EF

[long]

I am an average 50 yrs old man who had a normal stress echo,nevertheless I have questions about stress echo results. On the report is written the following "Resting Echo: Resting echo EF is estimated at 60%.Post Stress Echo: Post exercise echo EF is estimated at 75%." Also on the report is written that I exercised for 14 minutes on Bruce protocol and achieved Double Product of 28.58. 1. What would my true EF be if my resting echo EF is estimated at 60% and post exercise echo EF is estimated at 75% 2. What would post exercise echo EF normal ranges be and is the above EF difference normal? 3. I do know that normal resting echo EF is 50--70%,but what would ideal (best) resting as well as post exercise echo EF be for my age? 4. Going for 14 minutes on Bruce protocol is equal to how many mets if 1.a male 50 yrs person weighs 180 pounds 2.and also 165 pounds? 5. During (all 5-6minutes) recovery is blood pressure taken in lying or sitting position and if taken in lying position by how many points would systolic blood pressure be higher than if taken in sitting position?6 What would upper normal limits be for decrease in heart rate from peak heart rate during the first and the second minutes going into recovery?Thank you

[CCF-M.D.-RCJ]

long,

Thanks for the post.

Q1:"What would my true EF be if my resting echo EF is estimated at 60% and post exercise echo EF is estimated at 75%"

During rest, your true EF if 60%, and during exercise your true  EF is 75%.

Q2:"What would post exercise echo EF normal ranges be and is the above EF difference normal?"

Normal range would be 60-75%, at most centers.

Q3:"I do know that normal resting echo EF is 50--70%,but what would ideal (best) resting as well as post exercise echo EF be for my age?"

No one knows.

Q4:"Going for 14 minutes on Bruce protocol is equal to how many mets if 1.a male 50 yrs"

Approximately 14 METS.

Q5:"During (all 5-6minutes) recovery is blood pressure taken in lying or sitting position and if taken in lying position by how many points would systolic blood pressure be higher than if taken in sitting position?"

It's taken in different positions in different labs, mostly based on what is convenient for the lab.  I'm not aware of normal range predictions for post-exercise blood pressure

Q6:"What would upper normal limits be for decrease in heart rate from peak heart rate during the first and the second minutes going into recovery"

I am not aware of upper limits for normal -- we generally feel that the greater the drop, the better.  Lower limits for normal are 12 and 20 bpm at 1 and 2 minutes.

Please take a self-inventory.  If you are a person who likes to be maximally informed (like many of us), then great.  But if you are a person who will find an anxiety-provoking statement or finding in any normal test, then it may be time to seek treatment for anxiety.

Good luck.

[long]

Thank you Dr for answering my questions,but would an increase of 15% in EF during post exercise echo be better than if increase was 5-10% and vice versa?With the above resting(60%) and post exercise (75%) EF what would the odds be of this person having an undiagnosed old mild heart attacks even though wall motions are normal?Thank you

[CCF-M.D.-RCJ]

long,

Q1:"would an increase of 15% in EF during post exercise echo be better than if increase was 5-10%"

Yes, I think so, but I know of no hard science to prove it.

Q2:"what would the odds be of this person having an undiagnosed old mild heart attacks even though wall motions are normal?"

Define mild.  A stress echo is defined to look at wall motion abnormalities, which are usually present only when a significant amount of muscle mass has been rendered ischemic or scarred.  So it would be unlikely that significant coronary artery disease is present (in fact the test is about 85% sensitive for detecting coronary artery disease), but a "mild" old heart attack is not totally unfeasible.

[long]

Thank you Dr for answering my questions.By mild I mean old small heart attack. 1. Would you explain what does post exercise EF means,which EF(resting or post exercise) is more important and when asked which number should be given? 2. Are you saying that mild ischemia can not be excluded by stress echo?If yes what other test would you recommend for excluding mild ischemia other than catherization and (with what %) can mild ischemia be excluded with those tests?3. I got two differnt numbers written and reported for "METS": approximately 14 on stress test report and approximately 17 on ECG stress test tracing strips.Would the number written and reported on a ECG stress test tracing strips be accurate since I guess computer  prints it during the stress test?Thank you

[long]

Would you answear above last questions since Dr did not?Thank you

[long]

Hankstar Thank you for answering my questions. 1.Are you saying that mild ischemia can not be excluded by a stress echo?If yes what other tests would you recommend for excluding mild ischemia othr than catheterization and (with what %) can mild ischemia be excluded with those tests? 2. Does ECG stress test prints out during the stress test on ECG tracing strips achieved mets,because I got two diffrent numbers for achieved mets during the same test?Thank you

[long]

Hankstar what do you mean by "maybe the computerized printout evaluated your performace to the equivalent of 17 mets"? Do you know what are the normal ranges for double product(heart rate x systolic blood pressure) and is it better if it is at upper or lower normal ranges?Thank you

[rmanzo]

My Husband had a strest test and it said that his LVEF 41% with global hypokinesis without chamber dilatetion. Dr. never told us this and was never treaded for it.

My husband is 6' 1" and weight is of 265lb

Other findings were: The left ventricle is larged
The left atrium is slightly enlarged
*Impresion:
     Left ventricular enlargement with preserved contractility
     Slight left atrial enlargemtn

He is experiencing irregular heart beats fills dissiness light headed.
He was in the hospital 1 week ago and could not find anything wrong was send home. We were told that he has fibromyalgia. I see that he is going down heel fast and no doctor can find what is wrong yet his blood work shows low rbc 4.32 anyway they have gave up on him.
I know that FM is bad, but also MS and other like Lyme dease
they just don't even want ot rule out this other possibilities.

Q-What should I do?  
Q-Can FM affect his heart in any way?
Q-If is MS when is to late to find it?
Thank you so much for your help!

[long]

Hankstar I don't understand either but I am assuming that 14 minutes on Bruce protocol is equal to approximately 14 mets for people with an average body surface area,but for the people with the above average BSA achieved mets would be higher (17).Do you agree?Would resting EF at upper normal limits(69%) exclude old small heart attack(s) that person is not wear?I was told that EF can be determined from fractional shortening(FS).What's the equation and what would EF be if FS is for example 35%?Thank you

[long]

Hi Hankstar There is website which states that (team) athletes,like weight lifters have an average resting EF of 61+_5%,long distance runners 62+_6%,but a normal (control) subjects 66+_6%. Do you know why would weight lifters and long distance runners have lower EF(but not significant) than normal subjects?Thank you

[zk]

Hi, hankstar I had a normal stress echo but a month later anyway I had a nuclear resting only cardiolite test which showed a mild ischemia.Which test should I beleive?How accurate is nuclear resting only cardiolite test,because on the report said that mild ischemia could be from diaphragmatic attenuation artifact and correlation with a stress cardiolite examination is suggested to further evaluate for any possibility of ischemia?Would you have stress cardiolite examination to further evaluate for any possibilty of ischemia even though stress echo is normal?Thanks