Feeling Stress from The Stress Test

Feeling Stress from The Stress Test

 How frail the human heart must be – a mirrored pool of thought.

                                                                                                 –Sylvia Plath

This all began a couple of weeks ago when I experienced sudden, rapid heartbeat.  It was 10:00 pm and I had just gone to bed.  It was like a switch turning on.  An hour later, my heart was still trying to jump out of my chest so my husband took me to the hospital emergency room.  Five hours and several administrations of intravenous drugs later, I was diagnosed with AFIB – atrial fibrillation.  Two days later, I saw a cardiologist for the first time in my life. 

Despite my personal inexperience, up to this point, with heart disease, I have seen it in both my husband and my mother.  And that’s not unusual.  Maybe you, too, have some sort of Cardiovascular Disease (CVD).  According to the American Heart Association, an estimated 83.6 million American adults (>1 in 3) have one or more types of CVD.  Of these, 42.2 million are estimated to be over 60 years of age.  For the 60-79 year-old age group, the following have CVD:  70.2% of men; 70.9% of women.  In 2009, the leading causes of death in women over 65 were diseases of the heart (1), cancer (2), and stroke (3).  In older men, they are diseases of the heart (1), cancer (2), and Chronic Lower Respiratory Disease or CLRD (3).

Are you stressed yet?

My cardiologist decided to schedule me for both a Echocardiogram and a Stress Test.  I explained that I had a chemical stress test five years ago because I was unable to complete the treadmill stress test.  (Yes, I’ve been too much of a couch potato, or computer potato, as the case really is…)  I also told the good doctor that I had a terrible reaction to the chemical stress test.  In fact, I thought I was going to die.   He didn’t seem impressed.

So, with that dismissal, I resigned myself to having to endure another chemical stress test.  Yesterday, Jim, Chucky, (my Welsh Terrier) and I arrived early for my stress test appointment.  For those of you who aren’t familiar with the stress test, it is a general term for one of potentially eight different types of tests.  Knowing specifically which type of stress test you are having could have major implications on what it will cost. It could be as little as $200 or as much as $5,000—depending on the test.  My stress test, the chemical scan, is on the expensive end of the spectrum.  In the chemical scan, the patient is injected with radioactive dye and that dye is then picked up by a sensor and translated into an image.  There are two types of radioactive isotopes that are typically used: Technetium (often called Cardiolite) and Thallium.

The first major stress on the day of the appointment occurred when the nurse told me that the process would last 3-4 hours.  WHAT?  I ran out to the car, where Jim and Chucky were both sitting in the front seat, enjoying “Sweet Little Sixteen” by Chuck Berry, Jim’s favorite song.  Jim was in such a groove that he didn’t react when I told him that I wouldn’t be through for several hours.  Okay…back to the examination room.

The test consisted of four general steps:  1) resting images of the heart are taken, 2) the stress-producing medication is given intravenously, as per protocol, 3) a snack is provided to the patient, and 4) post-test images of the heart are taken.  The problem for me came during step 2, just after the administered medication/isotope was scanned.  In other words, the actual 4-minute test wasn’t too bad.  But just afterward I felt extremely flushed, nauseous, faint, and frightened – exactly the same way I felt when I took the test five years ago.  And, like the last time, I had a room full of nurses, technicians, and doctors, who treated my reaction as an emergency – complete with staff barking orders and physically moving me into a prone position.  They later told me my blood pressure went down to 80 over 60.  At that moment I thought I was a goner.  Talk about stress!

Obviously, I recovered and I’m fine now.  The nurse informed me that my reaction wasn’t too unusual.  Maybe not but it really bothers me that apparently my adverse reaction is acceptable and the patient isn’t fully informed about its potential before the stress test.

After the test, I went out to the parking lot, only to discover the hood up on our car.  Jim had drained the car battery from leaving the lights on and listening to the radio for almost four hours.  Yes, he feels rather stupid now!  Fortunately, we are members of AAA and after about 20 minutes, the tow truck arrived and gave us a jump.  Amazingly, the mechanic didn’t lecture Jim, enabling my embarrassed husband’s ego to stay relatively intact.

Yes, it was a stressful day – partly by design, partly by mistake and partly by….what?  I’m eager to hear what my cardiologist says about my adverse reaction to the chemical stress test.  I wonder if he will be a flippant as he was before the incident.  Since yesterday, I’ve read a couple of articles about the possible risk of heart attack and death with the use of the drugs typically used in chemical stress tests.  New recommendations from the FDA in 2013 advise doctors to screen all chemical stress-test candidates for their suitability to receive Lexiscan or Adenoscan, the drugs typically administered.  Doctors should not use “these drugs in patients with signs or symptoms of unstable angina or cardiovascular instability, as these patients may be at greater risk for serious cardiovascular adverse reactions,” according to the FDA.  I would have appreciated this warning from someone prior to my experience.

The biggest lesson learned for me is to follow my instincts, when I have concerns or questions.  If I had probed further as to why my cardiologist didn’t seem concerned about my previous experience with a chemical stress test, perhaps I might have been armed with the information I needed to make a more informed choice.  After all, our health is our most precious gift, perhaps even more so now that we are over 60.  Here are some questions to ask:

What are the risks of this procedure?

 Was my previous adverse reaction potentially dangerous?  Why or why not?

 Are there any FDA warnings about this procedure?

 Do I have other options?

Your health is yours alone.  Be mindful of it every moment of every day.

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