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Stress Test and mets?
There was a great question in the heart disease expert forum about exercising and METS. (maybe this should go in the hd forum? I'm not sure) http://www.medhelp.org/posts/Heart-Disease/Exercise/show/1461687 ;
I've often wondered how this works, because I have problems with exertion and exercise where I didn't have problems before I got really sick. I know I was fit before; even with an astounding number of pvc's I could walk 45 min, and run 15 min @ 4.0 or walk incline @9 and do a full circuit on my weight machine and really had no problems - heck even push mowing an acre in the July heat and humidity never bothered me; now I'm just a weak and frail old woman.
The article he gave says - Your heart's ability to recover during the first minute after a workout can be a vital indicator of your fitness level and could be a sign of potential heart issues. Those with a heart rate drop of 12 or fewer heartbeats during the first minute after exercise were more likely to have a heart-related death during the next six years and that would be considered abnormal heart rate recovery.
Read more: http://www.livestrong.com/article/253521-heart-rate-drop-in-first-minute-after-exercise/
So what if your HR drops too fast, what does it mean then? What if it drops so fast you faint such as I do? What role does bp play in this?
If I go on the maximal predicted heart rate (goal 85%) and the number of METs I did on my test, I failed miserably! But it's a bit confusing to me how MeTs are achieved; anyone know where I read about it or what it stands for?
My hr went from 74 to 154 (85%) within 2-3 minutes, but then dropped 33 pts within a minute in recovery which the dr says 15 to 20 beats is acceptable, while my bp resting was 130/70 and wouldn't get above 150/90 even at peak.
I have to start exercising again, slowly my dr says and this concerns me; I faint and have major problems when I exercise - nausea, chest pain, fainting, cold clamminess, increasing shortness of breath. I'm scared to death to try again every time I do it lands me in bed for days and if I try to do something like go shopping or go off with my family that's even worse.
I've often wondered how this works, because I have problems with exertion and exercise where I didn't have problems before I got really sick. I know I was fit before; even with an astounding number of pvc's I could walk 45 min, and run 15 min @ 4.0 or walk incline @9 and do a full circuit on my weight machine and really had no problems - heck even push mowing an acre in the July heat and humidity never bothered me; now I'm just a weak and frail old woman.
The article he gave says - Your heart's ability to recover during the first minute after a workout can be a vital indicator of your fitness level and could be a sign of potential heart issues. Those with a heart rate drop of 12 or fewer heartbeats during the first minute after exercise were more likely to have a heart-related death during the next six years and that would be considered abnormal heart rate recovery.
Read more: http://www.livestrong.com/article/253521-heart-rate-drop-in-first-minute-after-exercise/
So what if your HR drops too fast, what does it mean then? What if it drops so fast you faint such as I do? What role does bp play in this?
If I go on the maximal predicted heart rate (goal 85%) and the number of METs I did on my test, I failed miserably! But it's a bit confusing to me how MeTs are achieved; anyone know where I read about it or what it stands for?
My hr went from 74 to 154 (85%) within 2-3 minutes, but then dropped 33 pts within a minute in recovery which the dr says 15 to 20 beats is acceptable, while my bp resting was 130/70 and wouldn't get above 150/90 even at peak.
I have to start exercising again, slowly my dr says and this concerns me; I faint and have major problems when I exercise - nausea, chest pain, fainting, cold clamminess, increasing shortness of breath. I'm scared to death to try again every time I do it lands me in bed for days and if I try to do something like go shopping or go off with my family that's even worse.
Best Answer
They checked everything the 4 days in the hospital because they were so stumped about what was going on. I had blood tests daily and twice on my 2nd day. Everything they tested was in "normal" range; and didn't change much from the month before when my primary did blood tests.
I've always drank that much :P there's not a moment of the day/night I don't have water - I asked if I have diabetes since that's a classic symptom - no diabetes; but my A1C last check was 5.7 up from 4.0 so I'm having it rechecked again March 4th.
I don't think my dr quite believed me so I did an experiment :P I had to go back a week after my first visit, in that week I cut out 1 glass of water a day and lost 12lbs.; somewhere they're missing something that's right in front of them.
I think what I find so strange is; in April 2009 we went to the beach for a week - I had no problems doing anything - even running in the sand & sightseeing 12 - 13 hours a day and in May I packed our entire house to move; even moving heavy furniture & boxes with no problems.
In June I slipped and broke my foot and fell into the door jamb and had this intense pain in my chest, the dr said was muscle; but after that I could no longer even walk outside to the mail box without my bp dropping/hr craziness and more fainting spells than all my life combined I really started to wonder.
