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Heart Disease (Expert Forum)
Do I need this test?
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Do I need this test?
by Bigswede, Nov 30, 2006 12:00AM
I am a 69 year old 6’4” 220lb male with a lifetime history of smoking and more than casual drinking. With the exception of arthritis I always considered my health as pretty good.
About six weeks ago, I went for a pre-test exam in a hospital for an outpatient surgery procedure for carpal tunnel. During the pre-test, the doctor saw something in my EKG that suggested an arterial blood flow problem and I was told to see a cardiologist for further testing before getting clearance for the surgery. Up until this point, I have had no symptoms of any kind. The only cardiac test that I have ever had was twenty years ago when an inverted T-wave showed up in a routine EKG. At that time, I took an exercise echo-stress test that indicated no problems except a slightly enlarged heart.
This time, because of my arthritis, the cardiologist recommended a Persantine/Cardiolite stress test. The test ruled out any arterial problems but I had a strange reaction during the test. I had an episode of hypotension and bradycardia and almost passed out. (BP of 70/30 and HR of 30). The doctor initially guessed that it could have been a vasovagal reaction noting my apparent nervousness and apprehension before and during the test. I also discovered later that a small percentage of people have this reaction to Persantine – (.85%). The doctor followed up the stress test with an echocardiogram three days later. He diagnosed me with an enlarged heart and cardiomyopathy with an ejection rate of 40%. This was not a surprise to me because I had been diagnosed with the enlarged heart 20 years ago during the exercise stress test. I then “fessed up” to the doctor about my alcohol abuse and he told me that it was probably a major contributing factor to the cardiomyopathy. Up to this point, I am in complete agreement with the doctor and I have stopped my use of alcohol.
My question is this. Purely because of the reaction to the Persantine, the doctor now wants me to undergo an EPS test. I am reluctant to take this test because I feel there is nothing evident that indicates an arrhythmia problem other than a single episode caused by either an adverse reaction to Persantine or a vasovagal reaction to being stuck with needles. I questioned him about taking a Holter monitor test instead but he insists that I should take the EPS. What is your opinion? Please take into consideration the tremendous anxiety and fear that I have of any invasive tests.
About six weeks ago, I went for a pre-test exam in a hospital for an outpatient surgery procedure for carpal tunnel. During the pre-test, the doctor saw something in my EKG that suggested an arterial blood flow problem and I was told to see a cardiologist for further testing before getting clearance for the surgery. Up until this point, I have had no symptoms of any kind. The only cardiac test that I have ever had was twenty years ago when an inverted T-wave showed up in a routine EKG. At that time, I took an exercise echo-stress test that indicated no problems except a slightly enlarged heart.
This time, because of my arthritis, the cardiologist recommended a Persantine/Cardiolite stress test. The test ruled out any arterial problems but I had a strange reaction during the test. I had an episode of hypotension and bradycardia and almost passed out. (BP of 70/30 and HR of 30). The doctor initially guessed that it could have been a vasovagal reaction noting my apparent nervousness and apprehension before and during the test. I also discovered later that a small percentage of people have this reaction to Persantine – (.85%). The doctor followed up the stress test with an echocardiogram three days later. He diagnosed me with an enlarged heart and cardiomyopathy with an ejection rate of 40%. This was not a surprise to me because I had been diagnosed with the enlarged heart 20 years ago during the exercise stress test. I then “fessed up” to the doctor about my alcohol abuse and he told me that it was probably a major contributing factor to the cardiomyopathy. Up to this point, I am in complete agreement with the doctor and I have stopped my use of alcohol.
My question is this. Purely because of the reaction to the Persantine, the doctor now wants me to undergo an EPS test. I am reluctant to take this test because I feel there is nothing evident that indicates an arrhythmia problem other than a single episode caused by either an adverse reaction to Persantine or a vasovagal reaction to being stuck with needles. I questioned him about taking a Holter monitor test instead but he insists that I should take the EPS. What is your opinion? Please take into consideration the tremendous anxiety and fear that I have of any invasive tests.
Doctor's Answer
by CCF-M.D.-MJM, Nov 30, 2006 12:00AM
Hello,
It is true that bradycardia and can occur with persantine stress tests and hypotension is very common. It may help to see the EKG in order to answers this question. If your EKG is normal with no evidence of conduction abnormalities, it may be reasonable to wait for symptoms or more evidence of non medication related heart block or symptomatic bradycardia. However, I do not have the option to see the EKG he saw during your bradycardia episode. It is possible that there was a significant abnormality on the EKGs that has your doctor concerned. Ask your doctor what it is about the EKG or the episode that makes him want to pursue an invasive test. You could also take the EKGs to an electrophysiologist and ask for a second opinion.
EP studies are very straight forward procedures with minimal risks, but I do understand your hesitancy.
I hope this answers your questions. Good luck and thanks for posting.
It is true that bradycardia and can occur with persantine stress tests and hypotension is very common. It may help to see the EKG in order to answers this question. If your EKG is normal with no evidence of conduction abnormalities, it may be reasonable to wait for symptoms or more evidence of non medication related heart block or symptomatic bradycardia. However, I do not have the option to see the EKG he saw during your bradycardia episode. It is possible that there was a significant abnormality on the EKGs that has your doctor concerned. Ask your doctor what it is about the EKG or the episode that makes him want to pursue an invasive test. You could also take the EKGs to an electrophysiologist and ask for a second opinion.
EP studies are very straight forward procedures with minimal risks, but I do understand your hesitancy.
I hope this answers your questions. Good luck and thanks for posting.
wmac