Stress Test - When is it risky?

[Ashley]

Hi Everyone,
Just wondering about having a stress test when you have a biscuspid valve with severe (.8 - .9) stenosis. I assume, since the doctor has ordered it, that the test is safe. I know they run a ECG while you are exercising, so I imagine that they would quickly be able to tell if anything were wrong, but is there any thought that perhaps it isn't safe? I have had a few stress tests before, but I can't remember how hard you end up exercising.
Thanks!
Ashley

 

[Ross]

I am no fan of stress testing and I for one, do not feel it is safe regardless of what they say. It's a very tough physical test and poses most likely the greatist risk to your heart health. My last was a Chemical stress test. I'll never do another Chemical stress test again!!!!

 

[ALCapshaw2]

My understanding is that with AORTIC Stenosis there is a higher risk of SUDDEN DEATH with 'excessive' exertion. Ask for a second opinion, either another cardiologist or your Primary Care Physician.

There might even be an AHA (American Heart Association) guideline on this topic so do some research.

Be sure to express your concern to your cardiologist. Maybe he just 'forgot'.

'AL Capshaw'

 

[Mary]

Ashley,
Like Ross and Al say.
I know stress tests are number 1 on Tobagotwo's "things he has issues with"
list. Maybe he will chime in to give you his reasons.
I had one early in my diagnosis of my aortic stenosis. That was probably three years before surgery. I would hate to have taken one in the last year, so you might question whether this one is really necessary.
When is it scheduled for?
Mary

 

[DebbiN]

stress test

stress test

I have never been able to do the physical one, the one time I tried, I thought I was going to croak right then. So I have done the chemical one, and that is the only one I will ever do again!

 

[Ross]

I have never been able to do the physical one, the one time I tried, I thought I was going to croak right then. So I have done the chemical one, and that is the only one I will ever do again!

The physical would have killed me and the chemical darn near had me sent to the ER unable to breath. Never again for this guy!

 

[Johnny Stephens]

I never had a stress test prior to surgery - I had been sternly warned about sudden or strenuous exercise with my severe aortic stenosis. I did have one about a year after my surgery as part of certification for an exercise program. If they had pushed me that hard BEFORE surgery, I'm sure I would have collapsed.

 

[Nancy]

Joe cannot do a physical stress test. He has some orthopedic problems with his feet. He has had both a Persantine and a Dobutamine stress test. The Persantine stress test didn't phase him, but the Dobutamine test threw him for a loop for several days, plus they never did get up to his upper limits on heart rate that they wanted (160bpm). So they stopped it early. No one can tell me why. I guess they're going to keep that little secret. I made sure there were several techs in the room, and there was also an echo tech. Joe has pulmonary hypertension and could easily have fainted and fallen off the table. They were very careful with him.

I've had a physical stress test. I do not have neart problems. But I can tell you that it was very "stressful". I finished the test and by the time I was at the end, I was running uphill, and thought that I could not draw another breath. I believe it lasted for twenty minutes or so. Unless you are used to running uphill, you will have trouble finishing it with heart problems.

 

[Ashley]

Scheduled for Monday

Scheduled for Monday

It's scheduled for Monday - I should have posted on this topic earlier. What exactly is the purpose? Are they trying to determine if I can exercise and to what degree? I am asymptomatic, and up until March of this year, when I had my last echo, I was playing co-ed indoor soccer, which needless to say was very stressful. No symptoms though, and I seemed to be holding my own with the other healthy players. I thought everything was great until I had the echo and they had a bit of a bird and told me to stop playing right away. Made me think..well what about the last game I played, I was in this state then too! Luckily, I'm okay Well, this gives me something to think about. I'm curious to know what this test will tell them. I don't think they'd give me the go ahead again to play soccer and such, so I do wonder what the purpose is.
Thanks everyone!

