Boy, they don’t call it a “stress test” for nothing, right? I think about this every time I have one. And not just the simple, hey, hop on the treadmill, run a few minutes, we’ll take your blood pressure, now go home, you’re all good! But the nuclear stress test is pretty long and inconvenient. (But then, I’m a wimp: anything involving an IV is inconvenient to me).
I am not sure what it’s like when you’re not truly a cardiac patient and you’re doing it just to rule out cardiac issues. Maybe it’s easier to run uphill at whatever speed they set for you till your heart beats reach the stratosphere for a normal person. But I think any cardiac patient will tell you that it’s not a walk in the park for us - no pun intended here.
I’ve done maybe 5-6 of these in my life. Maybe more. Definitely not less. I fair it pretty well. These are the basic steps:
- First, they hook you up to an IV and they give you some contrast solution (this is part of the “nuclear” part of the test).
- Then, they make you drink a glass of water and sit in the waiting room for an hour.
- Then, they call you into a room and you lie on a skinny table for 10 minutes and they take pictures of your heart. (These are the pictures of your heart “at rest” - this is another part of the “nuclear” part of the test, as the pictures capture the contrast going through your heart blood vessels to see how well they’re functioning).
- Then, it’s back to the waiting room for a bit longer (if you’re lucky and they have no one else ahead of you, you’d skip this step, but for me, it was another hour).
- Then, they hook you up to all sorts of wires to monitor your heart (similar to those you get when you get an EKG), to a blood-pressure cuff, and to an oximeter. Yeah, you’ll feel like an alien.
- With all that gear, you then walk on a treadmill and they increase the speed and the incline of the treadmill as you go.
- The goal is to make your heart rate go up to a goal that the medical science deemed appropriate for your weight/ height and age. This is the most important part of the test (the “stressing” part) and I fail it every time.
- Once you reach their goal, they inject some more contrast through your IV and they slowly decrease the speed and incline of your treadmill till you come to a full stop.
- Then, they have you sit for a bit and then walk back into the picture-taking room to take pictures of your heart, now “stressed”.
- And that’s it!
During the test, they ask you if you’re experiencing any discomfort (shortness of breath, chest pains, cramps in arms or legs, dizziness, light-headedness, anything else), and they have you rate their severity on a scale from 1 to 10. They also have you rate your perception of the severity of the level of exercise you’re performing - this goes from 6 to 20 (they call it “the Borg Scale”). I rated mine a “49” by the time they stopped the treadmill!
The whole procedure took about 4 hours for me. There are lots of things that could happen during this whole thing. For instance, the first set of pictures (ar rest) was not good for me today, so they had to take them again. They said “there was intestinal activity” that obscured some parts of the heart. To “fix” this, they made me drink (on top of the water they gave me before the pictures) a whole can of Sprite. Somehow, Sprite is supposed to “fix” the “intestinal activity” and allow for better pictures (it feels like it does the opposite to me, but hey, I am no doctor).
Then, they told me that if I don’t reach my beat-per-minute goal (which is 147 beats!!), they will have to inject me with something similar to caffeine, to stress my heart “artificially” even more. This would make the test at least an hour longer and would come with side effects (which the contrast solution does not have). Well, this is the part that I always fail: I have never reached my goal. I have at least two (maybe three) things working against me:
- I have a sick heart, to begin with, so my level of endurance is low. I get symptoms early on while my heart is not beating as hard yet.
- I take atenolol, which is a beta-blocker. The whole purpose or atenolol is to slow down your heart rate. A normal person’s heart should be about 60 beats per minute, but in real life, it’s more like 62-65. Mine is usually in the low 50 range (52-55). So, when a normal person’s heart is stressed out it would beat at 147 beats per minute (my goal), my heart would make it to about 130, if that!
- A third thing is: so far, I have been young and skinny. So my goal (always done for a healthy individual, not for one with a compromised heart) is too high to start with.
But the lab techs have no choice. They have a grid, they must apply it. That’s all they are trained to do. And they can’t stop the test and just say “hey, she didn’t make goal, so this is the problem, she has a weak heart, let’s send her back to the doc”, because this is not the purpose of this test. The purpose is to take those pictures when the heart is most at stress.
Today, I actually saw my heart go up to 141 which was my max (still, 6 beats shy of the goal). There are usually two techs in the room: one that monitors your EKG, your blood pressure, your oxygen, and writes everything down, including your symptoms, and one of them who is injecting you with contrast (or giving you caffeine and injecting contrast, if needed) who will also take the pictures, after you’re off the treadmill. The monitoring lady wanted me to go higher than 141 and I simply just could not. The contrast-and-picture tech had to make a call: should he give me caffeine to stress my heart artificially to reach 147? Or leave me be, since I was close to it and my symptoms were so severe that my heart simply could not take any additional stress, either natural, by me trying to add more to it, or artificial, through taking some drug?
And for the first time in a long time, he actually looked at the patient, and not at the grid! He said: “her symptoms are already at 10+. I cannot, in good conscience, give her more caffeine, because I know her heart is already stressed out based on her symptoms”. I had shortness of breath of 10+ on the severity scale, chest pain of about a 7, dizziness of about an 8, a sharp, sudden headache in one side of my head of about a 6, a completely numb arm, from shoulder to fingertips - the arm was not in pain but it was so numb I could not hold on to the treadmill bar anymore, I would call the numbness a 10. In my experience, these are all symptoms of atherosclerosis and cardio-vascular disease. Because of the damage FH has done over the years, these are the symptoms that my body exhibits to indicate reduced vascular circulation due to plaque buildup and blockages. So, he injected me with more contrast to take the stress pictures and called it good at 141 bpm!
I am so grateful for that man! Something in my heart (quite literally) tells me he made the right call. I usually don’t drink caffeine (I drink decaf coffee and no sodas), so I am not sure what the side effects would have been on top of the exercise I got that felt so, so, so far over my threshold of normal activity.
I was just pleasantly surprised that for once I didn’t feel like a Guinea pig and actually felt like a human being. Seen. Heard. Understood. Listened to.
We need more of these techs in the medical world. Again, I am not a doctor, so I am not sure if he broke some kind of law here - but as a patient, it felt like he had my best interest at heart (no pun) and did not stick me in some artificial mold that everyone has to fit. He assessed me, my performance, my symptoms, my “clinical presentation”, if you will and evaluated that.
At one point, because he was paying attention, he told the monitoring lady to stop increasing the speed but to increase the incline more - which was smart and true: from my own experience, I know walking on an incline is infinitely more stressful to my heart than walking faster on flat ground. I didn’t tell him anything, but he noticed where the numbers were going up: and they were going up more when they increased the incline, not the speed. So, he adjusted the effort for me. He even said “her legs are so short, she can’t do the incline if we speed her up anymore” - and that is right! (I am barely 5ft tall).
No results yet, but I was grateful for a positive and humane experience for once. This is incredibly hard to find nowadays.
