What is a stress test like?

[Rosemary349]

Hi everyone

I have told my doctor that i want a battery of tests run on me because of what happened to my father last week.  The doctor asked me what type of test i wanted!  I don't know!  Maybe you can advise?

He's arranged for me to have a stress test.  What am i to expect with that?  Are there any dangers with that test?

I really just want a set of tests that will measure whether there is any heart disease or heart problems (i've had an irregular heartbeat although that seems to have resolved by about 95% since my thyroxine medication has increased).

Thanks for any advice you can give.  The doctor said he wouldn't recommend an angiogram because it can be dangerous.......thoughts?

[erijon]

ed pretty much explained it, I've had two and did not have a fatty snack prior to any scan and did not receive a nitro spray either, could just be a difference in how they are done in different countries. Plus, the actual heart rate they will push for is 85% of you maximum predicted heart rate calculated as (220-your age) X .85, for me since I'm 51 my number would be 144.

Again, I've had a couple, one on a treadmill and one with Adenosine to get my heart rate up due to a recent knee surgery. Piece of cake, I would opt for the nuclear scan because you'll walk away with an indication of the condition of your arteries that may not be caught on a normal stress test.

Good luck!

Jon

[ed34]

Well yes and no. Do you know what type of nuclear scan you are having because there are a few types. Most people assume there is only one but it depends which type your cardiologist has requested. Different scans actually focus on different issues.
Let me give you just two examples.
A nuclear perfusion scan is for determining whether blood is reaching all areas of the heart tissue and gives an estimate as to how much. It is used as a guide, a kind of map by cardiologists to guide them to which areas could be of concern. Our tiny blood vessels in heart tissue are not all mapped the same, which would be handy, but they are quite different. It is not possible for a cardiologist to know if there are problems with tiny blood vessels by looking with an angiogram, hence the nuclear scan. Everywhere the radioactive substance flows causes a glow on the image which shows blood is getting there. Whether it is enough is down to the judgement of the examiner of the scans.
A nuclear viability scan aims at focusing on tissue condition, showing if there is any tissue damage in the heart from a previous heart attack or infection etc. So the scans are totally different and give different information depending on the request made.
These are just two of many different types.

[erijon]

ed is correct, but bottom line is you'll know more than you would with a normal exercise test so it's worth doing. Also, the accuracy is much better;

Treadmill test: sensitivity of 67%, specificity of 70%
Nuclear test: sensitivity of 81%, specificity of 85-95%

The definition of specificity is;

"The proportion of persons without a disease who are correctly identified by a test. The specificity is the number of true negative results divided by the sum of the numbers of true negative plus false positive results."

To me, I would want the higher accuracy level if I'm taking a stress test anyways!

Good luck!

Jon

[cblmn7]

Everyone pretty much said it all on the nuc stress test the only thing they left out was you may taste metal when they inject you i did and it is a awful taste. so dont be alarmed the test is not that bad i was very nervous before my first one. but i still hate them though.lol

[kenkeith]

There is another option not discused by Jon and Ed  and may be more appropriate for you. Because you want to establish a base of your cardiovascular health and not looking specifically for lumen blockage, I would recommend a CT  scan, 128 slice if available.  The scan images the entire anatomy of the major vessels and establishes a calcium score based on the degree of calcium deposits (soft plaque) within the artery walls.  The calcium score has some validity to predict a future heart event.  This soft plaque usually does not cause stenosis (narrowing of the vessel) so it is not observed with a stress test.  Also, soft plaque is much more likely to cause a heart attack as any cardiologist will tell you, as it is the soft plaque that ruptures and causes a clot within the lumen (inner channel) and a heart attack. Stenosis is more,likely to cause chest pain and heart failurre.  I have had the test and I consider it informative, but didn't like the results :)  Stress test only observes stenosis within the lumen based on perfusion images and correleate with the individual's exercise tolerance. It can be utilized for post heart attack patients to establish exercise tolerance for heart rehabilitation as well.

Consensus statements from the American Heart Association, the American College of Cardiology, and other organizations have discussed the application of the coronary calcium score. These documents concur that coronary artery calcification is part of the development of atherosclerosis, occurs exclusively in atherosclerotic arteries, and is absent in normal vessel walls. Much better test for you or anyone with a family history of CAD or sudden death events from a heart attack with no prior symptoms..

For more detail: "A dedicated computer program identifies calcifications meeting the scoring criteria throughout the images. The person performing the analysis then identifies those calcified plaques in the epicardial coronary arteries and identifies the location of the plaque by the coronary vessel. The computer software sums the amount of calcification per lesion and per artery simply by adding up the pixel values and adjusting for the slice width (Figure 2). Pixel values are then converted to an Agatston score, plaque volume, or plaque mass. Each provides essentially the same information: The amount of calcified plaque in the coronary arteries. Currently, in clinical practice, Agatston scoring is used almost exclusively and has come to be known as the "coronary calcium score." The other scoring systems have various merits but have yet to be implemented into clinical practice in a meaningful way".

[cblmn7]

I have a question on the 128 slice ct scan i asked my cardio dr if i could get one and he said since i already have stents there is no reason for one. is this true or should i get another opinion. and would it show anything that they havent seen on other tests. im curious thx