Stress test question

Trey B. said:

I recently had a stress test (Bruce protocol) and have a question.

I went for 15 minutes, 30 seconds, and they said they had "all the
information" they needed for me, i.e., I'd reached the target heart
rate.

My doctor seemed to think that was a really good result (no problems
were found).

My question is more along the lines of fitness. Is 15 minutes really
that good from a fitness standpoint?

It is.

Quoted message said:

I mean, I notice that the test
could have gone on for five more minutes. I work out a lot (bike, jog,
hike, etc.), and I really thought I'd do better. (In fact, I think I
could have pushed it to finish stage six.)

Not really worried about it. Just curious.

Ok.

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

"Trey B." <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

I recently had a stress test (Bruce protocol) and have a question.

I went for 15 minutes, 30 seconds, and they said they had "all the
information" they needed for me, i.e., I'd reached the target heart
rate.

My doctor seemed to think that was a really good result (no problems
were found).

My question is more along the lines of fitness. Is 15 minutes really
that good from a fitness standpoint? I mean, I notice that the test
could have gone on for five more minutes. I work out a lot (bike, jog,
hike, etc.), and I really thought I'd do better. (In fact, I think I
could have pushed it to finish stage six.)

Not really worried about it. Just curious.

I completed one a few months back and quizzed the staff about the
protocol. They used a HR target of 85% of age predicted maximum. (220 -
age) x 85%. Do you remember what your HR was?

Phil Holman

"Phil Holman" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

I completed one a few months back and quizzed the staff about the
protocol. They used a HR target of 85% of age predicted maximum. (220 -
age) x 85%. Do you remember what your HR was?

Phil Holman

Phil: They told me my target heart rate was around 185, and I hit that
after around 13 minutes.

Other info: I'd thought I was suffering chest pains a couple of weeks
before the stress test, which led to me seeing a cardiologist. Full
blood work revealed I had elevated Lp(a) (my reading was 87; should be
below 30). Other markers were pretty good; HDL 68, LDL 120,
Triglycerides 88. (A year earlier, my total cholesterol was 276. I'd
lowered it through diet and exercise alone, plus 600 mg a day of
over-the-counter Niacin.) Doctor said VLDL was also good, though I
can't remember exact number.

Because of the elevated Lp(a), I'm now taking 2000 mg of Niaspan a
day, plus a baby aspirin.

I'm 37, 5-9, 180 pounds (down from 210 pounds a year and a half ago).
Some history of heart disease in the family (grandfather died of a
heart attack in his early 50s, and my father, who is 67, has been on
statins for years. He exercises and eats well, and has had no cardiac
events so far.)

Trey B. said:

"Phil Holman" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

I completed one a few months back and quizzed the staff about the
protocol. They used a HR target of 85% of age predicted maximum. (220 -
age) x 85%. Do you remember what your HR was?

Phil Holman

Phil: They told me my target heart rate was around 185, and I hit that
after around 13 minutes.

Other info: I'd thought I was suffering chest pains a couple of weeks
before the stress test, which led to me seeing a cardiologist. Full
blood work revealed I had elevated Lp(a) (my reading was 87; should be
below 30). Other markers were pretty good; HDL 68, LDL 120,
Triglycerides 88. (A year earlier, my total cholesterol was 276. I'd
lowered it through diet and exercise alone, plus 600 mg a day of
over-the-counter Niacin.) Doctor said VLDL was also good, though I
can't remember exact number.

Because of the elevated Lp(a), I'm now taking 2000 mg of Niaspan a
day, plus a baby aspirin.

I'm 37, 5-9, 180 pounds (down from 210 pounds a year and a half ago).
Some history of heart disease in the family (grandfather died of a
heart attack in his early 50s, and my father, who is 67, has been on
statins for years. He exercises and eats well, and has had no cardiac
events so far.)

What brought on the chest pains? Did it occur during physical exertion or
just at random?

Emotional stress can cause chest pain.

Mel

"Trey B." <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

"Phil Holman" <[email hidden]> wrote in message

news:<[email hidden]>...

Quoted message said:

Quoted message said:

I completed one a few months back and quizzed the staff about the
protocol. They used a HR target of 85% of age predicted maximum.

(220 -

Quoted message said:

Quoted message said:

age) x 85%. Do you remember what your HR was?

Phil Holman

Phil: They told me my target heart rate was around 185, and I hit that
after around 13 minutes.

185.... they'd obviously seen enough. The stress test is not an Olympic
event :-)
I'm sure this gave them all the data they needed.

Quoted message said:

Other info: I'd thought I was suffering chest pains a couple of weeks
before the stress test, which led to me seeing a cardiologist. Full
blood work revealed I had elevated Lp(a) (my reading was 87; should be
below 30). Other markers were pretty good; HDL 68, LDL 120,
Triglycerides 88. (A year earlier, my total cholesterol was 276. I'd
lowered it through diet and exercise alone, plus 600 mg a day of
over-the-counter Niacin.) Doctor said VLDL was also good, though I
can't remember exact number.

