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» LymeNet Flash » Questions and Discussion » Medical Questions » Stress EKG -- Treadmill or Meds?

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Author Topic: Stress EKG -- Treadmill or Meds?
seibertneurolyme
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Hubby has a new symptom. He is having heart palpitations. ER says within normal limits based on EKG strip. All cardiac enzymes within normal ranges.

LLMD agreed that an appointment with a cardiologist is in order. Appointment is not until July 7th.

Hubby has not had a stress EKG since November 2004 or an echocardiogram since October 2004. He has a mitral valve prolapse murmur (probably from birth -- diagnosed at age 3).

LLMD suggested using meds rather than doing the treadmill for the stress EKG. Can't remember the names of the 2 different meds mentioned. Hubby would prefer to do the treadmill -- worried about the meds.

Hubby has not done any routine excercise in the last 10 months since he began trying to treat for Bartonella. Previously walked up to 3 miles per day. Has been disabled for 7 plus years now.

Herbs from his herbalist seem to have slowed down the palpitations -- now missed beats every 10 or 15 beats instead of every 4 or 5 beats.

Blood pressure is normal and pulse is ok.

Please share your experiences with stress EKG's -- any problems if you used the meds instead of the treadmill?

I think the medication shot costs about $1200 so of course cost is a factor also -- even at 20% copay.

Thanks.

Bea Seibert

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Geneal
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I had a nuclear stress test done.

I still had to get on the treadmill, but only for about 5 minutes.

Despite all indications of a heart issue, my cardiologist pronounced my heart "perfect".

Go figure.

Hugs,

Geneal

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seibertneurolyme
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Anyone else have an opinion?

After 3 weeks of palpitations hubby was getting concerned -- called the cardiologist and there was a cancellation -- appointment is tomorrow.

Treadmill or nuclear stress testing?

Bea Seibert

Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004  |  IP: Logged | Report this post to a Moderator
hcconn22
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I had numbness in my left arm- 200-600 times a day and heart palpations.

Bitten 10 years ago given 2 weeks of abx and never got better. Finally saw a LLMD 6 months ago. Today 47 and lymee ridden.

My LLMD was helping me and said that I needed to see a cardiologist and get stress test etc... before I died of a heart attack-- and or we could could isolate my issues to my Lyme, Babesia and Bartonolla.

Went to stress test, treadmill etc a few weeks ago-- and low and behold the Dr said I had the CV system and heart of an athlete.... and I have not been able to work out for years due to being ill.
Used to be an elite athlete before Lyme.


Now after 5 1/2 months of treatment and one month after stress test--- NO MORE (NONE/NADA) NUMBNESS IN ARM AND HEART PALPATIONS......

Go for the treadmill-- it is no big deal and it is monitored on-site by a Dr.

I ran up to 8 levels on the treadmill and tested myself hard as proof that my conditions were not heart related --

but actually due to Lyme and co-infections.

PS They can do the stress test with some mild fast walking. It is not difficult.

--------------------
Positive 10 bands WB IGG & IGM
+ Babesia + Bartonolla and NOW RMSF 3/5/09 all at Quest

And still positive ELISA and WB two years after IV treatment
http://www.lymefriends.org/profile/blake

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echostef
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Bea,
Stress testing and Cardiac sonography are my profession.
I have a B.S in Cardiovascular Technology. I am a Certified Cardiograph Technologist as well as a Registered Diagnostic Cardiac Sonographer.

Therefore, I have performed thousands of stress tests in the last ten years, utilizing the treadmill, adenosine, persantine, and dobutamine.

I, myself, have an adenosine test performed yearly, not because I cannot exercise, but because I am 100% dependent on a cardiac pacemaker. There are several factors i.e an uninterpretable EKG and abnormal wall motion caused by the pacer wire, which prevent me from having an normal result to a nuclear exercise stress test.

Both the pharmacologic and exercise test yield the same results. The goal of a stress test is to dilate the cardiac vessels and then to inject a nuclear tracer when they have been maximally dilated.

If I were your husband, I would opt for the adenosine or persantine. I don't kow which one your doc uses. They are both the same, however, persantine is a bit harder to get through and requires a reversal med at the end of the test.
The only reason dobutamine is ever used if if your husband were to have asthma, which the other drugs tend to aggravate. Dobutamine raises the heart rate as if you were exercising, takes about 12 minutes to administer, and is pretty uncomfortable.