 

[mmarshall]

ash...i had one done 6 years ago with my old cardio. since you are in shape i would not be too worried about it. i was hooked up and on a treadmill for 10 min. and since you are active and playing soccer off and on...i think you will be in shape for this. the concern i have is the readings of your echo. 6 years ago i was in the "let's monitor him" phase so the ekg, echo, and stress test was done. then 6 years later...yes i waited too long...lol....i found a cardio that i liked and after the echo it was surgery talk....there was no need for a stress test....although i think i could have done one since i was doing 3 miles a day on the treadmill already. but definitely ask you cardio about your echo readings and see where you are on the replacement issue. a good cardio and surgeon can just look at the echo results and tell if surgery is in the very near furture....if you are in the severe state then the stress test sounds like just another test that you may not need to do.

 

[Ashley]

Physical Examination
A general physical examination with special attention to the systems listed in Table 3 usually is adequate for the pretest evaluation. Cardiac examination should include an assessment for the presence of murmurs and valvular disease. Severe valvular dysfunction, especially aortic stenosis, is an absolute contraindication to exercise stress testing.4,7 Gallop rhythms are noteworthy because the presence of an S3 may indicate significant congestive heart failure, a contraindication if it is clinically severe. While the development of an S4 during exercise may indicate significant cardiac ischemia, detection of it during a physical examination does not signify ischemia and is not grounds for not performing an exercise stress test.7

Just found this in the first article I googled from the American Academy of Family Physicians. http://www.aafp.org/afp/990115ap/401.html Reputable source? Perhaps I'll print it out and bring it to my cardiologist. Ahh - now I'm scared!!!!

 

[mmarshall]

woman!!!....stop stressin'....lol everything is going to be ok and you will be on here tuesday saying that everything went well and it was not bad at all.

 

[Ashley]

ash...i had one done 6 years ago with my old cardio. since you are in shape i would not be too worried about it. i was hooked up and on a treadmill for 10 min. and since you are active and playing soccer off and on...i think you will be in shape for this. the concern i have is the readings of your echo. 6 years ago i was in the "let's monitor him" phase so the ekg, echo, and stress test was done. then 6 years later...yes i waited too long...lol....i found a cardio that i liked and after the echo it was surgery talk....there was no need for a stress test....although i think i could have done one since i was doing 3 miles a day on the treadmill already. but definitely ask you cardio about your echo readings and see where you are on the replacement issue. a good cardio and surgeon can just look at the echo results and tell if surgery is in the very near furture....if you are in the severe state then the stress test sounds like just another test that you may not need to do.

Thanks Mike. Ya, I don't think I would have any problem with it - it's the SUDDEN DEATH possibility that is freaking me out! I'm in the let's monitor her phase - been there for about 8 years now. I went 4 years before my last echo - which I feel was too long!!! Why on earth they wouldn't at least do an echo bi-annually is beyond me. I feel I am learning so much now that I wish I had known before. For any new members - LEARN AS MUCH AS YOU CAN SO YOU CAN HELP TAKE CARE OF YOURSELF It's so important! I'll probably spend the rest of my day here at work researching about the test - and present my cardio with all my Internet findings on Monday. Bet she'll love that, hehe.
Thanks All

 

[Marguerite53]

Hi Ashley.

Hi Ashley.

Hello. I'm 51 and nowhere near in the excellent shape you are in. My aortic stenosis was discovered because I was beginning to have symptoms, knew that the symptoms were indicative of something, and went to my GP. She did an echo which came back at a 1.0, and sent me to a cardio for a Nuclear Stress Test. She is young, 30ish. Gifted and complete. She claimed that a regular stress test where you are simply hooked up to monitors and assessed DO NOT work well for women because the results do not show enough. Men are different. There was no talk of danger, just that a regular stress test for women in moderate stenosis is a waste of time. The nuclear stress test differs in that they use an injected dye to help see what is going on inside of you more clearly. You are injected with a nuclear dye before the physical test. They take a picture (the don't breathe, kind). THen they run/walk you on the treadmill and it begins to incline as you go along, reading everything pertinent. You are monitored with the EKG and they are constantly asking you if you feel any sharp pains (oh, so comforting!). When you stop (I stopped when I reached the heartrate they wanted since I didn't feel that well and saw no need to continue) they shoot some more dye into you and take another series of pictures. That's it.

