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Echo and stress test next week.
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This will be my follow-up post covid 19. I had an EKG several weeks ago and that was fine but they scheduled me for an echo and a stress test this upcoming week. What should I be looking for and what kind of questions should I be asking?
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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Fishbum wrote:
This will be my follow-up post covid 19. I had an EKG several weeks ago and that was fine but they scheduled me for an echo and a stress test this upcoming week. What should I be looking for and what kind of questions should I be asking?

Have you ever had an echo or a stress test before?
I would urge a degree of caution in trying to over interpret anything at this point. Main question will be is this echo and stress test normal for someone of my age and weight and co-morbidities and compared to any old echo's that you have had done (which you may not have had before).
There really is a heck of a lot of findings on an echo and all need to be interpreted in conjunction with the individual patient. The stress test is a little more black and white but still has a few caveats as well.
They should provide you or your treating team with a detailed echo report which will have a large number of measurements etc on it. Feel free to copy it and send it to the likes of myself or DTOCE and we can provide you with some feedback on it. Most reports will have a series of conclusions at the end which will give you the overall findings but there can be some smaller more important details in some of the reporting variables as well.

Importantly....how are you doing at the moment? Have you returned to exercise? If so, how is that going? Any excessive shortness of breath or chest pain etc?
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Re: Echo and stress test next week. [Amnesia] [ In reply to ]
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Thanks for the reply. To answer your question no I have never had any of this done before. This is all new to me and was recommended due to having covid-19. I had been working out lightly right after but over the past month I decided to take a break pretty much all together. With that said things have seemed pretty much normal. I have no known pre-existing conditions outside of busted up joints and it's my understanding the main thing she wanted to check for was myocarditis but at 41 it's probably not a bad time to get the ticker checked for the first time anyways.

Will there be results or things they can tell me about my test on the day I take them? just basic things like it all looks normal kind of deal?
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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I've done many stress echos, and usually they get some one to read your results that day at my office. I do the test, then about an hour and a half later I have an appt with the heart doc, different offices. If not, I would imagine within a couple days if they are busy and backlogged, never know what is going in some places with the Covid dominating everything.

But one thing for sure you get to know, is how long you stay on the test. I was reading up on this, and in general the length of time it takes you to failure on the test, the better your overall chances of not having any heart disease. They take your age and time on the treadmill into account, and then they have a huge database to pop out a % of chance you will have a big heart event in the next years. Of course it is not with pinpoint accuracy like actually reading your ultrasounds, but it is just a stat they have found overall that is quite relevant.

Dr toce here is in this actual business, and often chimes in on these threads. He is a great resource to have here, as he is also an athlete and understands the proclivities of the athlete heart as compared to the sedentary population. I'm assuming they will use the Bruce protocol for your test, that seems to me the universal standard with these things. Look it up online and you will be able to see what you are in for, it gets pretty brutal once you pass about 16 minutes..

Good luck, let us know how it goes..
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Re: Echo and stress test next week. [monty] [ In reply to ]
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I can't speak to the echo, but I've done many EKGs due to abnormal reading, as well as recently a stress EKG.

I was stressed out like hell during the stress EKG, so my blood pressure was through the roof. Anyways, if you are in decent shape, plan on it becoming a pretty intense workout. They pushed me pretty much to my max heart rate, around 188, which took quite some time to get there. Not to mention the treadmill is set at like a 16% incline.

The cardiologist reviewed the test results immediately and concluded it was all normal. He provided with me my metabolic equivalent of task (MET) score, which is basically your exercise capacity, and then a range for what that score should be for different ages. In my age bracket, "excellent" was 11.4 and I was at 17.5.

Didn't provide me with any other information other than that.
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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Bruce Treadmill Test Stages Stage 1: 1.7 mph at 10 percent grade´╗┐
Stage 2: 2.5 mph at 12 percent grade
Stage 3: 3.4 mph at 14 percent grade
Stage 4: 4.2 mph at 16 percent grade´╗┐
Stage 5: 5.0 mph at 18 percent grade
Stage 6: 5.5 mph at 20 percent grade
Stage 7: 6.0 mph at 22 percent grade

I found the protocol for the test, each stage is 3 minutes long, so you can see that you get to a pretty steep grade around stage 4. And 10 minute miles at 22% is no joke either!!!
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Re: Echo and stress test next week. [monty] [ In reply to ]
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monty wrote:
Bruce Treadmill Test Stages Stage 1: 1.7 mph at 10 percent grade´╗┐
Stage 2: 2.5 mph at 12 percent grade
Stage 3: 3.4 mph at 14 percent grade
Stage 4: 4.2 mph at 16 percent grade´╗┐
Stage 5: 5.0 mph at 18 percent grade
Stage 6: 5.5 mph at 20 percent grade
Stage 7: 6.0 mph at 22 percent grade

I found the protocol for the test, each stage is 3 minutes long, so you can see that you get to a pretty steep grade around stage 4. And 10 minute miles at 22% is no joke either!!!


