stress test

after 6 years on my icd they now tell me i have to have a stress test. seems to me to be a little late. i know i wont do well on it and seems unneccassary to me. what do you all think?

17 Comments

Stress test has nothng...

by donr - 2013-06-23 01:06:50

... to do w/ electrical part of heart. iCD is all electrical; stress test is all plumbing.

They will probably have you take a Lexiscan drug test, as opposed to a stationary cycle or treadmill test.. The Lexiscan drug suddenly will dilate your coronary arteries & they will be able to see how blood perfuses w/i the heart's distribution system.

Consists of three parts:
1) they inject you w/ a small amount of a radioactive chemical w/ a very short half life. You wait about 30 min & they lie you down in a "Radio Camera." It takes 15 min to essentially circle your body at heart level, finding out where the blood went & deposited the radioactive tracer.

2) Inject you w/ the Lexiscan drug to dilate your coronary arteries - also gets every other artery in body, but coronary is the set they are interested in. The Lexiscan lasts but a few seconds, so IMMEDIATELY after the lexiscan is injected, you get a second shot of radioactive tracer material.

3) they wait a few minutes & it's back into the "Radio Camera" fo a second "Photo" of heart. This time the tracer has shown where the blood went while the heart arteries were dilated.

A cardio reads the Before & after photos & can figure out if you have any blood distribution blockages - NOT to be confused w/ electrical system blockages.

It is NOT a fun test! But necessary.

Don

Ask them!

by Grateful Heart - 2013-06-23 02:06:04

A lot of us here have had stress tests, whether it be on a treadmill or nuclear. There must be a reason why they want you to have it, ask them so you know.

The first one I had was nuclear, they would not let me walk the treadmill at the time. Since then, I have had a few treadmill tests. So don't fret if they want to do the nuclear test.

Ditto what Don said, not fun but necessary.

Grateful Heart

Last Time I had a stress test...

by donr - 2013-06-23 02:06:07

...They told me the reason they wanted to do the Lexiscan test was because w/ PM/ICD's they often cannot get the pulse rate up to a point that the arteries are adequately dilated. From that stand point, it is safer to go the chemical (Lexiscan) route because it does NOT require physically stressing the heart by going to a high HR.

I had a bicycle test w/ nuclear back before I got my PM implanted. Obviously the nuclear part can be used w/ either method of dilating the arteries. Half way through my cardio called it off. I asked him why. Simple, he said - you don't want to code right here on the bicycle. That PM I had a cardiac cath.

Don

ask but

by Tracey_E - 2013-06-23 02:06:28

It's normal for them to want to keep tabs on our cardiac health, and this is a fairly easy way to do it. I've never had the nuclear kind, just the old fashioned kind where you run on a treadmill. Ask why and try to talk them into not doing nuclear unless they have a reason.

Are you 100% right Don ?

by IAN MC - 2013-06-23 03:06:07

My understanding is that Exercise Tolerance Tests are used to detect electrical, as well as plumbing problems.\\

As an example, they can be used to detect and record arrythmias which are provoked by exercise . I have no plumbing problems but am having my second treadmill test next week as my electrics do strange things when I run further than 2 miles.

Perhaps I am getting the terminology mixed up ... is an Exercise Stress test different to an Exercise Tolerance Test ?

Ian

rates

by Tracey_E - 2013-06-23 03:06:32

I exercise all the time so I regularly get my rate up to the level they want it for the stress test, guess that's why I've been successful talking my way out of nuclear ;) Or, the test was because of problems working out so they were more interested in watching what my heart was doing than how high I could get it.

Stress Test

by SMITTY - 2013-06-23 04:06:00


Hello,

You have been given a good run down on the whys and what-fors of a stress test, but I do have a couple of comments to add. One is very simply, either do what the dr orders, or at least get another opinion. As Donr said the stress test is more to check out the heart plumbing than its electrical system. However, the electrical system does not get a free ride during a stress test, as a "stressed" heart may be the only way to learn what the heart wants to do when loaded as it may be during heavy exercise or on your job.

One thing I have learned about the chemical, or nuclear stress test is it can have a more undesirable side effect than the treadmill test. The medicine that is used to dilate the heart's arteries, dilates blood vessels throughout the body. In my case when that happens I have a very uncomfortable feeling, not pain necessarily, just uncomfortable feeling, including slight nausea and even a headache. For me this occurs toward the end of the test and just before I am placed under the Geiger counter to see where the blood is, or is not flowing well.

Thank goodness an antidote is available that will clear up that side effects almost immediately for me. Let me add here I have had a stress test since Lexiscan was approved so it may not have the same side effect.

But believe what the others are saying, a stress test is very important in keeping track of your heart's overall well being and can identify problems, or potential problems not even your dr has thought about. In addition, it can identify the need for some pacemaker tweaking.

As you can see I am a firm believer in a stress test as one of mine identified a serious problem just waiting right around the bend for me. For those results I got a stent and probably avoided another heart attack or another bypass surgery.

Good luck,

Smitty

IAN: Stress Tests

by donr - 2013-06-23 05:06:42

I may be off on that issue. Tracey is saying the same thing as you. Not having had a situation where my electricals are affected by exercise, I am guilty of selective hearing when my cardio's staff discussed it.

You are completely correct on the issue about there being an interplay between the two - & I unthinkingly mentioned it when I talked about flunking my first stress test & getting a cath in lieu thereof. I was about halfway through the test when he stopped it - he saw something in my ECG - though that was not the reason he was running the test. Whatever it was, it was serious enough that I was on the table for the cath w/i 4 hrs & that included being transported to another hosp 35 mi away.

That was 11 yrs ago this summer & I got a clean bill of health from the cath test.

