Stress Echo

[DottyCece]

How is a stress echocardiogram done?  Are medications used?  If so, what type are coming used?

[CCF-M.D.-RCJ]

DottyCece,

Thanks for the question, but you better be careful ... asking 2 questions on the same day will often lead to harsh responses from the other readers.

There are 2 basic types of stress echo tests: exercise and pharmacologic (medication-based).

Both tests start with the echo tech obtaining a resting echo.  With an exercise echo, the patient will then get on a treadmill or bike and exercise to peak capacity.  Immediately after exercise cessation, the person moves back to the echo bed, and a second echo is done while the heart is still beating rapidly.  The two echo image sets are analyzed for differences in wall motion, valve regurgitation, pulmonary pressures, etc.

Pharmacologic echo stress tests are performed most often with dobutamine as the agent used to increase the heart rate and contractility.  Some European centers use adenosine instead.  Again, a resting echo is obtained.  The dobutamine is then infused while the person remains recumbent. The echo tech takes serial pictures as the heart rate increases. The two echo image sets are analyzed for differences in wall motion, valve regurgitation, pulmonary pressures, etc.

In general, if a person can exercise, then we recommend that that is the method used for the "stress".

Hope that helps.

[labrat]

Mine was done without meds, on a treadmill.  They did a resting echo first, then put me on the treadmill & at the point I had to stop I had only a few seconds to get back on the table for a repeat echo.  They then compared the resting echo to the one done immediately after the exercise.

Good luck.

[Squimsy]

Dottycece

Two questions posted in a day - Thats very fortunate!

This site has a very good search facility which can be helpful for providing insight into conditions, precedures etc.  You'll probably get more detail from browsing the archives then you will from the doctors reply.

Best Regards

Sq

[mmfd]

Yeah, two questions in one day, and three total for the week.  That's very fortunate for you, but what about the rest of the whole wide world?  You do realize that if you post a question that NO ONE ELSE CAN??  I had already requested that the administration of this board limit posters to just one per month, but you are incredible.  The above poster was being nice about it, but I can't...so selfish.

[Rick9897]

Wow

You folks are really MEAN!!  So what if there were two questions posted?  If the opportunity presents and this person has legitimate questions, we can all benefit from these answers.  I have been following this site for a long time and find a few people always responding.   I have never noticed such anger to people like Hankstar or whatever his name is.  BE KIND!! or this site looses all credibility.  Life is too short to deny someone some compassion.  Perhaps this person is seeking some answers for a very difficult burden.  Let us all be kind.

[kennyd]

Hey mmfd, relax.  You don't even know if this person knew that there was a limit for posting.  I agree that given the system that people should be limited to one per day, but without that, how can it be expected that everyone will know?  It's not like this on all the forums of this site.

[DottyCece]

For the record:

I DID NOT KNOW THERE WAS LIMIT TO QUESTIONS.  I forgot to include the second question withe the first and it did not appear any different that those who ask 5-6 questions in one post.

I have to make some very tough decisions in a very tough health situation that I find myself.  I will be spending thousands and thousands of dollars at Cleveland Clinics because my insurance will not give me a referral to CC since they think we have similar specialists in our network.  So, I feel therefore that I do have a right and responsibility to get as informed as possible and where better than where I am spending my money?????  So mmfd, so sorry you didn't get to ask your question.  I merely click on and if I can post I will post a question if I truly am seeking an answer instead of just pontificating... None of us are experts. We are all seeking solutions to very serious problems.  I just hope there would be a degree of compassion and caring for others.  I feel very badly that someone would be so nasty to me.  I am so depressed already and this just adds to it all.

I WILL NOT ACCESS THIS SITE ANYMORE OR EVEN FOLLOW THE CONVERSATIONS.  I AM GETTING SICK OF ALL THESE MINOR PALPITATION QUESTIONS.  FOR THE RECORD, THOSE ARE NOT A MAJOR THREAT TO ONE'S HEALTH AND ARE MOST OFTEN VERY NORMAL.  i HAVE LIVED WITH A WHOLE LOT OF THEM FOR OVER THIRTY YEARS..JUST GET ONE WITH IT AND COPE.  IT IS NORMAL11  

SO GOOD BYE EVERYONE. I WON'T BE BOTHERING ANY OF YOU ANYMORE.  I HOEP MMFD IS ABLE TO POST AS OFTEN AS SHE OR HE HAS A DECENT QUESTION THAT OTHERS CAN BENEFIT.

