STRESS ECHOCARDIOGRAM
Patient Name: Smith, Lisa
Date: 01/01/20XX
INDICATION: Aortic valve disorder, amitriptyline-induced left ventricular outflow tract obstruction, IHSS.
Medications: Alendronate, Excedrin, multivitamins, Claritin.
Medications withheld: Metoprolol.
Entry vital signs: BP 100/69, pulse rate 74 and regular, oxygen saturation 95% on room air.
PROCEDURE:
Resting EKG shows normal sinus rhythm. Resting echo shows normal wall motion in all segments, ejection fraction 60-65%, trace mitral regurgitation per color flow Doppler.
The patient exercised on a standard Bruce protocol for 2 minutes 50 seconds into stage I. (Bruce protocol includes EKG monitoring during exercise.)
Test terminated due to shortness of breath.
FINDINGS:
Peak heart rate of 23 b.p.m., which is 80% of maximum predicted heart rate.
Notably her blood pressure response was quite flat and there was evidence of increasing systolic anterior motion of the anterior mitral leaflet consistent with increasing obstruction.
Peak double product of 12,500 which represents a low cardiac workload.
Peak EKG shows no ST segment changes. No exercise-induced hypoxemia. No inducible ischemia.
Oxygen saturation maintained.
Exercise capacity is Functional class III at 4.0 METs.
CONCLUSION:
1. No evidence of ischemia to a low cardiac workload.
2. Moderate aortic insufficiency secondary to bicuspid aortic valve.
Robert Jones, MD
Electronically signed by ROBERT JONES, MD 1/1/20XX
