Stress test

[Milliemoopink]

Hi was at urgent care yesterday more spasms and weakness and tingling to arms and the doctor mentioned about getting a stress test done in order to get a firm diagnosis .What does this involve and are there any risks by having it ?

[Fanfab1]

hi which stress test are you having? Stress echo or stress MRI?

I’ve had both - to be honest I didn’t concern myself too much with the risks of having these as I just wanted to get a clear diagnosis. And trusted my cardiologist. It was more the process especially the MRI as it can feel a little confining when your in the scanner. And they deliberately inject meds to see what your heart does.

Stress echo for me was an echocardiogram done at rest then immediately after exercise (walking) on a treadmill with an ecg.

Stress MRI for me was scanning with med called adenosine. As you’ve mentioned spasms it may be this one!

There’s a fair bit on British Heart Foundation about how these procedures are done / what’s involved.

👍

[Milliemoopink in reply to Fanfab1]

Thanks for reply the provocative test to induce spasms. My G.p just says get on eith life which is hard when get pain when standing and walking too long .Just want a proper diagnosis being treated for all symptoms of Cas .

[Fanfab1 in reply to Milliemoopink]

I’m sad to hear that is the GPs response when you’re in pain but it’s common. Or they say it’s anxiety! Cos we’re women.

I get the same - angina when moving about / walking - just takes a few metres most days. And the stairs are 🥴

I have Angina with non obstructive coronary arteries (ANOCA) due to a myocardial bridge rather not spasms or microvascular issues as far as angiogram / stress tests show.

Believe in what your body is telling you and keep at it.

Good luck with the test. Let us know how you get on.

👍

[Milliemoopink in reply to Fanfab1]

Thanks 😊 Yeah make us think we are imagining it all .

Good luck on your journey x

[Milkfairy Heart Star in reply to Milliemoopink]

To diagnose microvascular dysfunction or coronary vasospasms a functional angiogram is required. The term 'provocative ' angiogram is an outdated term.

These functional angiograms are only available in a few centres on the UK at present.

During a functional invasive angiogram, how the blood flows through the small blood vessels is assessed by using a chemical adenosine and guide wires. From the measurements of the coronary flow reserve and index of microvascular resistence microvascular dysfunction can be diagnosed.

Another chemical acetylcholine can be injected into the coronary arteries. Normal functioning coronary blood vessels should dilate in response to acetylcholine, if the blood vessels respond to acetylcholine by constricting, accompanied by ECG changes and chest pain, then coronary vasospasms, vasospastic angina can be confirmed.

I had an angiogram with acetylcholine in 2014, which confirmed my diagnosis of vasospastic angina.

I also experience ECG changes during my chest pain episodes, however it can be difficult to catch a coronary vasospasm in action.

Microvascular and vasospastic angina are types of anoca/ ischaemia non obstructive coronary arteries ANOCA/INOCA. They are not easily diagnosed by tests that are designed to detect obstructive coronary arteries.

A stress test or cardiac perfusion MRI can be helpful in identifying possible microvascular dysfunction but not coronary vasospasms.

Have you been seen by a Cardiologist?

Your GP, sadly perhaps needs to update their knowledge about microvascular and vasospastic angina.

[Milliemoopink in reply to Milkfairy]

Only seen cardiologist when been in A&e or when been admitted twice this last month to cardiac ward .my angiogram was clear and my echo too .so just said angina symptoms or coronary artery spasms .On one lot of medication and have gtn spray but dont havevto stand up for long or walk that far before get tight band around ribs and pain that can radiate to side of left chest .at its worse will go up neck and jaw and came make arm and leg tingle too .

G.P not that supportive when I do manage to get appointment 🙃

[Milkfairy Heart Star in reply to Milliemoopink]

I am sorry your GP isn't supportive.I suggest you contact the Patient Advisory Liaison Service PALS of the hospital concerned and ask for a full assessment of the cause of your symptoms.

You would like a diagnosis and be offered the appropriate treatment.

Microvascular angina tends to cause chest pain and breathlessness on exertion.

While vasospastic angina causes chest pain at rest, in particular during the night.

[Milkfairy Heart Star in reply to Milliemoopink]

I am sorry you are having problems accessing the care you need.Do you have a follow-up Cardiology appointment?

[roughquest]

I won’t sugar coat it the stress MRI was horrible. Regardless if your being offered it take it! You will be wiped (if my experience is anything to go by) after, so do get a lift arranged or collected. The treadmill or cycle sessions are fine, just tiring. Good luck 👍

[AuntyEdna]

Hi welcome to the forum , I have Microvascular Angina. My MVA kicks off whilst stood ironing, walking in the cold and heat, stressful situations etc so I understand where you are now. I had a chemical induced stress test - it took the ‘very cynical ‘ Dr by surprise when my MVA kicked off it lasted 20 mins and showed up clear as day on the echo . You know your body take no prisoners keep going to get answers! Thinking of you ☺️ all the best 😊

[Milliemoopink in reply to AuntyEdna]

Thanks for your reply just want some answers as cant keep going back to A&E been on cardio ward twice in a month fir tests eggs bloods and angiogram were clear so said treat me for symptoms of angina, still suffering with symptoms so maybe meds need adjusting too .