I can't believe how upset this has made me and I am sorry about that.  I am at the end of my coping ability!!!!!

[DottyCece]

So Sorry that I violated some rule I knew nothing about.  I will be seeking a consult from Dr. P. McCarthy at CC and will be paying for it in cash since my insurance company will not give me a referral.  So, I do think I have the right to get as much information from you, a representative of CC to whom I will be paying thousands of dollars.  But, to avoid angering others, I will no longer be using or accessing this site.  I do not appreciate the way I was communicated with but I want you to know that your responses have been very helpful to me.  I have tough decisions to make in a tough situation and truly wouldn't want to wish this situation on anyone.

Thanks for your help.

[DottyCece]

So Sorry that I violated some rule I knew nothing about.  I will be seeking a consult from Dr. P. McCarthy at CC and will be paying for it in cash since my insurance company will not give me a referral.  So, I do think I have the right to get as much information from you, a representative of CC to whom I will be paying thousands of dollars.  But, to avoid angering others, I will no longer be using or accessing this site.  I do not appreciate the way I was communicated with but I want you to know that your responses have been very helpful to me.  I have tough decisions to make in a tough situation and truly wouldn't want to wish this situation on anyone.

Thanks for your help.

[Momto3]

Hi fellow posters,

It seems quite probable that if one person has a question, at least one other person on this forum has the same question. This isn't the first time that forum readers have lashed out at at one another for "frequent" posting. It is a shame that some of our readers have decided not to visit or post anymore. No doubt, we each arrive here looking for answers to our own set of "symptoms".  Yet, it doesn't take long to become a part of the forum "family"; we are a group who share a common interest and look out for one another. Certainly, the doctors have answered each of our questions many, many times over the years. Yet, each time, their responses are thoughtful and considerate.  

There are so many people who do not have the luxury of choosing the CCF for their cardiac care, and this forum provides them with a unique way of gathering a little information and perhaps, a little reassurance from a world renowned heart center!! Life is short and we are so fortunate to have the opportunity to ask ANY questions. Take the opportunity to learn from what is discussed, and remember if you are that concerned over your own medical care, it is always best to get in touch with your own doctor or go to the emergency room.  Please....If we are not careful, no one will be asking a question.

[sampants]

I am glad that this question was posted because I am having a stress-echo done soon myself.  This question addressed my concerns as well.

[pandora9048]

I for one dont care who posts or how often.  I think each and every question has merit to it and someone else, other than the poster, who reads this forum more often than not benefits from the questions because a lot of us have the same issues.
But Dotty, for u to say that u r tired of hearing about us with "minor" palpitations posting questions, is really unfair.  what may seem "minor" to u certainly is not minor to the people who experience the palpitations.  that was really an insensitive thing to say, in my opinion.
Pan

[starion]

I had a stress echo test & it was "normal," except it took 17 minutes for my heart rate to go from 181 peak down to 110 (though my baseline resting heart rate before the test was 88).  In addition, the blood pressure readings seemed a bit odd:
Rest 100/74
3 minutes  140/80
6 minutes 140/70
7 minute--peak exertion
recovery 1 minute 128/50
2 minutes 122/70
3 minutes 136/70
no further blood pressure readings
Just curious about the significance (if any) of these details.
Aloha,
Starion

[Guenter]

I was surprised at the comments and rudeness of some of you.  Where is the rule about posting?  I looked and cannot find it.  I agree that palpitations are minor in comparison to many other problems.  Some people obssess about these and get very anxious for no legitimate reason whatsoever. Those need to learn to adjust. I think palpitations should always be address to rule out any real problems.  They are often just normal and yes they feel funny.  Could we all be kind, courteous and I agree compassionate?  Life is fragile and very short.  This site should be a support.

