Problem still exsists - tests indicate 'normal'

[KH]

I had recently been to a cardiologist to get a series of test for
shortness of breath, tightness in chest, soreness in shoulders, etc..
during exertion.

On the basic stress test, it came back 'positive' - I reached my max
HR of 180 in just over 5 minutes (I'm 40). So I did a echocardiogram,
and a nuclear stress test. Both results showed 'normal', however,
there was a trace amount of leakage in both valves, but was told that
it was just a trace, and nothing serious.

This thing is really nothing new for me - I've had this fast HR during
exercise ever since I was a kid. Just the discomfort is increasing a
bit now, and as I age a bit, it is more concerning to me.

So, the question is: If, as the test shows, I am 'normal', why would
my HR go up so fast and I am experiencing these discomforts? For
instance, when I am backpacking on fairly level ground, moving along
at about 2- 2.5 mph, my sustained HR is about 172 - 176 bpm. Start
pulling hills, and it is easily up to, or over, 200 bpm.

They did also perform a PFT test and that came back normal.

Should I seek a second opinion, or is this truly normal? While I don't
think I'll get to the point where I'll feel I'll have a heart attack
or something like that, I am concerned that my heart working this hard
all these years will eventually 'wear out'.

Any advice?

[Dr. Andrew B. Chung, MD/PhD]

KH wrote:

> I had recently been to a cardiologist to get a series of test for
> shortness of breath, tightness in chest, soreness in shoulders, etc..
> during exertion.
>
> On the basic stress test, it came back 'positive' - I reached my max
> HR of 180 in just over 5 minutes (I'm 40). So I did a echocardiogram,
> and a nuclear stress test. Both results showed 'normal', however,
> there was a trace amount of leakage in both valves, but was told that
> it was just a trace, and nothing serious.
>

The nuclear stress test may be erroneous (a false negative) since your
symptoms are typical and your "basic" stress test was "positive."

The echocardiogram is not an appropriate test for evaluating chest pain.

The usual standard of care is for a "positive" stress EKG test to lead to
a heart catherization rather than a nuclear stress test.


>
> This thing is really nothing new for me - I've had this fast HR during
> exercise ever since I was a kid. Just the discomfort is increasing a
> bit now, and as I age a bit, it is more concerning to me.
>
> So, the question is: If, as the test shows, I am 'normal', why would
> my HR go up so fast and I am experiencing these discomforts?

The nuclear stress test may have been erroneous (false negative).

> For
> instance, when I am backpacking on fairly level ground, moving along
> at about 2- 2.5 mph, my sustained HR is about 172 - 176 bpm. Start
> pulling hills, and it is easily up to, or over, 200 bpm.
>
> They did also perform a PFT test and that came back normal.
>

So you do not have lung disease.... back to the heart.

>
> Should I seek a second opinion, or is this truly normal?

Would suggest a second opinion preferably from a cardiologist.

> While I don't
> think I'll get to the point where I'll feel I'll have a heart attack
> or something like that, I am concerned that my heart working this hard
> all these years will eventually 'wear out'.
>
> Any advice?

See above.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

[KH]

Thanks for info. One question regarding the Thallium (nuclear) stress
test, though.

From what I have read, the heart should be fairly well stressed for
this test. Some items I have read said the exercise should be up to
your limit. When I did it, the excercise portion lasted about 3
minutes on the treadmill, until I got up to my target HR (about 153
bpm), then injected and stopped. At that point, I was barely even
breathing harder. Could a false negative be rendered if the heart
wasn't working hard enough to get a really adequate picture of what is
going on? I'd think that maybe after 10 minutes or so at 180-190 bpm
would be much more accurate to determine blood flow. As a patient you
don't want to say anything because they are the experts, but I would
like to know what is the 'common' way this type of test is performed.
Thanks.



"Dr. Andrew B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote in message news:<3FD78637.92971113@heartmdphd.com>...
> KH wrote:
>
> > I had recently been to a cardiologist to get a series of test for
> > shortness of breath, tightness in chest, soreness in shoulders, etc..
> > during exertion.
> >
> > On the basic stress test, it came back 'positive' - I reached my max
> > HR of 180 in just over 5 minutes (I'm 40). So I did a echocardiogram,
> > and a nuclear stress test. Both results showed 'normal', however,
> > there was a trace amount of leakage in both valves, but was told that
> > it was just a trace, and nothing serious.
> >
>
> The nuclear stress test may be erroneous (a false negative) since your
> symptoms are typical and your "basic" stress test was "positive."
>
> The echocardiogram is not an appropriate test for evaluating chest pain.
>
> The usual standard of care is for a "positive" stress EKG test to lead to
> a heart catherization rather than a nuclear stress test.
>
>
> >
> > This thing is really nothing new for me - I've had this fast HR during
> > exercise ever since I was a kid. Just the discomfort is increasing a
> > bit now, and as I age a bit, it is more concerning to me.
> >
> > So, the question is: If, as the test shows, I am 'normal', why would
> > my HR go up so fast and I am experiencing these discomforts?
>
> The nuclear stress test may have been erroneous (false negative).
>
> > For
> > instance, when I am backpacking on fairly level ground, moving along
> > at about 2- 2.5 mph, my sustained HR is about 172 - 176 bpm. Start
> > pulling hills, and it is easily up to, or over, 200 bpm.
> >
> > They did also perform a PFT test and that came back normal.
> >
>
> So you do not have lung disease.... back to the heart.
>
> >
> > Should I seek a second opinion, or is this truly normal?
>
> Would suggest a second opinion preferably from a cardiologist.
>
> > While I don't
> > think I'll get to the point where I'll feel I'll have a heart attack
> > or something like that, I am concerned that my heart working this hard
> > all these years will eventually 'wear out'.
> >
> > Any advice?
>
> See above.
>
> Humbly,
>
> Andrew

[Dr. Andrew B. Chung, MD/PhD]

KH wrote:

> Thanks for info. One question regarding the Thallium (nuclear) stress
> test, though.
>
> From what I have read, the heart should be fairly well stressed for
> this test. Some items I have read said the exercise should be up to
> your limit.

Should up to about one minute *before* your limit.

> When I did it, the excercise portion lasted about 3
> minutes on the treadmill, until I got up to my target HR (about 153
> bpm), then injected and stopped. At that point, I was barely even
> breathing harder. Could a false negative be rendered if the heart
> wasn't working hard enough to get a really adequate picture of what is
> going on?

It is possible that had your heart rate been higher, they would have noticed something on the nuclear images.

> I'd think that maybe after 10 minutes or so at 180-190 bpm
> would be much more accurate to determine blood flow.

Accuracy won't be improved but correlation with earlier stress test might have been better.

> As a patient you
> don't want to say anything because they are the experts, but I would
> like to know what is the 'common' way this type of test is performed.

Both ways are common (to target heart rate and to peak tolerated stress).

>
> Thanks.
>

You are welcome :-)

Humbly,

Andrew
--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/