question about stress testing

[unterhausen]

went into my doc today because I realized I was having asthma attacks. He is worried they are cardiac events. I'm enough of a hypochondriac that I wouldn't mind having a test, but I have heard that the normal test usually don't show much for cyclists in good condition. Any comments on that? Is there something I should tell them? Do they charge by the minute?

I usually have asthma attacks after a fairly long time, 3-4 hours usually. They also respond well to albuterol. He says I shouldn't feel weakness, but it seems to me that weakness is pretty normal. Most people would just quit exercising after an attack, cyclists generally aren't that smart.

[pncguy]

First, I am not a doctor and I don't play one on TV.

Second, I have asthma and have had it for more than 40 years.

Third, I have skipped beats and just had my first bout of Atrial Flutter about two months ago.

It seems to me that if your breathing responds to albuterol, then it is asthma. When I have an asthma attack, I feel like I cannot get the air out of my lungs because of a constriction and/or wheezing. I've never had shortness of breath because of cardiac issues, but I would imagine that you feel like you can breathe fine, but you're just not getting enough oxygen. Also, the response to albuterol should be almost immediate.

The fact that a stress test isn't "hard" for a cyclist doesn't mean it isn't beneficial. Tell them you're in shape and they'll push you.

[makoti]

went into my doc today because I realized I was having asthma attacks. He is worried they are cardiac events. I'm enough of a hypochondriac that I wouldn't mind having a test, but I have heard that the normal test usually don't show much for cyclists in good condition. Any comments on that? Is there something I should tell them? Do they charge by the minute?

I usually have asthma attacks after a fairly long time, 3-4 hours usually. They also respond well to albuterol. He says I shouldn't feel weakness, but it seems to me that weakness is pretty normal. Most people would just quit exercising after an attack, cyclists generally aren't that smart.

I've had three. The first one (years ago) they ran me until I was gasping, and when I asked how I did they said "Oh, you passed 5 min ago. I was just wondering how much you could do".
The other two (much more recent) I had no trouble doing the twelve minutes & they asked if I could go more (yes), but I had passed.
I don't think it's cyclists per se. I think it's anyone in good shape. Remember, the bar is pretty low these days.

[unterhausen]

the reason I ask is that I feel like I've heard of people that passed the original test and then collapsed when it was extended. I'm not sure how far up my heart rate would be after 12 minutes, but I feel like my legs would be exploding if I tried to get anywhere near my max heart rate in that amount of time.

[donevwil]

In my experience every doctor will want to rule out a heart issue before anything else is considered, even if you had the exact same battery of tests only a year earlier (stress test, EKG, echocardiogram).

I recently performed both a stress test and, ultimately, a pulmonary function test to help diagnose a breathing issue that has developed. The technician present for the stress test and, ultimately, the cardiologist are only interested in heart function during the test, not athletic performance, treadmill duration, etc. They did make the recommendation that I improve my fitness because my duration to reach the target heart rate was significantly shorter than that from a stress test a year prior, but when I mentioned that was because I couldn't breath during the current test they sent me in for a pulmonary function test.

The pulmonary function test was graded relative to others of the same sex, size, age, etc., so your concern may be valid for that test. I passed it with flying colors (grade of 100+ whatever that meant) even though my breathing issue popped up in 8 of the 9 test cycles (9th cycle graded at 142).

My doctors simply didn't care since the pulmonary function test indicated I was far better than average.

I'm still fighting the battle with my doctor (Kaiser Permanente, ugh!).

Good luck

[bjf]

If you ask -- well, maybe, insist -- they can do a stress test on an exercycle instead of a treadmill. Much more of an accurate test for me.

[unterhausen]

I don't think my ankle would hold up under a treadmill test. I guess I better check

[efaust_o]

better sooner than later....KEEP IN MIND....ST can be false positive or false negative....not an absolute...I was fine according to ST but knew by symptoms something wasn't right....cardiologist will tell you after consultation if you are candidate for a cath.....you don't want to have a attack....

[Peter P.]

If you ask -- well, maybe, insist -- they can do a stress test on an exercycle instead of a treadmill. Much more of an accurate test for me.

I say "fat chance". I had a stress test performed in August. I've done several. As a cyclist and not a runner, your hip flexors and knees will fatigue and get sore before you run out of steam. At least that has been my experience.

So for the recent test I brought my cycling shorts, pedals, shoes, the works, planning on asking if I could use the exercise bike instead of the treadmill.

