Exercise stress test for women - false positives?

[Halya]

I had an exercise stress test a few weeks ago. It wasn't directly related to the BAV but rather to follow up on a poor reaction (hypotension, pre-syncope, fatigue and reduced exercise tolerance) after sedation for an upper GI endoscopic procedure. Symptoms gradually resolved over a couple of weeks but I still get lightheaded when changing positions rapidly.

I flunked the stress test. I lasted 13 minutes under the Bruce protocol so fitness level seems to be okay. However, I developed throat tightness at maximal exertion, arrythmia during recovery, and there was mention of an ST segment elevation.

Before the test, the doctor noted that stress tests were notably unreliable in women, especially young women (nice to be called that at 45) and not to be surprised if something turned up. He thinks this result is likely a false positive but is sending me for a nuclear stress (MIBI) test to make sure.

Has anyone else had experience with (possibly) false positives on exercise stress tests? What did further tests show?

Thank you,

Halya

 

[McCbon]

Hi, Halya:
I am female, 61 with BAV and had a stress test one year ago where they said I passed and my Oxygen utilization was in the "athletic range."
They reported that all was well and I was thus "objectively" asymptomatic. One thing they noted, however, and dismissed, was a "blunted BP." Now all I've read says that in active asymptomatic boderline severe BAV patients, a failure of the BP to rise adequately (I think More than 20 mm/Hg, but don't quote me) is SYMPTOMATIC. Oh well, mixed messages because they said I could exercise all I want and still had at least one year till OHS, BUT to keep my HR below 130!
In your case, I wonder what the endoscope was for and if that may have had more to do with your less than stellar stress echo results? Did you bleed, or is it a bleed? In which case hypovolemia or anemia could contribute to those symptoms when circulation is stressed. Did they medicate you for the endoscopy-since s/s have diminished-maybe you had a drug reaction?
Your stated symptoms are similar to what one might expect in a failed echo. In either case it's great that your MD is responsive and following up with another test. Good luck and keep us posted.

Bonny

 

[Halya]

Hi Bonny,

Thanks for your reply. Interesting to hear of your experience. It's so very confusing to understand what is considered a symptom and what is not. I think each doctor has their own interpretation of what is significant. Luckily I think the last few I've seen are on the cautious and suspicious side. I, too, was told that I have no restrictions on exercise at all. My stenosis is only mild at this point, so surgery is (hopefully) many years in the future. These investigations seem to be about establishing whether I have any coronary artery disease, not the aortic stenosis.

The endoscopy was for swallowing difficulties which had developed over a couple of years and non-cardiac chest pain which had been there for over a decade. The suspicion was eosinophilic esophagitis so lots of biopsies were taken. (Biopsy results were negative although the esophagus had a somewhat abnormal appearance. Now being treated empirically for GERD with some relief.)

Hypovolemia due to bleeding was the first suspicion, but there was no evidence (I was asked many ways at many different times) so that thought was abandoned. My adrenal function was also checked - all good. All kinds of other blood tests were done, too. It might have been a drug reaction, but since it was a fairly "gentle" sedation and my symptoms lasted longer than what would have been expected for a sensitivity they don't think so. So they started thinking cardiac. Right about that time, an echo after a routine physical turned up the BAV. I got turned over to another doctor and now there really is a full cardiac workup being done.

So, standing by, waiting for the next test. I might start to get used to this...no, not really.

 

[McCbon]

Yes, there is quite a bit of contradiction among "experts" as to what counts as a symptom. It's a little crazy-making. I hope your follow up echo
sheds more light on your situation and gives you some sense of reassurance. Be well, Bonny

 

[Halya]

So I finally heard back today. All is good. Follow-up MIBI scan last week showed no damage to the heart.

Clean bill of health other than the BAV. Specialist said to come back in a couple of years for another echo and that's all for now.

It's a beautiful day, I think I'll go for a nice vigorous hike this evening to celebrate

Halya

 

[McCbon]

Halya, good for you! I hope you get many many good years out of that valve!
B

 

[epstns]

Halya, I think I would be more concerned with the potential that various stress tests may show false negatives among women. This may have absolutely NO bearing in your case, but in general, women present different symptoms of heart disease than do men. My wife had numerous stress tests, aimed at diagnosing the cause for chest pain, all with absolutely NO findings.

Finally, after a particularly nasty bout that resulted in yet another hospitalization with no diagnosis or treatment, I convinced her to change to my cardio. We convinced him to do a radiological study (sorry, I forgot the name of the procedure, but it does about what a cath does, but via MRI), and the MRI study showed an artery that was OVER 99% BLOCKED! She was able to pass the stress test with flying colors, but she was at risk of a massive heart attack at any time!

Fortunately, this highly observant and highly regarded cardio inserted one stent, and all is well. But if we had not convinced him to do the MRI study. . .

I guess this is just my turn on the soapbox, ranting that cardio's need to be more aware of the differences between how men present cardiac symptoms and how women do. The schools have concentrated on symptoms among men, probably because for generations men were the ones who developed heart disease. Heart disease among women was far less common in my parents' and grandparents' generations. Of late, however, the probabilities have become more equal, but the symptoms presented by women are often different.

As a man, who loves a particular woman, I find it scary that the medical profession has only recently awakened to the fact that heart disease is on the rise among women and that many doctors are woefully unprepared to detect and deal with this.