Hi Songsi,

I am going to respond witha couple of assumptions to save time. If my assumptions are wrong, let me know and I can be more poiniant in my response to you.

Here's the assumption: "That you are referring to an echo stress (non-excersise) and a nuclear stress (treadmill).

I have done both and draw my comparisons from my own experience.

Assumption: Excersise vs. Non-Excersise Stress Echo.

The echo stress (non-excersise) is a little longer and more involved. 30 minutes of echo images are taken with the heart at rest. A dobutamine injection is given after the first pictures are deemed acceptable (you can't move a muscle while imaging is taking place or you could foul the imaging and be asked to take another set which prolongs the procedure further.) You will be guernied into an examination room where there is a cardiology staff, to monitor and interpret real time ECG graphing. When the ECG has been lined out more dobutamine is injected to chemically mimic an excersise stress test by increasing heart rate to excersise stress levels. This is the scary part especially if you have any signs of advanced artheriosclerocis (arterial thickening /narrowing). You will feel like your heart is going to pop out of your chest. You could experience angina like symptoms, which in itself will frighten the most stoic of men. Your heart will race your chest will tighten and you will feel like you are ready to "Meet Elizabeth" at the pearly gates. The cardio team is present, not only to monitor and interpret real time ECG but to be prepared if you were to go into arrest. When the team is satisfied that they have ample data to interpret your cardiac state, you will be guernied out and will wait and have another 30min echo image. You will be gurnied away to await patiently for the follow-up results. You will not get those results the day you go, but probably at your next cardio appointment. So the wait can be more stressfull then the actual test.

The excersise stress echo, mine anyway, was physically more taxing but it was a gradual taxing as your heart rate responds to an time weighted, graduated, excersise regimen on a tread mill.
I was given a thalium injection which is a radioactive isotope which allows for incredible detalied imaging of the heart. Similar images are taken before and after, and results will be communicated as stated before. A qualified cardio team will also be present as before in the event of similar events.

If I had a choice I would vie for the excersise stress echo. It apes real life circumstances as your heart is stressed by physical excersise over a chemically based antagonist. Either are equally accurate as to what they see at that instance, however; interpretted results may not discover other intangible annomalies which can surface at a later date bringing you down with a massive MI subsequesnt the test. We have folks here who have undergone stress tests only to suffer major coraonary events hours, days or weeks later. These events can only, logically, be due to an unknown factor which is not anticipated or able to be duplicated during either type of stress echo, which makes the test only an immediate and probable diagnostic tool. In no way a tool to impart confidence in negating the possibility of near fuiture events occurring.

Hope this helps. Great question Songsi. It keeps this all green in my memories.

Regards,

Your Friend, Just Joe

Ditto everything Joe said. I had a stress echo last year and it was not scary at all. After the initial echo I walked on a treadmill. I had a target heart rate which I could not reach, but I got close. Then they did another echo.

I've never had a test done with the injection, but like Joe I think the other one is more true to what you would experience in real life.

Pam

Just a warning,
If you go for the Nuclear stress test, it does not matter what they tells you --DO NOT EAT ANYTHING-- at least 8 hours in advance.

They told me that I could have breakfast ...and 4 hours later they complain that they were not able to see anything.

Perhaps I make too big breakfast!!

Jesus

Actually the Stree Echo I have sounds a little different.
A tech does an ultrasound of your heart at rest. The you walk on a treadmill to target heart rate and they immediately do another ultra sound while your heart is pounding at target rate. They then compare the difference. No injections for this just ultrsounds.

With the nuclear stress they inject you with an isotope and take pictures of your heart at rest with some kind of CT scanner. Then have you treadmill to target heart rate and inject you again. then re-take the pictures. And compare. They also can inject a substance in you while you are on the treadmill that dialates your blood vessels to mimick the heat at target rate for those who physically cannot walk to target rate. I have had both, just wondering if one is better than the other. I will ask on Wednesday..

My husband is having a "stress-echo test" April 1. We went for a check up last week, and hubby "want's to know where he stands almost a year post MI". So Doc said, since "you're a worrier", I will schedule a "stress echo test" to put your mind at ease. He said it is easier than the nuclear test - no injections - and cheaper. Hubby had the nuclear one last year, but this one is supposedly the same, without radioactive substances added to the body. Do echo - run treadmill - repeat echo. I think it is used for those patients that are less "at risk" of trouble during the test.

Cardi told me today the agiogram is the gold standard of tests for blocked arteries. The nuclear stress is next either chemical induced or treadmill. The nuclear stress test is about 5% to 10% better than the Stress Echo/ Ultrasound. Both Nuclear stress and stress echo can give false positives or false negatives. last is the non-stress echo or what they just call an echo or echocardiogram.
They just do an ultrasound of your heart at rest for this one. My stress echo today was considered inconclusive because I was not able to reach 85% of my target heart rate. Only 75%. They found no new problems at 75% but call results at less than 85% target heart rate inconclusive. Sure needed to hear that!!!! Not sure if they will call this close enough for jazz or want more tests..

