Dobutamine Stress Test Result questions --Doctors Lounge(TM)

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Forum Name: Ischemic Heart Disease

Question: Dobutamine Stress Test Result questions

Crown - Wed Aug 17, 2005 11:50 pm
I received my Stress Test results back today and I'm not exactly sure what they mean. Here they are....let me know if you can make sense of it for me. Rest Echo Analysis: Technically difficult study. Endocardium poorly seen. Tape alse reviewed. Normal resting left ventricular size and function. No regional wall motion abnormalities. (I assume he couldn't see much, but what he did looks normal) Stress Echo Analysis: Limited views, only one 4 chamber image available. Equivocal small area of lateral apical ischemia. Consider stress nuclear images to better assess this area. (Dr. simply said he saw some changes at the bottom of my heart...which means?) I have been set up for a Cardiac Perfusion Stress Test with Adenosine for Aug. 31. With instructions that if I felt any pain or heart like related symptoms to get to the hospital right away. And then she said, it is possible it's nothing to worry about. Couldn't be more of a mixed message. Also, ECG starts out with 'Normal Sinus rhythm' 4 minutes after start 'Sinus tachycardia' (what does this mean?) and Otherwise normal ECG At 6 minutes still has 'Sinus tachycardia' 'Low voltage QRS' and 'Abnormal ECG' At 9 minutes still has 'Sinus tachycardia' 'Low voltage QRS' and 'Borderline ECG' At 12 minutes same as 9 minutes At 15 minutes 'Sinus tachycardia' 'Low voltage QRS' and 'Abnormal ECG' also says 'Poor data quality, interpretation may be adversely affected.' At 18 minutes 'Sinus tachycardia' and 'Otherwise normal ECG' Back at baseline of 100 bpm 'Normal sinus rhythm' 'Low voltage QRS' 'Borderline ECG' They never went through the ECG results with me, the report said see seperate ECG report'. Sorry to be so full of questions, would just like to understand. Thanks for any help you can give. Pam
Shannon Morgan, CMA - Thu Aug 18, 2005 10:00 am
The problem viewing the heart on echocardiogram is due to body habitus (obesity). The low voltage QRS is also mostly due to obesity and edema, or in cases of kidney problems, which a basic chemistry would rule out - but usually it's obesity. Obesity also affects treadmill tests, as the leads have too much fat to read the electrical impulses correctly. The adenosine will definitely be accurate. The ischemic findings on echo are probably also equivocal. If there is any ischemia present, you will need to undergo an angiogram to actually visualize any possible narrowing of the artery Sinus tachycardia just means rapid heart rate (over 100 bpm) which is expected when exercising, so not to worry about that. When your doctor advised the ER if you experience and chest pain, it just means "better safe than sorry" due to the unclear results of your tests thus far. I hope this helps you relax; if there was anything definitively worrisome, you would have been sent straight to the cath lab for an angiogram.
Crown - Thu Aug 18, 2005 10:50 am
I am obese and wondering why they would do this test if it doesn't work on obese people. Now I'll have to pay thousands of dollars for two tests. That bothers me. Do you think it's necessary to do another test if he really didn't find anything? Thanks!
Shannon Morgan, CMA - Thu Aug 18, 2005 6:19 pm
It's not that they don't work, it can sometimes be a matter of how dense the body is, and sometimes the skill of the echo tech when faced with the challenge. Also, insurance companies will not pay for the Adenosine/thallium stress tests until the less expensive ones have been done, because obesity does not guarantee an equivocal result. Also, the treadmill and echo tests are noninvasive, so no chance of a reaction to the isotopes. It is very necessary to do the adenosine, since there is even a chance there is something abnormal. If they didn't and you had a heart attack, you would have wanted them to have done it, right? They are following the proper sequence of diagnostics.
Crown - Thu Aug 18, 2005 10:42 pm
I appreciate actually finding someone that will give me exactly what everything means. Unfortunately, my insurance only pays $4000/year and that was exhausted before this test I'm sure. Oh well, I know as you said...better safe than sorry. Have a GREAT night! One more thing...since last night I've had a pain in my right temple and the right side of my neck is stiff. I don't think it has anything to do with my heart as the pains have always been on the left side and entire neck. I've also been having dizzy spells, they don't last very long. What could this be from...stress maybe? Thanks again and God Bless! Pam
Shannon Morgan, CMA - Sun Aug 21, 2005 8:39 am
If you need more detailed answers on the results, I suggest you call your doctor. The pains do sound anxiety related; stress is the number one reason for neck pain and headaches. If your headache is located on one side of your head at the temple it sounds like migraine. Ask your doctor first about taking some Excedrin; the caffeine combined with the aspirin makes it stronger and is very effective on this types of headache.

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