Poor Manâs Exercise Test
Report:
Sinus rhythm
VEBs, multiform, some interpolated
Post-ectopic repolarisation changes
ST segment depression
Post-ectopic depolarisation changes
Rate-dependent right bundle branch block
Comment:
The presence of intermittent RBBB somewhat spoils the test: the ST segment would be expected to shift opposite the late QRS forces and at least some of the depression seen after long pauses would be abolished if the RBBB stayed.
The interpolated VEBs do not cause post-ectopic changes, but they do not abolish the RBBB either.
A more valid example, from another patientâs Holter monitor, is shown below (Fig 201a). T wave inversion is the commonest post-ectopic change.
The repolarisation changes are due to the pause induced by the ectopic beat (or any other mechanism). The âpoor manâs exercise testâ is, in reality, a poor test: it does not occur any more frequently in subjects with coronary artery disease than in normal people137.
201a. A 2-channel Holter strip: post-ectopic T wave inversion.
202. Unusual extrasystoles in a 47 year old man one day after acute anteroseptal infarction. New RBBB/LAHB and LBBB occurred, at different times, on his 12-lead ECGs. He had persistent chest pain while on a nitroglycerin infusion but seemed unaware of the arrhythmia.
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