Tuesday, August 17, 2021

Dobutamine stress test


My PCP (primary care physician) has been urging me, for the past 3 years, to get a stress test based on the results of a yearly low density lung CT scan.  He orders the CT scan due to my history of smoking, which I stopped on August 26th, 1996 at 3 PM.

I have had 2 previous stress tests which I did on a treadmill, one being a nuclear stress test.  All of these, including yesterday’s are predicated on; my smoking history, my dad, a smoker, dying of a heart attack at age 58, and my chest CT scan showing “significant” calcification in my coronary arteries.  This last finding always prompts our radiologist, Dr. Ali Gharagozaloo, to encourage Dr. Jaitly, PCP, to urge me to get a stress test.

Two things that have motivated me to put off taking the test are: 1. Lack of symptoms of circulatory impairment to my heart. I was a runner for twenty years as well as a lifelong weight lifter, down grading to walking since age 70. I’m aware of the Jim Fixx illustration that running does not prevent heart disease.  On that note however; I do believe that years of regular aerobic exercise can ward off circulatory disease. Also for the past 3 years I’ve been an ardent Pickleball participant, playing 3 to 6 days a week for the 6 - 8 months we are in Florida.  All of this without symptoms of coronary insufficiency.  2. Physicians are obligated to find something wrong with you; that’s their job.

I had agreed to the stress test last year but on the scheduled day for the procedure the cardiologist failed to show up for work and since we were leaving for Florida in 2 days a reschedule was out of the question.

Yesterday’s appointment for a stress test was like an old homecoming reunion with two co-workers from my years at Claxton-Hepburn Hospital; Kathy Beauchamp and Renee Palmer.  Renee did the echocardiography and Kathy was the infusion nurse starting my I/V and administering the dobutamine and keeping track of my v/s; B/P, Pulse, respiration’s and EKG. For the moment I’ve forgotten the cardiologist’s name (amended from report on 8/20/2021; DR. Geetanjli Sangwan) but she was adept and explained what she was observing while watching my EKG and echo.

The target heart rate to be obtained, as explained by Kathy, was 128 bpm.  I’m assuming that that is determined by some age/weight formula i.e. “Your  target heart rate during a stress test depends on your age.  For adults, the  maximum predicted heart rate is 220 minus your age.”  However infusion rates can be imprecise at best and subsequently a rate of 133 was achieved, 110% of predicted.  During that time, at a rate of 133 for 3 - 4 minutes, the cardiologist noted a 1 mm (millimeter) depression in my ST segment of my EKG.  She  explained that this was indicative of some degree of coronary insufficiency but that during that same time period (well, in fact through the entire test) my echocardiogram showed no abnormality and just as significantly I displayed no objective symptoms of insufficiency, i.e. pain. They asked me repeatedly during the test if I was experiencing and discomfort or any abnormal feelings. To which my reply was always no with the exception of hearing/feeling the drumming of my pulse in my right ear.

The cardiologist, Geetanjli Sangwan, called Dr. Jaitly while we were still in the procedure room and explained her findings to him and to me as well along with the suggestion that a follow-up cardiac catheterization might well be indicated to pinpoint any area of narrowing while noting the fact of no objective symptoms.


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