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goldyfm 02-20-2008 07:04 AM

Awaiting stress EKG results
I had a stress EKG yesterday but did not run on treadmill, but rather had the injection. I asked the technician what was the target rate of heart rate and was indicated I only achieved mid 80's on the test after the injection. I have other issues that prevent me from doing the treadmill and have had some instances of chest pain lately (mostly at night). I describe it as a pulling type pain and then some stabbing and smothering type pain. I wonder how accurate the injection stress EKG is compared to the actual running. Does anyone have any info on this subject?

huckfinn 02-22-2008 01:12 PM

Re: Awaiting stress EKG results
Goldy I am sorry but I have never had this test, either with the chemical injection or use of the treadmill. I do wonder about you max heart rate of the mid eighties only, that you achieved....

To me it invalidates the test results, unless the target heart rates are much lower than those of a nuclear imaged stress test, and I doubt that. Yours as well as mine should be around 145 bpm (for the nuke stress test).

Could it be that since you have a normally low heart rate, and you have valve problems as shown by more than a few echocardiograms, that they did not want your HR any higher than the mid eighties?

As far as the accuracy of running versus a chemically induced high heart rate, I would think the accuracy would be the same, as long as you met your target heart rate. It is done all of the time with regard to nuclear imaged stress test, that is chemically assisted versus use of the treadmill.

I wonder if they gave you the maximum dose of the chemical and you did not respond by achieving much higher heart rate, or if they only gave you a reduced dose due to your history?

Chest pain due to heart disease is so unique to all of us and we seem to describe it differently. I have had loads of real angina and I describe it as a dull, slightly burning pain radiating straight from my heart. I had a blockage that has been repaired that caused the same feeling in my back, directly behind my heart. The location of the blockage has a lot to do with where and how the pain is experienced. Of course I am getting off into the subject of CAD, instead of valvular disease.

The reason that I know what angina feels like for sure is when I had 2 of my 6 stents inserted, the Doc warned me that I was going to have a bad case of angina, because all of the blood flow to a certain area of my heart was going to be stopped while he inflated the balloon inside the stent that fully opens the wire mesh and presses it into the artery walls. This balloon stays inflated for 8-9 seconds. He was right! Wow what an attack of angina. Then he did it again while installing another stent. This time the pain did not stop and I thought I was having a heart attack (again). As they wheeled me out to recovery he said "don't worry, the angina will stop". It did after they maxed me out on morphine and nitroglycerine......War stories, lol.

Anyway, you should not have any chest pain at all. See your doctor!!! I have had some other "strange" heart pains, well I have them 24/7 and my heart feels "sore". I think it is the 6 stents and super high LVEDP. My LAD must look like a mess :(....

My wife is causing me much distress nowadays. She does not understand my limitations even though she knows that I was never lazy. It really hurts when I do not have support from her, (or somebody, lol).

My Diastolic Heart Failure includes reduced cardiac output as my HR increases. Even the smallest of chores fully exhaust me. She doesn't understand, or possibly doesn't believe me. Well there are plenty of fish in the sea....Huckfinnn

Oh yeah, I hope you lose the pain soon. Please take care of yourself neighbor :)


goldyfm 02-23-2008 06:13 AM

Re: Awaiting stress EKG results- Results in :(
Thanks Huck for your thoughts.

I got a call from my doctor (personally) who stated the Stress Test was abnormal and he wants to do an angiogram. He said it was not an emergency type situation, whatever that means, but that it did need followup. I am lost as to whether to seek this test immediately or if I can wait a few weeks. I was supposed to take care of some business that would take a couple of weeks away from home, but now I am wondering if I should delay. I now am hesitant to go away alone for a couple of weeks. I know that if they find a blockage and do angioplasty, I may be limited from travel for a while. I am researching this procedure now. Decisions, Decisions.

Huck, I do have valve problems, as you thought and am on Atacand to reduce the workload of the heart, as to whether that would affect the target heart rate is unknown to me. I did take the med prior to the test, so it could have had an effect on the test. I rest more than I am up lately. I know that I am deconditioned as one might say. I exhaust easily now and have not had good sleep since I was changed on Fibro meds. I sleep only 4 hours a night now if that. I even was given a temp handicap placard. I guess that shows my decline.

I know how stressful not having someone in your corner can be. I am pretty much alone when it comes to everyday and it is hard having all these tests, etc. I guess I will hire a driver when I have the angiogram. I dread even having to set it up. It is all so complicated when one is ill. Well I will ponder this dilemma over the weekend and decide Monday. I have already delayed my leaving. I just want to wake up one day with no health issues facing me squarely in the face.

jrmom1 02-23-2008 08:11 AM

Re: Awaiting stress EKG results
Goldy, if your Dr states an angiogram can wait, it can wait. Get your stuff done you need to. When he means yours is not am emergency, it means your test was abnormal, but not lifethreatening abnormal. 2 weeks is an average wait time for an outpatient, not hospitalized, awaiting an angiogram. Just dont overdue it, It sounds like you are fairly sedentary now anyways. As long as your business does not take you far from home, out of country, you should be fine ( I am thinking about insurance here)

Being in Canada, there use to be wait times of up to 9 months for an angiogram in an underserved area, so 2 weeks is very managable.