The adenosine stress test takes 4 minutes from start to finish. The drug does not raise the heart rate, it is simply a vasdilator. It does, however, cause very uncomfortable chest tightess, heaviness, a feeling of shortness of breath, and a general uncomfortable feeling.
This feeling will begin about 30 seconds after infusion, at two minutes the nuclear tracer will be injected (it has NO side effects) and the medication will be turned off two minutes after that. The chest tightness begins to disappear almost immediately after the infusion is turned off. Adenosine has an extremely short half- life, and disappears from the body about 60 seconds post infusion.

Persantine is the same type of drog as Adeno, but the infusion takes twice as long (8 minutes) and, therefore, is more difficult for patients to endure.

In all my many years of stress testing, I have incurred very few complications from pharmacologic stress agents.

The problem with the treadmill is this:
Your husband MUST exercise until he reaches his 85% of his max heart rate, and exercise for over 4 minutes. Sounds easy, but many people have a pretty hard time getting there. Even though patients who do not have mobility problems find it quite demanding.

Stress testing uses the Bruce Protocol, in which the treadmill will automatically begin at 1.7 mph at a 10% grade. Every three minutes the speed will increase by almost one mph and the grade by 2%.

Again, if your husband does not exercise for at least 4 minutes AND reach his goal heart rate, he will have an inconclusive test and have to use the med test anyway. Target heart rate is 220 minus patient's age, patient must reach 85% of target.

Stress tests using medical stress agents are pretty quick, and a lot BETTER than they sound.

If he has any reservations about being able to exercise for as long as he will need to, I would definitely opt for the meds and get it over with.

As I said, I've performed thousands of these type of tests myself, without a doc overseeing me, and I have never had a serious problem. Ever!

Hope that helps!

Sincerely,
Stefanie

[ 09. June 2008, 11:07 PM: Message edited by: echostef ]

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lymebytes
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My experience with a treadmill test was this. They start you off at a normal walking pace, slowly they increase the incline so it becomes harder as time goes on. So it goes from walkng on a flat surface to similarly walking uphill. You can stop at any time, I think they encouraged me to try do 10 minutes or so for a good reading, the longer the better they told me.

But when I reached my limit, I stopped. It makes you sweat and heart rate go up for sure, that is the point.

I know it has good accuracy for detecting any abnormalities.

I also would prefer the treadmill test over the pills.

--------------------
www.truthaboutlymedisease.com

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randibear
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my sister is a radiologist. she says the treadmill is "useless" for diagnosing any heart problems.

nuclear with injection dye is the way to go. she said they put an iv in, then you go somewhere for a couple of hours, then come back and they put you in a kind of ct scan donut thing and it rotates around you taking pictures every couple of seconds or so....

i have had heart palps for years and everytime heart is ok. even went to er and they couldn't find anything...

--------------------
do not look back when the only course is forward

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Keebler
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-

Stephanie's advice is helpful.

I think the treadmill test can be torture and dangerous for some.

The last one I had about 10 years ago, as soon as my heartbeat increased, I passed out. Everyone looked at me like I was an alien and the doctor became furious.

You mentioned some herbal formulas have helped to some degree, and I assume he's also takes magnesium to help.

I assume his doctor does not have him on anything that affects QT - elongated QT can be a side effect of some drugs. (QT has to do with long or short changes in rhythm.)

===

Now, my ND wants me to get a "cardiac impedance test" as Drs. Arnold Peckerman and Paul Cheney have written about. (You can google if you want). Sarah Myhill, a doctor in the UK has good information on her site about that, too.

I'd read all about that before agreeing to any treadmill.

===

http://drmyhill.co.uk/article.cfm?id=381

Sarah Myhill Limited :: Registered in England and Wales

Excerpts:

CFS is Low Output Heart Failure Secondary to Mitochondrial Failure


======

www.cfids-cab.org/MESA/cardiac-1.html

Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome

Journal: Am J Med Sci. 2003 Aug;326(2):55-60.

Authors: Peckerman A, LaManca JJ, Dahl KA, Chemitiganti R, Qureishi B, Natelson BH.

Affiliation: Department of Neurosciences, CFS Cooperative Research Center, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.

NLM Citation: PMID: 12920435_

BACKGROUND: Findings indicative of a problem with circulation have been reported in patients with chronic fatigue syndrome (CFS). We examined this possibility by measuring the patient's cardiac output and assessing its relation to presenting symptoms.

