Stress Echocardiogram

Stress Echocardiogram

by Lurker (Doc DX) - 2024-05-15 11:55:53

Gemita

i had the same thing last Dec after I went AFib in Nov. Nobody ever told me anything about the results. 
They do an ultra sound on you're heart before the treadmill. Then they do the treadmill, then almost IMMEDIATELY, they want seconds, do another ultrasound on your heart. I had to go off my Flecainide 2 days before. They did not do anything to the PM before, just left it as is. they also did a ECG before the procedure. But that is standard practice at this clinic if go in to talk to a cardiologist. But no ECG if you go in for a tweak. 

Doc DX

Puzzled

by Penguin - 2024-05-15 13:15:28

I'm a bit puzzled about stress exercise testing to determine whether or not you have heart disease. Is there a reason for not doing an angiogram if that's the gold standard test?  i'm probably behind the curve but can an echo show plaque build up?  

Lurker and Penguin

by Gemita - 2024-05-15 13:49:49

Penguin, A stress echo is less invasive and can certainly give them an indication of whether we are dealing with heart disease for which they would obviously start to treat with medication and if that didn’t help with my symptoms, they would do an angiogram to look further.  An angiogram (or CT angiogram) the latter was originally suggested, would have confirmed the level of disease and whether conservative measures (medication) or surgical intervention was required.  

When my husband had his stress echo, they wanted to treat his disease with medication which is common today even with extensive coronary artery disease because sometimes the risk of surgical intervention is too high in the elderly.  We both said no at that time and asked for an angiogram when they discovered an almost total blockage of his LAD artery which would have been fatal without clearing/stenting.  LAD = The left anterior descending artery.

Don’t worry, if I am not satisfied with the result of the stress echo, I will push for an angiogram.

Doc DX, thank you.  I was on Flecainide too for several years.  I hope your AF is under control now.  I expect you struggled to exercise if you were in AF at the time of your stress echo.  In many ways, I hope I am in "slow" AF during this test, so that they will see the symptoms I get from this irregular rhythm.  It can really mess with blood flow

I go back to see my cardiologist in June for the results, but I expect they will be posted to MyChart earlier

Stress test

by AgentX86 - 2024-05-15 14:00:50

Is your test going to be "with contrast"? One of my wife's friends just had one.  I didn't know there was such a thing, but learn something new every day. I didn't think an echo had enough resolution to see individual arteries.  Perhaps they can tell the condition of the muscle by looking at its movement under stress?

I'd be interested in knowing how they do a treadmill stress test with RR turned on.  It would seem that the heart rate would be meaningless, as would the maximum incline.  The oxygen limits are controlled, albeit indirectly, by the RR settings.

When I had my nuclear stress test a couple of years ago, they did a chemical stress.

AgentX86

by Gemita - 2024-05-15 14:54:16

I don’t think they are too worried about me because I had to chase this appointment up with my EP’s secretary.   The EP clearly wants all the tests done before I go back to see him in June when he and hopefully I will make a decision on treatment.  So far, apart from cholesterol levels, all blood checks have been okay.  

I know my husband had contrast but I am not sure what I am getting?  My paperwork doesn’t mention contrast but then the appointment was arranged in a hurry, so I can expect anything.  I will make sure that I understand fully what they intend doing and how they will assess my heart function and state of my arteries to rule out any serious blockages. 

They certainly confirmed after my husband’s stress echo that he had ischaemic heart disease and immediately after his procedure gave us a leaflet to read and all the possible treatment options.  According to the paperwork, there were four possible stress responses: normal, ischaemic, viable (? may recover systolic function after revascularization) and necrotic.  The Stress Echo clearly showed areas of his heart muscle that didn’t receive adequate blood supply, but it couldn’t provide images or confirm the state of his coronary arteries.  It is the initial investigation I suppose.

