I posted several months ago of pins and needles sensations in the left arm and hand. They come and go several time a day and last up to 30 secs. Well, they have not gone away and in fact have become more pronounced. Fearing cardio issues, I asked my Dr. to write the medical order for the next level up tests. In two weeks I am scheduled for a nuclear stress test. I have read up on the Bruce Protocol and understand the test is progressively stepped up every 3 mins until your max HR (or exercise) limit is reached or problems precipitate. I started going to the gym last week to get accustomed to the incline and speed changes that take place at the various test stages. Are you allowed to hold on to anything during the test? I would think you need some type of bar to hold at inclines above 15% to maintain stability. The treadmills at my gym will max out at 15% incline, I definitely need to grab the top of the machine (I canít imagine what 22% is like). I understand from reading many outstanding posts on this board that the test is not 100% conclusive, but it is an accurate test. Especially in finding advanced CHD, above 70% blockage. Also, I see mentioned that false positives and negative do occur and the test results should be considered together with your numerous and specific risk factors. I was told by the hospital that they only bring you to the max HR then stop the test, usually 10 or 12 minutes. I donít support this stoppage and for this reasons I plan on getting my monies worth by instructing the technician that I want to be pushed to the absolute extreme maximum limit of my exercise endurance. I suspect that this makes the test more accurate. Also, I understand that the higher your score (METs and stages completed) the better the prognosis, regardless of other findings. Generally speaking, do you think these assumptions are correct? Any long term risks from the radiation dose?
Any other relevant comments?
Low Side Stuff
I am 54, big family history of CHD, my Chol has always been on the high side with low HDL numbers.
High Side Stuff
No health issues to date, normal BP, sugar, LP(a) and homosys. In good shape with good exercise tolerance. I eat very well all the time, high nutrition foods only, low fat consumption, semi vegetarian. Also, I take numerous supplements. This has been my life style for over 15 years now.
I had a nuclear stress test the end of June. It was called a Mibi scan. I worried myself sick before the test, and really, it wasn't that bad. I went privately, so the whole test took 3-1/2 hours. In the hospital, it was a 2 day procedure. They put an open IV line in my arm, injected me with the dye. I waited an hour - they had a TV in the room, and then they took a series of "pictures". After that, I was allowed to have juice and coffee - waited another 1'2 hour, and went on the treadmill. I wasn't on that long - it's not a test to see how long you can stay on. You are monitored to the EKG machine and they take your BP every few minutes. When your maximum heart rate is reached, they inject you with dye again. They more "pictures" are taken. Thank goodness my results were normal. It's a good test to see if you have blockages by the way the dye flows through. My EF was 70% in that test, and 60% on an echogram that I had the following week. Also, I had no reaction what so ever to the dye.
I also have also worried much over this during the past two weeks and look forward to getting it over. Glad your test was normal. That must have been a big relief. Another thing, exercising on an empty stomach at 7:30 am is not appealing. Glad to see they allowed a snack time.
From what I have read, completing into stage 6 is very good and a sign of very good conditioning. It seems you could have gone longer but the doctor felt he could capture all needed data at the 16 min point and stopped the test. Do you feel you could have gone longer?
The Bruce test steps progressively though 7 stage as follows:
0 to 3 min 10 % @ 1.7 mph
3 to 6 min 12 % @ 2.5 mph
6 to 9 min 14 % @ 3.4 mph
9 to 12 min 16 % @ 4.2 mph
12 to 15 min 18 % @ 5 mph
15 to 18 min 20 % @ 5.5 mph
18 to 21 min 22 % @ 6 mph
Re accuracy, thatís amazing that the test failed to pick of your blockages in Nov. Do you recall what was the last stage # you were able to complete and did you exhibit symptoms during the test? I understand how the heart remodels itself with collaterals to balance the supply and demand equation. This concerns me because like you I am also in very good condition. So, it is possible that very fit people may have more false negatives. This is why I am going to request testing at the extreme limits of my endurance. I believe as the demand is increased through the protocol stages, the hearts capacity to re-energize via the blood supply will be challenged. Predicatively, test failure will occur if significant blockages exist. It is possible that collateral supply may meet needs at 17 min but not 18 min. Tomorrow, I plan on going to my local gym and getting on a treadmill to give the Bruce a trial run. I will report my experience, distance and time results tomorrow.
Rig - don't worry about exercising on an empty stomach - I was thinking the same thing. You don't feel sick because of fasting. After the first set of "pictures" I was only alllowed juice and coffee (no solid food), because I still had to go on the treadmill. I remember that I held on with my fingers - when I used my whole hands, something was getting in the way of the "recordings". But why do you feel that you have to exert yourself so much? The technician set the speed and I did what he told me to. There was also a cardiologist in the room as well, but he just sat in the background. That was probably in case I had chest pain. Are you having it done privately? Did you mention that you have an exercise treadmill stress test before?
Re: Left Arm Pins and Needles + self administrated stress testing
Your cautionary advice is much appreciated and I thank you for it. Re your false negative test result, the theory offered by your cardio doc seems plausible and applicable since you are physically conditioned. After all, our bodies are excellent machines and when it comes down to compensating for primary system failures our bodies come up with solutions. I guess it is reasonable to assume that the blood volume handling capacity of the collateral infrastructure approaches that of the normal capacity of a disease free LAD / RCA, or at the very least a significant percent thereof. Ranaj, I was off to the gym before reading your email. Again, I do appreciate the 100% solid advice given.
Other then this weird arm / hand pins and needles sensation that I have had for 5 months, which may or not be heart related, I am CHD symptom free. I exercise 5 plus times per week and experience no discomfort. In fact, during and after exercise, I feel my best. Lately, I have begun to dwell excessively on my heart along with other facts, such as my poor family heart history and my sub optimal lipid profile. This tends to make me think every burp is the on set of the big one. So, I decided to get to the bottom of all this and asked my Dr. for the stress test. He recommended the nuclear type. This was for my peace of mind.
I completed the self administrated Bruce Protocol test today. It was tough and very challenging. No discomfort or negative symptoms manifested themselves. So, I am very glad and this has given me hope that my bad family genes have not got me yet. As the real test approaches, next week on Friday, I have a positive outlook heading into it.
The treadmills at my gym only go to 15% of elevation, so the last 3 stages of the test received no additional incline increase. I was pretty much exhausted but not in any discomfort at the 21 minute point, so, I added one additional stage of 3 minutes at 6.5 mph, just to be sure (more like extra stupid). The 15% incline max limit at my gym makes the test not exactly equal to the formal Bruce test. I guess it to be at lest 80% plus of the real test. I guess I will find out soon enough.
Note: I do not advocate taking such a risk. I was OK with it because I know my exericise capacity. I have been swimming in the Virginia masters program for years. This program is strenuous and as a result I am used to pushing myself to the limits of my endurance during distance or sprint swims.
I will let all know the results of my test. The test is at the hospital, I have never had this test before so all of your inputs have been helpful. My insurance will cover it. I hope they give me some kind of indication right away so I donít have to wait all week end and then some for my doctor to call.
Rig - is it possible that your pins and needles are coming from your neck (osteoarthritis)? I had similar symptoms many years ago - had an MRI and went to a neurologist for some testing. It was osteoarthritis and eventually got better,after some physio. As I mentioned before - don't worry about the test and how long and how fast you have to be on the treadmill. It's not a test to see if you can be on the football team!!
Arlmon18, thanks for the encouragement and insight into the process. The arm issue may not be CHD related, thatís what I hope. Both my parents had CHD. So, I canít rule out anything yet. The nuclear stress test should go far in making this determination. I do believe it to be very accurate test based on my research.