The dr did a tilt test that shows my heart stops and my bp tanks when I faint; which he said is extremely rare and thinks I have some rare form of ANS problems and prescribed meds and a pacemaker/icd which did not stop the problem which I think is why the new cardiologist is sending me to Vanderbilt.
It was like one day I was fine; doing everything I normally did and then I fell and hit the door jamb = intense pain through my chest front & back and then like a domino effect all of this stuff started happening; like that was the catalyst for my body's breakdown.
I've always drank that much :P there's not a moment of the day/night I don't have water - I asked if I have diabetes since that's a classic symptom - no diabetes; but my A1C last check was 5.7 up from 4.0 so I'm having it rechecked again March 4th.
I don't think my dr quite believed me so I did an experiment :P I had to go back a week after my first visit, in that week I cut out 1 glass of water a day and lost 12lbs.; somewhere they're missing something that's right in front of them.
I think what I find so strange is; in April 2009 we went to the beach for a week - I had no problems doing anything - even running in the sand & sightseeing 12 - 13 hours a day and in May I packed our entire house to move; even moving heavy furniture & boxes with no problems.
In June I slipped and broke my foot and fell into the door jamb and had this intense pain in my chest, the dr said was muscle; but after that I could no longer even walk outside to the mail box without my bp dropping/hr craziness and more fainting spells than all my life combined I really started to wonder.
The dr did a tilt test that shows my heart stops and my bp tanks when I faint; which he said is extremely rare and thinks I have some rare form of ANS problems and prescribed meds and a pacemaker/icd which did not stop the problem which I think is why the new cardiologist is sending me to Vanderbilt.
It was like one day I was fine; doing everything I normally did and then I fell and hit the door jamb = intense pain through my chest front & back and then like a domino effect all of this stuff started happening; like that was the catalyst for my body's breakdown.
I was going to post and ask questions but don't want to take over others posts so I posted mine here. Your post was great and a lot of useful info in it =) I wish exercise made my pvc's go away, mine just worsen.
I used to be anal about exercise too...4-6 times a week (walking 45 min then jog/run 15-20 minutes in the morning) and sometimes 2-3 times at night on top of mornings; then on the off days I had a total gym....when I wasn't working or busy with family I didn't sit still.
I've always enjoyed yard work and found it a 'therapy' and helped with restless energy I've always had (even push mowing 1 acre, weeding, trimming etc). Then when i wasn't doing that the inside of my house was NEVER clean enough lol everyone used to laugh at me because there was nothing ever dirty anywhere; even with 4 kids...I was a neat freak from the time I was young - had to keep my world "perfect" :P
keep up the great work and keep us posted how you're doing with it
I used to be anal about exercise too...4-6 times a week (walking 45 min then jog/run 15-20 minutes in the morning) and sometimes 2-3 times at night on top of mornings; then on the off days I had a total gym....when I wasn't working or busy with family I didn't sit still.
I've always enjoyed yard work and found it a 'therapy' and helped with restless energy I've always had (even push mowing 1 acre, weeding, trimming etc). Then when i wasn't doing that the inside of my house was NEVER clean enough lol everyone used to laugh at me because there was nothing ever dirty anywhere; even with 4 kids...I was a neat freak from the time I was young - had to keep my world "perfect" :P
keep up the great work and keep us posted how you're doing with it
That's a lot of water. Are you sure you don't lose electrolytes? Remember if you lose too much K+ you will get prolonged QT. Just so you know, don't make any changes based on this.
I'm not sure if EF results with cardiac cath, MRI and echo can be compared. I'm not exactly sure how it works, but I think MRI estimates higher than echo, no idea about cardiac cath.
During the MRI your EF was high at least, maybe a sign that your heart can if it needs to ;) and maybe a sign that some ANS disturbances causes the low EF and not heart muscle damage? Again, just a question.
I guess the calculation for HR drop after exercise only counts heart rate that is caused by the actual exercise and not any other stimulation, due to anxiety, ANS disturbances, compensation for low blood pressure, and so on. Once (when my anxiety was really bothersome) I had a drop in the HR of almost 80 one minute after exercise. Just because the exercise made me panic and my HR increased far above 200 just by walking.
Again, if you have an overactive ANS, you may get increased heart rate without the normal BP increase. Your heart just works insufficient. I guess my EF was pretty crappy when my HR was 200 at that time, as well.
Look, we're possibly getting closer to something here :) Good luck at the Vanderbilt center, I think it's a good idea!
