Problem still exsists - tests indicate 'normal'

KH said:

I had recently been to a cardiologist to get a series of test for shortness of breath, tightness
in chest, soreness in shoulders, etc.. during exertion.

On the basic stress test, it came back 'positive' - I reached my max HR of 180 in just over 5
minutes (I'm 40). So I did a echocardiogram, and a nuclear stress test. Both results showed
'normal', however, there was a trace amount of leakage in both valves, but was told that it was
just a trace, and nothing serious.

The nuclear stress test may be erroneous (a false negative) since your symptoms are typical and your
"basic" stress test was "positive."

The echocardiogram is not an appropriate test for evaluating chest pain.

The usual standard of care is for a "positive" stress EKG test to lead to a heart catherization
rather than a nuclear stress test.

Quoted message said:

This thing is really nothing new for me - I've had this fast HR during exercise ever since I was a
kid. Just the discomfort is increasing a bit now, and as I age a bit, it is more concerning to me.

So, the question is: If, as the test shows, I am 'normal', why would my HR go up so fast and I am
experiencing these discomforts?

The nuclear stress test may have been erroneous (false negative).

Quoted message said:

For instance, when I am backpacking on fairly level ground, moving along at about 2- 2.5 mph,
my sustained HR is about 172 - 176 bpm. Start pulling hills, and it is easily up to, or over,
200 bpm.

They did also perform a PFT test and that came back normal.

So you do not have lung disease.... back to the heart.

Quoted message said:

Should I seek a second opinion, or is this truly normal?

Would suggest a second opinion preferably from a cardiologist.

Quoted message said:

While I don't think I'll get to the point where I'll feel I'll have a heart attack or
something like that, I am concerned that my heart working this hard all these years will
eventually 'wear out'.

Any advice?

See above.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

You're right to be concerned. How fast does your HR recover? If you get your HR up to 180 and then
rest for a minute, what is your pulse rate? If your pulse rate doesn't decline by at least 12 beats
that's a further risk indicator. Also, what is your resting pulse rate? Already you have higher risk
from lasting such a short time on your stress test. How's your blood pressure, and are you on meds?

[email hidden] (KH) wrote in message
news:<[email hidden]>...

Quoted message said:

I had recently been to a cardiologist to get a series of test for shortness of breath, tightness
in chest, soreness in shoulders, etc.. during exertion.

On the basic stress test, it came back 'positive' - I reached my max HR of 180 in just over 5
minutes (I'm 40). So I did a echocardiogram, and a nuclear stress test. Both results showed
'normal', however, there was a trace amount of leakage in both valves, but was told that it was
just a trace, and nothing serious.

This thing is really nothing new for me - I've had this fast HR during exercise ever since I was a
kid. Just the discomfort is increasing a bit now, and as I age a bit, it is more concerning to me.

So, the question is: If, as the test shows, I am 'normal', why would my HR go up so fast and I am
experiencing these discomforts? For instance, when I am backpacking on fairly level ground, moving
along at about 2- 2.5 mph, my sustained HR is about 172 - 176 bpm. Start pulling hills, and it is
easily up to, or over, 200 bpm.

They did also perform a PFT test and that came back normal.

Should I seek a second opinion, or is this truly normal? While I don't think I'll get to the point
where I'll feel I'll have a heart attack or something like that, I am concerned that my heart
working this hard all these years will eventually 'wear out'.

Any advice?

Thanks for info. One question regarding the Thallium (nuclear) stress test, though.

From what I have read, the heart should be fairly well stressed for this test. Some items I have
read said the exercise should be up to your limit. When I did it, the excercise portion lasted about
3 minutes on the treadmill, until I got up to my target HR (about 153 bpm), then injected and
stopped. At that point, I was barely even breathing harder. Could a false negative be rendered if
the heart wasn't working hard enough to get a really adequate picture of what is going on? I'd think
that maybe after 10 minutes or so at 180-190 bpm would be much more accurate to determine blood
flow. As a patient you don't want to say anything because they are the experts, but I would like to
know what is the 'common' way this type of test is performed. Thanks.

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

KH said:

I had recently been to a cardiologist to get a series of test for shortness of breath, tightness
in chest, soreness in shoulders, etc.. during exertion.

On the basic stress test, it came back 'positive' - I reached my max HR of 180 in just over 5
minutes (I'm 40). So I did a echocardiogram, and a nuclear stress test. Both results showed
'normal', however, there was a trace amount of leakage in both valves, but was told that it was
just a trace, and nothing serious.

