Heart Exercise Stress Test - Help Please

Since there are so many doctors here, I was wondering if you could help me with a serious concern.

My wife went for her annual health check-up at the hospital. This time we went with the gold standard executive plan. She did a treadmill heart monitoring examination. The doctor called her up and said that based on the results, it looked like she may have a problem with her heart. However, she refused to give us any more information until the full report was available in 3 weeks!

My wife is mortified as she thought she was in good health as she is only 45 and has never had any heart problems. What could be the problem(s)? I would assume a blockage somewhere or coronary artery disease? What other problems could this imply? Also, she had to wear a mask during the exercise. Could this affect the results?

She had only taken 1 dose of 1 mg Rapa + GFJ two weeks before the examination.

These nurses keep dropping bombs on my family members, and it’s making us worry a lot! Thank you in advance for your help.

My wife had a treadmill heart echocardiogram a few years ago. The nurse noticed an anomaly and mentioned it, but told us that he would get in all kinds of trouble for discussing it with us. We talked to the doctor a few days later and discovered that she had a hole in her heart. We also learned that the hole, called a PFO, was mostly harmless. I would just call the Doc that ordered the test and be persistent. I hope you also get good news.

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I don’t think a treadmill test would tell you about coronary artery disease - thats usually done by a scan.

Perhaps some sort of arrhythmia. But I’m not a doctor, so I’ll let the doctors here weight in. I’d wouldn’t worry to much. Just wait for the full report. Likely they’ll do more testing, if its serious.

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Strictly my own biased personal opinion on treadmill stress tests and cardiologists in general, not to be construed as any kind of medical advice.

I personally don’t know anyone who has passed a treadmill stress test.

Not only have I done many stress tests over the years, but so have many members of my family.

I also did not know anyone from work receiving an “Executive Level Annual Physical” who took the treadmill stress test and didn’t have to go back for “further consultation”

The dialog with the cardiologist usually goes something like this:

“We noticed some anomalies and would like to do some further testing. We would like to do some ultra-sounds and a nuclear stress test.”

Later:

“Well, we got the results back. You look pretty good, but just to be sure we can do an angiogram. It’s the gold standard and then we can be sure. Also, while we are doing the angiogram we can place stents if needed.”

Do you think I jest? I think not.

Still tickin’ after all of these years with no stents.

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Thanks. That makes me feel better. However, the problem is we don’t even know what problem it is! The doctor just said to refrain from heavy physical exertion.

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Off topic, but does anyone know a good place to get a ct angiogram in the midwest (Cincinnati). I have seen prices from 500 to 5000 usd. Per Peter Attia the quality varies a lot from different providers.

I’ve done numerous stress tests and can tell you that there’s multiple variables involved.

  1. Does she have any symptoms on exertion like shortness of breath or dizziness?
  2. Is she at high risk with family history or risk factors?
  3. How many of the 4 stages did she complete?

In general, for multiple reasons, the ETT isn’t as specific or sensitive in women as in men. It’s an okay first line screening but don’t panic over it.
Usually the next step is either a stress echo or thallium. Both yield higher sensitivity and specificity.

IF this represents coronary artery disease or even coronary spasm then it’s actually a good thing that it was picked up early since it’s very treatable. Early detection is Everything.
But I wouldn’t be overly worried at this stage.
Here’s a nice review

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She has no family history and she was able to complete the test. She said her heart was beating fast at the end, but isn’t that normal?

Thank you for your kind assurances. We called the doctor and they will have the report ready for us this week.

The doctor said she had 10 patient reports with the same issue sitting on her desk at the moment so it is quite common???

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It’s an excellent sign that she was able to complete the test and that her heart rate went up.

Relax. She’ll be okay.

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A treadmill stress test can reveal a variety of issues: irregular heart beat when placed under stress. The echo cardio can reveal regurgitation (known as a heart murmur), which means that the valve doesn’t close completely – an issue that many people have and is harmless unless there is serious regurgitation. or thickening of the wall of the heart (it’s a muscle afterall) or a potential blockage or newar blockage of the aorta. If they didn’t say go right to the emergency room I think you’re safe in assuming there isn’t a critical issue. Invariably cardiologists want to place everybody on statins and beta blockers, which they do by trying to scare you with jargon. The RapAdmin is correct that artherosclerosis is better diagnosed with a Calcium scan and/or a blood test for Apo(b)

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As some people have already mentioned, treadmill stress tests aren’t the best test for diagnosing coronary artery disease. It can, however, be the first step in diagnosis. Usually – since it’s so noninvasive – it’s the initial screening prior to pursuing something more invasive such as an angiogram. I wouldn’t stress too much, since she clearly has a high exertional capacity given she was able to complete the test. Even if she has signs of disease, high exertional capacity = low mortality risk. That being said, she may still have had signs of ischemia, which may warrant further workup (like an angiogram). Not sure if you were suggesting that the rapa somehow contributed, but I can assure you it had nothing to do with the result.

Full disclosure, I’m just an MD student, but have several years of experience working in cardiology.

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Thank you all for your knowledgeable and comforting words. I guess that’s one drawback to early screening and detection - you may find out something that is wrong and that may cause concern or worry. However, I think that it is better to find out early, address any issues that exist, and do our best to be careful and healthy to improve our outcomes rather than to live on and die early in ignorant bliss.

We will pick up the health report ASAP and hope that it is something relatively benign or addressable. Thank you again.

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We got the results. The doctor said “Positive stress test indicative of ischemia”

How bad is that? Is there definitely a blockage? What’s the next step?

It’s just a positive ETT but remember that there’s a fair amount of false positives in young females from that test. They’ll want to do a more specific test next.

Also, remember that her ability to complete all 4 stages is a very good prognostic indicator.

Even if there’s an area of the heart that’s getting reduced blood flow, it can often be treated successfully with medications alone.

Whether it’s a true positive or a false positive she’ll be okay.

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Certainly not medical advice, but if it was me, I would go straight to the angiogram.
Your cardiologist will keep giving you other tests and still say something like:
“We need to have an angiogram to tell for sure what’s going on”
Otherwise, you subject yourself to many needless visits to the doctor and still end up getting the angiogram"
According to many articles I have read, angiograms are quite safe. My only objection is trusting the cardiologist not to put in stents that are not needed.

"Silent myocardial ischemia is typically defined as objective evidence of myocardial ischemia in patients without subjective ischemia symptoms. Currently, coronary artery angiography is the gold standard for diagnosis of asymptomatic coronary artery disease.

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No question that angiography is the gold standard. I suspect that they’ll certainly go there if a nuclear stress test confirms the results.

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I double checked with my wife. I was mistaken in that she completed all 4 stages. She only completed 3. How badly does this affect things?

Did they stop her due to the EKG findings on the monitor or was she just not able physically to complete it?

They stopped her due to her reaching some value on the monitor.

I think the odds are high that you will find multiple videos from Ford Brewer MD MPH on ischemia. He seems to focus on cardiovascular and he seems to know a fair bit. YouTube is never better than speaking to a physician but since you have a delay.