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11849443 tn?1441302841

Echo-Stress test

I have a stress test in a week or so and wanted to know a few questions if you guys don't mind.

I have read they use the Bruce protocol, is this correct?
Also I'm so confused about the grade% I want to see how I can do this same test at my gym but
I can not find each grade/incline difference.
http://www.topendsports.com/testing/tests/bruce.htm

Is the test pretty tough, how long did you last?

I like to try my own that way I won't be surprised and raise any anxiety when I have this test, this kinda crap
makes me nervous.

49 Responses
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1807132 tn?1318743597
I'm not sure why you would become nervous.  Essentially they hook electrodes to you and ask you to get on a tread mill and walk.  They will then increase the incline and/or speed and make it a more difficult walk so your heart rate increases and they will keep doing this until you have reached your target heart rate.  Once you do they ask you to jump off and get on a bed and they will look at what your heart is doing with an ultra sound machine.  There is nothing you need to do, you are directly through out.  Try to not over think this.  It's super easy.
Helpful - 0
1124887 tn?1313754891
I have never had a treadmill stress test done, here they do the test on a stationary bike. But it's more or less the same.

However, I have no idea why they seem to stop you at a calculated target heart rate (85% of calculated max). For the test to be somewhat reliable regarding ruling out CAD and arrhythmias, the test must (according to my EP who I definitely trust) go on until max heart rate is achieved. My mom has a very high max heart rate for her age (she is 65, and her max heart rate is 180). 85% of her calculated max heart rate would be 131. At 131 bpm she is barely breaking a sweat.

My advice is: Push yourself until you can't walk/run any further, for the most reliable results.
Helpful - 0
1124887 tn?1313754891
Also, if the point is to reveal arrhythmias / SVT, you should do what you can to get them. The comfort in having a "clean" test result (for example, stressing as little as you can, not push yourself, take beta blockers) will just make the test money out the window. You are not taking the test for reassurance.

Ask your doctor if you can do the test without beta blockers. And if I were you, I would drink a couple of double espressos before the test. My point is, on this test you will want to have arrhythmias, so the doctor can give you a correct dx and treatment. And as I mentioned, push yourself.

Helpful - 0
1423357 tn?1511085442
I think I explained the entire echo stress test to you in detail in a previous post.  I'm confident of its accuracy, so I won't repeat myself.

Just to say though that you're misinterpreting the nature of the test.  The whole idea of the test is to bring your heart up to a "stressful situation".  This test is administered to people of all ages; children to seniors in their 80's.  The Bruce Protocol is nothing more than a standardized approach to the test.  Those who have difficulty walking or who otherwise are incapable of walking on the treadmill are administered a chemical stress test.  While I haven't experienced one, I understand it's an "interesting" sensation.

So I'll repeat myself in an effort to get this point across to you that it's not necessary to train yourself for the test.  No one there is going to judge you on how well you do on it.  It's merely to get you heart up to workout levels.  If you can only do 7 minutes, that's fine.  If you can get to 14 minutes, the cardiologist just has to wait another 7 minutes to get the test over with.  They could probably tell you to run around the hospital a few times and get the same results.
Helpful - 0
11849443 tn?1441302841
Thanks everyone, sorry I been losing my mind a bit lately with this and am so damn scared they are going to find some heart disease.

That is my biggest fear right now.....
Helpful - 0
1124887 tn?1313754891
That's irrational.

If you did have heart disease, you would want it to show up so you could get it treated.

Again, I believe you are getting this test for reassurance, you believe your anxiety will go down if you get a clean test result. It will only be temporary.

The fact of life is:
Either you have a heart disease, or you don't. We can of course hope you don't, but it you do, it would be in your interest to get it treated or under control. It would truly be bad if you had a heart disease but didn't get a diagnosis.

So in other words. Do what you can to provoke your arrhythmias during the test.

And by the way: SVT is not a "true" / structural heart disease. Some people have extra pathways in their hearts which make SVT more likely to happen, but just as often it's more a reaction to anxiety.
Helpful - 0
1423357 tn?1511085442
I don't know how it is in Norway, but in the states, I've noticed that an echo stress test is a step in the direction of an electrophysiology study.

Anxious4ever is losing sight of the nature of the test.  The "test" itself is the ultrasound of the "stressed" heart.  The part before, that is the treadmill portion is to get the heart beating hard and fast.  The imaging part is what is the meaningful portion of the test, and that you can't train for.
Helpful - 0
1423357 tn?1511085442
....and by the way Anxious4ever describes his events, it sounds more like NSVT instead of SVT.  Short duration, a dozen beats or so,then drops out to NSR.  Has a professional actually seen a trace of an event, or are they making a diagnosis based on the patient's description?
Helpful - 0
1807132 tn?1318743597
It could also be a simple run of pacs.  A dozen or so beats of pacs can sometimes be called svt though it is not unheard of that a run of pvcs can be caused by high anxiety but if the results said svt then I would suspect a run of pacs over pvcs.  
Helpful - 0
1124887 tn?1313754891
Stress echos are very rare in Norway. Instead, ordinary stress EKG testing is performed and you are pushed until complete exhaustion (max heart rate) and if the test is inconclusive, the next step is nuclear stress test and then angiography if CAD is suspected, or Holter/heart monitors and then EP study with arrhythmias.

