Stress Tests: Kick 'Em While They're Down?

[tobagotwo]

I may be nuts, but I don't understand why they take someone who has a known issue with cuff leakage or other valve damage, and is down to a very minimal EF (such as, say, 15%), and have them do a stress test.

At that point, what more knowledge is actually gained beyond what is already known from the standard echo? What in those results would possibly make them decide to change their planned course of action?

Why would a cardiologist want to run a person in that condition until they drop?

I'm not asking why they do stress tests in general, or what stress tests generally show. I'm asking why they do stress tests in people who plainly can't afford the exercise, and whose need for treatment and type of treatment needed is already obvious.


Dumbfounded,

 

[Granbonny]

Bob

Bob

I had never heard of a stress test..until a year ago..when my hubby went to local clinic feeling not up to par. I was in jury duty and did not know he went....sent him down for stress echo..I was still in jury duty..My cardio walked by and saw him..and said, let's do a Cath of heart on you. Sure, he says..but Cardio said, you need family. Where's bonnie. He said, in jury duty..so he called daughter to come over. She called me on mobile. I left jury duty and went down. It was over and he was flirting with nurses... My Cardio told him and me and daughter that his EF was around 35% and would not get better and put him on BP meds 2 a day..That was a year ago..Just 2 checkups since..one with cardio and 1 with clinical nurses. The man still works like a horse. Just finished remodeling kitchen..He will be age 74 in Nov. and looks more like someone in their 60's.. Ask, Ann, she met him..so I feel like his ef at 35% is not bothering him much..Our Cardio must not worry either.Hubby told me he was fine during stress test..but they must have seen something to want to do a Heart Cath.. I now remember. he did have a follow-up regular echo 6 months later and EF was a little better.not much. His b/p is great like 120/70 but has a low pulse rate. Like low 60's but has always had a low pulse rate. Bonnie

 

[Nancy]

Joe can't have a regular treadmill stress test because he could faint at the fast paces because of his pulmonary hypertension, he also has foot problems which would have caused problems on the treadmill at a fast pace. He does the treadmill at home, but at a slower pace. I was very concerned because his cardiologist wanted to see how his heart and pacemaker reacted at the faster heart rates to make sure his heart rate would increase properly with activity, and his heart function would react correctly.

He had a Dobutamine stress test, but even at that I guess he reached the max Dobutamine level before he reached the max heart rate they wanted which was 160. The test was stopped at 108. He felt terrible for about three days. It wasn't the Dobutamine because it has a short half-life, it was the test itself.

Let's face it, we all have to move around and maybe the cardiologist in this case wanted to see the limitations this man had when his heart was stressed, so they could adjust his medications, or suggest some other kind of correction (pacemaker, defib. or some of the newer heart appliances which are coming out to help with weak heart muscles), but I agree that a treadmill test seems cruel and unusual.

 

[Susan BAV]

My dad hated stress tests. Years ago an old doctor told him that he could get the same results from jumping up and down in the doctor's office and that most of the treadmill tests were just to make the doctors money. Cynical, of course. But that doesn't even address the issue of stressing patients with huge medical issues, as you have described.

Anyway, however, the last treadmill that my dad took was at his cardio's insistance and my dad knew that he would pass out (severe hypertrophic cardiomyopathy) and he did. But, his heart also stopped and they had to use the shock paddles on him three times, upping the voltage (or whatever) each time, to get him going again. It scared the cardio half to death and my dad felt vindicated, that not only were those things unnecessary, as had been his opinion, but they were also a menace. Cruel and unusual, indeed, in some cases at least.

I had a stress echo a couple of weeks ago (on a bike contraption, though, and not on a treadmill) and I haven't felt quite up to par since. And I don't even have a big health problem anymore.

 

[Karlynn]

I hate stress echos with a passion unequalled to anything else. The big thing they tell you NOT to do after physical excertion is to sit or lay down immediately and that's exactly what they do with a stress echo. I lay there, my heart jumping out of my chesting thinking "No wonder they have a doctor present - I'm going to have a heart attack."

 

[Phyllis]

****, in the month leading up to his AVR last December kept asking every cardiologist we got an opinion from if they would give him a stress echo. He was in complete denial that he needed the operation or that he was having any symptoms. He had fainted on the tennis court and still felt it was due to dehydration. All three cardiologists refused to give him a stress echo and said he would be "hard put to find one that would."