[CCF-M.D.-RCJ]

I have to say that once again, I agree with Hank.  Most of the participants of this forum are friendly, polite people.  Unfortunately, sometimes we read things on this forum that these same people say in anonymity that they would never say in person.  Thankfully, this is infrequent, but remembering that some of the people posting questions are quite scared or troubled might help us all to reconsider our poisonous words.  

Two questions per day are answered because that is all this site can afford in terms of bandwith from the ISP.  The doctors are certainly willing to answer more questions, and frequently we do if the questions are posed in the comment section (and seen by us!).

I am certainly amazed every day by the participants willingness to listen and help.  If someone on this forum is out-of-line, it's incumbent on us to treat that person in the same way that we would wish to be treated.

Thanks.

[mmfd]

Sorry to everyone that I offended but I stand by my response.  I was direct but not rude.  The people who keep taking the opportunity away from others are rude, IMHO!
Did anyone notice that the physician himself even mentioned the multiple questions?

As for not knowing there is a limit on questions, see the recent VERY lengthy discussion on this very topic.  DEC. 29! In addition, when one sees that only 2 questions are posted each day, then one might  be able to glean from that, that there is  a limit!

Hankstar, I am certainly not cruising this site looking to criticize people.  I am here because of the golden opportunity we have to ask questions from a real doc from a well known heart center, just like you.  By the way, I do value your responses and know that you do have a lot to offer.  I do plan on visiting the site often to read the MD answers.

[labrat]

I just want to say thanks to the docs from CC, the site owner as well as all the caring posters.

This site has made my own "less-than-desirable" situation a lot more realistic, less fearful and something to occasionally laugh at - for which I am grateful.  I also realize how well off I am compared to many, and for that I am also grateful.

Have a nice weekend.

[NBCT]

To everyone who has suffered with palpitations, benign, minor, severe, asymptomatic, symptomatic, anxiety induced, stress induced, no structural defect, structural defect etc..etc..THEY are real to each and everyone one of us and NO Question is less important if you do not know the answer!! Dotty continue to post when you can and use this forum as a source of research...clearly being able to post a question is luck of the draw everytime... and I am glad  for you luck was on your side, hope you were able to find comfort and obtain further knowledge about your situation...Best Wishes........I have been a nurse for 22 years and work on a cardio/pulmonary unit and have seen first hand hundreds of patients trying to cope with fear of the unknown...from a range of homeless people to multi-million dollar CEO's.....yet they are all the same on a hospital unit wearing a johnny coat.....HUMAN....and everyone deserves respect and compassion.

[Linda123]

Hi there
I'm a little amazed at this bit of bother.  I've read this forum for ages now and I've often known people write in with 4 or 5 questions in their post which the cardio ofen replies on the lines of
1. Answer
2. Answer
3. Answer
4. Answer
I've actually never known the cardio comment about the number of questions in a post before.  I'm sure I myself have asked more than one question in my posts.
Good luck to you, Dotty Cee.
Best Wishes, Linda

[Momto3]

Hankstar, I remember when you and a few other were "slammed" for posting "too many questions"...OUCH!! Like you, I can appreciate why some folks might be a little annoyed, but there are just as many others who are breathing a sigh of relief when someone asked "their" very question. The anonymity that the boards provide is great for people who may find it difficult to ask questions in a different setting. But, unfortunately, it also provides an opportunity for people to say things they otherwise might keep to themselves.

When I mentioned about "no one" posting, I was referring to us loosing the boards altogether. I was concerned that the doctors and administators would become so annoyed at the "slams" and degrading remarks that they would consider shutting down the forum. I sure hope that doesn't happen. I know that I have learned a great deal from everyone here, and I remain profoundly grateful to Dr. RCJ for his concern and thoroughness when I posted my questions last year.

