Help!!!

[starkone]

Ok....here is the story...short version for those who are not into it.
I went to hosp last week for echo....lasted 11 min. I complained vehemently.
The head of echo dept reviewed the echo and said the results were good, pics were clear etc. The echo showed valve area of .6cm and mild left ventricular hypertrophy. I am pretty small framed. To make a long story short....my PCP wanted me to go to Brigham again. He called there and the cardio said you need to stress test her to see if she is symtomatic. (I told them honestly I do not know cause I have so much anxiety from all this stuff!) The cardio here agrees and so it looks like I will have a stress echo?

I told him I thought a stress was contraindicated for this severe AS?
Meanwhile, my PCP says he wants to be present at the stress test to make sure it isn't done my some idiot tech?! and that the cardio who wants it is present! I told him why? so he could see me when I drop?
Oh boy, is this ever a circus?
Have any of you been through a stress test to see if you are symptomatic?
thanks for any info you can give me....
Karen

 

[Phyllis]

All I can tell you is that Dick, who was in denial that he needed the AVR, begged three cardiologists including Dr. O'Gara at Brigham to perform a stress test and none of them would. Now maybe he was in worst shape than you at the time, but they all said they would not risk a stress test.

 

[Phyllis]

Just checked Dick's records and his valve area was 5.2 cm, but he had also fainted on the tennis court after a strenuous 2 hour game, so they considered him symptomatic at that juncture and could be the reason they refused to do a stress test. He, being in denial and thinking that the faint came from dehydration not the valve, wanted a stress test which they refused to do. I'm sure others who have had a stress test will weigh in here, but you should feel confident in the fact that both the pcp and cardiologist will be there.

 

[Mary]

The cardiologist was with me when I had the stress echo done. It was the first time they were able to see that the valve was a bicuspid. I think my opening was calculated at .8 at the time.
I don't think I was having symptoms; I can't really remember.

 

[tobagotwo]

Exercise Testing for Valve Patients

Exercise Testing for Valve Patients

Here's from an earlier post: http://www.valvereplacement.com/forums/showthread.php?t=8350&highlight=stress

Stress Tests and ACC-AHA Guidelines
________________________________________
I was just going through the ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease, and came across this:

"Exercise testing in adults with AS has been discouraged largely because of concerns about safety. Furthermore, when used to assess the presence or absence of CAD, the test has limited diagnostic accuracy. Presumably, this is due to the presence of an abnormal baseline ECG, LV hypertrophy, and limited coronary flow reserve. Certainly, exercise testing should not be performed in symptomatic patients."

Red highlights were added by me.

The quote within the quote is from the American College of Cardiology Foundation (ACC) Site, http://www.acc.org/clinical/guidelines/valvular/jac5929fla16.htm#A4
"ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease" and is found in "4. Management of the Asymptomatic Patient," under "a. Initial Evaluation," third paragraph. Takes a sherpa guide to find this stuff...

Regardless, patients have a right to refuse tests. Hopefully, they would only do so for good cause, such as a safety concern. Doctors are well aware that there is usually more than one way to skin a cat, and will find a more acceptable test if pressed to.

Best wishes,

 

[Mary]

[ Takes a sherpa guide to find this stuff...
[/QUOTE]

Bob,
We'll get rid of your fishing pole and provide you with a walking stick and boots

 

[hensylee]

I had a stress test - rode a bike. There were tons of people standing right close to me, ready just in case. Nurses AND doctors monitoring every move. I almost couldn't go as far as they wanted, tried to stop and they said 'you're nearly there'. With their encouragement (well, ordering) I made it. Don't recommend it if you can help it. There are other stress tests that don't involve exercise - isn't it a dye? Somebody will know. You could request that one, perhaps?

 

[tobagotwo]

I am not a good team player on this one. I don't know why so many cardiologists think they have to have a stress test to prove something that is plainly obvious. Symptoms are just not required to determine that you've reached a point where surgical intervention is required. The only thing I can think is that they are performing CYA studies.

The fact that they want all these physicians present to make sure you don't come to harm obviously speaks to their own concern for the safety of the procedure. So why would/should they subject you to a danger that they themselves acknowledge, just to help them make up their minds whether you go in March or August? It's not that well-defined a line in the first place.

"The leg is broken, doctor."

"Yes, but does it hurt?"

While it is not the rule, there are numerous documented cases of bicycle racers and other atheletic individuals being brought in with absurdly small aortic valve openings and going right to emergency surgery. Most were entirely astonished that there could be anything wrong with their hearts, as they felt fine. Symptoms are not always evident, even under exercise.