Doc says, "No; that would take too long..." :confused: I guess my health wasn't that important.

As has been said, they're not looking to max out your heart; if you reach 12 minutes, they'll have all the data they need.

[rnhood]

If they were cardiac events, I would think that you would have other related issues like the pain running down the left arm, tightness in chest, etc. Breathing difficulties too (out of breath real easy, but no wheezing). So I don't think its a cardiac issue however, if your doctor thinks it could be then my recommendation is to see a cardiologist and get the stress test. Assuming they see some anomaly, the test will certainly be able differentiate between asthma and the cardio system. Cardiac events in an individual will have far more to do with genetics than someone's fitness, or perceived general health. I have several friends with bypasses and/or stents that cycled for years and were otherwise in very good general health.

Go get the test if your doc recommended it. The cardio doc will also screen you before the stress test, so it's still possible you won't get it.

[cadence90]

I absolutely do not understand the idea of soliciting medical advice on an internet forum of any kind.

Possibly after a medical procedure, to see how fellow cyclists, in this forum's case, dealt with recovery, etc.

But beforehand, without even knowing all the conditions? I really do not get it at all. What possible benefit can there be?

:confused:
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[Louis]

I say "fat chance". I had a stress test performed in August. I've done several. As a cyclist and not a runner, your hip flexors and knees will fatigue and get sore before you run out of steam. At least that has been my experience.

So for the recent test I brought my cycling shorts, pedals, shoes, the works, planning on asking if I could use the exercise bike instead of the treadmill.

Doc says, "No; that would take too long..." :confused: I guess my health wasn't that important.

How about a stepper - can they let you do a ST on one of those?

I can get my HR up much more easily on stepper than a treadmill. I avoid running on treadmills to protect my knees, and usually just do a fast walk, but even that can't get my HR very high. The highest I've seen on a treadmill is about 60 bpm below my max (no running).

[steamer]

I absolutely do not understand the idea of soliciting medical advice on an internet forum of any kind.

Possibly after a medical procedure, to see how fellow cyclists, in this forum's case, dealt with recovery, etc.

But beforehand, without even knowing all the conditions? I really do not get it at all. What possible benefit can there be?

:confused:
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Its a question about a test, not a proceedure. And specifically about how to ensure, ahead of time, that the test is done in a way that reveals the correct info despite a certain level of fitness unknown to the general population. If all medical professionals did a good job all the time, then this wouldn't be necessary, but they don't, so it is.

[Spaghetti Legs]

The HR goal of the stress test is to get 85% of your predicted max.

[carpediemracing]

I did a stress test about 10? years ago. At the time I could hold about 170 bpm in a race, max out at about 180-185 bpm, something like that. I was on a treadmill plateaued at about 168 bpm for a while and asked if I could stop. They said yes.

I have something where my heart zigs when it should zag. Apparently looks like a minor heart attack in progress. Doc told me that I could get a day off if I walked into an ER rubbing my chest and not saying anything because they'd have to hold me for observation.

At about 112-114 bpm the zig turns into a zag. This appeared during the stress test, so if nothing else, that was good.

The treadmills had weight limits on them. I think one was 450 lbs, the other 500 lbs. The fact that they had to label the treadmills showed what kind of clientele they normally saw.

[Peter P.]

How about a stepper - can they let you do a ST on one of those?


I don't know whether they are a standard offering in the test labs. They ALL have a treadmill; some have an exercise bike. But don't think something like a spin class bike. In the lab I went to was a recumbent bike-like thing which looked like it should have a beer-stocked fridge next to it, know what I'm saying?!

[unterhausen]

I absolutely do not understand the idea of soliciting medical advice on an internet forum of any kind.
I am definitely taking the test, I just want to make sure I'm getting my money's worth. I feel like i have seen reports that cyclists pass the test even though they have heart issues. So I'm more worried about passing the test and having a false negative. Cyclists are different enough from the general public that I am interested in the experience of outliers, many of whom can be found here.

Anyway, I'm glad I asked, because I hadn't thought about having to use a treadmill. I am pretty sure I can run without my ankle brace, I'll have to try it on our treadmill.

[bjf]

I say "fat chance". I had a stress test performed in August. I've done several. As a cyclist and not a runner, your hip flexors and knees will fatigue and get sore before you run out of steam. At least that has been my experience.

So for the recent test I brought my cycling shorts, pedals, shoes, the works, planning on asking if I could use the exercise bike instead of the treadmill.

