Stress testing?

[erijon]

I am a 49 year old male, non smoker, no diabetes, controlled blood pressure (110/70) and cholesterol (165) with no family history of early onset heart disease. I am 50 pounds overweight but have lost 50 pounds in the last 10 months. I had complete cardiac work ups each of the past two years, once in February 05 when I had some slight chest discomfort and again in March of 06 when I had an annual check up with a new cardiologist. Both work ups included echos, Thallium stress tests and bloodwork, all came back normal both years.

I was diagnosed with RA by a Rheumatologist 6 months ago and it was determined that the RA was most likely the cause of the pain in my intercostal joints. Other than the RA and the occassional PVC (always had these), I have had no new sypmtoms since my first workup in Feb 05. I continue to loose weigh with lifestyle changes. I exercise daily by doing 3 miles a day on the treadmill in 45 minutes without any symtpoms or discomfort. Most of the chest discomfort I had two years ago is gone with the RA meds. I am currently on Plaquenil for the RA (I do take Celebrex and Hydrocodone 5/500 during extreme flare ups), Benicar HCT 40/25, Vytoren 40 mg, 81 mg of ASA, Omega 3 and Aciphex for Reflux. Would you reccommend going through another work up his year, is that standard protocol? If I did have CAD, would I not feel some sypmtoms when I exercise or wouldn't my ability to exercise be diminished?


Thanks,

Jon

[Forum-M.D.-MM]

Hi Jon,

Would you reccommend going through another work up his year, is that standard protocol?

Not really.  Based on your history, if there are no new symptoms, evaluating your blood pressure and cholesterol may be helpful, but there is no clear indication for a stress test or echo.

If I did have CAD, would I not feel some sypmtoms when I exercise or wouldn't my ability to exercise be diminished?

Autopsy studies from the either the Korean War or Vietnam war (I can't remember which one) showed that soldiers 18-19 already had the early signs of coronary diesase.  Coronary artery disease can start at a very young age and usually only becomes symptomatic after the lesions start to significantly decrease blood flow to the heart. You can have coronary artery disease and be able to exercise vigorously without symptoms if the blockages are not compromising the blood flow to your heart muscle.  Unless you have a high risk job (like an air plane pilot), we do not usually test asymptomatic people for coronary artery disease.

I hope this answers your questions.  Thanks for posting.

[sandrabel]

I have a technical question. I've read that an exercise induced nsvt is dangerous. Why is that? Is it also dangerous in a normal heart? Is there a treatment?