No as you say, it won’t be possible to have RR on during a stress test but if I am not offered assistance and cannot get my heart rate up to a decent level to really challenge myself, they may have to consider all other options.  I don’t want this test to be inconclusive.  I have waited long enough to get some answers

stress test

by new to pace.... - 2024-05-15 16:45:47

i feel for you with this upcoming treadmill test.  For me that is a no go.  Even though i do not like chemicals.  My knees would give out on the tread mill. I took the chemicals for the stress test which i think was harder on my arteries.  i thought they would burst.

new to pace

Hugs

by Lavender - 2024-05-15 22:35:49

Sorry to hear of your chest pain and symptoms which are sure to be bothersome. 
I have had two stress tests which were done with an injection of chemicals. As new to pace said, I felt my heart would burst. It was more uncomfortable for me than the treadmill test-which I had two years ago to see how the pacemaker was doing. It was exhausting to walk it as the test progressed, but I was told my heart is working much younger than my age. Lol so I was pleased. It took a while to catch my breath afterwards but I was fine. 

New to Pace and Lavender

by Gemita - 2024-05-16 02:04:19

Thank you both for your kind reassuring words and helpful comments. 

I am going to get in touch with the EP’s secretary to confirm what test I will be receiving and the preparation instructions required since when the clinic first rang yesterday with my appointment they offered very little in the way of explanation.  I had to work hard to prise it out of them.  Not acceptable after being referred two months ago for chest pain.  

When the appointment letter with instructions was posted to MyChart health records online, some of the information didn't tally with what I was told on the phone and I need clarification, particularly about stopping the beta blocker in case there are rebound effects.  If I have a bad attack of AF (high heart rates) I wouldn’t be able to safely attend my test anyway, but I will do what I need to do to get answers

Not a Good Experience for Me

by SeenBetterDays - 2024-05-16 08:29:33

Hi Gemita

Sorry to hear you are still experiencing symptoms and also that you have had to chase your tests. Unfortunately that seems to be a common experience for many.  I had a stress test back in 2021 when I was developing pacemaker induced cardiomyopathy.  I had chest pain and was really struggling with exertion and asked for the test as I felt it would be a less invasive way of determining what might be going on.  I also subsequently had an angiogram to rule out any potential blockages.

I didn't have a chemically induced test but was required to use a supine bicycle to increase my heart rate while they had a look at the heart function through a simultaneous echo.  I found the test very challenging and really pushed myself with my heart rate elevating to 160.  They felt that it was a positive sign that I was able to achieve this and explained that the dyssynchrony in the ventricles may be contributing to my symptoms of breathlessness and chest pain.  Unfortunately, my body was not resilient enough at that time to recover from the test and it led to a period of exhaustion with worsening symptoms.  I think that my body was clearly struggling from the high level of RV pacing at that point and this just worsened the situation.  This would be a completely different scenario from yours Gemita so I think this would be a very unusual outcome.  My only reservation is that the test does put the body under a degree of stress (as the name suggests) so, in my case, I don't think it was my wisest move.  The positives are that you will get some useful real time information about your heart and how well it is functioning during exertion.

I hope that you are able to get some answers through this process Gemita, you will need to push yourself during the test but listen to your body. If it feels like too much then tell the medical team and don't push through like I did.

Let us know how you get on.

SeenBetterDays

by Gemita - 2024-05-16 14:31:52

Rebecca, thank you so much.  You certainly did put everything you had into the test and I would probably do the same, but I have been forewarned by your experience and won’t push past my comfort zone and pay the heavy consequences later.

I will certainly let everyone know how I get on and the eventual outcome.  I am waiting for confirmation from my EP’s secretary which test I am actually having - exercise or chemically induced stress test - might be easier to reach a higher heart rate and sustain it with intravenous meds, so they can see how my heart responds.  Perhaps stopping the beta blocker will automatically trigger worsening rhythm disturbances, so I won’t need to perform on the day. 

