Treadmill Stress Test With Cardiologist

I had one a few years ago and the cardiologist stopped the test once my HR hit 220 less my age..he hadn't read the famous BT thread about testing for HR zones  He was surprised how quickly my HR dropped and I recovered and said something like you are very fit.

Did the same test at http://www.myfitnessco.com/ it's me doing it on the image, it was an interesting experience, i think i was done after 20 minutes and i was done for the day

I shared an office in Dallas with a guy from East Texas who never exercised in his life. He was 6'3" and thin. This guy drank beer every night of the week and ate a very unhealthy diet of fried food and barbecue. I have never seen someone eat this much crap and be thin. He always wore a southwestern colored shirt with one of those western style string ties around the collar, Wrangler jeans that were always pressed and pointed toe cowboy boots. He was a pure Texan. He took my family out on Lake Ray Hubbard on his pontoon boat one summer evening (probably 90+ degrees) and he wore the same thing, no shorts no sneakers, no flip flops. Anyway one afternoon he fainted in a meeting so the EMTs took him to the hospital. They watched him overnight everything was good so he a came back to work. He told me he was scheduled for a stress test. Since I had never seen him wear anything but jeans and cowboy boots I asked him what he was going to wear on the treadmill. He did not know he was going to have to run on a treadmill. I explained this to him and he said he wasn't concerned and that he would wear his jeans and boots. The day after the test he was limping pretty bad so I asked him how it went. He stayed on the treadmill for a little over 19 minutes before the Cardiologist ended the test. He said that his feet were bleeding. I did not know that he did not wear socks with his cowboy boots. They never figured out why he fainted. I still laugh when I think of LD.

chevy57 

Glad all went well for you.  They do this testing because sometimes they find problems- which most often can be treated effectively. 

I am in healthcare & also amazed at number of cardiologists (or their nurses) who seem to think EVERYONE is a couch potato, a resting HR<50 is alarming, etc, etc.  Also amazed that the now scientifically discredited "220-age" calc of max HR is still etched in medical stone.  Traditional standard for an "adequate" test is 80-85% of that max HR calc, which IMHO is silly low for most serious fitness buffs (UNLESS some significant problem is seen during test like BP or heart rhythm issue).  I'm 51, so my "adequate test" HR would be 136-143---WTF???  My LTHR (run or bike) is well higher than that, and my max HR is low 180's.  I have had a few treadmill tests & have learned to express my desire to reach a HR relevant to MY workouts (YMMV). 

BTW- There are many thousands of cardiac patients worldwide who continue to enjoy serious exercise (some even doing long tris) despite the small (but real) risks.  OTOH- there are known risks to NOT exercising.  Just have to be smart (& realistic) about exercise goals.  Check out forums at www.cardiacatheletes.org.uk for many inspiring stories.

As we all know, even the fittest young athlete assumes some risk engaging in very strenuous activities (e.g. Notre Dame distance star who died during last US Olympic marathon trials).  It goes with the territory. 

After I had my leaky aortic valve replaced my resting HR dropped from 70bpm to 44bpm in less than a year, mostly because the heart didn't have to work as hard anymore to compensate for the leak.

I have to get EKG's and echocardiograms on a regular basis, but so far so good.  No problems in eight years since my surgery.

Fortunately, my doc is a triathlete so he "gets it" when it comes to athlete's health issues.

Mark

I had the "opportunity" to get a stress test a couple of years ago as well.  I had been rushed to the ER with chest pains and other heart attack symptoms.  Unlike the previous poster though, I was maybe 6-8% body fat and in pretty good tri-shape.  I was 38 at the time.

The cardiology team did listen to my story about being a triathlete.  And every test I did, (angiogram, echocardiogram, MRI, chest xray, as well as radiologic stress test), showed evidence of an athete's heart.  During the stress test, we quickly moved up levels.  They said only a couple of doctors testing out the equipment got to the level that I ended up at.  My HR at that time was 148, about my LT level for running, which I told them.  They said that was good enough and didnt go any further.

Oh, and the monitors for low HR.  Lord, that was annoying.  My resting HR would often go into the high 30s.  And no, their equipment did not like that at all.  They finally turned off the damn beeper, blessedly. 

They never did figure out what happened.  I had elevated cadiac enzymes like I had a heart attack.  My symptoms all fit a HA.  But they could not find any visual evidence of one.

Anyway, back to the stress test.  Another guy in my tri group had to get one maybe a week later.  He apparently went to a level above mine.  So we had all kinds of teasing going on about training for our stress tests, sandbagging them, etc.  It was really funny.  It was good to put a fun side onto something as scary as two rather fit guys around 35 to 40 years old needing stress tests.

Mrwrite,

Congratulations on your weight loss and subsequent lifestyle change. 

chevy57 

Last year I started having irregular heart beats and PVC's. After numerous trips to the doctor they placed me on an event monitor. I explained to the doctor that I was scheduled to run a half marathon while on the monitor and he had no problem, told me to wear it during the race (total pain in the a$$). My doc is an avid cyclist so, as many have said, he gets it. I was told to record any events and then phone them in. I finished the race with no PVC's but was having them after the race. I phoned in the results and the nurse who took the info freaked because I'd have a PVC then my heart rate would drop into the 40's (my normal resting heart rate).  I had to explain that I had just done a race and this was normal for me. She was ready to send me to the hospital in an ambulance.

That particular enzyme that alarmed them very well could have been CPK, or Creatinine Phoso-Kinase .... and it indicates some kind of major muscle trauma.

the basic tests measure Total CPK, and if high or elevated they can test for 3 sub-levels of this CPK enzyme  -- CPK-1 (CPK-BB), CPK-2 (CPK-MB), and CPK-3 (CPK-MM) ... and 3 specific tests they can do to look at each of these enzymes ... because depending on which of the 3 is elevated indicates what or where the possible problem is coming from.

