Stress should be a powerful driving force, not an obstacle - Bill Phillips
image by: Niel Romano
Dr. Marc Wallack routinely passed his cardiac exercise stress test with flying colors. He was, after all, a veteran marathon runner with respectable cholesterol and blood pressure numbers.
But as many heart disease patients discover, a treadmill analysis often isn't enough. Six months after a "normal" stress test, surgeons cracked open Wallack's chest for quadruple bypass surgery. An artery was 95% blocked.
"I thought I understood heart disease," said Wallack, a New York City surgical oncologist who has a strong family history of the illness. But his most recent stress test looked fine. So like many men, he convinced himself that the chest pain was merely heartburn.
Cardiac stress tests, also called exercise or treadmill tests, are commonly used to find evidence of blockages in the arteries of the heart. But they’re not 100% reliable.
An Echo Stress can be obtained in a physician's office or in the hospital. Imaging tests are generally obtained when a physician wishes to confirm or rule out the presence of coronary artery disease. A Stress Echo is also performed in patients who have disease involving the heart muscle or valve, or if a patient is having inappropriate shortness of breath and a cardiac cause is suspected.
Stress tests are among the best tools for diagnosing heart disease, and some research suggests that they may also be useful in estimating disease risk in people who don't have symptoms but have risk factors such as high cholesterol. If you are over age 40 and are at risk for coronary artery disease because you smoke or have high blood pressure or other risk factors, ask your doctor if you should have this test.
During exercise, healthy coronary arteries dilate (develop a more open channel) more than an artery that has a blockage. This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery. In contrast, narrowed arteries end up supplying reduced flow to it's area of distribution.
How does a Chemical Stress Test work? A chemical or pharmacological stress test combines an intravenous medication) with an imaging technique (isotope imaging or echocardiography) to evaluate the LV. In these cases, the medication serves the purpose of increasing the heart load instead of using exercise.
Lexiscan is the most widely used pharmacologic stress agent.
Stress tests pose little risk of serious harm. The chance of these tests causing a heart attack or death is about 1 in 5,000.
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