stress-cardio test tomorrow - any suggestions?

[grams]

Hi,

I have been doing the medical rounds lately and have a stress-cardio test tomorrow. The standard treadmill one seems to make the subject stop at 85% of max HR based on age. That # is way too low for me. I really want to get to at leat 95% of my personal max. My problem is being unable to breathe when I really push it on a bicycle, which leaves me gasping for breath big time.

Does anyone have any input on how to convince the testers to let me keep going?

Two other interesting statistics have come out of other checkups I have had:
CO2 92 (one point over recommended max) from blood test
136% of max lung function from blowing into a little gadget

What do the stats mean? Are they skewed for me because I am 63 yo and in better shape than most other ladies my age?

thanks,
grams

[Bob S.]

Does anyone have any input on how to convince the testers to let me keep going?
grams

Grams,

When I had a treadmill stress test about three years ago, the cardiologist (an outstanding OTW rower) stopped the test after only 6 minutes and a few seconds. I could tell by the expression on his face that I had failed the test. He told me that if we had continued I would have passed out. My blood pressure was dropping even as my heart rate was going up. The problem was stenosis of the aortic valve. It had gradually been getting worse and had reached the point where it couldn't keep up with the increased pulse. A few weeks later, the valve was replaced and 3 arterial bypasses were installed. Nowadays, when I do my 40 minute workouts on the treadmill, I sometimes get my heart rate up into the 140s and there is no problem. My formula max is 139, but I have had it up into the 160s on the erg with no ill effect.

Bob S.

[grams]

Its a good thing you did the test, I have a hiking friend who had a similar experience and ended up with a triple bypass, so paranoia has set in.

If I use the formula to calculate my max it looks like this:
220 minus 63 equals 157

85% of 157 is 133.5

Here's the thing: if I do the 'erg max hr test' ie: keep rowing harder untill I can't maintain the pace and heart rate my max is 175.

85% of 175 is 148

I generally do my 40 minute sessions at 90% to 95% of max. So 150-160

The problem is that I want to replicate my workout for the test to see if I have any problems and they are likely to make me stop too soon. You know-"old lady has cardiac on treadmill due to tech's negligence"

I will take in some data from when I was having Coach Paul coach me. He has a nifty spreadsheet which shows lots of stuff. It makes me look more like an athlete if I have graphs and charts and lots of statistics.

Wish me luck, I hope that my problems are just a persistent virus.

grams

[grams]

I had my stress test today and we ran my hr up to 180. My heart is fine; its my blood pressure medicine that needs changing.

I thought that the new dose was the problem when we were traveling and I couldn't do anything without getting lightheaded, but my md likes the numbers with the new dose and didn't want to change my prescription.

The cardiologist said he had a patient who actually brought in his C2 for his test in order to truly replicate his problem. Turns out he had the wrong bp medicine too. I wonder now about drugs that are supposed to make one 'normal' but actually prevent the body from regulating itself properly during exercise....

grams

[RowtheRockies]

Grams,

If I recall, you said you were on a beta blocker, correct? I am amazed that you were able to get your HR up to 180 on them. For the brief time that I was on them a few years ago. The highest I could get my HR on a run was 153 and I was about 30 at the time. They made my running performances crap and I quickly switched to Diovan. I had no issues with Diovan. Diovan is a angiotensin II receptor antagonists whatever that is.


I also remember that I would obsess about food during my run and eat like a pig when I finished.

[johnlvs2run]

Maybe they were going by your gas exchange ratios on the test, and not precisely by your heart rate, also wanting to not take you to peak exercise.

Because of your higher heart rate and also reactions at altitude, I wonder if one of the medications you are taking is diuretic, or if they are giving you a combination of drugs with counteracting effects.

As cardiac output is equal to your heart rate times your stroke volume, it would be interesting to see what your stroke volume was, and also the oxygen pulse, i.e. the vo2 extracted per heart rate.

[drkcgoh]

