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Heart Disease (Expert Forum)
Stress test accuracy
Answered by
Cleveland - OH
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.
Stress test accuracy
by volare, Sep 27, 2006 12:00AM
Hello,
One of my family members (late 70's in age but active and an exerciser) recently had a NORMAL nuclear stress test with no signs of ischemia. There was no chest pain, SOB or other symptoms. No fatigue during the test. Because of some benign palpitations, they also had a series of other testing....EKG's, blood work, echo, 2 24 hour Holter's -- all normal.
A couple weeks following the normal stress test, an E.R. visit for some chest pressure. Again, labs, EKG etc. were normal but because of symptoms and other discusssions a catheterization was performed, a very signficant blockage was found in the LAD and a stent was placed.
A stress test to follow up the stent weeks later was also NORMAL. Here's my question: If there are a very small percentage of false negatives, as I understand, with stress tests (and this was one case) is it appropriate to then follow-up the placement of a stent with a stress test? Would catheterization be in order here? It would seem to me that if the stress test was normal to begin with, it would be "normal" again even if there was a problem. Thank you.
One of my family members (late 70's in age but active and an exerciser) recently had a NORMAL nuclear stress test with no signs of ischemia. There was no chest pain, SOB or other symptoms. No fatigue during the test. Because of some benign palpitations, they also had a series of other testing....EKG's, blood work, echo, 2 24 hour Holter's -- all normal.
A couple weeks following the normal stress test, an E.R. visit for some chest pressure. Again, labs, EKG etc. were normal but because of symptoms and other discusssions a catheterization was performed, a very signficant blockage was found in the LAD and a stent was placed.
A stress test to follow up the stent weeks later was also NORMAL. Here's my question: If there are a very small percentage of false negatives, as I understand, with stress tests (and this was one case) is it appropriate to then follow-up the placement of a stent with a stress test? Would catheterization be in order here? It would seem to me that if the stress test was normal to begin with, it would be "normal" again even if there was a problem. Thank you.
Doctor's Answer
by Cleveland Clinic, Sep 27, 2006 12:00AM
, Sep 27, 2006 12:00AM
volare,
thanks for the post.
There are a few reasons why your test didnt show anything. First, stress testing is not perfect. The are false positives and false negatives with the test. The more likely a person is to have significant coronary disease increases the risk of a false negative. That said, stress testing itself can be prognostic, even if the test is negative. For instance, if a patient can exercise to an adequate level, then the stress is predicitve of better outcomes.
Second, there is a chance that your family member had an unstable plaque in the artery that ruptured leading to thier chest pains. Usually, the plaques that cause these problems are not the severe ones that show up on a stress test. Given, his presentation, this scenario may be more likely. Once the blockage was opened, then the repeat stress would be normal.
hope this helps....either way your family member needs to make sure he/she is doing all the things to prevent other blockages from progressing like lifestyle and risk factor modification.
good luck
thanks for the post.
There are a few reasons why your test didnt show anything. First, stress testing is not perfect. The are false positives and false negatives with the test. The more likely a person is to have significant coronary disease increases the risk of a false negative. That said, stress testing itself can be prognostic, even if the test is negative. For instance, if a patient can exercise to an adequate level, then the stress is predicitve of better outcomes.
Second, there is a chance that your family member had an unstable plaque in the artery that ruptured leading to thier chest pains. Usually, the plaques that cause these problems are not the severe ones that show up on a stress test. Given, his presentation, this scenario may be more likely. Once the blockage was opened, then the repeat stress would be normal.
hope this helps....either way your family member needs to make sure he/she is doing all the things to prevent other blockages from progressing like lifestyle and risk factor modification.
good luck
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http://www.heartsite.com/html/regular_stress.html
What is the reliability of a Regular Stress Test? If a patient is able to achieve the target heart rate, a regular treadmill stress test is capable of diagnosing important disease in approximately 67% or 2/3 rd of patients with coronary artery disease. The accuracy is lower (about 50%) when patients have narrowing in a single coronary artery or higher (greater than 80%) when all three major arteries are involved. Approximately 10% of patients may have a "false-positive" test (when the result is falsely abnormal in a patient without coronary artery disease
Similarly his two brothers passed stress tests. One had four bypasses and the other had SIX!!! They did the catherizations on them because of a family history of early onset CAD. My dad has since been back (at 7 years post-op) for three more stents, though his original graft sites remain clear.
I suppose stress testing can show the really really bad cases, but my dad and his brothers were/are very active guys. That puny treadmill was nothing compared to a day's work for them, and I think that the heart adapts to need and fitness level. But that's speculation.
All that said, I am glad the problem was found and stented. Hopefully that will cure the symptoms.
I read your comments with interest. It sounds to me like your dad/uncles we're able to do strenuous activity without any pain?
Is it really that common to have a blockage and not suffer from chest pain? I ask because my husband has symptoms other than chest pain and a rotten family history, and feels until he gets the pain, he is fine. I have been begging, cajoling you name it to get him to a Dr. He is short of breath with basic activities but has a job where he is lifting all day and seems to be fine with this. I'm not convinced...
