Is it important to get a stress test

[LindaTX]

I need some advice here....I had a stress test while living in Alaska in Aug08 which was incomplete.  I was on the treadmill 8 min and had to get off because of tightness in chest and shortness of breath.  Never had had that happen with a stress test before. They gave me the chemical adenosine and I immediately went into a-fib.  They allowed me to rest about 20 min and then when they put me in the machine to continue the rest of the test, when I layed down I went into a run of V-tach.  They didn't finish the test and admitted me to ICU (don't know why) and I was there for 4 days.  I know they weaned me off my flecainide and started me on Rhythmol, which I took for that next yr before it turned pro-arrhythmic.

I am scheduled for an ablation in Sept.  My regular cardio in Tx actually wanted to get another stress test a few months ago. I put it off because of what had happened during the previous test.  Then I was turned over to the local EP and he had retrieved my records from Alaska and didn't want me to have another stress test.  I don't understand why? He is not the Dr doing the ablation.  Wouldn't it be good to have the stress test to check for artery blockages before I go through the ablation?  I realize its not as diagnostic as an angiogram but I really don't want to have to go through that too.  Any advice would be greatly appreciated.   Thanks guys, Linda

[LindaTX]

The chemical they gave me for the stress test threw me into a-fib.  I assumed it was adenosine because that was the only thing listed on the report.  I think they were trying to see if they could induce a bad arrhythmia because they wanted to take me off flecainide.  They couldn't put me on tikosyn because of my QRS numbers being high? I think.  Anyway I went into v-tach when they started the second half of the stress test where they put you in that tube. They never did finish that part of the stress test and just admitted me to the hospital. Then after monitoring me off flecainide they put me on rhythmol.  I do feel I probably have some CAD because I can't hardly climb a flight of stairs without feeling winded.

[is_something_wrong]

Something is confusing me a little here.

Why were you given adenosine? Did the stress test provoke a supraventricular arrhythmia (AV nodal reentry tachcardia)? Adenosine is used to terminate AVNRT and inducing AV block to search for extra pathways, other than that it isn't very useful.

If you had chest pain, and shortness of breath, and the stress test didn't show any so-called ST depressions, angina / CAD is unlikely. It can't be completely ruled out, but really unlikely.

I don't think CAD makes ablation more dangerous. Your story is a bit short, what is being ablationed? V-tach, Afib or something else?

I think the more information the doctor get, the better. A stress test is usually safe, and if you get a dangerous arrhythmia, defibrillators are ready. I think if the stress test induced V-tach, getting admitted to the ICU is correct. It's important to find the cause of the V-tach.

Anyway, sorry I cannot answer more in detail, unless you tell me:

- Why were you given adenosine?
- What arrhythmia are you going to ablate?
- Did the doctor find any sign of coronary artery disease during stress test when you had chest pain?

[LindaTX]

No, I don't see how CAD can be ruled out if they didn't even finish the stress test.  I am worried that my diabetes will compromise my veins during catheterization with my ablation. I don't know if I should go ahead with plans to have the ablation if my veins are not healthy enough for it because of the diabetes.  Does anyone out there know the answer to this?

And my other question above...what other protocols are there for checking clpgged arteries as caregiver suggested?  I thought angiograms, stress tests and CT non-invasive 64 scan  were the only protocols available.  Is that right?

[itdood]

Hi Linda,

A stress test is primarily used to evaluate CAD, or blocked arteries.

Your stress test definitely raised alarms and landed you in ICU.  It also triggered a change in rhythm medication.  It did not trigger any further evaluation of CAD.  Either they are completely confident that they could rule out CAD or they made a huge mistake.  I'm hoping it's the former :-)

How confident are you that they didn't make this oversight up in Alaska?

I think if CAD has indeed been ruled out another stress test may be unnecessary.  

Stress test=CAD
EP study=Rhythm issue


What I think I'm hearing is that you don't have any CAD but you do have rhythm issues of unknown cause.

Ask your doc if indeed CAD has been ruled out.  If any doctor can answer 'yes' to that question then target the rhythm issues, which an EP study would be the next logical step.  hope that helps...

[LindaTX]

What other protocols are there other than stress tests or angiograms to determine artery blockages?  I didn't know about the mortality associated with chemically-induced stress tests.  Do you know what the percentages are?

[caregiver222]

There is good reason for them not wanting you to have another stress test.

There is a mortality associated with such tests, particuliarly the chemical-induced stress protocol. Different physicians have different gut feelings about the risk.  I would go with the cautious one.

The stress test if not necessary to determine arterial blockages. There are other protocols available.

Before you get the ablation discuss other alternatives, including taking magnesium glycinate supplements, with your current cardiologist.