Another stress test question:

[FoolWithMoney]

I had a Bruce protocol stress test done recently as part of a general physical unrelated to FAA.

I ended up going to just shy of 10 minutes, but significantly exceeded the target BPM in the final stage of the process (not sure why the tech allowed this). Otherwise, no problem at all.

All of the basic readings were fine, and the doc told me everything looked great, and I was above standard for my age.

A week later, I got a note saying that there was an indication on the ECG of "possible ischemia" at the very end of the test, when my heart rate was well above target. No diagnosis of anything. but a recommendation to talk to a cardiologist.

My father had something similar 20 years ago. He went through many many tests and procedures, including a heart cath that nearly killed him from an internal infection caused by the process. There never was any actual heart problem found, and the tests did a lot more damage than was warranted (ultimately resulting in his death). As a result, I take a very jaundiced view of any heart-based "indication" that is unclear, marginal, and/or has no related symptoms.

Since there is no actual diagnosis and no symptoms, am I safe to ignore this from a FAA perspective?

 

[bbchien]

Ugh. If you had a stress test, at your next medical, when you declare it the agnecy will demand the report. If it's not completely negative they will demand the tracings. If you don't declare it the AMe will be forced to inquire- "why a cardiologist?" If you don't declare, anytime anything happens they will find the procedure code. That is "NONREPORTING" and the resultant class 4 felony.....well let's just say it "has impact".

Why Why why would anyone run beyond 100%? You only make bad stuff appear! Do guys run it becuause of ego (I have posted the "run to adequacy and quit" advice here, many many times) ?

Now you need a stress treadmill nuclear, run to 90% of (220-YourAge) for max heart rate and also to nine minutes, get to both targets and QUIT: "Oh my left ankle is killing me" and get off. What in the heck were you thinkin?

Get the ADEQUATE and negative running stress treadmill Nuclear, and THEN you have excluded the diagnosis. Right now your cardiologist has told you he thinks you have an issue....NO BUENO.

 

[FoolWithMoney]

Why Why why would anyone run beyond 100%? You only make bad stuff appear! Do guys run it becuause of ego (I have posted the "run to adequacy and quit" advice here, many many times) ?

I had no idea where I was. I stopped when the tech told me to stop. I didn't realize we had gone past both the test requirement and my pulse limit until later. The doctor's read that day was that there was no problem, as well.

In all seriousness, how do you know when you're on the treadmill and the screen is pointed away from you?

If you had a stress test, at your next medical, when you declare it the agnecy will demand the report. If it's not completely negative they will demand the tracings. If you don't declare it the AMe will be forced to inquire- "why a cardiologist?"

Right now your cardiologist has told you he thinks you have an issue....NO BUENO.

I haven't seen a cardiologist (and don't intend to at this point, unless there is some further evidence). All I have is a wishy-washy statement from a GP who recommended I see a cardiologist a week after having told me that there was no issue...hence, my question.

 

[FoolWithMoney]

Get the ADEQUATE and negative running stress treadmill Nuclear, and THEN you have excluded the diagnosis.

To clarify, though: You are suggesting that a repeated stress test done properly that shows no problem resolves the issue? This would make sense, but I want to make sure that I understand you completely.

 

[bbchien]

Yes but this time with a nuclear. Not only will that settle the question at the doc's office but a nuclear is a "Superior rank" for data @ FAA. If it is negative, you're done (in a good way).

If it's positive you have let it go too long and you need intervention, which as you note has some risk (your dad waited wayyy to long). If you wait too long and your aorta has gotten cruddy- you're too far down the line anyhow.... .

I didn't realize we had gone past both the test requirement and my pulse limit until later....how do you know when you're on the treadmill and the screen is pointed away from you

Just like "rolling in for a flight physical....."

....You don't do cardiac testing this way. You have them point out the heart rate monitor, place it where you can see it, and make sure they understand that the MOMENT you have reached Hear rate ((220-YouAge)*0.9) AND nine minutes you are outta dere. Rremember, YOU are Paying. THEY WORK FOR YOU. No agreement, No test, no insurance payment. Lay down the law.

I write many such letters to cardiologists and cc: the airman, AND make sure the airman understands. Some of the readers here will still have copies of the letters that I wrote. Receipt of such a letter is at tiems the basis of "Your facility did not do this as requested, therefore an "on the house" do over".

You don't take "cavalier" approach, eg. "head on in and roll". When both (duration 9 mins, rate) targets are made you complain of something othopedic and quit the test....