i failed the regualr stress test today, dr sd there were minor changes in the ekgs every 2 minutes. so now im set up for a nuclear stress test. question i have is if i already failed a reg stress test doesnt that mean im definete going to fail the nuclear also?? what does he mean by minor changes in the ekgs? he didnt elobarate
It seems like your doctor is just being cautious by ordering another exercise stress test, this one with imaging. Sensitivity of en exercise ECG is lower than that of stress imaging. The test you'll be having is much more expensive than the one you've just had, but also more accurate, yielding more information than an exercise ECG stress test. It provides a good assessment of blood flow and detects any ischemic areas within the heart.
Do you know which test you'll be having? Your doctor might decide not to put you on a treadmill. If you are physically unable to exercise, pharmacological agents will be used to simulate exercise. I don't think people can fail this particular test - one actually doesn't do anything but lie on a gurney. A drug, such as dobutamine is used to simulate exertion. There are doctors close by if needed. Prior to the test, an IV injection of a tracer is given. The subsequent imaging shows the distribution of a radiotracer throughout the left ventricle. Any areas not receiving adequate blood flow can be easily seen. The ventricle volume and ejection fraction are also determined. Images are taken again at rest. The test is an easy one to have compared to others. The only side effect I had was a nasty, long-lasting headache from the tracer. There is a small amount of radioactivity during the imaging process.
I've had both types of stress tests. Regular stress testing in unsuitable for people with abnormal baseline ECGs and in certain cirumstances, including chronic kidney disease and long-standing hypertension. The accuracy of testing in such settings varies greatly. I read that for this reason, an ECG stress test is a waste of time in people with chronic kidney disease.
I don't think you will fail this test so don't worry. Let us know how it goes. Good luck!
Last edited by flowergirl2day; 04-01-2009 at 10:37 PM.
As you say, the symptoms can be really strange and inconsistent. Pain comes and goes and so do all the weird sensations. While some of these manifestations are brought on by exertion, others are not. I wonder if it is "normal" to experience several different types and levels of chest pain.
As for the ECG abnormalities, unbalanced electrolytes (K) will cause changes and so will some rx drugs. That is why people are asked to stop their beta blocker a few days prior to the stress test.
Your doctor did not elaborate on his statement because he is not sure about the reliability of the ECG. That is why a better test is needed. You'll be fine.
does an abnormal exercise stress test mean that it can only be blocked artieries or could it be other problems? if so what else could be wrong
There are many variables in exercise stress testing. The unfavorable variables include angina and ischemic ECG changes during exercise, complex ventricular arrhythmias at low exercise workloads, fall in blood pressure during exercise, abnormal heart rate recovery and inability to increase the heart rate or systolic blood pressure with increased workloads. Functional capacity is probably the most important variable.
Normal, healthy people show ECG changes during exercise. Factors associated with changes that might be seen on an exercise ECG in people with potential problems are listed above. Myocardial ischemia manifests itself as angina at low exercise workloads and could represent an increased risk of a multivessel coronary disease or vasospasm. Wall motion abnormalities from a prior MI can be seen, as can ventricular arrhythmias.
One thing to remember is that the sensitivity and specificity of this test can be as low as 68-77% for obstructive CAD of more than 70%. So, false positives or negatives are possible. Sensitivity to detect CAD increases with the severity of narrowing of blood vessel, or when multiple vessels are involved.
Abnormalities in baseline (rest) ECG from conditions such as left bundle branch block, Wolff-Parkinson-White syndrome, left ventricular hypertrophy and digitalis therapy reduce the specificity of exercise test to exclude CAD. In these circumstances, it is best to use exercise stress tests with imaging. Other factors that can give a false positive result are severe anemia, low potassium, oxygen deficiency and MVP. So, the abnormalities on your ECG might not mean anything more than a low potassium level, which is easily corrected. Or, a false positive result, given the limitations of these tests. You'll just have to wait and see. Try not to worry too much! Meanwhile, read about the specificity and sensitivity of stress exercise ECG testing and you'll feel beter.
That is correct, according to my favorite book about cardiology, titled Cardiovascular Medicine, written by many experts in the field, edited by Willerson, Cohn, Wellens Holmes Jr. It covers every cardiology topic imaginable. It is huge (3000 pages) and heavy, so a bit awkward to read. Two volumes, instead of a single one, would have made more sense.
You'll have a better idea where you stand after your nuclear exercise stress test. I hope things will go well for you and that you'll get a clean bill of health. Good luck!