Stress Test

[skidogg]

my stress test revealed sinus rhythm with incomplete right bundle block. What does that mean.I'm 63 have CAD , however, did reach stage 2 of the bruce protocol in 8 minutes, any idea what the mets would be? Thanks

[FergalEmmanuel]

Nice post…. Stress tests are tests performed by a doctor and/or trained technician to determine the amount of stress that your heart can manage before developing either an abnormal rhythm or evidence of ischemia not enough blood flow to the heart muscle.

[Mom2four85]

I've been researching METs also; here's a thread on the expert forum that the doctor talks about it: http://www.medhelp.org/posts/Heart-Disease/Exercise/show/1461687

"Usually we look at both maximal predicted heart rate (goal 85%) and the number of METs you can do on exercise.  Usually greater than 8 METS is good (5-7 adequate) and 10-11 would be excellent."  "I would just be able to assume that if you can get to 85% of your maximal predicted heart rate and at the same time exercise at least 8 METS, you have a good functional capacity and are able to do an good amount of exercise without any symptoms."

here's a list from the American Heart Association, not sure if it's different in other countries =) METs - http://www.americanheart.org/downloadable/heart/1176406256764PA_Intensity_table_2_1.pdf

[erijon]

According to the Bruce Protocol, stage two achieves a mets of 7 which is considered good enough for some one like you. If you Google Bruce Protocol and go to the Wiki site, it will show you a chart that breaks down the performance by stage. If you have a problem finding it let me know and I'll PM the link to you.

Jon

[skidogg]

Thanks for the info, I did take a look but I'm still puzzled as to what my met calculation would be. The reason I ask is that the VA wanted a stree test for an agent orange claim for CAD, and the test did not list the mets achieved. Just curious as to where I stand. Thanks Skidogg

[erijon]

Your numbers are fine and prove my point. For me, I would have to be at 10 - 11 mets to achieve 150-155 BPM. You achieved 96% of your max which is very good and is adequate for an accurate stress test. For me, 96% would be approx 162 BPM which would make me be work out at around 12 - 14 mets so you can kind of see the  relationship between mets, heart rate and conditioning.  

For this reason, I am less concerned about my mets as they are a measurement of your overall condition, not necessarily your cardiac health. You achieved  a high percentage which is very good. In cases of heart disease, most patients are unable to achieve your numbers without changes in their EKG or symptoms so you did very well. The fact that you were ale to almost reach you max targeted heart rate  without being stopped is an excellent sign, congrats.

I remember my first stress test, it took me only 6 minutes to achieve 98% of my max heart rate, which is a little quick but I was very out of shape. On my last stress test it took 10 mins to achieve 85% of my max and I was allowed to go all the way up to 100% as I was symptom free so you can see how out of shape I was the first time and what affect my improved conditioning had.

If you go to the expert forum and go back a week or so, I asked the expert about mets and heart rate with exercise. The doctor's input was very interesting, take a look.

Jon

[skidogg]

My stress test reveals that my baseline was 72 beats per minute and rose to a maximum of 151 per minute achieving 96% predicted maximum heart rate. Again I am 63 with diagnosed CAD. Thanks for any additional info.

[erijon]

I'm sorry, what I posted is correct. From Heartsite.com based on NIH protocol;

"As noted earlier, the EKG is constantly displayed on the monitor. It is also recorded on paper at one minute intervals. The physician pays particular attention to the heart rate, blood pressure, changes in the EKG pattern, irregular heart rhythm, and the patient's appearance and symptoms. The treadmill is stopped when the patient achieves a target heart rate (this is 85% of the maximal heart rate predicted for the patient's age). "

Again, they are tracking BP, EKG changes, heart rhythm patient symptoms and terminate the test at 85% of the max predicted heart rate, no mention of mets.

Mets are important to determine the physical condition of the person being tested, that's all mets really is. They include mets to understand the patient's condition at the time of testing and as a goal to improve conditioning. The stress test is based on heart rate response, not mets.

I too can tell you exactly what my heart rate is at each met  as well. In order to determine your actual goal for mets you take your age times .11 and subtract that from 14.7 and you have your goal. For me that would be 8.98 so I try to achieve that number plus for about 5 mins. However, according the the NIH and the AHA my target heart rate is 70 - 85% of my max which is an average of 127 BPM. According to both, anything over that will add no incremental benefit and may in fact be detrimental. In the case of the OP that would be a target met of just under 8 mets. It may be dangerous to work out at this level based on his conditioning. I have no problem as I exercise everyday, but if the OP is not as well conditioned they will exceed the max heart rate which is not safe. For that reason, it is more important to manage a work out to heart rate and not just mets.