Doc says, "No; that would take too long..." :confused: I guess my health wasn't that important.

As has been said, they're not looking to max out your heart; if you reach 12 minutes, they'll have all the data they need.

I was very lucky. My cardiologist let me bring my own bike and trainer to the lab for an echocardiogram. His reward was he got to see my arrhythmia on the screen in real time. He loved it. Me, too, as it produced a correct diagnosis.

[dr50470]

As a physician I would have to suggest that if your symptoms occur after several hours of cycling it would be unlikely for the treadmill to simulate that degree of exercise in 10-15 minutes (unless your first few hours of riding are so low keyed that your heart rate never exceeds your target). There is a well known variant of asthma that is triggered by exercise and can be averted with specific meds (inhalers). The fact that the albuterol relieves your symptoms would also argue that this is exercise induced asthma. The albuterol might actually worsen the situation if it was from a cardiac source. Unfortunately many of my colleagues practice defensive medicine and typically order unnecessary testing rather than using the information that patients provide in establishing the proper diagnosis.

Good luck and have fun with your brief exercise adventure.

[unterhausen]

Well, I think there is also a factor that he doesn't want to explain why he left it untested to my wife, who went to med school with him. And heart issues are endemic in my mother's family. My mother probably died of a heart issue. And I engage in fairly extreme rides, so I would be more at risk than a sedentary person with my same circulatory system.

I'm convinced I have exercise-induced asthma, and have had it for quite a while. I am pretty sure most people just stop when they have an asthma attack, but I always blamed it on poor eating or being out of shape. In many cases, that was obviously wrong, so I feel a bit sheepish about that.

[metalheart]

I am sure there are some medical types here who can speak to the specifics of stress tests, but from a consumer/patient perspective I can share my experiences. Assuming you are having and EKG stress test with a treadmill, it is common to use the Bruce Protocol (https://en.wikipedia.org/wiki/Bruce_protocol) in which the grade and speed of the treadmill is raised every three minutes. The max is a level 7 or 21 minutes. There is a chart in the link that gives you the details.

My exams have mostly been stopped when you reach "maximum heart rate" usually calculated by the Karvonen method (220-age). Establishing max heart rate can be problematic (http://eprints.qut.edu.au/96880/), but that aside, if you have some idea of what that is going into the exam, things are easier on everyone. Just my experience.

Anyway, if your asthma issues do not prevent you from reaching your max heart rate as determined by the examiners, then it is likely you will be able to continue beyond the calculated max if they use the usual Karvonen method. IN three out of my six stress tests, the examiners said it was fine to continue until I wanted to stop. If you are having a stress-echo, depending on the examiner, they may wish you to stop at the calculated number so that the imaging is not affected by the extra effort on the treadmill.

There is a whole protocol for when to stop the test if the subject/patient is exhibiting symptoms. And, there are enough stories about folks dying on the treadmill to make you think when you start the exam, but in general, if you are not having other cardiac symptoms, then you are probably not going to have those worries.

It is a point-in-time exam. Once you walk out the door, all bets are off about feeling as if you are in great cardiac health, at least that was my experience 3 weeks after a stress test: I went for 17 minutes using the Bruce protocol and was described as having "excellent" exercise tolerance for a 65 year old male with a previous heart attack. Then, the second heart attack happened while I was lifting a bundle of tile out of a bin and off to the ER, etc...... So, my take away from that experience is that the exam can certainly be diagnostic, but it is diagnostic for the duration of the test with no guarantees afterward.

[soulspinner]

Had a friend who had a treadmill test, labeled fine and died of a heart attack 6 weeks later. I have heard of others its happened to.

[ptourkin]

If you're interested in the subject of afib and the endurance athlete, this is the must read: https://www.velopress.com/books/the-haywire-heart/

[shovelhd]

I've had the test once, on a treadmill, and it was predictably inconclusive. I can't run worth a crap, either. But by seeing the cardiologist, it exposed that I have a congenital irregular heartbeat, both at rest and under stress. That was the benefit of going through all that. It's good to know. I have to let first responders, new PCP's, and OR staff know ahead of time, because when they hook me up, they freak out, thinking that I've been walking around having a heart attack all day.

I also have EIA. Lots of knowledge and snark on the forum about that already.

The asthma is easy to diagnose and treat in most cases. Cardiac issues need a cardiologist, preferable one that deals with older athletes. I would take the advice of your cardiologist first and foremost.