I'm not sure if EF results with cardiac cath, MRI and echo can be compared. I'm not exactly sure how it works, but I think MRI estimates higher than echo, no idea about cardiac cath.
During the MRI your EF was high at least, maybe a sign that your heart can if it needs to ;) and maybe a sign that some ANS disturbances causes the low EF and not heart muscle damage? Again, just a question.
I guess the calculation for HR drop after exercise only counts heart rate that is caused by the actual exercise and not any other stimulation, due to anxiety, ANS disturbances, compensation for low blood pressure, and so on. Once (when my anxiety was really bothersome) I had a drop in the HR of almost 80 one minute after exercise. Just because the exercise made me panic and my HR increased far above 200 just by walking.
Again, if you have an overactive ANS, you may get increased heart rate without the normal BP increase. Your heart just works insufficient. I guess my EF was pretty crappy when my HR was 200 at that time, as well.
Look, we're possibly getting closer to something here :) Good luck at the Vanderbilt center, I think it's a good idea!
You saw my question! It's nice to know they get read by others. As you can tell, I'm a little anal about exercise. I do it every day and it really came out of an initial heart anxiety that I had years ago that became a habit. My thinking was if I did the equivalent of a stress test every day, the heart must be good:)
You are correct about the recovery rate of your heart rate. I was already aware of it but wanted the doctors opinion. One of the key thing that causes you to drop too quickly and get light headed is by not doing a proper cool down. You MUST do a good 5 min cool down or 2 things happen. First, your capillaries will still be wide open and you will have too much blood in your large muscle groups which will cause your PB to drop as well as your heart rate and you will get light headed. Second, when you stop the demand for oxygen rich blood too suddenly to your large muscle groups your heart slows down too quickly to compensate and you will get lightheaded.
Bottom line, take a good 5 mins to cool down from your peak exercise.
Have fun with it. I like exercise because it makes my PVCs go away.
Jon
You are correct about the recovery rate of your heart rate. I was already aware of it but wanted the doctors opinion. One of the key thing that causes you to drop too quickly and get light headed is by not doing a proper cool down. You MUST do a good 5 min cool down or 2 things happen. First, your capillaries will still be wide open and you will have too much blood in your large muscle groups which will cause your PB to drop as well as your heart rate and you will get light headed. Second, when you stop the demand for oxygen rich blood too suddenly to your large muscle groups your heart slows down too quickly to compensate and you will get lightheaded.
Bottom line, take a good 5 mins to cool down from your peak exercise.
Have fun with it. I like exercise because it makes my PVCs go away.
Jon
See this is what is confusing to me - how can these be so different.
7/6/2009 Echo showed EF 55-60% (not anxious)
8/27/2009 Cardiac MRI showed LVEF 76% (anxious about ARVD and ticked over having to have this done)
8/28/2009 Cardiac Catherization EF 40% (not anxious - out cold) also showed mild systemic hypertension and moderately elevated LVEDP/34
I'll have to look at my bloodwork; I think they would have done the NT-proBNP in the hospital or ER but the name doesn't seem familiar.
I couldn't be dehydrated if I tried :P I drink so much water I float rivers lol about 2 gal a day they did my fluid intake/urine output in the hospital for those 4 days and couldn't believe how much I drank, my out put was a lot but I wasn't dehydrated.
Another curious thing I've been reading about is my coronary circulation is co-dominant, I wonder what part that plays in my heart issues since that seems only to occur about 7% of patients, especially since you mention the SA.
7/6/2009 Echo showed EF 55-60% (not anxious)
8/27/2009 Cardiac MRI showed LVEF 76% (anxious about ARVD and ticked over having to have this done)
8/28/2009 Cardiac Catherization EF 40% (not anxious - out cold) also showed mild systemic hypertension and moderately elevated LVEDP/34
I'll have to look at my bloodwork; I think they would have done the NT-proBNP in the hospital or ER but the name doesn't seem familiar.
I couldn't be dehydrated if I tried :P I drink so much water I float rivers lol about 2 gal a day they did my fluid intake/urine output in the hospital for those 4 days and couldn't believe how much I drank, my out put was a lot but I wasn't dehydrated.
Another curious thing I've been reading about is my coronary circulation is co-dominant, I wonder what part that plays in my heart issues since that seems only to occur about 7% of patients, especially since you mention the SA.
It's a shame that you don't seem to handle beta blockers. Often, with ANS dysfunction (especially pronounced with heart failure) the heart, as in sinus node at least, seems to overreact to exertion.
