I think I’ve written before about how much I dislike treadmill running… Well taking a treadmill stress test is much worse! Not a casual walk in the park during the test you are essentially hooked up to a EKG monitor the whole time running on a treadmill and not being allowed to take your hands off the rail except to have your blood pressure and pulse oxygen taken every 3 minutes. Try running all out uphill with one hand being held by a technician. And they are trying to get you to talk to them!
During the setup time she told me that the maximum length the test would go for is 21 minutes. Using the
Bruce protocol at 21 minutes you are running at a 22% grade at 6 mph pace. The pace isn’t super intense but the hill is brutal. I thought to myself that I’d like to hit the time limit, but didn’t make it. I ran for 16 minutes which put me at 20% grade and 5.5 mph pace. I think if I hadn’t done 5×5 squats that morning I could have lasted a little bit longer!
Oh yea, one last hard thing – the second the test is over you have to turn around and lay down in the exact right location to get an ultrasound of your heart. While panting and out of breath, they ask you to hold your breath to get a quality image.
All of that and I didn’t have any “episodes” during the test, though there were some minor things but nothing that the cardiologist on duty was concerned about. My pulse did hit 190+ for at least 4 minutes which is pretty high.
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EXERCISE STRESS ECHO REPORT
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Patient Name: NICHOLAS H CROSS Date of Exam: 9/16/2015
Type of Study: STRESS ECHO 2D Echo/Doppler/Color Doppler.
Indications: Exertional palpitations
___________________________________________________________________
Summary:
1. Normal stress echocardiogram with no inducible wall motion abnormalities at stress.
2. LV function is normal. The visually estimated ejection fraction is 60% at rest.
3. Mildly elevated pulmonary pressure estimated at 25.6 mmHg plus right atrial pressure.
4. PSVT in recovery at about 140-150 spontaneously resolved.
5. No anginal symptoms with exercise.
6. Dyspnea with exercise.
7. Target heart rate achieved.
8. Normal exercise capacity.
____________________________________________________________________
History: Patient with a history of No cardiovascular risk factors. Special Considerations: Lung CTA and No Murmur. Multivitamin daily.
Exam Protocol: Bruce stress protocol. Predicted maximum heart rate is 186. 85% percent target heart rate is 158.
Patient Performance: The patient exercised for 15 minutes and 35 seconds to stage VI of a Bruce protocol, achieving 15 METS. The patient developed dyspnea and leg fatigue during the test. The resting heart rate was 88 beats per minute. The resting blood pressure was 102/78 mmHg. The peak heart rate achieved was 192 bpm, which was 103% of the predicted target heart rate. The peak blood pressure during stress was 158/70 mmHg. The double product achieved was 30336. The stress test was terminated due to target Heart rate achieved and leg fatigue. O2 saturation at rest is 99% on room air. O2 saturation with stress is 92% on room air.
EKG: Resting EKG showed sinus rhythm and freq premature atrial contractions at a rate of 88 beats per minute. The patient developed no ecg changes and PSVT > 6 beats during exercise.
REST ECHO:
Left Ventricle: The left ventricular size is normal. LV function is normal. The visually estimated ejection fraction is 60% at rest.
Valve Findings: Mild aortic valve sclerosis. The aortic valve is trileaflet. Trace aortic valve regurgitation. No evidence of significant mitral valve regurgitation. Trace tricuspid regurgitation.
Right Ventricular Systolic Pressure Estimate: The estimated pulmonary artery systolic pressure is mildly elevated at 25.6 mmHg plus right atrial pressure.
Exercise Data:
+————-+—+——+———————————————+——-+
:Stage :HR :BP :Comments :Initial:
+————-+—+——+———————————————+——-+
:Supine :88 :102/78:Stiff muscle in left shoulder and upper back :GD :
: : : :at rest, frequent to bigeminal PAC’s, : :
: : : :occasional PVC’s at rest : :
+————-+—+——+———————————————+——-+
:I :106:122/70:no symptoms and O2 sat 98% : :
+————-+—+——+———————————————+——-+
:II :124:136/70:no symptoms and O2 sat 98% : :
+————-+—+——+———————————————+——-+
:III :145:144/72:no symptoms and O2 sat 99% : :
+————-+—+——+———————————————+——-+
:IV :174:148/70:Slight leg fatigue, O2 sat 95%. : :
+————-+—+——+———————————————+——-+
:V :192:158/70:Mild shortness of breath, O2 sat 92%, rare : :
: : : :PVC and leg fatique. : :
+————-+—+——+———————————————+——-+
:VI :192:- :Mild shortness of breath, leg fatique and : :
: : : :rare PVC. : :
+————-+—+——+———————————————+——-+
:Post 1 min :145:- :Mild shortness of breath and rare PVC’s. : :
+————-+—+——+———————————————+——-+
:Post 3 min :114:130/70:O2 sat 98%, 2-3 beat bursts atrial tach-no : :
: : : :symptoms. : :
+————-+—+——+———————————————+——-+
:Post 5 min :111:120/60:No symptoms and 2-3 beat bursts atrial tach, : :
: : : :frequent PAC’s. : :
+————-+—+——+———————————————+——-+
:Post 7 min :108:112/70:Rarre PAC’s, waiting on heart rate to : :
: : : :decrease and no symptoms. : :
+————-+—+——+———————————————+——-+
:Post 9 min :102:- :No ectopy and no symptoms. : :
+————-+—+——+———————————————+——-+
:Post 9:39 min:99 :- :Rare PAC and no symptoms. :GD :
+————-+—+——+———————————————+——-+
