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    Stress Test result question
    syrinx68 posted:
    I did a nuclear stress test this past month.They used Persantine.The findings were normal.I have a paragraph on my results and I will type it below.I am wondering if I should do further testing for Ischemia.
    Resting ECG is abnormal secondary to poor R wave progression,and secondary to nonspecific ST/T-wave changes.The patient undergoes standard Persantine infusion with a maximal dose of 57 mg,The initial heart rate is 60 and the baseline blood pressure is 126/83.The heart rate increased to a maximum of 98 and maximum bloopressure was 118/75.At the time of isotope injection the heart rate was 85 and the BP was 126/89.Aminophylline was utilized for Persantine reversal.
    Stress EKG is nondiagnostic.chest pain is absent.ECG changes are suggestive of Ischemia.ST segment changes are accentuation of baseline abnormalities.BP response to stress is normal.Stress induced arrythmias are absent.
    syrinx68 responded:
    My oxygen level is 96 and when the lung Dr tested my oxygen while I was going up and down the stairs it went down to 95.Is this too low.Should I be worried?
    James Beckerman, MD, FACC responded:
    You didn't include the report which deals with the nuclear imaging, although I'm assuming that if you were told it was normal, then there were no concerns.

    While no noninvasive test is perfect, these types of tests are considered fairly reliable in most situations. I'll defer to you and your doctor as to whether further testing is appropriate for your situation.

    A drop in your oxygen saturation from 96 to 95 would not generally be cause for concern.

    I hope that's helpful!
    Mesa1328 responded:
    I have a perspective I must share with all of you. I have been complaining to my Doctors (3 different primary care Doctors), about heart and chest pain for over 30 years. All tests I was given were always negative, and they have all, (ekg, blood work, strtess tests, etc) have been repeated every two to three years. I was told to quit drinking tea, and that I have heartburn, (indigestion), and to take antacids. Obviously, they didnt help my chest pain. Two years ago, I was starting to have progressively more severe pain, and couldnt walk into work without stopping and resting. I told my primary care doctoroif this, and he ran the usual EKG, which of course was normal, and gave me a prescription for Nexium which I took. The pain didnt get better, and I was out mowing my lawn when I felt dizzy, weak, and had a lot of chest pain. My legs gave out, I went to the ground, and couldnt get up, or even speak for about 20 minutes before a neighbor drove by, saw me, and came to my aid. He gave me water and helped me inside, and that Monday morning I again called my Doctor. FINALLY, I was referred to a Cardiologist. The Cardiologist ordered a nuclear contrasted stress test. I took this test, and I was told I "passed with flying colors", "with no evidence on nuclear images to suggest any ischemia or infarction". The cardiologist wanted me to go to another specialist and have an upper GI exam done, and told me heartburn can act the same as a heart attack, and recommended a mild tranquilizer, (which angered me, and I didnt allow). I continued with the pain becoming more severe for the next several weeks, and angrily went back to my cardiologist, telling him I couldnt even walk into work, or up a single flight of stairs without pain, and told him I was having pain radiating into my jaw and shoulders. The Cardiologist said the only test left was to have a angiographic examination in the Cath lab, and I consented. Long story short, this procedure showed I have "significant, multi vessel coronary disease", with my LAD having two blockages, one %75 and th other %95, My Ramus Intermedius had an %85-90 stenosis, my Left Circumflex was, "severely diffusely diseased", with a %95 lesion, and my right Coronary artery had two different areas of %75 to %85 blockages. A surgeon was brought in during the procedure, and I was told I was not a good candidate for surgery, but that multi-vessel stanting was my best course of action. The Cardiologist stented two of the blockages, and sent me home. Three months later, I was still having significant pain, I was given another cath, and had one more vessel stented. About 12 months after the second procedure, I was still having significant pain, and MY Cardiologist told me there awas nothing more they could do, and to keep taking my nitro and watch my diet, but I would not get better, as the disease was progressive. I was frustrated, and my wife suggested I get a second opinion. I researched some Doctors, and made an appointment with anothe Cardiologist, and sent him my medical records. This wonderful man told me I should have had all the vessels stented in the first procedure, and said he was confident I would get some relief by stenting the rremaining blockage. I had this procedure done three weeks ago, and have had significantly less pain, and almost no severe angina since. This was along story to tell you that the ONLY definitive test is to be catheterized and examined in the lab. Good luck. Bob
    Haylen_WebMD_Staff replied to Mesa1328's response:
    Thanks for sharing your story Bob. I'm glad that your pain has decreased!

    For those who are unfamiliar, here is a link with more information: Cardiac Catheterization

    CABonnie responded:
    I had a nuclear test after going to the ER with chest pain. It was normal, according to my doctor. I wasn't so sure, especially since they took the electrodes off (said my heart rhythm interfered) and made me go through the 2nd part AGAIN. I went to a cardiac doctor about 2 months later, and he thought an angiogram was merited. This test turned into angioplasty and double stents because I had a major blockage in the left descending artery. Obviously, the stress test is not completely accurate.
    CABonnie replied to syrinx68's response:
    My oxygen level doesn't get much better than 94. When it goes down to 90 or 92 that is a major concern.
    syrinx68 replied to Mesa1328's response:
    Thankyou so much Bob for writing this.I am going to my Primary Dr. Tomorrow and I wrote the name of the procedure.I have been dealing with all this for a good part of 20 years. The chest pain.pain down my arm and pain in my jaw. I have even been to the hospital and given the nitro and told your oxygen level is too low. But I felt like I was going in circles.Nobody was listening. I can't walk up a flight of stairs without being short of breath.I sweat profusely doing a simple household task.That was very nice of you to take the time and post what happened with you. I hope you feel better.
    cardiostarusa1 replied to CABonnie's response:
    Hi CABonnie:

    "Obviously, the stress test is not completely accurate."

    Nuclear stress tests are not 100% perfect, and unfortunately, from time-to-time, can yield a a false-negative or false-positive result.

    One example, and at the very extreme, a nuclear stress test can appear normal in some individuals with multi-vessel coronary artery disease (CAD), said to occur due to so-called "balanced ischemia".

    The bottom line

    Coronary stents (bare-metal or drug-eluting) are only a Band-aid or spot-treatment, and coronary artery bypass graft (CABG) surgery is just a clever way of temporarily circumventing the problem (atherosclerosisi), as it doesn't address the disease process and what drives the progression.

    Coronary artery disease (CAD) is a lifelong unpredictable (may/can exhibit periods of stabilization, acceleration and even sme regression) condition requiring a continuum of care.


    WebMD member (since 8/99)



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    Living with Heart Disease

    Coronary artery disease (CAD)

    CAD is a chronic disease with no cure. When you have CAD, it is important to take care of your.....

    This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart../It is up to you to take steps.....

    Recognize the symptoms......

    Reduce your risk factors......

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    See your doctor for regular check-ups...


    Good to know, for the primary and secondary prevention of heart attack and brain attack (stroke)

    Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, which includes age, gender, genetics (gene deletion, malfunction or mutation), diabetes (considered as being the highest risk factor), smoking (includes second and thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, LOW HDL (less than 40 mg/dL, an HDL level of 60/65 mg/dL or more is considered protective against coronary artery disease), high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).



    Coronary artery anatomy

    Starting with the left anterior descending (LAD), the most critical, next to the ultra-critical left main (LM).



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