Jon

[kenkeith]

That isn't quite true.  METs are a  useful calculation to know as it can be related to other exercise equipment as well as brisk walk, running and so on.  If one knows the heart rate based on METs, that degree of  the metabolic equivalent and the heart rate thereof, there is no need to keep testing heart rate. After many years I don't need to check my heart rate as I am well in tune to what my system is capable of doing from an exercise perspective. Having been a member of Health Center for going 20 years, one doesn't see the long time members ever testing their heart rate...we know based on METs.

I can produce a numbert of different opinions what is the appropriate heart rate and so on with exercising.  The best method for someone with a heart issue is to have a stress test.  A stress test is oftened done for the purpose of learning the degree of tolerance/risk one can safely do.  The rule of thumb stated is not recommended for someone who has heart issues.  You will be safe to engage in exercising according to METs.  Also, the rule-of-thumb does not apply to someone that is on a beta blocker as a beta blocker decreases heart rate, etc.  

You should contact you doctor to confirm that is alright if you are exercising and that staying below the tested MET is OK..  My stress test report:  "The patient exercised for a total of 4 minutes and 20 seconds equivalent to 7.2 METs.  The pateient had a l mm ST segment  depression resolved 5 minutes into recovery.  One minute heart rate recovery was 115 beats per minute.  (the depressed ST segment indicates deprived oxygen rich blood to the heart shown on the EKG). No surprise as I knew I had CAD, but I didn't know the degree of exertion with exercising that would be appropriate as I didn't experience chest pain, etc.I also had the Bruce protocol calculations and I reached 7.2 METs  with 4 minutes and 20 seconds on treadmil.  It seems strange that you went 8 minutes for 7 METs!  

[erijon]

I wouldn't get too hung up on mets. What the cardiologist is looking for on a stress test is achieving 85% of you max predicted heart rate. Once that is met, the test is usually terminated. In you case that would be 133 BPM (220-age)*.85). Mets is simply a calculation used to determine the amount of energy expended to calculate calories burned. They measure mets to get a determination of your overall conditioning because a well conditioned person will take longer to reach 85% of MHR while some one in poor condition will reach it very quickly and they need to be able to distinguish what that length of time means. A mets of 6 -7 is considered adequate for a person your age with 8 -10 geing considered good. I work out daily on a treadmill and try to achieve 10 mets for at least 5 mins, the rest of my time on the treadmill I stay at 6 - 7 mets as that is the level of workout that meets my heart rate goal of 80% of my max.

Again, mets is useful but what cardiologists are looking at is heart rate and your heart's response to increase demand.

Just want to throw in my 2 cents.............

Jon

[kenkeith]

A stress test will be discontiued by the tech, and there should be a doctor involved as well to stop the test when a monitor indicates a possible risk to increase the METs or more time taking the test.  To complete the test would take about 12 or more minutes as I remember.  It seems reasonable the 7 METs would be your high safe exercise tolerance, and the test was stopped when reaching a safe level of exertion for your heart.

Going on 6 years I had a treadmil stress test and my test was terminated at 7 METs as well.  I regularily work out with a treadmil 3X a week.  I do a brisk walk at 4.5 METs and that is about 3.5 mph...that works for me.  There doesn't appear to be any progression of CAD, and I feel well currently and for the past several years.  

Thank you for your response, take care and I wish you well going forward.

Ken  

[skidogg]

Thanks again for replying to my question. With the info I posted is 7 mets the right number at the high or low. Thanks Skidogg

[kenkeith]

Mets is the metabolic equivilant and the amount of energy required for essential physiological functioning.  An MET of one would represent 1 MET.  If there are  4 METs displayed on the treadmill, that would indicate one is working 4 times as hard as one would be at rest. This would indicate one is consuming 4 times as much oxygen and burning 4 times as many calories as you would be at rest, etc. .

Exercising at a moderate intensity, which is important for weight loss, is estimated to be 4-6 METs, and to be beneficial for the heart would be a heart rate that is 220 minus age and 80 to 60% would be the upper and lower range and the METs associated with that reading to be the safe and the most effective range for one's heart.  Your MET calculation would be the acceptable rate according to your physiology monitored during the test.  The 7 METs can shown bicycle or any other exercise that measures METs.

The partially blocked right bundle branch indicates there is some blockage of the electrical impulse that discharges heart cells in the right ventricle.  Usually not considered a problem. A bundle branch block is either a complete or a partial interruption of the electrical pathways inside the wall (septum) of the heart between the two lower chambers (ventricles).

A bundle branch block usually causes no symptoms. and right bundle branch block is not serious in itself and may occur in apparently healthy people. However, it may also indicate significant heart damage due to, for example, a previous heart attack. You doctor would have information regarding whether or not the partial block is of any medical significance in your situation.

Thanks for the question and if you have any further questions or comments you are welcome to respond. Take care, .

[erijon]

Stage 2 of the Bruce Protocol will be 7 mets.

Jon