Understanding test results for subjects that are fit.

[Steve606]

I'm a marathoner and 1/2 Ironman triathlete and I have recently had some problems with my breathing. Diagnosed as exercise induced asthma. Also had an exercise stress test and pcp told me that my tolerance to exercise was great but my EKG was, in a word, crappy. Scheduled to see a heart specialist as a result. I've been told by a number of educated friends that an abnormal
stress test is fairly common for people that are fit. Looking for more information to at least help put my mind at ease prior to heading to the heart docs. Can anyone confirm that fit people are very apt to have bummer stress tests.
Thanks,
Steve

[CCF-M.D.-MJM]

Hi Steve,

The safest thing to do is cut back on your exercise until you see the cardiologist.  Stress tests are complicated to interpret.  Your age, sex, cardiac risk factors, exercise tolerance, and EKG interpretation are all used to determine your risk.  Nuclear or echocardiographic imaging is often added to standard exercise stress testing to improve accuracy.

As a cardiologist, I have diagnosed many people who thought they had asthma with heart problems and I know lung doctors diagnose asthma in patients thought to have heart failure.  Sure it is possible the stress test is a false positive and I hope that it is.  In the interim, be safe and avoid strenuous activity until you see your doctor.

Thanks for posting.

[arthur]

A typical ekg finding is Left Ventricular Hypertrophy which is conisdered abnormal...for all but athletic types, where that portion of the heart (which is actually the main pumping chamber of the heart) is naturally enlarged because of exercise and not because of disease.  The best thing to do is to avoid getting hyper about it until you have a good chat with a cardiologist, in particular (I would recommend) one that either specializes in sports medicine or is familiar with the oddities that characterize athletes.

-Arthur

[arthur]

...and, oh, there's always bradycardia, another abnormal finding on an ekg (slow heart beat)...also very typical in athletes.

[Sylviapap]

I had an abnormal EKG, Left Ventricular Hypertrophy was mentioned, but when I had a stress echo test, they actually told me my heart was perfectly healthy and in good shape.
So, I guess EKG's can be wrong.

[netrox]

Exercise induced asthma can cause EKG to look abnormal.

If the heartbeat problems begin before you have trouble breathing, it may not be an exercise induced asthma but rather that the heart is not pumping enough O2 due to irregularities in heartbeats.

It's a good thing you'll see doctor for more testing.

-jeff

[runnertom]

I hate to be a wet blanket on this party, but I was a 30 year runner/cyclist,triathlete who was having breathing problems. Mine was manifest by transient shortness of breath in the first 1/4 mile of running that would clear up and allow me to run without further difficulty. I never had any issues during cycling except that I would experience PVC's that caused my heartrate monitor to be unable to update.
   Based on the intuition of my savvy sportsmedicine oriented GP from whom I was trying to get a "better inhaler", I saw a cardiologist. He prescribed an angiogram that found a 90% blockage of the LAD that required CABG to "fix". 18 months later, I am back to my old performance level without the shortness of breath and few PVCs. The cardio claimed he ordered the angiogram based on my concern about the PVCs, but I am skeptical. He did say that the reason I was in general not symptomatic for the blockage was that my extensive collaterals would dilate and take over but may not have been available immediately when I started to run. I guess I didn't have a problem in cycling because I would typically ride the first few miles at a lower effort allowing the collaterals to dilate before serious exertion began.
   I hope that your situation is different from mine. I think the big distinction is that my shortness of breath was immediate and then resolved with exercise. Exercise induces asthma I think would be the reverse, being OK at the start and then coming on with exercise. Good luck.
Tom

[Konopka1955]

Hi Tom,  Sorry to hear about your 90% blockage.  :-(  But I'm glad they caught it and its now 'fixed' and your doing so well.  :-)  

I also know this guy in my running club who was running a marathon - dropped at the 24 mile mark due to dizzyness - he came out of it - finished the race - in 'qualifying' time for the Boston Marathon !!!   A week later he had the same dizzy episode and went to the ER and ended up with 2 stents and an ICD..  They said one artery was 97% blocked !!! Its amazing how strong the heart is and what its capable of doing.  

Biking looks like so much FUN. I thought about trying it - but I've got this running craze !!!   I should try a duathlon..

Konopka1955

[Steve606]

Hello again.  Since my stress test, I've had a meeting with a cardiologist who took a baseline EKG.  ONce again, came out being "very abnormal".  From my reading, and will the help of all of you, I'm thinking I may have LVH.  In anycase, all the reading I've done so far on athletes that have had bad ekg's said they went for further testing, usually an echocardiogram.   I've been scheduled for a cardio catherterization as well as an echo.  Should I be concerned about hte cath test?   I know it's a bit invasive and I'm not altogether sure it's necessary.   My doc says he just wants to make sure there is no blockage.  Does this make sense to anyone else or should I protest the cath test?
Just looking for all the info I can get.
Thank you all for your previous posts.
STeve

[arthur]

The cardiac cath test is the gold standard for detecting blockages.  It's often recommended to rule out anything serious.  I've been an athlete all my life (now 56) and it was recommended to me despite the absence of symptoms other than PACs.  Be sure the doctor describes the procedure to you and fills you in on the risks.  Other than than, don't read too much into it...it's just the very best test that exists to insure your arteries are clear.

-Arthur

[kley]

I hope everything is fine with you.

I had an interesting/scary event yesterday... I went to the doctor for a physical and after he told me he heard a murmur in my heart he did an EKG. The readings were very bad. So I was rush to a cardiologist (to one of the best centers in the country, in Redwood City, CA) the same day. They did a threadmill test together with multiple ultrasounds, where they could see pictures of my heart. Pretty neat to watch the valves of your heart opening an closing, and also to hear the sound of your blood flowing through your veins.

The cardiologist told everything was perfect!!, and the reason why my EKG was bad was because, on slim/fit people like myself the old EKG machine my doctor had was picking up the electrical signal of my heart too strong! He also did not mentioned a murmur.

OK I'm happy I won't cancel my usual 5-6 hour mountain bike ride this Saturday. :)

[kley]

Steve, I hope everything is fine with you.

I had an interesting/scary event yesterday... I went to the doctor for a physical and after he told me he heard a murmur in my heart he did an EKG. The readings were very bad. So I was rush to a cardiologist (to one of the best centers in the country, in Redwood City, CA) the same day. They did a threadmill test together with multiple ultrasounds, where they could see pictures of my heart. Pretty neat to watch the valves of your heart opening an closing, and also to hear the sound of your blood flowing through your veins.

The cardiologist told everything was perfect!!, and the reason why my EKG was bad was because, on slim/fit people like myself the old EKG machine my doctor had was picking up the electrical signal of my heart too strong! He also did not mentioned a murmur.

OK I'm happy I won't cancel my usual 5-6 hour mountain bike ride this Saturday. :)