Failed Stress Treadmill Test

[Minnie64]

Hi All

I had my STEMI heart attack on 20th August last year when I underwent an emergency PCI to LAD and had a stent inserted. I've had quite a traumatic recovery as a week after coming out of hospital I was readmitted with ? gastric bleed as my haemoglobin level had dropped significantly and I was passing black stools, suggestive of a bleed somewhere.

I kept trying to tell the Doctors that this had only happened since starting on the Prasugrel and Aspirin and to this date I am still covered in huge purple bruises which come up without me even having to knock myself. However, I have still had to undergo an endoscopy and colonoscopy where thankfully nothing serious was found. I am now taking iron supplements but seem to be unable to store iron for some reason, although I have read through the medication i'm on and that is a side effect to some of them..... so why doesn't my GP or the Consultant's seem to recognise this ?

I should be able to stop the Prasugrel in August (12 months after stent) but I am a little worried about that as no one has ever explained why you are only on it for 12 months and what is different after that to be able to stop it ?

Anyway, i'm sorry for rambling on.... I was originally told that I wouldn't need to see the Cardiologist again but 3 weeks into my cardiac rehab they stopped it as I was getting chest pains and breathlessness, they said they would contact the Consultant as it was too dangerous to let me continue without review and my heart rate was very high and taking a long time to come down after exercise. To cut a long story short I had a stress treadmill test in February and I have just had a letter to say he doesn't think there is any significant lack of blood supply to the heart but my heart rate only achieved 76% of the target so he would like to review me to decide on if I need any further investigations given the previous history of stenting !

Has anyone had anything similar and what tests are they able to do to look at this ?

I can't understand why if my heart rate was so high at the beginning why it looks as if it is low now ?

Has anyone had a cardiac CT or MRI ? Would that be a test that is useful ?

I'm just clutching at straws really as I don't know what to expect next.

Thank you for reading and any comments would be really appreciated

[mjames1]

Antiplatelet medications like prasugrel are generally taken for only 6 to 12 months post-PVI. This is because the highest risk for clots in the arteries or stent occurs during this time. After that, the decreasing benefit of the drug is outweighed by the increased risk of bleeding. Baby aspirin is usually continued for life.

Jim

[Minnie64 in reply to mjames1]

Thank you and even though I will be nervous stopping it, the risk of bleeding really worries me, especially when they tell you to go straight to A/E if you bang your head !

[mjames1 in reply to Minnie64]

I'm in your situation post stent and I'm nervous taking a similar antiplatelet medication. I'll be glad when they let me off of it! These drugs have their place, but you do not want to take them beyond the period of time where they are most helpful.

Jim

[ChoochSiesta in reply to Minnie64]

To put your mind at rest I am on Aspirin. A couple of years ago I slipped on ice (my fault for trying to feed the birds in slippers), and cracked my head on block paving. The blood was pouring out. A few minutes later it did stop and I was fine.

[Minnie64 in reply to ChoochSiesta]

ChoochSiesta, wow that's the sort of thing I would probably do ! I'm glad you were ok though, phew ! Take care x

[maple34]

Regarding the stress test and CT scan, my cardiologist said the stress test shows what it shows with 80% certainty, CT angiogram is 97% and invasive angiogram is 100% certainty.

[Minnie64 in reply to maple34]

Thank you Maple34

[mjames1 in reply to maple34]

CT angiogram is 97%

This assumes that you don't have a lot of arterial calcification, as many of us do by the time we need stents. With significant calcification, a CT Angiogram may not be helpful at all.

Jim

[fishonabike]

We can only suggest possibilities so it would probably be best if you wait until you see the cardiologist to find out what further investigations they plan to offer you and why, i.e. what they might be looking for

Meanwhile it can take a while for haemoglobin to return to normal, it can involve more than simple iron supplements, ask your GP if your Ferritin levels have been checked and whether that would be helpful

Are you taking your prasugel with food or a PPI like Lansoprazole to protect your stomach?

And by the way, you fud not fail the stress test, it is an investigation not s test you pass or fail - the interpretation of the results helps to identify problems not label you or you heart as failures

[Minnie64 in reply to fishonabike]

Thank you for the info fishonabike I think she did check my Ferritin and it was low. I do take Lansoprazole 1/2 to an hour first thing before food and meds. I normally take the Prasugrel with my other meds after breakfast.

Thank you for replying

[bluemoon572]

I was told that after 6-12 months certain stents develop a protective lining that prevents clotting and that's why only one medication like aspirin is usually taken after that time. Also,were you taking a beta blocker at the time of your stress test as it could prevent your heart from reaching the target heart rate during exercise?