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Forum Name: Cardiology Diagnostics

Question: Stress test for pacemaker users


 jwill - Fri Jan 28, 2005 12:39 pm

About four months ago I experienced heart block and had to get a pacemaker. I was told that the heart block was the result of calcification of the aortic valve which may have been caused by mitral valve prolapse.
A pacemaker interogation recently showed one incident of ventricular tachycardia in the preceding 2 month period. My doctor prescribed to take a beta blocker to prevent VT and said that I should have a pharmacological stress test.
I told the doctor that I had had no symptoms of VT and believed that the VT was due to sleep apnea made worse by drinking alcohol, and that I can prevent sleep apnea by sleeping on my side as long as I do not drink. I concluded that I don't think I need the beta blocker but he prescribed it anyway.
I told the doctor I would rather have the exercise stress test than the pharacological test as I am not intolerent of exercise. He said that the pacemaker could result in a "false positive" on the exercise test.
QUESTION: Is there any real reason I should have the pharmacological stress test rather than the exercise stress test???
 Dr. Yasser Mokhtar - Fri Feb 11, 2005 9:17 pm

User avatar Dear Jack,

A stress test depends mainly on the ekg for interpretation in addition to the patient's symptoms. Whether this stress test is an exercise stress test or a chemical stress test, you will have ekg leads to monitor the ekg changes that might occur if there is ischemia.

The problem in patients who have pacemakers is that the ekg becomes abnormal and does not change and it is not possible to interpret ekg changes during a stress test because they do not occur as the ekg morphology does not change because of the pacemaker.

Ventricular tachycardia is not just a simple arrhythmias, it has to be taken seriously. Having ventricular tachycardia can have lots of reasons including ischemia (which is a serious condition) for which the stress test is being done. It can also mean that the pacemaker is not working as one of the causes of ventricular tachycardia (believe it or not) is bradycardia. So, having a stress test might show that you have coronary disease but it is not an absolute proof that the ventricular tachycardia was secondary to this ischemia. However, if it turns out that you have ischemia, then most probably, this could be the cause behind the ventricular tachycardia.

So, in cases of patients who have pacemakers, usually something besides the ekg is used for interpretation of the test results such as a nuclear study or an echocardiogram. Personally, i think that if a patient can exercise, then the best thing would be to do an exercise test. i am not sure whether your doctor wanted you to have an echocardiogram or not, but if this was the case, then it is better to have a chemical study because, with the patient hyperventillating, it is not easy sometimes to get good echo views of the heart and it is better if the patient has a chemical stress but if a nuclear study is to be done, then both chemical stress and exercise stress can be equally done.

i am not sure what kind of pacemaker you have but most probably you have a pacemaker that accelerates when you exercise but if this is not the case, then i would go with the chemical stress test and not just any pharmacological stress but adenosine stress in particular because you don't have to achieve a certain heart rate to be able complete the study.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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