Problem still exsists - tests indicate 'normal'

Discussion in 'Health and medical' started by Kh, Dec 17, 2003.

  1. Kh

    Kh Guest

    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?
     
    Tags:


  2. 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/
     
  3. You're right to be concerned. How fast does your HR recover? If you get your HR up to 180 and then
    rest for a minute, what is your pulse rate? If your pulse rate doesn't decline by at least 12 beats
    that's a further risk indicator. Also, what is your resting pulse rate? Already you have higher risk
    from lasting such a short time on your stress test. How's your blood pressure, and are you on meds?

    [email protected] (KH) wrote in message
    news:<[email protected]>...
    > 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?
     
  4. Kh

    Kh Guest

    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" <[email protected]> wrote in message
    news:<[email protected]>...
    > 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
     
  5. Kh

    Kh Guest

    Thanks for the info.

    My resting HR is pretty much normal - about 80. Blood pressure is normal as well, 78/120, I think.

    My HR after high stress does come down quickly, and I know from what I have read at least that is a
    good sign.

    I decided to buy a HR monitor (a polar A3, supposedly fairly accurate)and wore on this last
    weekend's backpack adventure.

    My average walking HR stayed somewhere around 155-165 for mostly flat, or very slight uphill
    walking. On the longest uphill, it peaked at about 196. Other hills were about 180-190.

    while I can do this all day (each day was about 9 miles), my main concern is that as I age, all this
    hard work of my heart may wear it out faster than it should. Is this a valid concern?

    One thing of note from this last outing, I only felt some very slight chest discomfort this time.
    Sometimes I get quite a bit, along with discomfort in the shoulders, neck, jaw, other times, pretty
    much feel fine.
     
  6. 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/
     
  7. Andrew Kerr

    Andrew Kerr Guest

    "KH" <[email protected]> wrote in message
    news:[email protected]...
    > 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.

    I'm not Dr Chung, I'm another Andrew. I'm a nuclear medicine technologist who spends most of his
    time in nuclear cardiology.

    My opinion is that you were not adequately stressed for the thallium scan to be accurate.

    Standard procedure in our lab is to exercise the patient to their target heart rate, inject the
    tracer, and keep the patient exercising for at least one minute after tracer injection. If we find
    that a patient has reached their target too soon (in our opinion) we will keep them going as long as
    they are able to continue safely.

    The fact that you reached your target within the first stage (three minutes) is a bit concerning to
    me, though I would defer to a cardiologist on that point. Our physician will usually use a
    pharmacological stress in combination with a slow walk in patients who reach their target that early
    on the standard stress test. Do you know what your blood pressure was during the stress? I would
    expect a 40 year old to go at least 6 minutes into the Bruce protocol before I'd inject the tracer,
    depending of course on symptoms and ECG changes.

    Andrew Kerr M.R.T.(N.)
     
  8. [email protected] (KH) wrote in message news:<[email protected]>...
    > Thanks for the info.
    >
    > My resting HR is pretty much normal - about 80. Blood pressure is normal as well, 78/120, I think.
    >
    > My HR after high stress does come down quickly, and I know from what I have read at least that is
    > a good sign.
    >
    > I decided to buy a HR monitor (a polar A3, supposedly fairly accurate)and wore on this last
    > weekend's backpack adventure.
    >
    > My average walking HR stayed somewhere around 155-165 for mostly flat, or very slight uphill
    > walking. On the longest uphill, it peaked at about 196. Other hills were about 180-190. Karl,

    Glad your resting heart rate and BP are normal. The fact that you can backpack all day is also a
    good sign. One question - has this high heart rate with exercise something new or something you've
    had for years? I'm not a doc, but I don't believe your heart can "wear out." Exercise is generally
    good for your heart. One thing I'll suggest is trying to eat as heart healthy as possible. Avoid the
    western diet of "meat and potatoes." According to Dr. Willett at Harvard up to 80% of CHD can be
    explained by poor diet and exercise habits. See
    http://www.hsph.harvard.edu/nutritionsource/pyramids.html

    > while I can do this all day (each day was about 9 miles), my main concern is that as I age, all
    > this hard work of my heart may wear it out faster than it should. Is this a valid concern?
    >
    > One thing of note from this last outing, I only felt some very slight chest discomfort this time.
    > Sometimes I get quite a bit, along with discomfort in the shoulders, neck, jaw, other times,
    > pretty much feel fine.
     
  9. Andrew Kerr

    Andrew Kerr Guest

    "KH" <[email protected]> wrote in message
    news:[email protected]...
    > Thanks for the info.
    >
    > My resting HR is pretty much normal - about 80. Blood pressure is normal as well, 78/120, I think.
    >
    > My HR after high stress does come down quickly, and I know from what I have read at least that is
    > a good sign.
    >
    > I decided to buy a HR monitor (a polar A3, supposedly fairly accurate)and wore on this last
    > weekend's backpack adventure.
    >
    > My average walking HR stayed somewhere around 155-165 for mostly flat, or very slight uphill
    > walking. On the longest uphill, it peaked at about 196. Other hills were about 180-190.
    >
    > while I can do this all day (each day was about 9 miles), my main concern is that as I age, all
    > this hard work of my heart may wear it out faster than it should. Is this a valid concern?
    >
    > One thing of note from this last outing, I only felt some very slight chest discomfort this time.
    > Sometimes I get quite a bit, along with discomfort in the shoulders, neck, jaw, other times,
    > pretty much feel fine.

    Your heart rate of 160 when walking flat is WAY too high. Have you had a Holter monitor test?

    Andrew
     
  10. Kh

    Kh Guest

    I am not sure what a Holter monitor test is, so I suppose I haven't had one. I think that sometimes
    being in a HMO plan, that unless you appear to be on the brink on death, they tend to do what is
    minimaly required to try to avoid malpractice suits, or to pacify the patentient. I really can't
    blame the doctors - the insurance companies really seem to running the show.

    In any case, this is a condition I've ever since I can remember, so in some sense, I've never
    considered myself to be 'abnormal'. So, I suppose, my heart has just become accustomed to beating
    like a little bird heart :))

    I'm not the type that likes to run to the doctor for every little thing, and I almost felt silly
    going to the docs about this. It is just as I get older and start to think about mortality more, I
    have been more concerned, and if there is a treatable problem, it would be nice to get it fixed.

    Thanks all for the info!
     
  11. Andrew Kerr

    Andrew Kerr Guest

    "KH" <[email protected]> wrote in message
    news:[email protected]...
    > I am not sure what a Holter monitor test is, so I suppose I haven't had one. I think that
    > sometimes being in a HMO plan, that unless you appear to be on the brink on death, they tend to do
    > what is minimaly required to try to avoid malpractice suits, or to pacify the patentient. I really
    > can't blame the doctors - the insurance companies really seem to running the show.

    A Holter Monitor is something you wear for a length of time and it records your heart rythem. There
    is a button you press each time you feel chest discomfort, so the doctor can see what your heart
    rythem is like when you feel the discomfort.

    You could ask your cardiologist about it.

    Andrew
     
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