How hard they let you work must "depend" on something. When I did my nuclear stress test back in May, they chose a target HR of 144. With an LTHR of 178 and a MHR of 194, that's mid zone-1 for me. I made it to stage 4. I went in prepared for a workout...and left dissapointed. I should have asked how they come up with the target HR.

Even still....the tech asked, "You must workout a lot? Most people don't make it past stage 1/2."
Last edited by: Tom_hampton: Aug 7, 20 9:04
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Re: Echo and stress test next week. [Tom_hampton] [ In reply to ]
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How hard they let you work must "depend" on something. //

Ya, they still use the old outdated 220 minus your age. So a lot of people like us get a really bad starting number if you are on either end of the bell curve. My place just lets me blow through what they considered my max HR, just depends on what they think of you as a patient I suppose. A guy like Lionel would never hit their number, but of course would break all the time records..Next time just tell them you want to keep going, then you get some good info for yourself and future training plans and zones..
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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I've had a stress echo before and it was fairly straight-forward. The cardiologist consulted with me immediately.

Fingers crossed you don't have to ask any questions and the cardiologist says everything looks perfectly normal.

Side note: The treadmill exercise was strangely fun for me.
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Re: Echo and stress test next week. [monty] [ In reply to ]
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monty wrote:
Next time just tell them you want to keep going, then you get some good info for yourself and future training plans and zones..

Given that I was having the test because I thought I was feeling angina symptoms, and we were doing the test to verify that my bypass grafts weren't failing...that probably would have been bad form. :-)

Next year, though....me and Bruce are going to have it out. :-D
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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For me, it was important to have a clear definition of what 'stress test' meant to the technician, Doctor, and me. It was important to inform them that I was a runner/triathlete. I'd spent a lifetime suppressing pain and pushing to physical limits. 'stress test', especially to stress and check my heart, would mean to approach unconsciousness, is that what you need?

As Monty said, when at the upper end of these levels, passing out on the treadmill would not be a desirable outcome!

I was in pretty good condition when I asked to have this test - I was approaching the end of stage 7 and they stopped the test - they did not know what their software or treadmill would do as they never had a person get to that point before. The tech and doctor felt they had enough information.

For me, the result was instant. The Doctor was with me the whole time and pointed out what she was looking for both during and post test. She had zero concerns for my heart health.

I trust and hope very similar results and outcome for you, that there are no lingering issue from COVID, and you trigger 'game on' mode as you click past the levels !

Andy
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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new disease, with a lot of as-yet unknown effects varying by individual.. so no-one knows what to look for, yet. You will be part of the research that lets us learn more, if that's any consolation ..
So I wouldn't expect the doc to be able to make a clear diagnosis/decision right away.
I had stress test and echo at National Jewish, had to make another appointment to discuss results.
They took me off the treadmill when blood oxygen saturation dropped below 84% as that seemed to be an issue for them ;-)

Especially with an athlete's heart they are going to find things like 'enlarged heart', 'bradycardia' etc which are perfectly normal for an athlete.

the echocardiogram is downright spooky, watching your heart flopping around inside your chest.. it does that, all day, every day, silently and efficiently, while we don't think about it..
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Re: Echo and stress test next week. [doug in co] [ In reply to ]
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I've had two different stress echo's. One where they did the echo while I was laying down on a table, then had me get up and use the treadmill to get HR rate up, and then lay down again to do the echo again. When on the treadmill, I was unable to get my heart rate as high as they wanted. Honestly, it wasn't really well suited for somebody in reasonable shape (older model treadmill). I'm guessing most of their patients tire pretty easily so it usually wasn't an issue. The other time, I was laying down and they had me pedal on an exercise bike type of contraption that was part of the table. That worked better. Might be worth checking with the office ahead of time on what equipment they plan to use. As another mentioned, it was interesting to see blood pressure measured when heart rate was up.

One of the other posters mentioned "athletes heart", which is when the septum of your heart can get larger. As part of the echo they will give you a measurement of the thickness of the septum. I've subsequently been told an echo is not the most accurate where to measure this, the best way to get an accurate number is to do a CT scan. So if septum comes up, its worth discussing with the doctor.

In one case, the doctor was not present and the technician made a comment that it was pretty straightforward, but then in both cases the doctor came in and discussed the preliminary results with me. I also got the written report that was done subsequently by the radiologist. You want to get that.

Good luck.
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Re: Echo and stress test next week. [giddyup] [ In reply to ]
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Thanks everyone. I will follow up on Wednesday afternoon after the test. Feel fine but took some time completely away from working out. So not in great shape but oddly have a little anxiety about the test.
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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Fishbum wrote:
This will be my follow-up post covid 19. I had an EKG several weeks ago and that was fine but they scheduled me for an echo and a stress test this upcoming week. What should I be looking for and what kind of questions should I be asking?

These tests are used to assess the heart structurally and physiologically. The echo will look at the heart function and valves-especially important as viruses can attack the heart and cause heart muscle weakening, like coxsackie virus, and lead to cardiomyopathy (weak heart muscle) and heart failure. Data are evolving that covid may do something similarly.

