Re: Cardiologist too conservative?

On May 30, 10:01=A0am, Jason Earl <je...@[EMAIL PROTECTED]
> wrote:
> Truth <yamant...@[EMAIL PROTECTED]
> writes:
> > On May 29, 11:30 am, "Zen Cohen" <atu...@[EMAIL PROTECTED]
> wrote:
> >> I had to take a treadmill stress test yesterday because I had minor
> >> right-side chest pain a couple weeks after a 40% spontaneous
pneumothor=
ax in
> >> my right lung. I suspect the test was overkill but I wasn't going to
de=
fy my
> >> doc's advice.
>
> >> He said he'd calculate 220 minus my age (49) so limited the test to
171=
 bpm.
> >> I told him that I sometimes approach 180 when exercising and that I'd
l=
ike
> >> to see if there are any problems when my heart reaches that range.
Also=
 said
> >> I'd heard the 220-minus-age formula was arbitrary, He agreed but said
i=
t was
> >> a good rule of thumb and summarily dismissed my request by
pronouncing =
I
> >> just shouldn't exercise above my 220-minus-age. I realize that there
is=
 some
> >> additional risk by exercising at higher heart rates but I'm willing
to =
take
> >> some measure of risk because I like to push myself and better my
> >> performance. Nonetheless he stopped me right at 171. I feel like the
do=
ctor
> >> didn't do me a service because he didn't provide a sufficient reason
fo=
r
> >> this and it seems his refusing to let me go further may have left him
i=
n the
> >> dark about potential problems that could develop in these higher
ranges=
 if I
> >> don't follow his advice.
>
> >> I get the impression this cardiologist knows plenty about counseling
an=
d
> >> treating sedentary or ill patients but has no interest in advising
fitt=
er
> >> patients who want to push their endurance without undue risk. Has
anyon=
e had
> >> experience with cardiologists who are more fitness-friendly? What
have =
they
> >> said about the risks of exercising at or near max HR?
>
> >> BTW, it took me 15:30 to reach my "max" HR. He said his patients
normal=
ly
> >> don't last longer than 11 minutes but heard of some accomplished
athlet=
es
> >> going over 20 minutes. I might've gone another minute or so but
nowhere=
 near
> >> 20 (with the speed/incline increases every minute). If you've done
this=

> >> test, how long did you go?
>
> > Hi Zen, A couple of years ago I used to do a day of treadmills once a
> > week. Most of the patients did a standard Bruce protocol which is the
> > increase grade and speed at intervals. The idea is to complete a
> > certain amount of stages based on the patient's age. While the patient
> > is exercising, I am watching the EKG tracing for abnormalities and
> > watching the patient for signs of discomfort or fatigue.
>
> > The results of the exercise treadmill test (ETT) can help to diagnose
> > causes of chest pain and can help to predict if there are existing,
> > fixed atheroscl*****c narrowing s to the coronary arteries.
>
> > In your case, the pretest likelihood of you having coronary artery
> > disease as a cause of your atypical, right-sided chest pain was small.
> > It was most likely pleuritic pain due to the pneumothorax. But since
> > an ETT is an easy to perform, noninvasive test of function it was
> > worthwhile to order.
>
> > I can't tell from your description exactly which protocol was used,
> > and it doesn't matter. For explanation sake I'll discuss a Bruce
> > protocol. It consists of four 3-minute stages and involves changes in
> > both grade of incline and speed of treadmill. Stage 1 is 1.7 mph and
> > 10% grade, stage 2 is 2.5 mph and 12% grade, stage 3 is 3.4 mph and
> > 14% grade and stage 4 is 4.2 mph and 16% grade.
>
> > Once you have completed a Bruce protocol, you've completed the ETT.
> > The heart rate is another parameter that can be monitored. I want to
> > see a patient get to the minimum predicted exercise heart range. I may
> > stop the test on a patient who appears fatigued, winded and has
> > reached higher than the average predicted maximal heart rate.
>
> > In your case, if you felt fine I would have let you keep going even if
> > you had passed the predicted maximal heart rate limit. It's only an
> > average and a guideline. OTOH, if you had already exercised 15:30
> > without any worrisome symptoms or changes on your EKG, you had already
> > passed the test if a Bruce protocol was used. No further information
> > would be gained by continuing to exercise or pu****ng your heart rate
> > higher. The question, "was this atypical right-sided chest pain due to
> > a fixed blockage of a coronary artery or are there any other
> > significant existing blockages at this time?" was answered, and the
> > answer is, "no."
>
> In other words, the doctor had enough information to due his diagnosis
> and he wasn't particularly interested in seeing if Zen could break a new
> world record.
>
> I have a question. =A0Are the treadmills that are used for these tests
> special? =A0The treadmills that I have access to don't seem to have as
> much incline as a Bruce Protocol Test would require.
>
> Jason- Hide quoted text -
>
> - Show quoted text -

Any treadmill that I've ever used for patients' exercise treadmill
testing (ETT or "stress test") is a proprietary one that is attached
to a computer and cardiac monitoring system, and sold/serviced by a
medical device company. The treadmill automatically increases in speed
and grade depending on what protocol I'm using.

But aside from that, they look pretty much like a treadmill one would
find in a health club.

The computer gives a constant, realtime print out of the patient's EKG
tracing and periodically makes a hard copy for the treadmill test
re****t.