METHODS: Impedance cardiography and symptom data were collected from 38 patients with CFS grouped into cases with severe (n = 18) and less severe (n = 20) illness and compared with those from 27 matched, sedentary control subjects.

RESULTS: The patients with severe CFS had significantly lower stroke volume and cardiac output than the controls and less ill patients.

Postexertional fatigue and flu-like symptoms of infection differentiated the patients with severe CFS from those with less severe CFS (88.5% concordance) and were predictive (R2 = 0.46, P < 0.0002) of lower cardiac output. In contrast, neuropsychiatric symptoms showed no specific association with cardiac output.

CONCLUSIONS: These results provide a preliminary indication of reduced circulation in patients with severe CFS. Further research is needed to confirm this finding and to define its clinical implications and pathogenetic mechanisms._

- Link to full article at PDF. , . or Google first half of title for other formats


=


www.cfids-cab.org/MESA/Lerner.html

Cardiac Insufficiency Hypothesis - article and many links, including to: Pittler MH, Schmidt K, Ernst E., Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003 Jun 1;114(8):665-74. [PDF Format]

=========================

www.cfids-cab.org/MESA/CFS_Dist.htm

Video: A three-hour talk by Dr. Cheney on diastolic cardiomyopathy and ME/CFS.

CFS and Diastolic Cardiomyopathy - Paul Cheney, M.D., Ph.D.

New Research on Cardiac Insufficiency

several articles (not sure if I have excerpts from articles or what here).

There is new research from a New Jersey team, authored by Doctors Arnold Peckerman, Benjamin Natelson et al., which found left-ventricular dysfunction following exertion and orthostatic stress in patients with myalgic encephalomyelitis/chronic fatigue syndrome.


. . . In an NIH-funded study on impedance cardiography . . . Peckerman and Natelson found that low cardiac output correlated with symptom severity in ME/CFS.


Dr. A. Martin Lerner . . . Viral infection persists in the heart, causing left-ventricular dysfunction, producing exercise intolerance.

Exercise, in turn, worsens the cardiac dysfunction.

. . .

More recently, physicist, physician, long-time ME/CFS researcher and clinician, and heart-transplant recipient Paul Cheney, M.D., Ph.D., has offered an alternative theory

that a subset of ME/CFS patients suffer from a diastolic cardiomyopathy, a problem with ventricular filling resulting from mitochondrial dysfunction and low ATP energy in the heart.

=====================================

Again, presented not to sadden, but if there is a dysfunction, treatment for underlying causes and employing support measures can make a difference.

the link to the Hawthorn research above holds hope. I feel so much better when I take that.

-

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echostef
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Yes, the CT scan is definitely becoming the "gold standard" for detecting CAD and vessel occlusion. The Philips 64 slice CT scanner is becoming much more popular, however, most insurances still won't cover the procedure and it is not widely available as of yet.

Also, randi, I'm not sure quite what the procedure you are referring to is, because, with a CT scan, the dye is injected while the patient is being scanned, and the whole procedure takes 5 minutes from start to finish.

It is with a nuclear stress test that you are injected with tracer and then have to wait to be imaged.

CT scanning does not used radioactivity, and there is no waiting period involved.

It will probably, over the next several years, cause classic stress testing to be a thing of the past.

Unfortunately, vessels may be up to 75% blocked and STILL cause no noticeable occlusion during exercise. Thus, my doctors prefer to order both a cardiac CT and a regular stress test. They will not stent patients who have blockage that is not causing blood flow occlusion during exercise.

Also, echocardiography will still also be necesssary, since all the pictures taken during the CT show only still images of the heart.

A nuclear treadmill and/or pharmacological test can detect coronary artery blockage with about a 90% accuracy, whereas a exercise stress test without nuclear tracer only picks up disease about 75% of the time.. A CT scan is one of the only tests that is absolutely 100%.

And, lymebytes, while having a treadmill test, you must stop exercising if you cannot go on.

If, however, you do not reach your target heart rate, the test will be inconclusive.

Also, the fact that Bea's husband has had ectopic beats is another good reason not to opt for a test that will alter his heartrate and possibly cause him to convert into a dangerous rhythm.

The vasodilator used in the place of exercise has no effect on the heart rate and is therefore safer for patients who have a history of premature beats.

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seibertneurolyme
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echostef and Keebler,

Thanks for all the info. Will share with hubby. The final decision will be up to him and the cardiologist.