YOu will be very pleased after the angiogram is done. You will go in nervous but after it is done, will say it was not that bad . All the best to you

goldyfm 02-23-2008 08:44 AM

Re: Awaiting stress EKG results
thanks for the reply jrmom. I will be approximately 800 miles from home during my trip. I worry that I may get stranded there and have no one with me. Also it is a 12 hour drive and that is so tiring. I also know what is to be done once I get there and then a 12 hour return trip. I really don't think I am up to it now. I am going to mull it over before I decide. I don't like the idea of being so far away from my doctors until I know what I am facing.

jrmom1 02-23-2008 03:07 PM

Re: Awaiting stress EKG results
oooh 800 miles, alone , driving, that is stressful
I might rethink that one myself until you have your definitive answer ( the angiogram). Ask your cardiologist what he thinks about the drive

huckfinn 02-24-2008 09:00 AM

Re: Awaiting stress EKG results
Goldy :)

I have been studying your situation for a couple of hours. I got up at 3 am. Basically I have made a few notes pertaining to your current medicine-Atacand. When I hear the term "this medicine takes a load off of my heart", I think about the beta blocker class of medicines. So I had to study Atacand and it's possible side affects, and just exactly what it does.

I tried this specific drug, Atacand, probably over a year ago, after I developed the very common and intolerable side affects of the ACE inhibitors. I had taken them since my heart attack, but amazingly after about 3 years, the side affects started. Coughing and angioedema were the side affects. The angioedema caused my face and airways to swell.

Atacand is one of the newer classes of drugs known as ARBs (Angiotension Receptor Blockers) that block the angiotension II, AT1 receptors in our hearts and really anywhere the receptors are found. They do the same as ACE inhibitors but in a different way.

So I went for almost a year without taking any angiotension blockage medicine (ACE or ARB). I went through all of the ARBs, but could not find one that I could tolerate. So in desperation, I stated back on the old bottle of ACE inhibitors (Altace) I had and so far (6 months) I am ok. I don't have a cough but I still have some swelling in my lower airways, which I watch close.

The reason that I am telling all of this to you is because I am boring :) No, I believe that going without one of these classes of medicines last year and longer, allowed my heart to remodel and cause the Diastolic Dysfunction/Diastolic Heart Failure.

Per the pharm literature, ARBs (Atacand) can [B][I][U]possibly[/U][/I][/B] cause all kind of side affects/symptoms. Bradycardia is one. It also increases your potassium and serum creatinine significantly. Potassium helps with the control of our heart rate, and all muscle movement.

While you are taking Atacand, you need to have a basic metabolic panel blood test periodically, which measures sodium, potassium, chloride, bicarbonate, blood urea nitrogen (BUN), magnesium, creatinine, and glucose. It also sometimes includes calcium.

So I cannot tell if the Atacand affected your stress test. I will make an uneducated guess and say that it did not.

I do not know what you have to do so far away from home, but if it is emotionally or physically challenging, I would put the trip off for sure. It is kind of rare these days to receive a phone call from your doctor, although I have one that will call me and discuss all of my test results. I feel really fortunate to have found him.

If I were you, I would have the angiogram asap. I do not know your doctor, so I cannot determine the urgency involved or emphasized during the phone call. I do know as a general rule doctors do not want to alarm you. They know that this will only make the situation worse. Maybe you could call the nurse and arrange to speak with your doctor again, or have the nurse ask the doctor about when the angiogram needed to be scheduled.

There is nothing comparable to an angiogram when it comes to "searching and seeing" the condition of your heart and coronary arteries. There are many people that waited too long to have, or never had a chance to have an angiogram. I had a friend that I worked with for over 20 years that died of a a massive heart attack 2 weeks ago. He was 57, looked 47, and was the most active man I have ever known. He was a medic in VN.

After having the angiogram, you will feel much better. If nothing is wrong you can rejoice. If something is found, you can still be happy because it can be fixed and you can get your life back. You may still have to deal with FM, but the symptoms of FM and heart disease are so alike.

I have had 10 left side cardiac catheterizations, and 1 right side catheterization. They are a piece of cake. I had a left ventriculurgram during my last cath at the Cleveland Clinic. This is where the cath wire is guided through the aortic arch to the aorta and through the aortic valve. Once there, contrast dye is injected and shows all dimensions and volumes during systole and diastole, movement or lack of and any disease process that could affect the muscle of the left ventricle.

Start eating and put on some weight before the angiogram! Are you still very slim? If so, eat like a pig, lol.

