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Cardiovascular Disease Prevention (Expert Forum)
Q on my stress test
Answered by
Lee Kirksey, MD - Peripheral Arterial Disease, PAD, Cardiovascular Disease, stroke, treatment, angioplasty, spider veins, laser ablation, wound treatment, surgery, leg pain, Prevention, Varicose veins
Penn Presbyterian Medical Center of the Univ. of Pennsylvania Healthcare Clinical Assistant Professor at The University of Pennsylvania School of Medicine
Philadelphia - PA
Questions in the Cardiovascular Disease Prevention forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine.
Q on my stress test
by bham_bob, May 13, 2008 02:26PM
I'm 30/male, 5'10 240 lbs. I went to a cardiologist with:
New onset palpitations
atypical chest pain (heavy, tight, not worse with exercise)
feeling breathless
New onset exercise intolerance/fatigue
over-awareness of heartbeat (beating too strong)
Near constant lightheadedness
I'm about to have a CTA done (actually he gave me the option between CTA and cath. He said if I was 50 he'd say cath but due to my age he said CTA should be okay).
IF that is normal, then does that mean the stress test was a false positive?
How often do you see stress tests like this turn out to be "nothing"?
(I should point out that at home I'm able to exercise 30 mins daily at a HR of 155-160, it's just the intensity level of the treadmill was too high for me; but I still do perceive far more fatigue than usual)
Max HR: 184
Exercise time: 7:30
Reason to terminate: fatigue
Left ventricle size/thickness normal. EF 61%
Perfusion: Abnormal
Ischemia: Mid anterior
FINDINGS:
1. Reduced nuclear isotope uptake in the mid anterior wall on stress imaging when compared with rest imaging. Findings may indicate ischemia in the distribution of the left anterior descending or branch vessel of the left anterior descending.
2. Soft tissue attenuation does reduce the sensitivity and specificity of the study.
3. Mild hypokinesis of the mid anterior wall with otherwise normal segmental wall motion and a calculated ejection fraction of 61%.
4. Normal left ventricular size and wall thickness.
5. Clinically negative and electrically nondiagnostic stress, exercising only 65%.
CONCLUSION:
1. Nuclear imaging suggests the possibility of ischemia in the distribution of the left anterior descending. Very poor exercise tolerance, as well. Clinical correlation recommended.
THANK YOU FOR YOUR TIME
New onset palpitations
atypical chest pain (heavy, tight, not worse with exercise)
feeling breathless
New onset exercise intolerance/fatigue
over-awareness of heartbeat (beating too strong)
Near constant lightheadedness
I'm about to have a CTA done (actually he gave me the option between CTA and cath. He said if I was 50 he'd say cath but due to my age he said CTA should be okay).
IF that is normal, then does that mean the stress test was a false positive?
How often do you see stress tests like this turn out to be "nothing"?
(I should point out that at home I'm able to exercise 30 mins daily at a HR of 155-160, it's just the intensity level of the treadmill was too high for me; but I still do perceive far more fatigue than usual)
Max HR: 184
Exercise time: 7:30
Reason to terminate: fatigue
Left ventricle size/thickness normal. EF 61%
Perfusion: Abnormal
Ischemia: Mid anterior
FINDINGS:
1. Reduced nuclear isotope uptake in the mid anterior wall on stress imaging when compared with rest imaging. Findings may indicate ischemia in the distribution of the left anterior descending or branch vessel of the left anterior descending.
2. Soft tissue attenuation does reduce the sensitivity and specificity of the study.
3. Mild hypokinesis of the mid anterior wall with otherwise normal segmental wall motion and a calculated ejection fraction of 61%.
4. Normal left ventricular size and wall thickness.
5. Clinically negative and electrically nondiagnostic stress, exercising only 65%.
CONCLUSION:
1. Nuclear imaging suggests the possibility of ischemia in the distribution of the left anterior descending. Very poor exercise tolerance, as well. Clinical correlation recommended.
THANK YOU FOR YOUR TIME
Doctor's Answer
by Lee Kirksey, MD, May 13, 2008 02:50PM
, May 13, 2008 02:50PM
To: bham_bob
Hello
How long have you had these new onset symptoms? Your stress test suggests that it was difficult to see this area of the heart because of your body habitus. Your fatigue with exercise caused additional concern. It's very inconsistent with what youre able to do on your home tread mill. Depending upon what study you quote and what age and population of people were included in the study, the false positive rate for nuclear medicine stress test may range from 20-35 %. Remember that it is a screening test for a life threatening disease so we accept some degree of false positive if it recognizes all of the people that really do have Heart Disease. Hopefully, your CT will be negative
What is your body type. What are your risk factors for CAD. If youre not sure, check out my blog on risk factors. Is your cholesterol normal. I would use this "scare" to take stock of your current health and the direction that youre moving in. It sounds like youre in very good aeroebic shape on your test was otherwise normal. Good luck
How long have you had these new onset symptoms? Your stress test suggests that it was difficult to see this area of the heart because of your body habitus. Your fatigue with exercise caused additional concern. It's very inconsistent with what youre able to do on your home tread mill. Depending upon what study you quote and what age and population of people were included in the study, the false positive rate for nuclear medicine stress test may range from 20-35 %. Remember that it is a screening test for a life threatening disease so we accept some degree of false positive if it recognizes all of the people that really do have Heart Disease. Hopefully, your CT will be negative
What is your body type. What are your risk factors for CAD. If youre not sure, check out my blog on risk factors. Is your cholesterol normal. I would use this "scare" to take stock of your current health and the direction that youre moving in. It sounds like youre in very good aeroebic shape on your test was otherwise normal. Good luck
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