By the way, today is National Wear Red Day for Women, when women are asked to "...join the movement to take charge of your heart health..." I'm wearing a red shirt, and a somewhat embarrassing red dress sticker (NWRDW logo) to show my support for this, and for women's heart health. Join up. Take charge.

Best wishes,

 

[starkone]

Lots to digest here....

Lots to digest here....

I get the feeling that there are various opinions on this issue!
I know about the stress test being contraindicated for AS.
On the other hand, I have had two of them at Brigham where they do it with asymptomatic patients. I have always gone through it with no problem.
I think they just want to see if I can still go through it or if I am symptomatic at higher levels of exercise. I think they have the smarts to stop the test if they see changes they don't like? They mentioned something about a stress echo? I guess this means they do an echo at a high heart rate?
I hate the idea of having so much anxiety about this but apparently I do! I wish I could just say "hey, I am symptomatic"!
Another question off this subject. Can a narrowed valve cause high blood pressure? I haven't tested mine in quite awhile and I didn't like what I saw today?
Thanks for all your responses....I will keep you up to date.....
Karen

 

[tobagotwo]

The fact that someone will be there to try to revive you if you have a heart attack or go to dangerous arrythmias is only vaguely reassuring at best. The quote above was from the segment for asymptomatic patients, and I only highlighted the one line about symptomatic patients for others who may be reading.

Frequently, people who have done this have come back with the answer that the results were "inconclusive." Not much payback for the risk. There have been several who have posted who had bad experiences during the testing.

As with the cyclists, the fact that you "pass" the test may not be indicative of how safe you actually are. Everybody's different. Some don't ever get much in the way of symptoms. Some internally refuse to acknowledge them. And some never recognize the symptoms until they realize the change after surgery.

If you do decide to undergo it, I hope you have a safe test and usable results.

I am not aware of stenosis causing high blood pressure. The high pressure is in the heart, trying to deliver normal pressure to the arms (and elsewhere).

Best wishes,

 

[MomOfThree]

Hi Karen,
After I was diagnosed with AS, I had 3 echo stress tests (almost yearly, I guess). At the time my AV was at 1.0 and the last time I had one it was at .7. HOWEVER at the the time of all 3 of these tests I was asymptomatic. My cardiologist was present during all 3 tests. Over the period of 3 years my excercise function did decrease slightly. My cardio told me that sometimes people say that they have no symptoms, but can only last, say, 2 minutes on the treadmill. Other doctors I know do not recommend stress tests.

However, at the last cardio visit, when I stated that I was maybe, slightly more short of breath, he did not recommend an echo stress (though I requested it --- anything but surgery is what I wanted), but immediately recommended surgery, which I had within 4 weeks. I think after monitoring my heart's condition over the past few years, he was being cautious, waiting for symptoms, but closely watching me. During the last year, I saw him every 4 months. That should have been my first clue...
Martha

 

[kia]

chemical stress test instead of physical

chemical stress test instead of physical

My daughter had 2 aotic dissections and a heart attack followed by OHS to perform a by-pass of the dissected coronary artery. The heart attack left her with CHF. Four months after surgery they implanted a bi-ventricular icd.

Two months after that, in order to answer questions about valve leakage, her original cardiologist ordered a stress test.

When I questioned the wisdom of that (with a healing aortic dissection?) he blustered a bit, said the question HAD to be ansswered sometime, so why not via the stress test.

That bothered me, a lot. I contacted Cedars-Sinai's, Dr. Raissi. He recommended a chemical stress test instead. It worked just fine and the doctor got the information he needed. And we've switched cardiologists... Dr. Raissi and Cedars-Sinai (hello, Arlys V.!) have been just great.

Kia

mother to my daughter, age 34:
Type B descending aortic dissection
Type A ascending coronary artery dissection
MI, nov 03
OHS
Medtronic BVD implanted, mar 04
Ischemia
severe MVR and TVR

 

[Bionic Man]

Stress test stress

Stress test stress

I had a stress test when my business first started. I thought it was going to kill me but I did ok I guess. I'd really recommend having a doc there!

Just before my surgery I was FINALLY beginning to have symptoms and the nurse scheduled me for a stress echo in response to my complaining of chest pains. Not knowing any better and thinking she'd cleared it with the doc first I was going along but then just as they were hooking me up I had to say something so I kind of jumped on them for putting me through something I knew would be hard on me. The tech got really nervous and went off in search of the doctor who eventually came in very very upset and put a stop to the whole thing. He basically made them do a resting echo and was even more angry when he realized that the stress test would likely have KILLED me.

(not cool) Anyway I guess my advice is to stick up for yourself but make sure your docs know exactly where your health is at. Perhaps the test will help but I'd only say to go along with a stress echo if you've already had a standard echo. And if you are having symptoms then get a second opinion.