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Stress echocardiogram yesterday - clinic employee out of line?

Discussion in 'Autonomic, Cardiovascular, and Respiratory' started by picante, Oct 12, 2018.

  1. picante

    picante Senior Member

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    A PA referred me for a chest X-ray and a stress echo because I complained that I've told 5 doctors about my disabling air hunger and none of them has seen a need to do any cardio testing. I've never had any cardio tests other than pulse oximetry/blood pressure.

    When the cardio clinic called, I told the nurse about the post-exertional symptom flares and asked, do you want to see me post-exertional or not? At my worst or my best? She said let's try post-exertional.

    The stress echo was yesterday, and my air hunger was bad enough that I was sitting on the waiting room floor leaning back against a chair. A staff person came in to get someone else and said "Are you all right?" I told her I would be a lot better lying down. She said loudly in a rather shocked/irritated tone "A stress echo and you need to lie down??" for all the waiting room and staff to hear. I merely breathed "Yes". "I'll get Jackie and she'll help you," she replied.

    In your opinion, how out-of-line was this comment?
     
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  2. Shoshana

    Shoshana Northern USA

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    Definitely out of line, yet sadly so common, these types of public comments, insinuations, and put-downs and critiques.

    SO common, while so disrespectful, hurtful, rude , and imo, also outside of respectful privacy rights, as well.
     
  3. Gingergrrl

    Gingergrrl Senior Member

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    Very out of line but sadly not surprising. I am sorry that happened to you. How did the stress echo go and how are you feeling now?
     
  4. picante

    picante Senior Member

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    Thanks for asking, GG. The ultrasound tech was great. I told her I had air hunger, and while she was setting me up I was reclining, so I had enough air to tell her a bit about the post-exertional symptom flares and the pattern of air hunger & worse brain fog coming on 2 years ago. And that I might not last through the treadmill test long enough to get my pulse to 134.

    So she knew all that, but the RN and tech who came in to get me on the treadmill evidently did not get that info. As soon as I started walking the tech asked me who referred me. I gave her a weird look and eventually said the doc's name.

    Immediately she asked why he referred me. I said, rather irritated, "Don't ask me questions!" She snapped "But it's important." [So why don't you look in my file, you idiot?]
    I said with finality "I have air hunger" and shut my eyes to focus on my breathing and walking. And she shut up. Thank God.

    When they sped me up, the ultrasound tech asked how I was doing. I didn't answer for a while. Trying to think how to phrase it and staying focused on breathing. A minute later I said "Mostly, I'm just breathless". The treadmill tech flipped the switch off.

    I was going to wait a tad longer before asking them to stop it, but the nurse said they don't want to risk me falling.

    So I didn't finish, didn't get to the target heart rate, but certainly got higher than I ever push myself at home: 123, I think the RN said.

    We'll see if the ultrasounds show anything. Unfortunately, the information I most want is whether the volume of blood pumped is low, and the RN told me that's not part of the stress echo. I said, what, you don't measure ejection fraction? He said no, that's with a regular echocardiogram. I got totally frustrated at that point, and said, well, I wish doctors would order the appropriate tests for me.
     
  5. picante

    picante Senior Member

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    Sorry about the long reply, just needed to vent. That clinic is one of the worst I've been to (for interactions).

    I was feeling OK by evening yesterday. Today, of course, the post-exertional symptoms flared up in the afternoon. Big gut-ache & inflamed sinuses/brain fog and mild neck spasms. A nap and some lymphatic massage on my neck helped.
     
  6. Gingergrrl

    Gingergrrl Senior Member

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    Sorry you had to go through all of that and hope you are feeling better today @picante!
     
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  7. CreativeB

    CreativeB Senior Member

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    @picante sorry to hear you had such a shockingly bad experience. There is absolutely no excuse for the lack of compassion and respect you were shown.
     
    Shoshana likes this.
  8. valentinelynx

    valentinelynx Senior Member

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    I am a little confused by this. The purpose of a stress echo is to look for signs of cardiac ischemia under stress. This is usually tested with an EKG based stress test, unless you have an uninterpretable EKG (A fib, Left bundle branch block). But before stress testing is done, you would typically have a regular echocardiogram to look at baseline cardiac function.

    Also, given that you are limited in exercise capacity, if you needed a stress test, you should have had a pharmacological stress test, in which you are given a drug that raises your heart rate. I expect the nurse was reacting to this, not to you personally, but that someone would order an exercise stress test on someone who apparently can't exercise.

    I also don't understand about the ejection fraction. I see a lot of these studies, and they typically include an EF, to compare with the baseline EF.

    Perhaps you could suggest to your PA that she order a regular trans thoracic echocardiogram to get a sense of your baseline cardiac function. And, if you or she has a concern that you might be having cardiac ischemia (chest pain or shortness of breath increased with exertion) then you should have probably have a pharmacological stress test with perfusion scintigraphy (otherwise called a nuclear stress test) rather than a stress echocardiogram. I may, however, be unaware of her reasons for choosing the stress echo rather than the nuclear scintigraphy, so I suggest you ask her why she chose that particular test. Better yet, request a referral to a cardiologist who will know the best testing to request in your circumstance (to rule out cardiac ischemia, not necessarily to work up CFS!).
     
  9. jesse's mom

    jesse's mom Senior Member

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    I am sorry they were rude to you. I write letters to human resource departments, then mostly don't mail them.
    I get thing off my chest so to speak. ;)
    If I stay mad, I then burn said letter. :mad:
     
  10. picante

    picante Senior Member

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    The echocardiogram (ultrasound) was indeed before the treadmill. And a quick one after they stopped the treadmill.
    I did have leads hooked up, so I'm assuming those were EKG wires.
    I hope you're right. The nurse who called me to make the appointment was the one who told me that the ejection fraction would be included, and that it is a measurement of blood volume pumped by the heart. The nurse at the actual testing said it wasn't included, and that wasn't part of the purpose.
     

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