Re: treadmill vs. thallium stress test

Posted By chris on May 12, 1999 at 10:12:08
I hope you don't mind me asking two questions in a row. I have a friend whose husband (51 yrs old, elevated lipis under control, poor family history, was complaining of shortness of breath and had a treadmill stress test done which was normal. His doctor ordered a thallium stress test "just to be sure" which showed a blockage in the right coronary artery. He then had a cardiac cath and angioplasty scheduled. Why would the thallium test show something the treadmill did not? Should a thallium test be done when symptoms persist even if the treadmill is normal? The reason I am personally interested in this is that when I started on a fitness program (the reason I started!) I couldn't climb more than a few landings of stairs or climb hills without exhaustion, shortness of breath, and upper chest discomfort. (not pain, just a feeling of discomfort) The stress treadmill test required because of my age (not old enough to require physician supervision) was normal. I didn't seem to have this problem with hills when the technician increased the grade of the treadmill.I thought maybe I was out of shape.  After 6 months of the exercise routine, I can climb stairs without much discomfort other than what you would normally expect from someone my age. (48 yrs,female) However, I still have a problem with hills, especially if I am carrying something in my arms. I'm usually okay if I go slow and balance the weight between both arms. After hearing of my friend's experience, I am a little worried. I don't want to be an alarmist but I also don't want to collapse on the street.  Thank you for your response. I find it fascinating reading the doctors answers to all the questions!  Chris      

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 12, 1999 at 11:01:59
Dear Chris,
What you have touched on is actually a very complex topic and one that whole books are written about.  The simple answer is that the treadmill test is more likely to have a "False negative" result than the thallium.  This is where clinical judgement and experience comes to play and was beneficial in your friend's case.  In your case your doctor may or may not want to pursue further testing.  Are you having the discomfort only with exertion?
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[chris-]

Posted By chris  on May 12, 1999 at 14:27:54
Thanks again for your response to my questions. I seem to only have problems walking up hills. I can go through an entire step aerobic class,(getting my heart rate up to 120, after that I feel kind of crummy) gardening, walk briskly, and now climb stairs, with no problems, but as soon as I try to climb a hill I have problems. I especially notice it if I am carrying a tote bag of books. I have the discomfort to a lesser degree if I'm not carrying anything. I see the doctor in August for a followup. I take 25 mg atenolol for episodes of high blood pressure.(had the hill problem before the atenolol was started) I still haven't decided what to do about the cholesterol situation and will be retested in August.  My total cholesterol is now below 200 (193) through diet but my HDL is still poor (26) despite 6 months of regular exercise. I'm not sure about my family history. Parents are okay, but my father's mother, her father,and all 3 of her brothers died of strokes by age 60 and all of the descendents of these brothers (all male) have had bypass surgery. Two of my father's sisters died of heart attack in their late 50's. I don't know if this puts me at risk. I started to worry when the high blood pressure was diagnosed (6 months ago) and that's why I've been so interested in the cardiac questions. I'll ask my doctor about the homocysteine level in August too. Thanks!            

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 12, 1999 at 16:00:24
It could be just deconditioning but it is possible that it could be heart related.  Be sure to mention it to your doctor.  Best wishes.
Dear  Amy,
There are many causes of chest pain.  The one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  Once this is ruled out the work-up can proceed at a more leisurely pace.
Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[Melisa-Lanham]

Posted By Melissa Lanham on May 12, 1999 at 22:07:42
I don't know the difference, but i know that chest discomfort is very serious, my Mother, 52 years old just had a triple by-pass, she never really knew she had a heart problem, always thought she was just having a pulled muscle, or something else. I urge you to have extensive testing done if you suspect anything, my mother had tests(EKG, stress tests) TWO YEARS AGO AND WAS TOLD ALL WAS FINE, then she had a heart catherization which found blockages. Just a concerned person...










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