Honestly I don't understand why the original poster is getting a stress echo instead of a normal stress test, if the point is only to reveal SVT.

I'm willing to bet 100 dollars that the original poster suffers short runs of atrial tachycardia, simpy "some PACs in a row". It doesn't sound like a reentry tachycardia like AVRT or AVNRT, the rate is too slow and the duration is too brief. If that's the case, EP study with artificial pacing to reveal reentry circuits would reveal nothing. But loading up with isoprenaline/adrenaline would possibly reveal something.
Helpful - 0
1807132 tn?1318743597
The stress echo is not used to determine if there is an arrhythmia present unless it does show that it is exercise induced. If they were only looking for arrhythmia they would only do the stress test but generally the stress echo is done to rule out heart disease so the doctor can safely say that any symptoms you are having are benign, regardless if they are able to catch or diagnose what those symptoms are.  When people complain of heart symptoms the rule is to verify that the heart is structurally normal and then from there what actions need or don't need to be taken.  It is generally the way for doctors to know there isn't anything to be concerned about regardless of symptoms.
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1124887 tn?1313754891
OK, I understand, but doesn't a normal echo (resting echo) rule out structural heart disease?
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1124887 tn?1313754891
By the way, it was not my intention to offend anyone regarding my "bet" earlier in this post. It was most of all a figure of speech, meaning "I'm very sure...". Just wanted to clear that up, as I know there may be differences in the way we express ourselves in Norway and US/UK :-)
Helpful - 0
1423357 tn?1511085442
I had my Stress Echo done prior to my electrophysiology.  This was done after a normal treadmill stress test.  The stress echo wasn't done as part of the pre-admission testing, but was done as part of the path towards the electrophysiology procedure.  My cardiologist, whom I'm very friendly with told me it was done to rule out any structural abnormalities, and that he wanted to see my heart working under physical strain and compare it to when it was at rest.  He ran me on the treadmill to failure, about 13 minutes (no SVT!), and then took ultrasound recording from that point until I recovered.  I'm not sure if he was comparing valve operation.... I think he also took measurements in both states.  Anyway.... that seems to be the norm here; stress echo before the electrophysiology procedure....
Helpful - 0
1124887 tn?1313754891
By all means, I fully respect (and envy you) the healthcare system in United States. I believe the financing is completely nuts, but that's another discussion :-)

What I don't understand (perhaps because it's very different in Norway and in Europe generally) is the aggressive treatment of high blood pressure (including white coat hypertension) and high cholesterol which is practiced in United States, and how frequently drugs like Xanax and Klonopin are prescribed. Regarding the latter, the ONLY time Xanax could be prescribed in Norway, is if it can make the difference between a career at work and permanent disability, and ALL other treatment options (at least two SSRIs/SNRIs, Buspar, antipsychotics, other benzodiazepines and CBT) have been tried unsuccessfully. Regarding blood pressure, Stage 1 hypertension is only medically treated in the presence of other risk factors. For high blood pressure to be treated in the absence of other risk factors, it would have to be stage 2 (>160/100) or involve organ damage (LVH, etc.)

But it's difficult to say which one is right or wrong.
Helpful - 0
995271 tn?1463924259
I did the Bruce protocol treadmill test when I was out of shape.  Not overweight, but deconditioned.  They keep raising the incline.  4 stages.

No biggie.  They will stop it when you need to.  They don't want you to stop it though.

I tried to tap out with like 30 seconds left at stage 4 and the tech was like "seriously dude?  you're not at max, man-up".  So I held out to the end and I didn't die.  Threw some PVCs in recovery though.  I said "HAH!!  see!?!?  I told you so!!"  This was the first time I saw PVCs on a monitor after years of conjecture.  It was exciting, because my cardiologist was there.  I thought what a huge breaktrough!!  guess what.   it was meaninglessness in the long run because there still wasn't anything that could be done about them.  This was like 13 years ago.  I was 35.   Things have changed, up and down over the years, but the muscle is still fine.  much anxiety and crazy work over nothing it turned out.
Helpful - 0
995271 tn?1463924259
USA docs practice defensive medicine due to the litigious nature.

The thought process has one foot in the patient's well-being, and the other foot in preventing a lawsuit due to not following what are considered model-practices.

