AboutTodd Bublitz, RCEP Expertise I can answer questions on Cholesterol & Lipids, Cardiac Rehabilitation, and
preventive cardiology. I can also explain the risk factors for
cardiovascular disease and most cardiac diagnostic tests and procedures.
Experience
Professional Experience Former Lipid Clinic Coordinator for large Cardiology practice. Seventeen years experience in Cardiac Rehabilitation and risk factor modification. Researcher in cardiovascular exercise, cardiac function and cardiac testing.
Developed and maintain Lipid-Clinic.com
Also, Nuclear Cardiology Research Organizations National Lipid Association
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
American College of Sports Medicine (ACSM)
Preventive Cardiovascular Nurses Association (PCNA)
Rocky Mountain Cardiopulmonary Rehabilitation Association (RMCRA)
Education/Credentials Registered Clinical Exercise Physiologist by ACSM Certified as 'Exercise Specialist' by ACSM
Question I have mitral valve prolapse which causes worrisome skipped beats and also I have left bundle branch block which has not given me any problems, yet...but my cardiologist wants me to have a stress test to check it out. Problem is, he wants to do the test by injection. The reason is that supposedly women's results on the treadmill are not as definitive. I'm not comfortable with...in fact I'm scaired to death at the thought of them injecting me with something that is going to make my heart race and my blood pressure soar. I have had problems with panic attack in the past and to me this will be like inducing a panic attack and I'm afraid of the short term and long term psycholgical effects on me. How much do you know about this chemical test, it's effect and it's safety?
Answer Carolyn,
People with a left bundle branch block (LBBB) are more likely to have inaccurate imaging when they walk on a treadmill as part of the test. It is well known that doing the "stress" part with either persantine (dipyridamole), adenosine or dobutamine will more likely give accurate results. Persantine is the most commonly used medicine and you can expect an accuracy of up to 90-95%.
Persantine and adenosine work by causing vasodilatation of arteries - making them relax and open a bit - which increases the blood flow to the heart muscle. This is what happens when we exercise – increased blood flow to the heart muscle. Most of the time people feel nothing during the test. Some people may feel a little flushed in the face or light-headed. The actions of Persantine do not last long, about 15-30 minutes, and can be immediately reversed with another medicine, Theophylline. People who are older and in poor health are a little more likely to feel side effects. It is a good idea to have something to eat the day of the test, but they will probably ask you not to eat for a few hours prior to the test.
Persantine may cause the blood pressure to go down, but it is usually not more than 5-10 points. Persantine does not directly cause heart rates to increase, although your heart rate may increase a little (5-10 beats per minute at most) if you blood pressure goes down. Persantine will not make your “heart race and blood pressure soar”. Tell your doctor if you have asthma because Persantine should not be given to people with uncontrolled asthma.
Dobutamine works by increasing the strength of heart contractions – again, this is what happens when we exercise. Dobutamine can increase heart rate and blood pressure, but it is given slowly so heart rate and blood pressure should not get too high.
I have personally participated in thousands of stress tests with Persantine and the vast majority of anxious people leave the lab thinking, “That wasn't so bad.”
If you are having second thoughts (which I feel are probably unwarranted) you should talk with your doctor's office BEFORE the day of the test.