He did use a modified Bruce protocol the last time he did the treadmill test in 2004.

The herbs he is using are hawthorne and cactus grandiflora.

Worried about Zithromax -- palps seemed to start after this med. Only taking 300 mg 3 times per week. Think that drug can affect QT. Tried stopping the med, but heart palps did not stop.

LLMD thinks Babesia is the factor rather than meds -- just don't know at this point.

hcconn -- Glad antibiotics are working for you and that your heart is not a problem.

Geneal -- Hubby knows all about those tests that are "normal" but you still have symptoms. He has had way too many EEG's.

Bea Seibert

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hshbmom
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Bea and Steve,


How'd it go today? I've been wondering about you both.

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groovy2
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HI Bea--


Babs caused my heart palps-
After treating babs for long enough my palps
have dissappaired completely -

Took about 15 months of constant treatment-
-Jay-

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bettyg
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darn, i just read this for 1st time.

had bad experiences both ways.


couldn't breath, started vomiting, etc.. longest 4 minutes in my life!


injection ended up showing a problem where they sent me for a balloon test but NO balloon needed.


treadmill text, they used ultrasound on me pushing my ribs, etc. and almost BROKE them so very painful ... will never go thru that again.


hope steve's experiences today went OK FOR HIM/YOU! [group hug] [kiss]

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seibertneurolyme
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Had the appointment which was a one hour new patient getting to know you kind of thing. This is an integrative cardiologist who believes in nutrition and stress reduction etc.

Seems to be middle of the road as far as Lyme and tickborne illnesses. Actually lives about 10 miles away from us and commutes to his practice which is in North Carolina about 50 miles away. He knows there are lots of ticks in this area because he lives on a 5 acre wooded lot. I think he was surprised that hubby has been sick for 7 years and has had all the problems he has had, but he at least was openminded.

Said he could hear the missed beats with his stethoscope. Discussed our options and he wants hubby to do the treadmill test but with a nuclear tracer so they can get better pictures than with ultrasound alone. Seemed to prefer the treadmill instead of the medication route.

Plan is to do an echocardiogram and a stress EKG on the treadmill on the same day -- next available appointment was not until July 29. Hubby was relieved that the doc didn't seem to feel there was any urgency in trying to fit him in sooner.

By then hubby should be at a higher dose of Rifampin which may or may not calm things down.

I guess the doc thought that without any other heart symptoms -- no chest pain, no shortness of breath, no edema, normal cardiac enzymes, normal resting EKG, etc -- the heart palpitations were probably not serious and there was no rush to do additional testing.

Bea Seibert

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bettyg
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bea, thanks for the update; glad it went well and he explained things well. [group hug] [kiss]
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aiden424
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I had the non-treadmill stress test. It took several hours. First I had a dye injected and then they injected me with something, they never said what it was, and I thought I was going to die.

I had CRUSHING chest pain, and burning in my chest. They told be it would only last a few minutes, which it did. It was awful!! I kept thinking, I hope they understand how drug sensitive I am and not kill me.

Kathy

--------------------
You never know how strong you are until being strong is the only choice you have.

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duke77
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quote:
my sister is a radiologist. she says the treadmill is "useless" for diagnosing any heart problems.

nuclear with injection dye is the way to go. she said they put an iv in, then you go somewhere for a couple of hours, then come back and they put you in a kind of ct scan donut thing and it rotates around you taking pictures every couple of seconds or so....

i have had heart palps for years and everytime heart is ok. even went to er and they couldn't find anything...

I think your friend is misinformed. The treadmill is not the test. The treadmill is used to stress your heart so they can see if the problem exists easier. There is a stress echo which is on the treadmill until pulse is over 160 I believe. They they sit you down quickly and echo your heart. My cardiologist says this test is good for finding structural abnormalities such as prolapse, etc. The nuclear sress test is more effective, but it still uses a treadmill or the meds. After the treadmill and iv injection you go to this CT machine which takes 12 minutes of pictures from every angle around your heart. The cardiologist says this test is great for seeing blockages because it checks the blood flow through the heart. He said if it is normal you have less than a 1% chance of having a heart attack in the next year. They do both of these tests before and after exercise.

I had both done using the treadmill. During the nuclear stress test I had to go over 2o minutes on the fastest setting my pulse would not go up. I don't have heart palps or elevated enzymes, but my bp is slightly elevated. Besides all the trips to the ER and chest pains they said both tests were normal.

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