The nuclear stress test may be erroneous (a false negative) since your symptoms are typical and
your "basic" stress test was "positive."

The echocardiogram is not an appropriate test for evaluating chest pain.

The usual standard of care is for a "positive" stress EKG test to lead to a heart catherization
rather than a nuclear stress test.

Quoted message said:

This thing is really nothing new for me - I've had this fast HR during exercise ever since I
was a kid. Just the discomfort is increasing a bit now, and as I age a bit, it is more
concerning to me.

So, the question is: If, as the test shows, I am 'normal', why would my HR go up so fast and I
am experiencing these discomforts?

The nuclear stress test may have been erroneous (false negative).

Quoted message said:

For instance, when I am backpacking on fairly level ground, moving along at about 2- 2.5 mph,
my sustained HR is about 172 - 176 bpm. Start pulling hills, and it is easily up to, or over,
200 bpm.

They did also perform a PFT test and that came back normal.

So you do not have lung disease.... back to the heart.

Quoted message said:

Should I seek a second opinion, or is this truly normal?

Would suggest a second opinion preferably from a cardiologist.

Quoted message said:

While I don't think I'll get to the point where I'll feel I'll have a heart attack or
something like that, I am concerned that my heart working this hard all these years will
eventually 'wear out'.

Any advice?

See above.

Humbly,

Andrew

Thanks for the info.

My resting HR is pretty much normal - about 80. Blood pressure is normal as well, 78/120, I think.

My HR after high stress does come down quickly, and I know from what I have read at least that is a
good sign.

I decided to buy a HR monitor (a polar A3, supposedly fairly accurate)and wore on this last
weekend's backpack adventure.

My average walking HR stayed somewhere around 155-165 for mostly flat, or very slight uphill
walking. On the longest uphill, it peaked at about 196. Other hills were about 180-190.

while I can do this all day (each day was about 9 miles), my main concern is that as I age, all this
hard work of my heart may wear it out faster than it should. Is this a valid concern?

One thing of note from this last outing, I only felt some very slight chest discomfort this time.
Sometimes I get quite a bit, along with discomfort in the shoulders, neck, jaw, other times, pretty
much feel fine.

KH said:

Thanks for info. One question regarding the Thallium (nuclear) stress test, though.

From what I have read, the heart should be fairly well stressed for this test. Some items I have
read said the exercise should be up to your limit.

Should up to about one minute *before* your limit.

Quoted message said:

When I did it, the excercise portion lasted about 3 minutes on the treadmill, until I got up to my
target HR (about 153 bpm), then injected and stopped. At that point, I was barely even breathing
harder. Could a false negative be rendered if the heart wasn't working hard enough to get a really
adequate picture of what is going on?

It is possible that had your heart rate been higher, they would have noticed something on the
nuclear images.

Quoted message said:

I'd think that maybe after 10 minutes or so at 180-190 bpm would be much more accurate to
determine blood flow.

Accuracy won't be improved but correlation with earlier stress test might have been better.

Quoted message said:

As a patient you don't want to say anything because they are the experts, but I would like to know
what is the 'common' way this type of test is performed.

Both ways are common (to target heart rate and to peak tolerated stress).

Quoted message said:

Thanks.

You are welcome :-)

Humbly,

Andrew
--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

"KH" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Thanks for info. One question regarding the Thallium (nuclear) stress test, though.

From what I have read, the heart should be fairly well stressed for this test. Some items I have
read said the exercise should be up to your limit. When I did it, the excercise portion lasted
about 3 minutes on the treadmill, until I got up to my target HR (about 153 bpm), then injected
and stopped. At that point, I was barely even breathing harder. Could a false negative be rendered
if the heart wasn't working hard enough to get a really adequate picture of what is going on? I'd
think that maybe after 10 minutes or so at 180-190 bpm would be much more accurate to determine
blood flow. As a patient you don't want to say anything because they are the experts, but I would
like to know what is the 'common' way this type of test is performed. Thanks.

I'm not Dr Chung, I'm another Andrew. I'm a nuclear medicine technologist who spends most of his
time in nuclear cardiology.

My opinion is that you were not adequately stressed for the thallium scan to be accurate.