I've also noticed that quite a few regulars have stopped frequenting the site, and I feel bad about that. We each have something to offer and the forum works best when we all share ideas and listen to one another. Hank, I'm glad you toughed it out and decided to stay!! By the way, it is about 10 degrees in Cleveland!! Send us some sunshine :)

Connie

[starion]

Actually, the protocol is DESIGNED so you reach your peak heart rate in 7 minutes; my heart rate was 181 bpm (10 METS, incline 14%, 3.4mph) at peak & the docs said my exercise tolerance was good.  Neither I nor any of my docs believe I am at all deconditioned & I have never smoked.  I have idiopathic emphysema but no limitations on my exercise & my pulmonologist says I walk at twice as fast as a "normal" person.  I am considered in excellent physical condition, so I puzzle my cardiologist, since I do not have problems with oxygen saturation during exertion either.  He has ordered an echo next week & also another holter withholding my lung meds that may be responsible for my tachycardia.  My pulmos have agreed, providing I can take rescue meds as needed.

Thanks for your insights.  I really appreciate all your thoughtful comments & help.  You & many of the others & the great Cleveland Clinic docs really help SO MANY of us!  

I am saddened to see folks turn on one another here--I've seen it on some of the lung forums & boards as well.  Sure wish folks would try for more understanding and tolerance, since we're all in this together & we're all trying to help one another & optimize our health.

[Guenter]

It is unfortunate that this has happened.  Let us all just agree to be respectful, considerate and kind.  The lesson in this is we should not jump to conclusions but, instead, validate our perceptions in a tactful and respectful manner.  When we are ill, it is very natural to be focused on one's self and not really sensitive to others.  It is helpful to recognize that and try to take this into account as we communicate and interact with others.  I do not want to appear as "preaching".  This is how I view all of this so let us continue to help and support each other.  Looks like Dotty is gone and that is too bad but we can all work to make sure that does not happen again.

[raildown]

w.r.t. how much bandwidth each poster is entitle to: it is really a matter of good old fashioned economics and yup business sense; this site is a pro bono kind of service to the larger community; it is a promotional tool for CCF and there is Nothing wrong with that; it is also an informational reservoir kinda like a lending library; additionally, it is a forum for CAD patients of all types to support, advise each other;

a pretty complex stew of missions;

and all at no direct monetary charge too all comers;

like any other high value good which is deep discounted, the demand will by definition Greatly exceed supply, so the information supplier/provider gates down the demand by limiting the input of queries to 2 posts per day;

now one can ask multiple questions/subqestions per query or just one question; and apparently initiate 2 queries per day with Lots of questions /subquestions each; and then generate more queries within days on the same general topic (like jerry78);

the software could easily limit the queries per poster at the top level but appaently it doesn't (yet) but then a _slightly_ clever poster could simply get another screen name/registration via another computer and post some more top level queries...;

soooo ....much of the issue is Built into the system and some of the 'excess' demand could be 'managed' better by more clever software but then the more clever posters can game the system....around and around...;

if 'we' don't self-regulate and 'behave', this 'free'good will no longer be free (it could become a fee based system) or it could become an information source with information output only, or the docs could be removed and then it would be just another forum with CAD patients only and/or a moderator;

a well integrated health care system would treat Anxiety/existential angst as an integral part of chronic or serious illness; the reason for the huge demand for 'alternative' medicine is in my opinion based on the difficulty of access to information beyond the pipes and wiring stuff from the traditional medical establishment, the managed care envirovment and the 7 minute office visit...and it's hard to know in advance what subsequent questions are  likely generated by the doc's answers...and then overlaid on all this is that people want some more hands-on time... more soft-touch healing of the spirit...especially during the initial 'adjustment' to the 'acceptance' of the reality of their changing health situation...;

there also is some idioscyncratic pathologies built into this communication modality (posting...email etc) that creates easy misunderstanding...lack of larger context available in person to person communcation, lack of other visual ques from body language, vocal tone, etc ; and like the doc said the (positive and negative) idosyncracies of anonymous communication ...'flaming' is as old as teletype (paper based communications terminals) on the Arpanet ithe early 1970s...where I got ripped regularly by colleagues who 'misunderstood' what I had (lamely ?) conveyed in those pre-Internet, pre-PC Dayz of Olde...; I learned what kind of things to say over teletype and then when to pick up the phone or get on an airplane to deliver a message...;

play nice or it'll be 'time-out' and to bed with no desert ;-) ;