The main objective of a stress test is to stress your heart enough to bring out any abnormalities in your EKG which show up as 1mm ST depression for 80msec. Many modes are used, and the favorites are the Cycle ergometer & the Treadmill. Then there are many protocols, such as the YMCA, or branching protocols, or the Ramp test on the cycle, the Bruce, modified Bruce, Balke, the Ramp etc on the treadmill,
Anyone trained by the ACSM or the AACVPR for cardiac rehabilitation will be competent to conduct the stress test.
The max HR is one of the criteria used to stop the test at an intensity safe enough for the subject. There are many formulae used, and the
"220-Age", is the most widely used one, with 85% of this value. This formula, "220-Age" was the one that William Haskell of Stanford University propounded, and he has stated at the ACSM meeting in SF that he thought of it "out of the blue", without any scientific research, and there is a leeway of + and- 15 beats on either side for the normal. Hence for some it may be way too low a calculated max. Mine becomes a ridiculous 166 against my usual 171 when erging.
The more accurate formulae arrived at from considerable research are:
"205-1/2 age", devised by Leonard Kaminsky of Ball State U. Mine becomes 173 for 64 years against a usual 171 during a 2K erg race
and the accepted "?210-0.7*age found in the ACSM Guidelines to Exercise Testing. (I am not very sure of this 2nd formula).
The usual mistake is that technicians insist you hold on to the treadmill rails to avoid falling down. I have tested many subjects who seem to be able to last 18min (Grade VI) when holding on, but actually can only last 12min (Grade IV) when not holding on to the rails while performing the Bruce Protocol.
Gas analysis gives the best results, and the same result in terms of VO2max. It is done in the Cardiac Rehab unit in U of Fl Gainesville. (I have a VO2max of 49, which is the same as Sir Edmund Hilary's when he climbed Mt. Everest in 1953)
The accepted protocol now is the Ramp Protocol on the treadmill. That gives a decent gradual increase in speed and treadmill grade every 20 sec, instead of the brutal jump of 2% and about 0.8mph speed increment every 3 min on the Bruce Protocol used by most cardiologists. At every 3min stage, the speed & grade of the Ramp Protocol are equal to the Bruce, and yet is not widely accepted by cardiologists.
In spite of performing stress test correctly, the results are not very reliable to predict heart function, and probability tests are used by cardiologists, and other investigations are also used, especially for elderly women.

So take your stress test with a pinch of salt, and listen to the advice your cardiologist gives avter his careful evaluation.
drkcgoh-MD

[grams]

Thanks Dr Goh for the additional ways to determine max heart rates and stresses.

The cardio folks let me go to failure instead of stopping me, which was what I needed to have happen. My md changed my bp meds, and now I take them at night to minimize the effect it has on me while erging.

I won't be able to really erg to the max until my acl knee surgery is pronounced a success about 8 months from now, however I am back on the erg for short sessions at low resistance already. I look forward to having a stronger more efficient erg ability than ever before.

grams

[igoeja]

I have insulin dependent diabetes, take an ACE-Inhibitor, lipitor and aspirin daily. Like many diabetics, I look fit, but cardiovascular issues exist somewhat hidden.

Anyway, as part of preventive maintenance, I had a CT Calcium scoring which returned a 750, a high value. The next step was a cardio-stress test. It felt funny sitting next to people that seemed so near death, and I felt and looked so fit in comparison. Anyway, it was obvious to the doctor I was fine, and I asked whether I could keep going - I had probably expressed an interest in doing so in several small ways - and she just let me, although she eventually stopped me after 13.5 minutes (Bruce). I would have loved to have kept going.

By comparison to people in this forum, the performance was nothing great, but ranked as standard deviation against the normal population, it was very good. I'm healthy, at least as far as my doctors are concerned.

[drkcgoh]

It's good to hear that your Drs pronounced you healthy. The cardiologist could have stopped your stress test because you tested positive by showing 1mm ST depression lasting 80msec. But if that had been so, then she wouldn't have passed you, but recommended further investigations such as the gold standard angiogram..
It sounds as if you had been stopped because you had reached the theoretical safe heart rate limit based on the percentage of the 220-Age formula commonly used. If you had worn a gas mask, and your MET values had been truly monitored, then it would have been a true test. But if you had held on to the treadmills, then 13+min on the Bruce Protocol is no true measure of your MET level attained.
In any case, Diabetics are at high risk of suffering from heart attacks, and exercise does not make one immune fom them, though it does give quality life & good blood sugar control.
drkcgoh MD

[igoeja]

No electrical issues, other than rare VPD's, and the only other findings were attributed to diaphragmatic attenuation or my size, e.g., increased LV volume post-exercise. I wonder if the latter is attributable to general fitness and/or rowing.

[drkcgoh]

The LV increase in size is a result of training at rowing. I asked that question at the Advanced Team Physician's course in San Antonio of Margot Putukian when she quoted an Italian study where 15 out of 16 athletes with increased LV size were rowers. Paul Thompson (Hartford cardiologist & past President of the ACSM) said that all rowers were giants, & their LVs correspondingly large, but in the Italian study quoted by Putukian, the LVs regressed back to normal size when the rowers stopped their rigorous training. So most rowers will get this increased LV size because they are highly competitive, and train too hard. Have easy days alternating with hard days, & do more intervals rather than long hard session. That way the LV won't enlarge that much.
drkcgoh MD

[editedby]

Dr. Goh is the beta-blocker patient incapable of heart rate training?

[drkcgoh]

The Beta blocker patient has to test out his own max HR, as there is no formula to estimate it. Other than that he is capable of heart rate training, applying the principles of Karvonen's formula. Beta blocker patients have a proportionately lower increase in HR with exercise, and Michael Polllock has shown in some studies that the linear increase in HR is still present among them, though it is not as large as in normal subjects who do not use them.
drkcgoh MD