And now, after reading this thread, maybe it ISNT uncommon to not experience a lot of pain.
While the most common symptons for men are chest pain, arm pain, jaw pain, shortness of breath, it is indeed possible to have a heart attack w/o alot of pain. Women can also present with symptons than men.
It can be difficult to diagnose a heart attack...
So you say you didnt have chest pain before? I'm just not liking the sound of this...It seems to me symptoms other than classic angina are more common than your average joe realizes. That would include my hard headed husband who is 43, dad had quad bi-pass at 45 and died at 58. I have noticed the shortness of breath, he of course insists its all in my head.
Thanks for responding to my query. I truly do hope you're alright for a very very long time! 54 is just too young!
Scary really when you think about it....aceing a stress test with blocked arteries. Heart attacks in progress with no chest pain....
My brother in law, who suffered a massive, near-fatal heart attack at 40, said he just felt "lousy" for a few months. Tired, generally crappy. When his hit, he was sweating profusely and nothing would help. Then came the pain and he called the ambulance. He flat-lined four times during the trip to the hospital, then again once there. Unfortunately, he suffered some heart damage, but he is alive and better since his stents were placed.
My grandfather, who finally suffered a fatal heart attack, had been having serious symptoms for days (severe pain, shortness of breath). Stubborn, he didn't want to wait at one hospital, so he went home and finally checked into another several days later. By then, the damage was done and he died shortly after refusing cardiac catherization.
My grandmother's symptoms were like heartburn, but she also could not catch her breath and knew something was very wrong. The pain came in waves, but was quite nasty.
My uncle, the one who needed six bypasses, is quite overweight (340 pounds). His breathlessness, he figured, was probably his weight. It wasn't. One day while he was working on a job with my father, he couldn't finish screwing in a fuse because holding his arms up made them go numb and weak and he began to sweat each time he tried. My dad took him immediately to the ER. Good thing. He was the only one who didn't have pain, but he also was not having a heart attack at that point either.
From what I have seen, pain, shortness of breath, weakness and sweating seem pretty much universal. At that point though, getting to an ER - FAST - is important.
Pain prior to the actual event though, it seems easy to dismiss as something else (muscle pain, heartburn, etc.) This is why it's important to keep an eye on other things, like shortness of breath or weakness...or unusual fatigue. Everyone I know who had ischemic chest pain had unusual fatigue long before the actual heart episode, usually along with the pain. Unfortunately fatigue is vague too.
Certainly my family doesn't paint a universal picture of what every heart patient will feel, but maybe it gives an idea. Yes, they could perform activities without pain. Sometimes they would get pain and sometimes not. Cardiac pain can start and stop over time, with many factors playing a role in whether it pops up or not.
I exercise every day. I walk 5 miles at a 6.5% incline on a treadmill 4 times a week and still go to rehab the remaining days.
I feel pretty good.
Good luck with your husband! I think you are doing the right thing in trying to get him to go to the Dr. It is amazing how pigheaded some men can be in some matters. I wish you the best of luck!
I'm interesting and wish to compare my holter with you. Is that Ok? Which numbers or sections showed possible ischemia? Do you have a report in your hand?
Take care.
With symptoms and strong family history of HD and negative tests, patients are entitled to a Heart Cath for peace of mind....
ST SEGMENT ANALYSIS
Total ST Minutes CH1 : 0
Total ST Minutes CH2 : 17
Total ST Minutes CH3 : 0
Max Delta ST Depression : -1.6 at 21:19 @ CH2
Max Delta ST Elevation : +1.9 at 6:14 @ CH2
Max ST Episode : 5 Minutes at 9:28
Max HR In ST Episode : 96
BRADYCARDIA
Pauses in Excess of 2.5 sec : 1
Max Pause : 3.2 sec at 14:14
I've a pacemaker. I'm a wpw and the people in the web said wpw with ST segment is normal! Stress Test said "The changes seen could be due to attenuation artefact, but ischaemia cannot be excluded." My cardio not a concern either!
report as follow:
Report said : 24 hour thallium study shows at most a very small
amount of reversible ischamia in the posterior wall. No major
reversibility is seen.
Cardio explained : It is due to the pacemaker pacing. They don't
know I have a pacemaker.
Report said : Clinical Indication: Multiple risk factors with
pacemaker in-situ and atypical PIC.
My explained : Proved that he didn't read my full report!
Report said : The changes seen could be due to attenuation artefact,
Cardio explained : It wasn't any ischaemia there, not real one.
Report said : but ischaemia cannot be excluded.
Cardio explained : standard print, everyone's report printed like that!
I showed/gave him a copy of my holter monitor report. He looked at that for a while. He said, "it didn't make sense!" He told me my pacemaker has a built in holter. After he checked my pacemaker, he said, "the pacemaker said only a few skip beats, that's all! If you want can take some medicine but it wouldn't help at all." See you six months time, around next year April.
I walked out with a crying and broken heart.......... Didn't get fix!
He said won't help at all, so why I wasted my money and left the unwanted chemical flow in my body? He didn't write the script and didn't tell me what med are they?
Pika