What happens is that in lack of muscular activity, you don't get sufficient venous return to the heart, so the heart will basically "pump air" (no air in there, but very little blood). Like pushing the gas pedal when the car is not in gear. Your blood pressure drops, the heart will further try to compensate, and so on. You probably know the Frank-Starling law, which basically tells you that low filling -> further decreased EF. Double negative effect.
This happens to everyone. When I got my first echo, I was seriously scared and my HR was 120 when I got tested. Result: EF 56%. Second time, more calm (on beta blockers and after a year of therapy). Slower heart rate. EF 80%.
This is also one of the mechanisms contributing to OI and NCS.
A lot of things may contribute. Dehydration will make it really bad, as your blood volume is further decreased.
I'm curious about your next echo. I really hope you still have an acceptable EF. Did you take a blood test named NT-proBNP by the way? This is a marker of increased LVEDP and heart dilation.
CPVT manifest with so-called bidirectional polymorphic VT and it's quite easy to recognize for your doctors. This VT is usually caused by one of two things: CPVT or digitalis toxicity. They both increase intracellular calcium to a point where so-called delayed afterdepolarizations are triggered (in contrast to LQTS that's most often causing early afterdepolarizations due to potassium channel blockages). I'm possibly on thin ice here. This is difficult stuff and honestly I don't want to know too much about it :p
Maybe you're on the right track investigating your ANS. It can of course explain a lot of your trouble.
By the way I think you spelled Norepinephrine right. If you want to use an easier word, say noradrenaline :)
What happens is that in lack of muscular activity, you don't get sufficient venous return to the heart, so the heart will basically "pump air" (no air in there, but very little blood). Like pushing the gas pedal when the car is not in gear. Your blood pressure drops, the heart will further try to compensate, and so on. You probably know the Frank-Starling law, which basically tells you that low filling -> further decreased EF. Double negative effect.
This happens to everyone. When I got my first echo, I was seriously scared and my HR was 120 when I got tested. Result: EF 56%. Second time, more calm (on beta blockers and after a year of therapy). Slower heart rate. EF 80%.
This is also one of the mechanisms contributing to OI and NCS.
A lot of things may contribute. Dehydration will make it really bad, as your blood volume is further decreased.
I'm curious about your next echo. I really hope you still have an acceptable EF. Did you take a blood test named NT-proBNP by the way? This is a marker of increased LVEDP and heart dilation.
CPVT manifest with so-called bidirectional polymorphic VT and it's quite easy to recognize for your doctors. This VT is usually caused by one of two things: CPVT or digitalis toxicity. They both increase intracellular calcium to a point where so-called delayed afterdepolarizations are triggered (in contrast to LQTS that's most often causing early afterdepolarizations due to potassium channel blockages). I'm possibly on thin ice here. This is difficult stuff and honestly I don't want to know too much about it :p
Maybe you're on the right track investigating your ANS. It can of course explain a lot of your trouble.
By the way I think you spelled Norepinephrine right. If you want to use an easier word, say noradrenaline :)
ok it's the same article =) I had to register to view it though - Ambulatory electrocardiographic monitoring in 100 healthy teenage boys
my hr and bp are even more whacko than when I had my testing done...my icd interrogations show I have a lot more NSVT runs daily now; sometimes back to back and longer ones at higher rates - some I can pinpoint to things I'm doing at home like walking around cooking, showering; cleaning etc
Exertion makes my HR shoot up immediately (probably due to being out of shape now) when I've tried to walk; even walking as slow as I could on my treadmill - my bp will not rise with exercise, I get dizzy, nauseous and symptoms like I have low blood sugar but I don't; I'll shake so bad I have to stop and lay down for hours after even getting sick to my stomach and vomiting after trying sometimes; then as soon as I stop moving - bam HR/bp drop dramatically and I'm left stumbling for something to hang on to.
If I try to go shopping this happens too, so it's not just exercise it's exertion in general. I'm wondering how diastolic/systolic dysfunction or failure is playing a part in all this. New Echo next week, so hopefully I'll have some more answers and can stop making myself be lazy lol there will be nothing wrong in my echo :P
I think this is why my new cardiologist is referring me to Vanderbilt to see what role my ANS is playing in heart things and if that bad 4 letter word has anything to do with my problems...they're going to check Norepinephrine and Catecholaminergic levels...I know I botched those spellings :p
my hr and bp are even more whacko than when I had my testing done...my icd interrogations show I have a lot more NSVT runs daily now; sometimes back to back and longer ones at higher rates - some I can pinpoint to things I'm doing at home like walking around cooking, showering; cleaning etc
Exertion makes my HR shoot up immediately (probably due to being out of shape now) when I've tried to walk; even walking as slow as I could on my treadmill - my bp will not rise with exercise, I get dizzy, nauseous and symptoms like I have low blood sugar but I don't; I'll shake so bad I have to stop and lay down for hours after even getting sick to my stomach and vomiting after trying sometimes; then as soon as I stop moving - bam HR/bp drop dramatically and I'm left stumbling for something to hang on to.