Because of the elevated Lp(a), I'm now taking 2000 mg of Niaspan a
day, plus a baby aspirin.

I'm 37, 5-9, 180 pounds (down from 210 pounds a year and a half ago).
Some history of heart disease in the family (grandfather died of a
heart attack in his early 50s, and my father, who is 67, has been on
statins for years. He exercises and eats well, and has had no cardiac
events so far.)

Wow, good job on the weight and keep up with the exercise. If the chest
pains persist, go back to your MD/Cardiologist until you get a
satisfactory explanation.

Phil Holman

"Phil Holman" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Wow, good job on the weight and keep up with the exercise. If the chest
pains persist, go back to your MD/Cardiologist until you get a
satisfactory explanation.

Phil Holman

Phil: Thanks. The chest pain thing seems like it was a one-time deal.
In retrospect, I think I probably strained a chest muscle. (I had just
started doing some weight lifting.) But because of the family history
and my previous sky-high cholesterol reading, I didn't want to take
any chances, so I got checked out with EKGs (normal) and that blood
test that checks for damage to the heart muscle (also normal). That
was six months ago, and I haven't had any discomfort since.

I am 40, so my target is 153 and max is 180.

I have live with shortness of breath, chest tighness all my life,
recentl, I finaly decidied to go in to see what was going on.

On the stress test, I hit my target HR in a couple of minutes, leveled
out until level 2, then hit my max HR at just a bit over 5 minutes.

Needless to say, I was scheduled to go back for a nuclear stress test,
as I was told I tested 'positive'

But 15 minutes, just to reach target HR, at least to me, seems really
good.

[email hidden] (Trey B.) wrote in message news:<[email hidden]>...

Quoted message said:

I recently had a stress test (Bruce protocol) and have a question.

I went for 15 minutes, 30 seconds, and they said they had "all the
information" they needed for me, i.e., I'd reached the target heart
rate.

My doctor seemed to think that was a really good result (no problems
were found).

My question is more along the lines of fitness. Is 15 minutes really
that good from a fitness standpoint? I mean, I notice that the test
could have gone on for five more minutes. I work out a lot (bike, jog,
hike, etc.), and I really thought I'd do better. (In fact, I think I
could have pushed it to finish stage six.)

Not really worried about it. Just curious.

Trey,

It's a good sign that you felt you could go further on your stress
test. I remember mine - I felt I had never exercised that hard in my
life. A possible explanation for you: max heart rates have a
standard deviation of 16 beats. It's possible your max is higher than
the 220 - 38 formula would predict. Thus, since you weren't near your
max you would feel you could easily go further. You seem fit, to test
yourself see how far you can run in 12 minutes. I believe 1 1/2 miles
is considered good according to Dr. Cooper that's a 7.5 mile per hour
pace. 1.75 miles is considered excellent. If you have access to a
heart rate monitor or if you are adept at taking your own pulse there
is a simple test you can do to judge your risk of CHD. First,
exercise to get your heart rate up to 85% of max. Then stop and sit
down for 60 seconds. Find out how far your pulse has declined. If
your heart rate has declined by 13 beats or more, you're okay. Mine
declines by 35 beats. Researchers at the Cleveland Clinic have found
this recovery heart rate is a better predicter of risk than the usual
treadmill test. You are becoming proactive about your health - that's
good. Here are two simple things that can lower your risk further: 1)
become a moderate drinker - one or two drinks a day (unless you are at
risk of becoming alcoholic) 2) eat oily fish at least 2 x per week.
Keep watching your weight and your waistline. Keep track of your
blood pressure - it's a good idea to test it periodically at
supermarkets or drugstores. 120/80 is good, 115/75 is ideal. BTW my
LPa is also high, please post if you are able to lower it. Keep up
the good work!

[email hidden] (Trey B.) wrote in message news:<[email hidden]>...

Quoted message said:

"Phil Holman" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

I completed one a few months back and quizzed the staff about the
protocol. They used a HR target of 85% of age predicted maximum. (220 -
age) x 85%. Do you remember what your HR was?

Phil Holman

Phil: They told me my target heart rate was around 185, and I hit that
after around 13 minutes.

Other info: I'd thought I was suffering chest pains a couple of weeks
before the stress test, which led to me seeing a cardiologist. Full
blood work revealed I had elevated Lp(a) (my reading was 87; should be
below 30). Other markers were pretty good; HDL 68, LDL 120,
Triglycerides 88. (A year earlier, my total cholesterol was 276. I'd
lowered it through diet and exercise alone, plus 600 mg a day of
over-the-counter Niacin.) Doctor said VLDL was also good, though I
can't remember exact number.

Because of the elevated Lp(a), I'm now taking 2000 mg of Niaspan a
day, plus a baby aspirin.

