Earlier this week we learned that the specialist machine doing CT angiograms is very busy at the big hospital in Saint Brieuc. They are backed up and will not be able to do the study before the date upon which my hip operation is scheduled. This means that the risk is less quantified. They are possibly worried a little about how I might respond to being hacked open and losing a few wine glasses of blood while someone saws off the head of my femur and whacks in a Titanium implant.

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The added concern comes from my recent resting electrocardiogram (ECG) in which the ST level was depressed below the isoelectric point.

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The ST segement is seen as potentially diagnostic for a number of conditions, lowering is correlated with these things.

Causes of ST segment depression:

Myocardial ischemia

Hypokalemia

Digoxin

Cocaine

Left ventricular hypertrophy (with concurrent T wave changes)

Bundle branch blocks (with concurrent T wave changes)

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I can exclude the three middle suggestions unequivocaly.

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The depressed ECG ST wave form is characterised as above into three basic types. My ECG has a lowering of  about 1 mm and is most like the horizontal depiction above

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Bearing in mind that I have spent decades looking at spectroscopy traces on chart paper, oscillosocpes and computer screens it is easy for me to spot “anomalies”.

Whenever I see ECG traces the first thing which comes to mind is, “why is the data so shite?”

Is the test human not grounded, is there a floating earth?

Can’t they do better, develop better machines, improve protocol?

Verbally the cardiologist wanted to check for myocardial ischemia or ventricular hypertrophy. The latter can come from being overly athletic in which case it is ok or it is simply that the heart if gettting old. Back in the last century I had strong athletic tendencies.

He has propsed a so-called cardio stress test. They asked me if I could pedal. Maybe enough to raise the demand on the heart…we shall see.

Going left to right the power output by the human hamster wheel rider increases by 50 watt quanta B-C. This data shows the depression of an ST ECG trace as incresing demand is placed upon the heart.

“Reversible ST-segment depression is the characteristic finding associated with exercise-induced, demand-driven ischemia in patients with significant coronary obstruction but no flow limitation at rest.”

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The jury suggests that this methodology could tend the “diagnosis” either towards or away from ischemia or blood supply insufficiency. The guess was that my aging heart was just as bit too big and aged. The holy trinity of fat, fags and booze have given me their sacred blessing.

If I am losing blood during the operation the heart will pump that little bit harder.

All the articles suggest that when a stress test is done there is a medic present who is cardio-trained in case the stress test causes a heart attack…

It was mooted that an appointment for this stress test may also not be easy to come by. The pre-op anaesthesia meeting is scheduled about 1 month out before the operation.

If the ST depression is unexplained, will they go ahead or will they insist upon more data?

There is a potential fly in the ointment.

We have found that in general the French are more keen on lastminute.com than we are…I foresee a mad clustering of yet more medical appointments early autumn…