There has to be a difference in the tests - Tracey talks about taking a "Stress" test w/o the nuclear. There is no way they can tell if the heart perfuses sufficiently w/o the nuclear.

Ian, do they do the nuclear bit on you when you have your "Stress" tests?

I know that I have only had nuclear because they were worried about perfusion & clogged arteries prior to surgery.

Makes me wonder if we have collectively been missing something in terminology.

Don

Smitty: Good to see you again!

by donr - 2013-06-23 05:06:45

You had the Persantine test, apparently. Yes, the Lexiscan test is relatively new.

I've had both, now, & definitely prefer the old Persaantine test.

It took exactly 15 minutes & the tech could predict exactly what was going to happen to you at essentially each minute. The antidote was aminophyllin (SP?) & reversed the effect in about 5 -6 seconds. The nice part of it was the predictability of the phases of the test.

The Lexiscan test, OTOH, comes on so fast that there is zero time for any explaining while it is in progress.The whole thing, IIRC took place in about 20 seconds & it was dramatic. The phases of the test are probably about the same, but so compressed in time that you cannot even sense that they are happening.

W/the Persantine test, I had no side or after effects.

W/ the Lexiscan test, I had a wicked headache afterward. Their solution was to drink a cup of coffee, which did the trick. My Cardio makes terrible coffee.

Don

Don

by IAN MC - 2013-06-23 06:06:11

In answer to your question..No. they have never suggested going nuclear on me !

My understanding is that the nuclear test is purely to measure blood flow and in turn damaged heart muscle ; in my case whatever is causing my problems on exertion is believed to be purely electrical. As you know ,exercise-induced electrical problems such as arrhythmias / missed beats are common and can be identified by treadmill tests while you are wired up for an ECG ( EKG if you must ! )

I understand that you can also have an echocardiogram while you exercise to see, for example, how the valves operate under stress.....I agree that the terminology for these various " tests-while-you-exercise " may become a little blurred .

Cheers

Ian

Strest Test

by SMITTY - 2013-06-23 07:06:18

Thank you Don. You are correct, mine was with Persantine and the last one of those was 2007. That shows how good my memory is now.

Smitty

names

by Tracey_E - 2013-06-23 07:06:58

I think we're confusing windowguy with semantics! You can call it whatever you want. If you get on a treadmill, my dr calls it a stress test, the impression I got is he uses the nuclear for people not capable of running or it's not safe for them to run. Maybe he's looking for something different when he puts me on it, I don't know, but that's what he calls it. He's never mentioned worrying about perfusion, usually he just wants to see how I'm handling the stress of my daily workouts. I've also had stress-echos, where they use the echo machine during a run. I only have electrical problems, am under 50, a good weight with excellent blood work, have never had an indication of anything plumbing so there's no reason to do more.

Windowguy, just ask more questions! Me personally, unless I have a problem or an indication of something going on, I'm not going to agree to anything invasive or with medication or radiation. That's just me, I've had a lifetime of more than the average number of tests and a history of drug interactions so I question everything and shy away from anything I deem unnecessary.

Semantics become important...

by donr - 2013-06-24 01:06:41

...especially when crossing the North Atlantic!

Ian: I once was in the High Wycombe hosp ER because I was violently ill w/ abdominal cramps.

That's when I found out that "...feeling sick..." meant something dramatically different to you than it does to me. Next I found out that an ECG, when filtered through an Englishwoman's lips & a Yank's bad ears is NOT an electroencephalograph, but rather an EKG.

Semantics was extremely important that night!

Until this little discussion, I'd never thought about all the nuances to "Stress Tests."

One of the significant issues for exercise induced stress is the possibility of SCA (SCD?). Dunno how it is in the UK, but every year we lose several High School aged athletes to SCA playing American Football or basketball. Always it is young men in supposedly great health & superb physical condition who just drop dead on the spot & cannot be resuscitated.

Wonder how many times this has happened on this subject or some other & we did not collectively catch it?

Don

Semantics... Don

by IAN MC - 2013-06-24 05:06:13

I hope that you didn't ask for ER when you arrived at High Wycombe hospital . That would have totally confused them ! Asking for A&E may have got you there ( Accident and Emergency )

ER , to us, is simply an American TV program . Next time I'm in the States and need emergency care I will probably forget and ask for "Cheers" or "Mash" or "Homeland"

It is one of life's mysteries why you opted for EKG ( Kardia is the Greek for heart ... but why suddenly go Greek on us ? ) ECG is an accurate reflection of the word electroCardiogram whilst EEG accurately describes an electroencephalogram.

As long as we all keep our sense of humour, or even humor, some sort of communication will remain !

Best wishes to y'all

Ian

thanks!

by windowguy28 - 2013-06-24 07:06:02

i want to thank everyone for their replies! i received a letter from the va explaining the test. they said it would take 4 hours. so i am going to discuss it with my private doctor to see what he thinks. i really do believe the ann arbor va is doing a very thorough job on me. thanks again everyone!

windowguy

by IAN MC - 2013-06-24 07:06:27

..... sorry about all the diversions from your original query.

I found the wording in your question interesting

- how do you know that you won't do well on a stress test?

- if you are right, and you don't do well , then the Drs MAY be able to do something about it to help you.

If they think you would benefit from it; then go for it; it won't harm you and just may help.

As Tracey says, ask questions then make a decision !

Best of luck

Ian

Lexiscan Test

by donr - 2013-06-24 08:06:50

Is most likely what it is. That takes about 4 hrs w/ all the waiting time for things to absorb, to take the "Photos," & to actually have the test run.

If this is the case, they are looking for heart muscle damage from something in the past or clogged coronary arteries.

Good luck w/it, no matter what its purpose is.

Don

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