Stress echocardiogram yesterday - clinic employee out of line?

picante

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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?
 

picante

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How did the stress echo go and how are you feeling now?
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.
 

picante

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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.
 

valentinelynx

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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!).
 

picante

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But before stress testing is done, you would typically have a regular echocardiogram to look at baseline cardiac function.
The echocardiogram (ultrasound) was indeed before the treadmill. And a quick one after they stopped the treadmill.
This is usually tested with an EKG based stress test,
I did have leads hooked up, so I'm assuming those were EKG wires.
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.
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.
 

Gingergrrl

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Guess what! I just got the report. There is an ejection fraction: it's 60%, which my referring PA said was "stellar". Is it? I was so glad to hear it!
I couldn't remember so I just checked the last echocardiogram that I did with my former cardiologist (in Sept 2016) and my ejection fraction was 65% and labeled as normal. I Googled it and it appears that anywhere from 55% to 75% is "normal" (per Dr. Google).
 

picante

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I write letters to human resource departments, then mostly don't mail them.
I get thing off my chest so to speak.
I actually wrote one last night after I saw what someone put in the report. I don't know who to mail it to: HR or the cardio clinic? It's a big hospital medical group with lots of clinics. I've seen the immunologist there, the infectious disease doc, etc.
In my experience, these kinds of problems are created by poor management, like subjecting people to crazy schedules and hostile supervisors. So I suppose it should go to HR.
 

dannybex

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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 ended up in the ER a couple weeks ago due to chest 'aches'. Not really pain, but every 4-8 minutes or so I'd get this kind of sinking 'twinge' to the left of my heart, so of course once I called 911, I was off to the ER even though the EKG they did here at my apartment came out fine.

As did the 3 1/2 hour one they did at the hospital. They also did two trophonin tests, which also came out normal. And sure enough, about an hour after I got home, the 'twinge' went away.

Anyway, I have to go to a cardiologist followup on Thursday, and seriously doubt I can do the treadmill-type stress test, so I'm wondering if anyone knows what kind of drugs they use for the pharmacological stress test? And are they in general considered safe for ME/CFS patients?

Any info would be greatly appreciated.
 
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I just went through that test with the drug because I cannot exercise. I did not get the list of medications, but I know the part where they induce stress only lasted 5 minutes at its peak 15 minutes total, then it tapers away. It was not he most comfortable test I have ever done, but the one for my rotator cuff was worse for me with the contrast dye. I was very tired after the test, but not much more so than other tests. It was a great relief to be tested and then get that call that nothing is wrong with my heart.

Best to you and let us know how you do!
 

dannybex

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@jesse's mom, good to know it doesn't last very long. I'm curious however, why did you need a rotator cuff test/exam? Was that related to heart issues, or to find out what kind of damage you may have had w/your rotator cuff?

Thanks so much for your good wishes as well as yours @CreativeB -- they're very much appreciated!
 

valentinelynx

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I'm wondering if anyone knows what kind of drugs they use for the pharmacological stress test? And are they in general considered safe for ME/CFS patients?
@dannybex: The most common drug used for nuclear stress testing is Lexican (regadenoson), an adenosine analog. It simulates the effect of exercise on the heart by causing dilation of the coronary arteries. Coronary arteries that are obstructed by atherosclerosis will not dilate to the same extent as those that are not, and this will show up as relative ischemia on the imaging (which is done using a tiny dose of radioactive tracer to show what parts of the heart are more or less perfused with blood after the stress drug is administered. Other drugs sometimes used for these tests are dobutamine (for stress echo, sometimes with atropine), dipyridamole, and adenosine (mostly replaced with Lexican, which is safer).

The side effects of Lexican include increased heart rate, raised or lowered blood pressure, headache, dizziness, flushing, shortness of breath, nausea, and chest discomfort. The effects of the drug are gone in literally seconds, so these side effects don't usually persist either. It's really hard to say if something is "generally safe" in CFS, because there are no studies on this. I would speculate that if you have severe POTS or other autonomic disregulation, then this test might not be advisable, because of possible effects on your blood pressure and heart rate. If you think you fit in this category, you should bring it up with the cardiologist ordering the test.

I had a stress test a year or so ago. It was weird: feels like you've suddenly run up a hill, while sitting in a chair! But the sensation vanished quickly.

Here's a pretty good info resource on chemical stress testing. Hope this is helpful. Good luck and I hope your test is normal (I strongly suspect it will be from what you've said :)).