The stress test is a graded test-with the TM going faster and steeper, via a protocol-every 3 minutes, in order to look for electrical changes on the ekg, or problems with the heart rhythm/bp or symptoms which could suggest trouble with the blood supply to the heart. It is best done as a 'symptom limited' test. The end point is when you can't go any further safely. More tricky if it is an imaging test with sestamibi as it must be timed 60=90 seconds before your 'max' effort.

I'd ask about what the doctor's interpretation is of the heart muscle function and whether there is anything abnormal with the EF-as the ejection fraction is the number used for assessing heart muscle function. Normal EF is >50%. It should be noted that you are an athlete and certain normal changes are likely. The heart will physiologically 'enlarge' with endurance training, becoming an 'athlete's heart'. The heart rate often drops and the stroke volume increases as the muscle is more efficient. I'd ask specifically if the diastolic function was normal, as it always is in athlete's, but it is not known what happens with covid.

Good luck. Discuss your concerns with YOUR doctor.


giddyup wrote:
One of the other posters mentioned "athletes heart", which is when the septum of your heart can get larger. As part of the echo they will give you a measurement of the thickness of the septum. I've subsequently been told an echo is not the most accurate where to measure this, the best way to get an accurate number is to do a CT scan. So if septum comes up, its worth discussing with the doctor.
.

No. The echo is quite good, as is CT, but MRI is probably best. The concern is that there can be confusion with HCM (Hypertrophic Cardiomyopathy) a genetic condition which is far more serious, when the septum is greater than 1.3 cm. There is an overlap between 1.3-1.5 and if the septum is > 1.5 cm, that is usually abnormal-not from being an athlete.
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Re: Echo and stress test next week. [dtoce] [ In reply to ]
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So after everything was reviewed with the echo and the stress test to put it simply everything is considered normal no sign of damage to anything and free and clear to start working out again.
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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Fishbum wrote:
So after everything was reviewed with the echo and the stress test to put it simply everything is considered normal no sign of damage to anything and free and clear to start working out again.

Awesome, glad to hear!
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Re: Echo and stress test next week. [jeremyscarroll] [ In reply to ]
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jeremyscarroll wrote:
I've had a stress echo before and it was fairly straight-forward. The cardiologist consulted with me immediately.

Fingers crossed you don't have to ask any questions and the cardiologist says everything looks perfectly normal.

Side note: The treadmill exercise was strangely fun for me.

I had one a bunch of years ago due to an asymptomatic heart block, and they let me go 'all-out'.

The young girl techs were scared and horrified at the sweat and suffering I put out in that effort. I remember them when I finished saying softly "uhh-wow, that was really scary...." LOL
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Re: Echo and stress test next week. [lightheir] [ In reply to ]
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lightheir wrote:



jeremyscarroll wrote:
I've had a stress echo before and it was fairly straight-forward. The cardiologist consulted with me immediately.

Fingers crossed you don't have to ask any questions and the cardiologist says everything looks perfectly normal.

Side note: The treadmill exercise was strangely fun for me.


I had one a bunch of years ago due to an asymptomatic heart block, and they let me go 'all-out'.

The young girl techs were scared and horrified at the sweat and suffering I put out in that effort. I remember them when I finished saying softly "uhh-wow, that was really scary...." LOL
I had one 8 years ago when I was in much worse shape than I am now, but still a lot better than the typical heart check-up patient.
They used 220-age to assign a max HR figure and set the stop point for the test based on that. I was stopped about 14.5mins into the 15min protocol. They made a big deal of the fact I'd almost got to the end of the full 15mins and no-one ever manages that. I was a bit frustrated I hadn't been allowed finish, especially as my max HR was actually much higher than the 220-age guess suggests and I really wasn't near my limit yet.
More frustrating was the fact that they misdiagnosed the data, suggested I had a problem, and left me worrying for several weeks until I got a second opinion.... In the end it was concluded that the technician had misplaced one of the contacts, and there was nothing wrong at all.
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Re: Echo and stress test next week. [Ai_1] [ In reply to ]
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During my stress test they were making comments about how long it took to get me to the heart rate they needed and then how long I continued after that. I'm not saying this because I'm in good shape because I'm certainly not but apparently there's only been a handful of people they've seen go the distance on this thing. And I think it's more of a sign of how fat and out of shape our society has become.
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Re: Echo and stress test next week. [Fishbum] [ In reply to ]
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Fishbum wrote:
During my stress test they were making comments about how long it took to get me to the heart rate they needed and then how long I continued after that. I'm not saying this because I'm in good shape because I'm certainly not but apparently there's only been a handful of people they've seen go the distance on this thing. And I think it's more of a sign of how fat and out of shape our society has become.

I got the same response the first time I had one.

The last time I had one (just over a year ago), they were making comments before we started about if I was going to break my previous record. During the test, when it became clear that I might, I asked if anyone had seen "American Flyers". One of them said yes, so I replied "I just need to go one second longer than Marcus"...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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