Standard procedure in our lab is to exercise the patient to their target heart rate, inject the
tracer, and keep the patient exercising for at least one minute after tracer injection. If we find
that a patient has reached their target too soon (in our opinion) we will keep them going as long as
they are able to continue safely.

The fact that you reached your target within the first stage (three minutes) is a bit concerning to
me, though I would defer to a cardiologist on that point. Our physician will usually use a
pharmacological stress in combination with a slow walk in patients who reach their target that early
on the standard stress test. Do you know what your blood pressure was during the stress? I would
expect a 40 year old to go at least 6 minutes into the Bruce protocol before I'd inject the tracer,
depending of course on symptoms and ECG changes.

Andrew Kerr M.R.T.(N.)

[email hidden] (KH) wrote in message news:<[email hidden]>...

Quoted message said:

Thanks for the info.

My resting HR is pretty much normal - about 80. Blood pressure is normal as well, 78/120, I think.

My HR after high stress does come down quickly, and I know from what I have read at least that is
a good sign.

I decided to buy a HR monitor (a polar A3, supposedly fairly accurate)and wore on this last
weekend's backpack adventure.

My average walking HR stayed somewhere around 155-165 for mostly flat, or very slight uphill
walking. On the longest uphill, it peaked at about 196. Other hills were about 180-190. Karl,

Glad your resting heart rate and BP are normal. The fact that you can backpack all day is also a
good sign. One question - has this high heart rate with exercise something new or something you've
had for years? I'm not a doc, but I don't believe your heart can "wear out." Exercise is generally
good for your heart. One thing I'll suggest is trying to eat as heart healthy as possible. Avoid the
western diet of "meat and potatoes." According to Dr. Willett at Harvard up to 80% of CHD can be
explained by poor diet and exercise habits. See
hsph.harvard.edupyramids.htmlOpen ↗

Quoted message said:

while I can do this all day (each day was about 9 miles), my main concern is that as I age, all
this hard work of my heart may wear it out faster than it should. Is this a valid concern?

One thing of note from this last outing, I only felt some very slight chest discomfort this time.
Sometimes I get quite a bit, along with discomfort in the shoulders, neck, jaw, other times,
pretty much feel fine.

"KH" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Thanks for the info.

My resting HR is pretty much normal - about 80. Blood pressure is normal as well, 78/120, I think.

My HR after high stress does come down quickly, and I know from what I have read at least that is
a good sign.

I decided to buy a HR monitor (a polar A3, supposedly fairly accurate)and wore on this last
weekend's backpack adventure.

My average walking HR stayed somewhere around 155-165 for mostly flat, or very slight uphill
walking. On the longest uphill, it peaked at about 196. Other hills were about 180-190.

while I can do this all day (each day was about 9 miles), my main concern is that as I age, all
this hard work of my heart may wear it out faster than it should. Is this a valid concern?

One thing of note from this last outing, I only felt some very slight chest discomfort this time.
Sometimes I get quite a bit, along with discomfort in the shoulders, neck, jaw, other times,
pretty much feel fine.

Your heart rate of 160 when walking flat is WAY too high. Have you had a Holter monitor test?

Andrew

I am not sure what a Holter monitor test is, so I suppose I haven't had one. I think that sometimes
being in a HMO plan, that unless you appear to be on the brink on death, they tend to do what is
minimaly required to try to avoid malpractice suits, or to pacify the patentient. I really can't
blame the doctors - the insurance companies really seem to running the show.

In any case, this is a condition I've ever since I can remember, so in some sense, I've never
considered myself to be 'abnormal'. So, I suppose, my heart has just become accustomed to beating
like a little bird heart 🙂)

I'm not the type that likes to run to the doctor for every little thing, and I almost felt silly
going to the docs about this. It is just as I get older and start to think about mortality more, I
have been more concerned, and if there is a treatable problem, it would be nice to get it fixed.

Thanks all for the info!

"KH" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I am not sure what a Holter monitor test is, so I suppose I haven't had one. I think that
sometimes being in a HMO plan, that unless you appear to be on the brink on death, they tend to do
what is minimaly required to try to avoid malpractice suits, or to pacify the patentient. I really
can't blame the doctors - the insurance companies really seem to running the show.

A Holter Monitor is something you wear for a length of time and it records your heart rythem. There
is a button you press each time you feel chest discomfort, so the doctor can see what your heart
rythem is like when you feel the discomfort.

You could ask your cardiologist about it.

Andrew