [PMC]^[6]) |

| Heart-rate response: Max 148 bpm (\~91% of predicted). | Tests are generally considered adequate once you reach about ≥85% of age-predicted max HR; β-blockers can blunt HR, which is why many labs hold them before a diagnostic test. You were on a β-blocker but still reached 91%—good effort and a valid test. ([AAFP]^[5], [AHA Journals]^[1], [ASE]^[3]) |

| Blood pressure & symptoms: Normal rise in BP (to \~140/80). No chest pain. No concerning arrhythmias. | That’s the pattern we want. No angina, no arrhythmia, no hypotension → all low-risk features. Quick 1-minute heart-rate recovery of 31 bpm is very good (better than the >12-bpm benchmark linked to lower risk). ([AHA Journals]^[7]) |

| What next? — not specified on the form. | With low-risk treadmill results (high METs, no ischemic symptoms, no clear ≥1 mm ST changes, normal echo images), guidelines note that extra urgent testing usually isn’t needed; decisions hinge on overall risk and shared decision-making. ([American College of Cardiology]^[8], [PMC]^[9]) |

^[1]: https://www.ahajournals.org/doi/10.1161/cir.0b013e31829b5b44?utm_source=chatgpt.com Exercise Standards for Testing and Training | Circulation

^[2]: https://pmc.ncbi.nlm.nih.gov/articles/PMC4958709/?utm_source=chatgpt.com ST-segment changes with exercise stress - PMC

^[3]: https://www.asecho.org/wp-content/uploads/2020/01/Stress-Echo-2020.pdf?utm_source=chatgpt.com Stress-Echo-2020.pdf

^[4]: https://www.onlinejase.com/article/S0894-7317%2819%2930825-9/fulltext?utm_source=chatgpt.com Guidelines for Performance, Interpretation, and Application ...

^[5]: https://www.aafp.org/pubs/afp/issues/2017/0901/p293.html?utm_source=chatgpt.com Exercise Stress Testing: Indications and Common Questions

^[6]: https://pmc.ncbi.nlm.nih.gov/articles/PMC2826719/?utm_source=chatgpt.com Achieving an Exercise Workload of ≥10 METS Predicts a ...

^[7]: https://www.ahajournals.org/doi/10.1161/jaha.117.005505?utm_source=chatgpt.com Heart Rate Recovery and Risk of Cardiovascular Events ...

^[8]: https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2021/10/27/14/06/2021-Guideline-for-Chest-Pain-gl_chestpain?utm_source=chatgpt.com 2021 AHA/ACC Chest Pain Guideline Perspectives

^[9]: https://pmc.ncbi.nlm.nih.gov/articles/PMC11308083/?utm_source=chatgpt.com The 2021 AHA/ACC Guideline for the Evaluation and ...



What next? — not specified on the form. With low-risk treadmill results (high METs, no ischemic symptoms, no clear ≥1 mm ST changes, normal echo images), guidelines note that extra urgent testing usually isn’t needed; decisions hinge on overall risk and shared decision-making.  

⸻

The good stuff (why this test is mostly reassuring)

• Strong fitness for your age. You hit 13.5 METs, which is better than average and associated with very low event rates. 

• No chest pain while pushing hard. That makes serious flow-limiting blockages less likely today.

• Normal blood-pressure rise and no dangerous rhythms during exercise.

• Fast recovery. Heart rate dropped 31 beats in the first minute—excellent, and linked to better outcomes. 

• Echo pictures stayed normal under stress (no new wall-motion issue), which usually means no significant exercise-induced ischaemia on imaging. 

⸻

Key concerns (what to keep an eye on)

• Wording vs. criteria. The official form calls the test “positive,” but the ECG changes were under the standard 1-mm cutoff, and the echo imaging stayed normal. Reading this strictly by guidelines, the ECG part looks borderline, not clearly positive. Doctors sometimes err on caution when any ST change appears.  

• β-blocker on board. These medicines dampen heart-rate rise and can reduce test sensitivity, which is why some centers hold them when the goal is diagnosis. You still reached 91% of predicted HR, so the test was adequate, but this nuance is worth discussing.  

• A test is a snapshot. Great treadmill results don’t cancel long-term risk from cholesterol, diabetes, etc. (Prevention still matters.)

⸻

Action plan (simple, practical)

1. Confirm the wording. Ask your cardiologist to reconcile the “positive” label with the facts that ECG dips were <1 mm and echo showed no wall-motion abnormality. Clarify whether they view this as borderline rather than truly positive—and what that means for you.  

2. Decide on further testing (or not). With high METs and no symptoms, many patients don’t need more tests right now. If extra reassurance is wanted, discuss watchful follow-up vs. a one-time anatomic test (e.g., coronary CT angiography) based on overall risk and preferences. 

3. Medication timing (future tests). If another diagnostic treadmill test is planned, ask whether holding the β-blocker beforehand would be appropriate and safe for you to avoid blunting the result. 

4. Keep doing the preventive work. Keep walking/exercising (your test shows you tolerate it well). Maintain blood-pressure, glucose, and cholesterol control per your care plan. (Prevention is where we win the long game.)

⸻

Smart questions to take to your visit

• “Does my test truly meet the formal criteria for ‘positive’?” (Because <1 mm ST depression and normal stress-echo images usually do not.)  

• “Given I hit 13.5 METs with no symptoms, do guidelines support no further testing now?” If not, why?  

• “If we repeat testing, should I hold my β-blocker to avoid masking findings, and is that safe for me?” 

• “What day-to-day steps matter most for me now?” (Exercise target, diet, medication adherence, and how/when to seek help if symptoms change.)

⸻

Bottom line for Dad

You walked hard, your heart kept up well, you had no chest pain, your recovery was excellent, and the echo pictures stayed normal. The tiny ECG blips were below the usual line for calling a test “positive.” So, big picture: this test is reassuring. The next wins come from staying active, taking your meds, and regular follow-ups—and making sure the team and the paperwork agree on what the test really showed.