 

[tobagotwo]

Stress Tests and ACC-AHA Guidelines

Stress Tests and ACC-AHA Guidelines

I was just going through the ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease, and came across this:

"Exercise testing in adults with AS has been discouraged largely because of concerns about safety. Furthermore, when used to assess the presence or absence of CAD, the test has limited diagnostic accuracy. Presumably, this is due to the presence of an abnormal baseline ECG, LV hypertrophy, and limited coronary flow reserve. Certainly, exercise testing should not be performed in symptomatic patients."

Apparently, there is some agreement that this is the wrong time to exercise stress test. Most of us know of someone who had a heart attack or near miss (e.g. former President Clinton) within weeks or months of an exercise stress test. The ACC/AHA Guidelines seem to acknowledge that they are not effective for determining CAD, at least in some circumstances, and dangerous in others (no kidding!).

Best wishes,

 

[JimChicago]

It might be in many cases that tests like the stress test are prescribed since if the Doctor didn't prescribe it and someone had a later problem it could be said that the Doctor was negligent in not prescribing the the test.

I've heard of several people who have died during their stress tests - a sad way to find out there is a problem.

I have enough stress as it is and I don't want to get any stress tests.

 

[Marguerite53]

thanks!

thanks!

Bob. Your timing is uncannily perfect. I'm scheduled for my second ever treadmill nuclear stress test next wednesday and dreading it. I don't understand why she is calling for one. I think I'll cancel it.

I went in complaining of chest pressure and extreme (for me) exhaustion that wouldn't quit. She took me off a new Rx (spironolactone) which my GP had given me 2 months before and put me on Dioxin 80. I felt renewed and my old self again in two days. It must have been the meds. It hasn't returned.

You are all my angels, I'm sure. I'm calling to cancel. She's not going to like it. I'll fax her my old results, how different can a year be? Like it's going to be better??

Thanks everyone!!

Marguerite

 

[Susan BAV]

Marguerite -

Just one thing... I believe I have read that when bicuspid valves fail or begin to fail, they can do so rapidly. One symptom for me was 'extreme' exhaustion. There are some other tests they can do besides a stress echo, however, to test the valve's decline. One doctor did some kind of an MRI with contrasts of my heart, I think it was called but I'm not sure if that was exactly the correct name for it.

But it seems odd to me, as I read your 'signature,' how your doctors can specifically expect that your valve might need replaced in 2006. My (former) cardio told me that mine "might never need replaced," only several months before it was failing and needed replaced! This isn't to worry you but just something to think about. Best wishes.

 

[Marguerite53]

Bob, I'm hijacking your thread, for a minute...

Bob, I'm hijacking your thread, for a minute...

Susan,
Thanks for your concern. I didn't like the extreme exhaustion either, and thought I might be failing so I went right in to see her. She said that complaining of chest pressure (or carrying around a weight is what it felt like) is what bought me a ticket on the tread mill. Now that the pressure feeling is gone (new meds, or was it a virus??), I'm questioning the dreaded procedure (I thought I was going to explode last time, but technically, to me, no dizziness or pain). As far as my signature goes, my first cardio said I would definitely need an AVR in one to 3 years (in Sept. of 2003). I think my current cardio kind of nodded when I mentioned the remark. My valve is narrowing slowly but surely, currently at .95 cm sq..

Anyway. I've put a call in to the cardio's office and am waiting for a nurse's reply. She is the stress test nurse, so I'll ask as many questions as I can and get back to you, especially if I can wiggle my way in to answer Bob's frustrations!

Bob, I was looking through those guidelines in search of your quote about discouraging testing in AS patients, etc. Can you link me through?

Later. thanks. Marguerite

 

[tobagotwo]

Here's the link to those ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease, also available through Ross's "Must-Have Reference Links" in the Reference Sources Forum: http://www.acc.org/clinical/guidelines/valvular/jac5929fla16.htm

Marguerite, I concur with Susan that if you are having a sudden upswing of symptoms, you should still have it checked. However, I also think it is appropriate to bring a printout of the contents of the ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease from the link above to your cardiologist. You might say you don't feel safe doing a stress test and want a different type of test. You are a symptomatic patient. The guidelines seem very plain about not exercise-testing ("stress-testing") symptomatic valve patients.

The type of test Susan was referring to was likely what is termed an MRA (basically an MRI used to delineate the coronary arteries, or in the case of one I had, the carotid arteries). MRI stands for Magnetic Resonance Imaging, MRA for Magnetic Resonance Angiogram. There is an injected dye used to illuminate the arteries, but there is no radiation involved. It's all done with magnets...

Best wishes,