If I can help, CALL ME :)


goldyfm 02-24-2008 10:05 AM

Re: Awaiting stress EKG results
Thanks Huck. Yes, I have decided to get this out of the way before I tackle the trip and all the work involved there. I am cautious as I am now the age of my father when he lost his battle with heart disease. I am the skinny one of the family and the rest of the family is healthy as horses when it comes to their hearts. I just caught all the familial cholesterol and heart problems. I am a little heavier than I was while working- I hover around the 140's now but I am still okay according to my BMI. I am the skinny one of the bunch but also have a little height compared to my siblings, so I am okay there. I know my lack of exercise due to the fibro fatigue is the culprit.

Yes I also was tried on 3 other heart meds, but could not tolerate. Procardia made me a nervous wreck, and the other two (Cozaar and Nifedipine) gave me a persistent cough. I have acquired a cough now, I am sure from my smoking and to add to that was intolerable. I have become concerned as I am experiencing some chest discomfort daily now. I was having some exertional chest pain and SOB but now it is becoming more routine than I would like. It was my revelation of this to the doctor that prompted the Stress test and I am sure it is probably a blockage or COPD related. I know that with my other heart issues, it is not wise to delay workup and repair if necessary. I have been under some extreme stress the last few years and I am sure that has not helped with my heart issues either.

Do you know if a Cardiologist with Nuclear credentials would perform the angiogram? Am I right that an angiogram is the same as what was commonly known as a heart cath? I am a little concerned as I had an uncle by marriage who died during a heart cath and a uncle by relation that died one day post cath. It really weighs heavily on your mind, knowing someone personally who reacted to the procedure itself. I know that it is likely that these deaths may have occurred even in the absence of the procedure, but it is unnerving to know the possibility so personally.

Well I will be calling tomorrow as I know that even though the heart valve issue is stable at the moment, any additional factors need to be addressed to ensure that I have the best chance possible in the event a valve replacement comes my way in the future. I am sure that a weakened heart would not be optimum to withstand the rigors of cardiac surgery/repair of any kind. Thanks for your comments and support.

Oh yes, I had a chem panel in January that was normal!

huckfinn 02-24-2008 04:45 PM

Re: Awaiting stress EKG results
Hi Goldone :)

Yes, an angiogram is done via a heart cath or cardiac catheterization.

Here is the deal.....I would not have it done on an outpatient basis. I did before and regreted it. It should be done where that if something were to go wrong.....It can be fixed, right? If they find a blockage >70% closed, they will want to stent it. If so, only use a drug eluding stent (DES). You will get immediate relief afterwards and it may save (have saved) you from a heart attack. If they want to do bypass surgery, try to resist until you are clear minded and have time to think. You have to sign a form giving them the right to insert a stent prior to the cath, if the policies have not changed. Of course you could talk them out of a stent, but I wouldn't.

You hit the hospital doors at early 30 :) . You will do the regular insurance junk. Next you go to a room and wait to be called back to another room where you get your gown on and an IV started. It could be a long wait, because someone may get ahead of you because they are in a very bad shape. Finally they will come and get you. They will slip you a tad of valium. Then when you get to the cath lab room, you will freeze your buns off, lol. Ask for heated blankets! These cath lab teams are a bunch of jokesters. They know how scared some people are.

Then the RN will inject you with a mixture of Versed and more valium. The Versed makes time go by really quick and causes amnesia, so you want remember what happened. I always do though. They want you consciously sedated, but still able to help them, say by coughing when they tell you to, or holding your breath. If you are still way to conscious, TELL THEM!

The doc will make a tiny, maybe 1/4 inch incision after giving you numbing medicine. The location will be high (really high) on the inside of your right groin, if women have groins....The doc will insert a small sheath for the cath wire to glide through your femoral artery, up your abdominal aortic artery, past your aortic arch and down into your left main and RCA. One side at a time. They will inject contrast dye into the left main and then take pics of the dye with a fluoroscopy camera (nuclear camera). They can even advance the cath wire down inside of your LAD or left circumflex. If you wear specs, keep them on so that you can watch the monitor. Where there is no dye, there is a blockage. Ask for a cd of the angiogram to take home with you. You may need it to show another doctor.

The whole thing is over in a blink of an eye. You cannot drive for a week, and your leg may be sore. You activities are also limited and you cannot lift over maybe 5 or 10 lbs. When you go back to your hospital room, you will have to keep your leg still for a few hours :( . You will spend the night. I start walking as soon as they say that I can, and I believe it really helps the soreness down the road, not to mention a blood clot, which you will have to watch for. This type of blood clot would not go to your heart or brain, it would just head for your toes, lol, but would not make it. It would cause pain and change of color. They can find them fast with ultrasound.

Goldy these docs do these all of the time. I really cannot understand how your family members ended up, unless they were in a small hospital with an inexperienced Interventional Cardiologist.

Any extra weight will be good for you.

Yours Truly,


goldyfm 03-01-2008 05:34 AM

Re: Awaiting stress EKG results
Catherization was done Wednesday and all turned out well. No blockages severe enough for stents or angioplasty at this time. I suppose the chest pains are due to other health issues. I can breathe easy for now. Thanks all for your concern and support.

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