Expert: Todd Bublitz, RCEP - 3/22/2007

Question
I am having an adenosine stress test tomorrow morning. I've never had one before and I am a bit frightened. I've heard horror stories about them regarding shortness of breath, severe pain in the chest and arms. Needless to say, I'm not looking forward to it. Can you put my mind at ease? At least a little?
Also - 3 months ago I was in the hospital with atrial fib. They had to electrically induce me back to normal sinus rhythm after trying to with meds for 2 days. I have been on Sotalol ever since. My question - I was told to not take my Sotalol the morning of the test. Couldn't that cause me to go into A-Fib again during the adenosine part of the test? I'm hoping you get this and can answer before tomorrow, but if not it was my fault for waiting so long to ask.
Thanks,
Dave

Answer
Dave,

It has been my experience that the vast majority of patients who undergo a pharmacological stress test (adenosine, persantine or dobutomine) have no symptoms or side effects at all.  It has also been my experience that the people who tend to have symptoms or unpleasant side effect are the people who are obviously "sick".  By this I mean, older people with known medical problems.  

It really makes sense if you think about it.  The tests are to determine who has significant heart disease.  People with serious heart disease are likely to develop chest pain and/or shortness of breath during exercise or simulated exercise (pharmacological stress test).  

A-fib may or may not be a sign of heart disease.  Exercise may make A-fib more likely to occur, but Sotalol helps keep the heart rhythm better regulated and under control.  Yes, you are a bit more likely to go into A-fib after stopping your Sotalol for a day, but Sotalol keeps working for a few days after you stop taking it.  Part of the reason for the test is to see if simulated exercise triggers your A-fib.

The bottom line: If you are "sick" you are more likely to have a less-pleasant experience (but you may feel just fine, also).  If you are basically "healthy" (other than the A-fib) you probably won't feel any unpleasant effects from the Adenosine.

Best of luck!

Todd