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Re: Echo stress test Echo stress test was ordered by

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Re: Echo stress test

Echo stress test was ordered by my long-time pulmonologist (for adult onset asthma) as most recent breathing tests now show 'restriction' and wanted to check for ischemic heart disease.

Question, please: During the stress echo, the presiding doctor (who I had never seen before) and who was watching the test measurements asked the tech if electrode/s were unattached --thus indicating something was amiss, it seems. (Short story: A non-nurse/non-tech initially put them on; the test tech then came in the room and determined she had to remove and re-position them, which she hurriedly did as the doctor apparently was waiting. During the test, he seemed to notice something was wrong with the electrodes.) The test continued. It seemed to last only a few minutes. The doctor/interist told me he saw changes but final reading would be done by cardiologist. That report from an unknown-to-me cardiologist was reported as normal.

1) Can you comment please on the 'electrode' issue -- what effect on the test, etc.

2) Will you address the matter of the internist saying he saw 'changes' and that he could see how obviously difficult it was for me to breath, but the cardiologist's reading as 'normal'

3) Daily routine is a challenge due to breathing issues. More testing needed?

I've made a follow-up appt with the pulmonologist who ordered the test.

Thank you.
Posted Thu, 23 Nov 2017 in Hypertension and Heart Disease
 
 
Answered by Dr. Ilir Sharka 38 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that the accuracy of echo stress test does not depend on the electrode placement as its results are evaluated based on the myocardial contractility in the echo view.

In my opinion the test results (normal) are reliable.

So, to conclude, with a normal stress echo result, we can exclude any possible myocardial ischemia or coronary artery disease.

Coming to this point, the difficulty breathing is not related to any cardiac disorders.

In this regard, I would recommend performing further tests to evaluate for the underlying possible causes (lungs, musculo-skeletal structure, anxiety, etc.):

- an arterial blood gas analysis
- a chest X ray study
- pulmonary function tests with bronchospasm induction
- allergy tests
- complete blood count for anemia
- PCR, ESR for inflammation.

Hope you will find this answer helpful!

I remain at your disposal whenever you have any other questions.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by
 
Follow-up: Re: Echo stress test Echo stress test was ordered by 1 hour later
Thank you.

Follow-up, please:

1) What, then, is the function of the electrodes? And what effect/s would unconnected, etc., electrodes have on the test. Why are they used if not important?

Next:
Info: The pulmonary functions studies were done recently --prior to the order for the echo stress test. The function studies showed a decline (if that's the proper term) from prior studies over the years (done due to adult onset asthma).

I'm extremely well-educated (although not in the medical genre). The fact is that breathing problem/s effect daily life significantly. It's not anxiety.
The pulmonologist, and the internist at the stress test, have now 'seen' the breathing problems.

2) There must be a finite number of things that could be causing the same. Why does it seem so difficult to detect?

Thanks
 
 
Answered by Dr. Ilir Sharka 8 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Here are my answers to your questions:

1- The electrodes function is to evaluate the heart rhythm regularity during the echo stress test and also evaluate the two phases of the heart cycle: the systole and the diastole.
The ECG electrodes are not only used in this test, but other tests as well like a routine echo, coronary angio CT scan or coronary angiogram.

But as I explained the possible ischemic changes are revealed in the Echo view during the test, based on the contractility of the heart muscles.

2- Regarding your breathing complaints, your respiratory function tests have not resulted normal. They have revealed a restriction pattern, which means that your shortness of breath is not just anxiety and is related to a possible underlying lung disorder.

That is why, I recommended performing the above mentioned tests, in order to investigate if these pulmonary function alterations are related to an allergic reaction or to an inflammatory disorder.

But, as a cardiologist, considering your echo stress test which have resulted normal, I would exclude any cardiac disorder.

Anyway, I would like to directly review your stress echo report, if you can upload it for a more professional opinion.

Hope you will find this answer helpful!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by
 
Follow-up: Re: Echo stress test Echo stress test was ordered by 27 minutes later
Thank you. :)

I requested a copy of the stress echo but have not as yet received it.

I'll try again.

Thanks.
Follow-up: Re: Echo stress test Echo stress test was ordered by 21 minutes later
Thanks for your note; here is what I found (the test was stopped fairly as I was winded and had apparently reached a certain BP, is my understanding):


TREADMILL SUMMARY

Total time: 00:07:31 Resting BP: 124 / 80 Peak BP: 174 / 84
Maximum HR: 145 % age-predicted: 92 METS: 8.326
Reason for stop: XXXXXXX HR

EXERCISE SUMMARY
1. EKG response to exercise: No diagnostic changes. Much baseline artefact.
2. No angina or anginal equivalent.
3. Exercise capacity was average.
4. Normal heart rate response to exercise.
5. Hypertensive blood pressure response.
6. No arrhythmias were noted.
ECHOCARDIOGRAPHIC FINDINGS
RESTING:
Normal left ventricular function at all wall segments.
Normal chamber sizes.
No significant valvular abnormalities.

Ejection fraction at rest: 68%
POST EXERCISE:
Normal augmentation of contractility of all myocardial segments.
Ejection fraction at exercise: 78%
CONCLUSIONS:

Negative stress test with low likelihood of clinically significant ischemia by
clinical, electrocardiographic, and echocardiographic wall motion scoring
criteria.
 
 
Answered by Dr. Ilir Sharka 12 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I carefully reviewed your exercise cardiac ultrasound and would like to congratulate you for the excellent results; it is considered a normal test without evident signs of cardiac ischemia.

Besides a slightly hypertensive response to exercise everything seems to be OK.

So, after this test any important cardiac ischemia is excluded with a high certainty.

It is necessary to investigate in a different clinical direction in order to find the exact nature of your complaints.

The medical tests I recommended you earlier during our thread could be a reasonable start of the differential diagnosis workup.

First of all, the clinical implications of your actual impaired pulmonary function should be thoroughly sought.

You need to discuss again with your attending pulmonologist.

I would like to review any new medical tests you are going to have.

I remain at your disposal for further discussions.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by
 
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