Well songsi,

I am so glad I am going to have a chance to jump on this. I am just going to ask everyone to re-read your post and really try to understand where your mindset is. Songsi, you accurately depicted the viability of all the current cardiac health determining diganostic tools and their comparisons to predicting heart health. The key statement that you shared from your cardiac team was that since you only achieved 75% of target heart rate to meet the diagnostic protocol for a determization of your heart health, and that their conclussions were "inconclusive". Further since they felt that there were no more indications of advanced heart deteriorization, "This was close enough for jazz" or were not sure if they would require some additional tests to further confirm.

These statement would have left me very worried about the state of affairs concerning my heart. Close enough for jazz for them? Or close enough for jazz for you? Are you willing to take "close enough for jazz" or "inconclusive" as a free ticket to go home and feel easy that you can camel up and bury your head in the sand and since they were not concerned, that you will not be also. This is a very perilous posture. For me I would damn well demand to know conclusively and damn well know it was opera and not jazz when it come to my cardiac health. This is where patient advocacy is paramount, not in defining the specific diagnostic, but more the accuracy of the diagnostic in determining a future course of action that both you and your clinician can chart to make songsi a more healthy individual.

No more will I just roll over and take the interpretation of results as concrete fact without knowing how these conclusions were reached. That not only keeps the clinician and you involved and up-front but also educates the patient in his own health and fosters an ownership of that health to further enable both to make songsi the best songsi he can be. There is more chance at success with an empowered patient, especially when life style change is equally as efficacious as a medication.

Thanks Songsi,

Best Regards,

Just Joe.

Thanks Joe I understand where you are coming from and I also was not very pleased with an inconclusive determination of the condition of my heart. I did revieve a call from my cardi today and he said in his opinion knowing my case from MI to present that he was as confident as he could be that an MI was not looming on the horizon. He explained several reasons why, all of which I am not going to go in to but in his opinion the 75% rate I was only able to reach was probably due more to my current physical condition. [ A little out of shape} rather that diminishing heart function. At this point I am going t see how I feel and let my body guide me through the decision making process. If I'm not comfortable with how I feel I will look for a second opinion.

Thanks
SJ

Songsi,

That's what I'm talking about. You da Man Songsi. Give em hell.

Best Regards,

Just Joe

My cardio, who is highly experienced and well-regarded, basically told me he thinks that in many cases, stress tests are of little value clinically and are basically money-makers for those involved. Which kind of corresponds with our experience here in this group, where some friends passed one with flying colors then had a heart attack soon after. Or got a heart attack during the test. I don't mean to be negative toward those who are "believers", but I feel a bit cynical about this issue.

He recommended a different test- I was worried about my younger sister, and wanted his recommendation. I wrote down the name of the test, but can't remember (it's been several months). If you want, I can ask him when I see him next month. My sister had no interest in the alternative test- she wanted to believe the good stress test results she got, never mind her high blood pressure.

Interesting Sue. A different test to ascertain heart health. That this cardio pretty accurately defined the inadequacies of the stress test as we know what has happened to some who have passed with " flying colors" suggests that cardiac diagnostics hasn't come to far.

The stethescope used to be the only thing used, and then the EKG machine was introduced, but these were reactive tools at best. 16 slice CT scans are exciting and are doing some early diagnostics on heart condition. However; we know there are certain intangibles which are associated with heart attacks that science, as yet, can't explain with any certainty. Many authorities "Think" stress has something to do with it. I would rather "Know" then think.

I go see Dr. Rader on thursday 31 March and would like some additional questions to ask him. This is dferfinitely one.

Best Regards,

Just joe

Just wondering, a nuclear stress test isnt very reliable??

FYI The nuclear stress test is about as reliable as they come right now however I believe they are working on some that may be better.
Right now the only test widely used that is better is the angiogram and they don't do those for screening or routine tests. Only if they feel an intervention is going to be necessary. I think the nuclear stress test is about 85% accurate and can give a false positive once and awhile. If that happens they will catch it when they do the angiogram and skip the intervention. Hope this helps.

Not to denegrate the validity of Songsi's rhetoric, but the stress test can only see what the heart is doing during the stress test. It doesn't account for the intangibles that medical science cannot predict or detect unless these intanibles are obvious at the time of the stress test. We have numerous people here in our group that have passed a stress test only to drop with major MI's days or weeks later. Inflamation, anxiety and diet will bring on an MI faster than a jog around the park. It is important for us to know all the variables that can affect our cardio systems. More importantly it is more important to know that age is a major factor whether you smoke, drink or eat junk. Early diagnostics is imperative. Angiograms are good tools to see early onset. I insisted on it following my first MI. I also got advice from a cardiologist when asked what the chances that other ateries in my body were in the same shape as my cardiac arteries. He said over 75%. I asked what he was going to do about it. His response was, we'll wait till you are symptomatic. That infuriated me given that 2 of 3 people who sufeer MI's "DIE". So I am proactive with my heart health and challenge my doctors to join me in my heart health. Which they do now proactively And be aware it is not only our hearts that are in question here it is other major organs showing ischemic symptoms. TIA's and even worse, a life altering or ending stroke.

Thanks for the input and observation Songsi.

Love you,

Just Joe