Peak exercise ECG in 48 year old women (Taken from from Ref 1)
What is the likely coronary lesion ?
Answer
The mechanism of false positive TMT in MVPS is easy to understand.The pap muscle attachment zone of LV are under strain. In fact the commonest cause of ST depression in inferior leads are typical of MVPS. (Though it can occur in V5 and V 6 also as in this case) Both pap muscles are relatively posterior (Even the so called antero lateral) and the axis of strain is directed towards inferior leads.
The following table compiles few of causes of false positive stress test.
Final message
Never report TMT in Isolation. Not all the frightening ST depressions are left main. Unfortunately, no cardiologist can realsitically exist in this world , to report TMT as false positive, without doing at least a CT angiogram or a SPECT imaging
Reference