I had stage 1 hypertension back in my 30s, meds were suggested but I went off on my own.  For some reason I don't have it anymore.  weird.
Helpful - 0
1423357 tn?1511085442
Interesting...  Yes, we've talked about the differences in our healthcare systems before.  It hasn't gotten any better!  I'm about to enter the US Medicare system when I retire and turn 65 in February.  The Medicare cost is deducted from the monthly Social Security "pension" that most (but not all) Americans have paid into all of their working lives.  But Medicare doesn't cover everything, and there are gaps that need to be filled with out of pocket cash or "Medi-gap" Insurance companies offer policies that fill the gaps in the overall medical care.  My employer, a large US corporation offers a "retirees policy" that I will go on to accomplish this.  It's a good policy, but of course it's not free.

My wife has been on a "as needed" dose of Xanax for years, and was recently transferred over to  Klonopin.  She doesn't like it.  There is an apparent shift from Xanax due to the habit forming nature it possesses.  We are required to present our motor vehicle driver's license when it is purchased.  Our ID is bar coded onto the license which is scanned and recorded.  

Yes, hypertension is aggressively treated here, as is elevated cholesterol and triglycerides.  For me, Metoprolol, a former front line blood pressure med works very well for me, and Simvastatin controls my elevated cholesterol to about 135 now.  Both of these drugs have become extremely affordable; literally pennies per dose.  My primary care physician thinks that nearly everyone should be on both medications as a prophylaxis against each.

Which begs a question:  Is Metoprolol an "over the counter" medication in Europe?  I've been led to believe that it is available without a prescription in some countries, but I can't confirm that.

Also, I was wondering if you are a native Norwegian  or perhaps a British expatriate as you have a great command of English.
Helpful - 0
1124887 tn?1313754891
Thank you for a detailed answer. Always nice to talk with you :-)

It seems like far less medications are OTC in Norway than United States. I went on a trip to Texas and New Orleans earlier this year, and I was surprised how much medications were available OTC in pharmacies and grocery stores. Meds like pseudoephedrine/phenylephrine, Benadryl and the cough syrup DM something, would not be sold OTC here. Metoprolol is only available with prescription here, I'm not sure if it's OTC in some countries but I doubt it. I know that Simvastatin has been discussed for sale OTC (I wonder if it possibly is OTC in UK in 10 mg pills) but so far it is not.

In Norway, our cholesterol is generally higher than in most parts of the world. I don't know why, I don't think it's caused by generally unhealthy living, but >200 is more the rule than the exception here. My cardiologist told me it's somewhat genetic. He also told me that my cholesterol would have been treated in United States but I didn't meet the criteria for getting treatment here, probably because my blood pressure is low. If I should be treated, most Norwegians would have to be.

Thank you for saying my English is good. Unfortunately, my teacher in high school didn't agree - which is one of the reasons my grades weren't good enough for med school (I would need A average, I only have B average). I'm native Norwegian, but I love UK and US :-)
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1124887 tn?1313754891
I forgot to say; I didn't know that Klonopin could be taken as needed. I know one guy at work, who suffers severe anxiety and former substance abuse, taking it (daily) and he finds it very helpful. Personally, I believe it's healthier to take Xanax as needed than coctails of mood-stabilizers, antidepressants and antipsychotics which some people with anxiety are taking instead of Xanax. Again, it's hard to say who is right and wrong.
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11849443 tn?1441302841
Mornings have been the worst for me right now, if I had any heart disease wouldn't it be picked up by the chest xray and all the blood work I had done?

Also by the many of EKG's and the 24 hour heart monitor?

The Dr said I have SVT they did not explain to me what kind or if it was a run of PAC's.

My svt has been caught on a EKG and the 24 hour heart monitor....

I'm still freaking out daily, I still can't sleep or eat very well, its flipped my life upside down and I can't not handle waiting to find out if there is something wrong.
I cry atleast once a day, I have a break down.
Helpful - 0
1807132 tn?1318743597
Considering the amount of anxiety you are feeling crying isn't a bad thing. It is the body's way to release stress and anxiety and fear so go ahead and cry but also try to self soothe if you can.  Talk to yourself like you would a small child who is afraid and remind yourself that it's going to be OK because odds are highly in your favor that it will be fine.  They are doing the test not because they think there is something wrong it is just a standard of practice is all.  Odds are if there was anything seriously wrong it would have shown signs on the ekg so please try to stay as objective as you can.  It is normal to be fearful just try to do your best to walk through the fear and allow yourself to cry if you have to.  There is no shame in it.  HUGS.
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11849443 tn?1441302841
Thank you michellepetkus
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11849443 tn?1441302841
The sad part is I have all this time to wait for the test, that is the hardest part is wondering if there is some thing wrong.

I end up surfing the web going through different heart diseases and see if I have any matches on the symptoms.

If I had heart disease would I be able to get on a treadmill for 30mins day or would I be exhausted and not be able to finish?

Helpful - 0
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