If I try to go shopping this happens too, so it's not just exercise it's exertion in general. I'm wondering how diastolic/systolic dysfunction or failure is playing a part in all this. New Echo next week, so hopefully I'll have some more answers and can stop making myself be lazy lol there will be nothing wrong in my echo :P
I think this is why my new cardiologist is referring me to Vanderbilt to see what role my ANS is playing in heart things and if that bad 4 letter word has anything to do with my problems...they're going to check Norepinephrine and Catecholaminergic levels...I know I botched those spellings :p
No, this one :)
http://heart.bmj.com/content/51/2/179.full.pdf
It works perfectly fine to open and it's free if you download it there.
What is your blood pressure and heart rate doing now? ;)
http://heart.bmj.com/content/51/2/179.full.pdf
It works perfectly fine to open and it's free if you download it there.
What is your blood pressure and heart rate doing now? ;)
can't get into it...do you have a paid subscription or I just have to register for a free acct? I'd love to read it :)
well since I rated yours the best answer, can you tell me why my BP is whacky and my HR drops too much and my ANS is out of kilter? hehehe
well since I rated yours the best answer, can you tell me why my BP is whacky and my HR drops too much and my ANS is out of kilter? hehehe
Lol, thanks for rating my answer but it really wasn't much ;)
Anyway, did you read the article I posted on the other post? It's really interesting concerning what's "normal" arrhythmias and not.
Anyway, did you read the article I posted on the other post? It's really interesting concerning what's "normal" arrhythmias and not.
Does anyone know what METS stands for? I'm still looking for it and can't find it. It's on stress treadmill test and scores how well you do. I just see abbreviations...help?
Read through this - http://www.medhelp.org/user_journals/show/266295/Test--Surgery-Results-updated-February-2011?personal_page_id=861727
I had many tests from April 2007 until now and my cardiologist told me in July 2009 I had no structural heart problems and my Cardiac Cath showed no CAD or ischemic problems in August 2009.
7/1/2009 24 hr holter (abnormal)
7/6/2009 Stress test (abnormal)
7/6/2009 Echocardiogram (Normal)
7/26/2009 CTA and EKG's (Normal) except for frequent multi-focal pvc's, cardiomegaly and Degenerative changes in the thoracic spine
8/26/2009 RF Ablation (dx malignant arrhythmia's)
8/26/2009 Head up tilt table test (Abnormal)
8/27/2009 Cardiac MRI (Normal)
8/28/2009 Cardiac Catherization (Normal - abnormal) There was no angiographic evidence for CAD, kinks, clots or plaque present. However, Non-Ischemic Cardiomyopathy with an ejection fraction of 40% was found. Hemodynamic assessments demonstrates mild systemic hypertension and moderately elevated LVEDP.
I am having a new echo done on Feb 25th so maybe it will yield some other answers.
I had many tests from April 2007 until now and my cardiologist told me in July 2009 I had no structural heart problems and my Cardiac Cath showed no CAD or ischemic problems in August 2009.
7/1/2009 24 hr holter (abnormal)
7/6/2009 Stress test (abnormal)
7/6/2009 Echocardiogram (Normal)
7/26/2009 CTA and EKG's (Normal) except for frequent multi-focal pvc's, cardiomegaly and Degenerative changes in the thoracic spine
8/26/2009 RF Ablation (dx malignant arrhythmia's)
8/26/2009 Head up tilt table test (Abnormal)
8/27/2009 Cardiac MRI (Normal)
8/28/2009 Cardiac Catherization (Normal - abnormal) There was no angiographic evidence for CAD, kinks, clots or plaque present. However, Non-Ischemic Cardiomyopathy with an ejection fraction of 40% was found. Hemodynamic assessments demonstrates mild systemic hypertension and moderately elevated LVEDP.
I am having a new echo done on Feb 25th so maybe it will yield some other answers.
Perhaps it is time to do an echocardiogram, isotope stress test and high speed CTA scan.
This is what I would certainly ask my PC or cardiologist to preform. These test will give you all the information needed to assess your current problem. Your symptoms suggest transient ischemic heart problems and I wouldn't hesitate to find answers.
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