//

[starion]

Dear Hankstar & Everyone,
Received an e-mail from my cardiologist today.  He's conferred with my internist & the electrophysiologist in his practice.  They all agree I MAY have IST (inappropriate sinus tachycardia).  The repeat holter without my lung meds should be helpful in sorting out the diagnoses (both lung docs have approved); we'll schedule it after we discuss the results of my upcoming echocardiogram.
Thanks for your thoughts on this.  Appreciate it.
Aloha,
Starion

[Momto3]

Wishing you luck on your upcoming tests!  We will be thinking of you. Maybe your doctor is on to something here.  Buena suerte!

[cuore-rotto]

This is my first time to come across this web site and I have read through many of the rants about multiple postings.  What is the protocol for getting a question answered?

I suffered a pretty bad MI a little over two years ago and things seem to just continue downhill for me.  Within the first year of the MI I had two more angioplasties w/stents, which brought the total to three.  One high in the LAD where the plaque rupture occured and two in the RCA.  In June of last year I was admitted to the hospital for observation due to several symptoms.  A week later I went through another Nuclear Stress Test that showed some additional ischemia, but my cardiologist just wanted to watch it for a time.  He also added a diagnosis of Congestive Heart Failure to the list of ailments I seem to have.  Last week I went in for an Echocardiogram, because the cardiologist did not like the sound of something he heard during a routine follow-up visit.  I was told via telephone last week that my EF% had dropped about 10% since June and there was also an irregularity with the mitral valve.

What am I looking at here in all reality?  I never feel like the doctors and nurses want to be blunt about such things, because they do not care to dash one's hopes or add any increased stress.  I just can't help but feel that I am on a slow downhill slide and would like to have a feel for what faces me over the next several months.

[LORIANDTOM]

Wow. That is my first response to all the above comments.  

I found this site a couple of years ago when I was having problems with "benign" pvc's.  The information I learned from reading about other peoples medical problems and posting my own question spared me from going on an anti-rythmtic medication that could of turned pvc's into something much more dangerous.

Did I learn this from my own Cardiologist? Nope. I learned it here.  

Sure my pvc's are harmless, but somehow I can't seem to train my brain to remember that so unfortunately they make my life a bit more difficult.  My family doesn't really understand and I am not going to walk around all the time talking about it.  But if I feel I need to keep my sanity then I have always felt like it could be done here where people know what it feels like.

My point is that this forum is wonderful and should not be taken for granted by any of us and it should be open to all and for all.

Lori

[Guenter]

You just don't give up, do you?  How do you view those who post and ask 5-6 questions in a row?  And, the Doctor answers all of them.  Should they be restricted to one question only to follow your rules?   Also, who would know go back and read all postings to Dec. 29th to find what information you are talking about.  Hope you get beyond this and change your attitude about things.  This is bizarre!!!!!

[Kristin391]

I have been searching for a place like this for awhile.  and as I have read these postings I am very confused.  How is it different for people to ask 5,6,7 questions in one posting that the Doctor answers from someone who accidently gets to post two questions?   Where are these rules written?  Certainly someone's posting on Dec 29 cannot be the rule.  I did not see it in the Terms and Conditions.  Why can't everyone just give everyone the benefit of the doubt and not be so critical and judgmental???  

I have serious arrhythmias that I looking for information on.  I too have had palpitations for many years but I consider them to be part of life.  That is what I have always understood to be the truth.  As long as serious health problems are ruled out we can all change the amount of caffiene, alcohol, and other stimulants that we may take.  We can also learn to manage our stress and get good exercise and take the focus off of how we feel and move on the focusing on other people and other projects and so forth.  To dwell and obsess about palpitations once real disease is ruled out doesn't do anyone any good.  I do enjoy reading the postings in this site.  Some are very perplexing to me but I don't own them, others do and none of us should judge and criticize.