CPK-1 is found mostly in the Brain and Lungs, high CPK-1 can indicate Brain Injury, Seizure, Pulmonary Infarctions ...  not likely what is seen in athletes.

CPK-2 is found mostly in the Heart muscle, high CPK-2 can indicate a recent heart attack and is actually the standard quick test that EMT's and ER personnel administer to detect heart attack ... cause this CPK-2 enzyme is elevated 3-6 hours after a heart attack, peaks at 12-24 hours, returns to normal in 12-48 hours.   ... this is usually what a doctor will test for first if they suspect your are having heart troubles ...

CPK-3 is found in Skeletal Muscle ... and is probably most likely the cause for your elevated Total CPK, as was the case with me.

Causes for high CPK-3 are crush injuries, muscular dystrophy, recent seizures, a few other things, and in all the literature I've been able to research on the matter ... the following cause is always listed last (once you've been scared to death reading about all the possible horrible things that could be wrong with you...) ... and the final cause is:  Strenuous Exercise.

These docs re-tested me 3 times before they were convinced that my elevated CPK was from triathlon training.

I was actually tested 4 times, 3 by the research team of a clinical trial I was participating in, and 1 from my regular doctor.  1st time showed high CPK (Total CPK), they were alarmed and tested me a few days later, still high ... I told them it was most likely the training so they told me to not do anything for a week ... and re-tested .... (I cheated though ... I did do some training ...) but the 3rd test was way lower ... still high or out of normal range ... but way down ... so they were convinced ...

... in between those I was actually concerned myself and had my regular doc test specifically for CPK-2 ... to make sure I hadn't suffered some kind of heart attack ... and CPK-2 was perfectly normal ... this was in between 2 of the CPK tests from this research team ... but they were just looking at Total CPK and didn't realize it.

I tried to educate them on CPK-1, 2, and 3 that I learned from Googling ... but hey, they were the resident docs at this clinic ... right?

Very Interesting!

I kinda suspected this but was unable to find enough information to support my hypothesis ... but this same clinical trial I was in, they did an ECG at the beginning and when the trial was over and on my last one it displayed an error about SINUS BRADYCARDIUM .... which they were able to figure out meant low heart rate .... it was 55 bpm during the test ... but it also showed an elevated ST segment ... actually it was worded as: Lateral ST Elevation - SUGGESTS EARLY REPLOARIZATION.

Every Google search I could find on elevate ST segments and Early Repolarization sounded pretty negative and indicated I could possibly have some serious issues ... but I kinda suspected it went along with the low RHR and from run fitness.

Klowman,

Some REALLY interesting stuff you mention there.

The enzyme that the docs flagged when I went in was actually Troponin.  When I was first admitted, it was very low, 0.08.  But about 12 hours after the event, it was measured at 1.19, or above the 0.78 threshold that indicates a heart attack.  It drfted down over the next 48 hours or so to normal levels. 

Not sure if Troponin is related to CPK-2.

As an aside, if you are bored, here's a link to my "hospital report" (like a race report) on my 2 day hospital stay with this heart issue.

http://www.beginnertriathlete.com/discussion/training/index-weekly.asp?memberid=35379&year=2007&month=11&day=13#

gadzinm - 2009-01-28 11:31 AM I was having some shortness of breath three years ago when I was getting back into this sport. (Turned out to be pollen and allergies) My doc right away sent me to a cardiologist and from there I was sent for an ECG and a nuclear stress test on the tread mill. My family history had a little to do with his decision. Long story short I ran the test into the ground and they had no more isotopes to inject in me and the treadmill went to its max height and speed for the test. HR never went above 180s... Very interesting to watch your blood pressure drop as your HR increases. I never knew they work in opposites. Needless to say I am fine. It's a pretty good test to have done if your insurance and doctors will let you go through with it. I recommend it if anyone in your family has a history of heart disease and/or heart defects. Last thing I needed was dropping dead from some hidden heart condition when all I was trying to do was have fun!

I am confused about the isotopes? Did you have a Nuclear Stress Test? Blood pressure will usually rise with exercise, it's interesting that yours went down.

It's good to hear you are in good shape.

I tried to get my cardiologist to order a nuclear stress test on me when I was having chest pain after a pulmonary embolism that I had but he said a nuclear test wasn't justified and ordered a stress echo. FWIW - A stress echo isn't a very good test for an endurance athlete. My HR dropped so fast that they couldn't get any stress information from the test, I basically had a regular echocardiogram and a bonus run on the treadmill.

I checked out Troponin, but just on Wiki-pedia so far, but it looks like it is very similar to CPK-2 or CPK-MB ...they are both caondiered cardiac markers or enzymes that can be tested and high levels indicate heart attack ... or strenuous exercise.

Here are 2 links, the first one in the mext to last paragraph under the heading of Non-cardiac conditions, it states:

"Strenuous endurance exercise such as marathons or triathlons can lead to increased troponin levels in up to one third of subjects, but it is not linked to adverse health effects in these competitors."

The 2nd link is about CPK-MB and states:

"The CPK-MB test is a cardiac marker.^[1]  It measures the CKM and CKB forms of phosphocreatine kinase.  In some locations, the test has been superseded by the troponin test."

Here are the 2 links and an image of the cardiac markers:

http://en.wikipedia.org/wiki/Troponin_test

http://en.wikipedia.org/wiki/CPK-MB_test

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