[AuntyEdna in reply to Milliemoopink]

Frustrating that ECG comes back normal for me every time. The echo picked up leaking valve that’s the only thing I’m monitored for! I had an Angiogram showing mild blockage so that Dr washed his hands of me. You need thick skin and persistence with this diagnosis 🥴

[SkyBluePInk47]

Hi! Your doctor might be able to prescribe anti anxiety meds, just ask, long before your test date. not day of… If you might he interested in that?

Have you been in an MRI machine before? I tried the closed one but needed 2 valium pills and it helped take the edge off things (when I was in my 30’s).

Now that I am older, I asked for an open MRI machine (for brain and neck, didn’t do a heart one) … they can do heart ones in open MRI machines. Wondering if they offer that in the UK/your area.

I have had a heart stress test twice in my life..: one on treadmill and one via drugs to stress my heart. It was actually not bad, for me. I worried a bit beforehand and it was more stressful to worry about that than the actual tests.

I wish you the very best and hope that there isn’t anything seriously wrong and it will end up being something simple to explain and you will not get more of those symptoms.

[Qualipop]

A basic stress test is an exercise machine. YOu get electrodes stuck on your chest and you just walk on the machine. They increase it gradually. You can stop at any time. They monitor your heart while you walk. If they see anything untoward they will s top it. I a strongly advise you to get it done. A lovely urgent care doctor said I needed one when I went with bad breathlessness. He was the only doctor to EVER ask about my family history. It took so long to get the appointment, I had a heart attack before I could go. I still bless that doctor because prior to his comments I wouldn't even have thought about heart and probably wouldn't have rung 999 when it happened because my only symptom was indigestion. It was 3 days before my arm started tingling.

[Milliemoopink]

Wow Finding a doctor that's listens is a bonus

I hope you are doing ok now x

[fishonabike]

realistically there are risks with all tests, but tests like this one are carried out under very closer monitoring, with well trained staff who know what to look out for and what to do

in addition doctors request investigations because they are necessary (particularly in these days of tight budgets etc) - i guess this is a test for microvascular issues and ths is the best test for getting a clear diagnosis - you need this to get the right treatment

so, ask your doctor to explain the risks and then it's up to you to decide: how much risk are you willing to take to get answers about a condition which could take over your life if you don't get good treatment?

[Milliemoopink]

Thanks for your reply and reassurance. Need to get answers and the right treatment .

[TuckBox2]

I had a 'Stress Echocardiogram' 10 days ago.

I was laying on a bed while the echo was being done, then I was injected with 'Atropine' at different levels, via a canula, to put my heart into stress, this is more controlable and more accurate than on a treadmill or exercise bike,

I was in and out in 40 minutes. I did have the test on the treadmill about 16 years ago (I managed 9 minutes) many years before my heart attack (Aug 19). Just waiting the follow up to see the consultant and get the results.

[Milliemoopink in reply to TuckBox2]

Thanks for your reply hopefully I will be offered one soon to get firm diagnosis!

[Billett]

I had a dubotamine stress test when they bring your heart rate up using a drug and then use a echo to record the results I found it no problem at all because its all done to suit you age weight height etcetc

[Milliemoopink]

Was there any after effects from this ?

[Milliemoopink]

Hopefully will get offered one soon to try get firm diagnosis .it effects every part of life including mood ,had to come off Hrt medication as couldn't have with heart medication.

[Fanfab1]

Hi I’m not entirely sure but yes my symptoms came on while on treadmill. I was cleared of microvascular issues (not sure they were checking for vasospasm). I think ecg was generally ok but report does state ventricular premature beats against arrhythmia section.

My condition doesn’t tend to show up on ecgs or there can be a variant (not sure what that means) but is always deemed normal to date.

Hope helps.

👍

[Fanfab1]

Same here but mines a myocardial bridge - hopefully they will test you - angiogram with acetylcholine - milkfairy above knows a great deal about vasospasm angina. 👍

[Milkfairy Heart Star]

I have a confirmed diagnosis of vasospastic angina following an angiogram with acetylcholine. ECG changes don't always show up while you are having chestpain due to microvascular dysfunction or coronary vasospasms.

It's difficult to catch a coronary vasospasm in action.

Many patients have only subtle or no changes on ECG.

I sometimes have no ECG changes, sometimes ST elevations, depressions or T wave inversions. These ECG changes alter overtime the longer and more severe my episodes of chest pain occur.

Most people living with vasospastic angina can exercise. I can, I had no problems completing my stress echo.

I started getting chest pain later at rest in a delayed response, which is one of my symptoms.

People living with microvascular angina tend to experience chest pain and breathlessness when exercising. The cause of microvascular angina is different to vasospastic angina which is caused by transient constrictions of the coronary arteries.

Microvascular angina is due to the inability of the small blood vessels to dilate or stay dilated in response to extra demands like exercise.

The treatment offered for each type of angina is different too.

Have you been offered a cardiac perfusion MRI? In some cases a cardiac MRI can help to diagnose microvascular angina.