Here are my stated "conclusions" from the cardio's final assessment of the results: "1. Likely normal myocardial perfusion study. A. No ischemic defects seen. Mild anterior breast attenuation present. (I think it was in the way!! ) B. Normal size left ventricular cavity. 2. Normal left ventricular systolic function."

That's still pretty Greek to me, but maybe others can gleen something from these words. I was told to lose weight, get my cholesterol down (it was not high at all) and exercise (which I hadn't been). I'm in waiting mode.

I chose to go to a new cardio -- wanted a woman of higher community stature, and a second opinion. At one point, a year after that she recommended another stress test because I was having chest pressure. I had coincidentally started on a blood pressure med which turned out to be the wrong one. We changed the med, the feeling disappeared and I cancelled the stress test. She didn't. I did. You do have the right to refuse things. Just be VERY sure you know why you are refusing it. I do recall that when I complained of the chest pressure she immediately said okay, stress test for you!

I hope my experience can be of some help to you. If I were you, I would walk over to my telephone right now, call the cardio's office, tell them you are thinking of cancelling your stress test because you've read it might be dangerous for you. If they say, oh sure, honey, whatever you want....I would seriously consider changing doctors. If they put you through to a qualified nurse to discuss it, then make sure you have some questions ready and get all the answers you can. If they say that the doctor will call you back him/herself at the end of the day then you know it's an important thing and he/she will listen to your concerns and questions respectfully. Have that little list ready!

Good luck. Keep us posted.

Marguerite

 

[ALCapshaw2]

By all means, give a copy of the AAFP guidelines to your Cardio (or call beforehand and ask to speak to his nurse about your finding). Somebody needs to WAKE THEM UP.

Stress Tests, and especially nuclear stress tests, are primarily used to check blood flow to your heart under stress, i.e. to see if your Coronary Arteries have any blockage. I have no idea if they show anything in regard to valve disease.

The "contraindication" with Severe Stenosis is that the valve could CLOSE OFF and then it's ADIOS AMIGOS. This is one of the leading reasons that athletes 'drop dead' on the basket ball court or playing field.

'AL Capshaw'

 

[Karlynn]

Ashley, if you aren't feeling well while doing the test, then stop. So often we do things that the doctors tell us and think we'll "flunk" if we don't follow through all the way. Remember, you're the one in control.

 

[savysmommy]

Ashley,
I too had a BAV - But, I had severe insufecency rather than stenosis. I did the stress test, I made it I think 11 minutes. Thats when my cardio decided to medicate me and watch. I started going down hill shortly after the stress test. Even if it had nothing to do with it... less then 3 months later I had surgery. So.. it makes me wonder if there was some connection. I felt like absolute hell after the stress test! It reminded me of how I felt a few months prior, when I knew nothing of my condition and I TRIED to go for a jog.. Got real sick.. and couldnt figure out why I felt that way.

Anyway, Good luck Monday.. I think the risk of sudden death is probably rare, and they do (or should) have a doctor in their the entire time supervising it.

Take Care,
Shannon

 

[inlaguna]

I exercised with severe stenosis, but did not do a stress test. I only pushed my heartrate to 130 when I was in severe/critical right before surgery and I know many on this forum would say I was nuts doing that. The last formal stress test I had done was when I had moderate stenosis prior to surgery ( about 8 years ago). I did OK, but it was rather taxing as I recall......despite being in pretty decent shape at the time. My max heartrate (180) and BP were all within normal limits as was recovery time.

You are more prone to a-fib and other things while under exercise stress and it is extremely wise to have the test done at a facility ( hospital) that can react and treat quickly if something does happen

 

[jax3172]

An alternative to Stress Test

An alternative to Stress Test

I am not a doctor but, based on your current data, I urge you to not have a stress test. I would I think that a reasonable alternative to te Ssess test would be a CT scan of the chest with contrast (dye). I had one last week and my cardiac surgeon said that it (along with recent echo) is all he needs for a complete diagnosis and surgical recommendation. IMO, it provides much better data than a stress test with none of the risks.

 

[Phyllis]

Dick asked both the cardiologist and surgeon if they would do a stress test as he just didn't believe he was ready for the surgery , and both absolutely refused to do it.