I'm 37, 5-9, 180 pounds (down from 210 pounds a year and a half ago).
Some history of heart disease in the family (grandfather died of a
heart attack in his early 50s, and my father, who is 67, has been on
statins for years. He exercises and eats well, and has had no cardiac
events so far.)

I had a Bruce protocol stress test after one minor incident of angina.
I passed with flying colors, primarily because I also worked out a
lot.

I subsequently had a heart attack within two weeks. I did some
internet research later and found that the Bruce protocol stress test
has a false negative result about 33 percent of the time.

I believe that a nuclear stress test would have been better and
possibly detected my problem prior to the heart attack. Of course,
the nuclear test is more expensive and often is not done as a first
stress test.

You should confirm these results for yourself and perhaps Dr Chung
might like to comment on my observation.

Nathan Liskov

ps. I later had a false positive with the nuclear stress test (after
stents had been installed and I was about to resume sports activity).
A subsequent catherization showed the test to be false positive. My
internet research showed that a false positive occurs in about 15
percent of the nuclear stress tests.

(Trey B.) said:

I recently had a stress test (Bruce protocol) and have a question.

I went for 15 minutes, 30 seconds, and they said they had "all the
information" they needed for me, i.e., I'd reached the target heart
rate.

My doctor seemed to think that was a really good result (no problems
were found).

My question is more along the lines of fitness. Is 15 minutes really
that good from a fitness standpoint? I mean, I notice that the test
could have gone on for five more minutes. I work out a lot (bike, jog,
hike, etc.), and I really thought I'd do better. (In fact, I think I
could have pushed it to finish stage six.)

Not really worried about it. Just curious.

--
[email hidden] http://nateliskov.ne.client2.attbi.com
or http://home.attbi.com/~nateliskov

"Nathan Liskov" <[email hidden]> wrote in message news:<SHh2MDlfCd4M-pn2-opHfPQdvJZvp@localhost>...

Quoted message said:

I had a Bruce protocol stress test after one minor incident of angina.
I passed with flying colors, primarily because I also worked out a
lot.

You passed primarily because you did not have "significant" occlusive
coronary disease at the time of the stress test.

Quoted message said:

I subsequently had a heart attack within two weeks.

There are no tests that can reliably predict imminent heart attacks
before they happen.

Quoted message said:

I did some
internet research later and found that the Bruce protocol stress test
has a false negative result about 33 percent of the time.

See above.

Quoted message said:

I believe that a nuclear stress test would have been better and
possibly detected my problem prior to the heart attack.

Unlikely.

Quoted message said:

Of course,
the nuclear test is more expensive and often is not done as a first
stress test.

It is primarily reserved for folks who EKGs are too abnormal to be
interpretable.

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

Perhaps I did not have occlusive coronary disease at the time of the
stress test, but the catherization done after my heart attack showed
100 percent blockage of the LAD.

Also, they did a nuclear stress test after the heart attack but before
the second catherization (when the stents were inserted) and that test
did show significant aschemia. This is why I thought that the
nuclear stress test is better than the stress test without heart
imaging.

However, it is possible that I did not have full blockage during the
stress test and some artery spasm event caused the partial blockage to
become full. I did have a bad flu just before the heart attack, which
also could have been a complicating factor.

Nate Liskov

(Dr. Andrew B. Chung said:

"Nathan Liskov" <[email hidden]> wrote in message news:<SHh2MDlfCd4M-pn2-opHfPQdvJZvp@localhost>...

Quoted message said:

I had a Bruce protocol stress test after one minor incident of angina.
I passed with flying colors, primarily because I also worked out a
lot.

You passed primarily because you did not have "significant" occlusive
coronary disease at the time of the stress test.

Quoted message said:

I subsequently had a heart attack within two weeks.

There are no tests that can reliably predict imminent heart attacks
before they happen.

--
[email hidden] http://nateliskov.ne.client2.attbi.com
or http://home.attbi.com/~nateliskov

Nathan Liskov said:

Perhaps I did not have occlusive coronary disease at the time of the
stress test, but the catherization done after my heart attack showed
100 percent blockage of the LAD.

Heart attacks require the latter.

Quoted message said:

Also, they did a nuclear stress test after the heart attack but before
the second catherization (when the stents were inserted) and that test
did show significant aschemia.

Not surprisingly.

Quoted message said:

This is why I thought that the
nuclear stress test is better than the stress test without heart
imaging.

It is when the resting EKG is markedly abnormal at rest (Heart attacks can cause marked changes on the
resting EKG).

Quoted message said:

However, it is possible that I did not have full blockage during the
stress test and some artery spasm event caused the partial blockage to
become full.

It would most likely have been a plaque rupture with thombosis rather than spasm that caused the 100%
blockage.

Quoted message said:

I did have a bad flu just before the heart attack, which
also could have been a complicating factor.

Any infection can trigger the plaque rupture that can evolve into a heart attack.

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