Yes certainly the stress echo is a much kinder investigation than an angiogram (in my opinion) which can be extremely painful/uncomfortable if they go through the femoral artery.  On balance I would prefer to avoid an angiogram and perhaps request a CT angiogram instead, although if they found something significant, I would still need an angiogram to fix the artery.

I have had a supine bicycle stress test which is when they first found chronotropic incompetence (pre pacemaker days).  They were very surprised since I was able to keep up my effort for 30 mins without increasing my heart rate.  Not sure that I could do that today.

Angiogram

by Daedalus - 2024-05-16 16:41:06

Gemita....back in 2016 I had an angiogram, but perhaps was lucky as the doc entered by a vein my wrist.  Woke up feeling fine.  Whole thing went smoothly and if I knew they'd go in via that same vein, I'd go for that over the chem stress test.  But that's just me. 
Wishing you the best, regardless! 

Daedalus

by Gemita - 2024-05-16 17:57:07

Thank you Daedalus for your kind wishes and for reminding me to ask about going through the radial artery next time. 

They used several catheters during the course of an EP Study and combined Angiogram (using both the femoral vein/femoral artery).  I developed a pseudo aneurysm following the procedure and had to stay in hospital for 4 days.  Bruising was horrendous and I stopped anticoagulation.  That is why I fear another angiogram. 

I see radial access is associated with a significant risk reduction in bleeding, vascular complications, and mortality compared to femoral access.  I am still occasionally getting pulsations in the groin area even after seven years

Angiogram

by AgentX86 - 2024-05-16 23:43:00

My cardiologist uses the radial artery, if at all possible.  They still prep the groin for access to the femoral artery, in case the radial isn't useful. 

The radial artery is much simpler, for both the doctor and patient.  The path from the right wrist to the LV is pretty straight and a lot shorter than the groin. As noted, the recovery is a lot easier. 

They just put a compression cuff, sort of thing.  As soon as I was "awake" (twilight sedation) and they were sure I was OK, they sent me out the door with a schedule of when, and how much, to release the pressure cuff. 

Contrast that with the femoral artery access to my carotid artery. I had to be fully awake for it, so they could ask questions and give instructions to make sure they hadn't broken off chunks, going to the brain.  The hard part was laying on my back for five hours after.  I'll take the pressure cuff any day.

Most of us are familiar with catheterization via the femoral vein.  The vein is a lot easier because veins are under a lot lower pressure. The femoral artery isn't fun.

I found the chemical stress test (both nuclear and not) was a lot easier than the treadmill. I didn't even notice the test.  Again, I don't understand it, since my pacing is under complete control of RR. I guess it relaxes  the arteries so the heart works harder to maintain BP? I've never gotten a good answer.

AgentX86

by Gemita - 2024-05-17 07:22:53

I was also fully awake when they first “attempted” to puncture my femoral artery and they had to give me more sedation to get the job done.   I too had a hard time lying flat for 5 hours after the femoral artery puncture because of an overactive bladder!   I got up next day and left the hospital, only to return some hours later, when I was admitted and diagnosed with a pseudo aneurysm, a locally contained hematoma outside the femoral artery, due to damage to the artery wall.  It took weeks to settle and for the purple/blue bruising to drain to below the right knee.

I was told pseudo aneurysms can occur when the femoral artery puncture is too low?  I did some research and found the following:  Puncture of profunda femoris artery may cause a pseudo aneurysm because the vessel is not supported by the femoral head or bone.  When the operator looks for the femoral neck and then punctures the artery, incidence of femoral pseudo aneurysm is less.   Looking for the neck of the femur and puncturing by the Seldinger technique is an accepted method of preventing pseudo aneurysm.  

Yes these stress tests are not easy to accurately interpret are they and I suspect there are many variables between patients with different health conditions, lifestyles and the methods used to carry out a stress test may make a difference too.   I hope I get some answers and not further questions?