Nuclear Stress Test: I'm afraid to do it

Posted by Gail, Alumni Mentor @baxtersmom, May 17, 2017

I had an EKG and my doctor dictated that it showed the following: Sinus Rhythm 79 PVC Inferior Lateral ST Depression. My doctor has ordered a nuclear medicine stress test because I have some back problems and I was concerned about doing the treadmill stress test. I guess I have two questions/concerns and wondered if anyone might shed some light on either of them. First, what does this dictation that my doctor put in my record mean about my EKG? I have had a benign PVC all of my life but don’t know if this is the same thing. I had been feeling like my chest was heavy and very tired, a little breathless sometimes which is why I went in to the cardiologist. Second, has anyone had a nuclear medicine stress test? I am concerned about the side effects and not being able to control them. I read about some of them and saw that the FDA had issued a warning about risks with nuclear medicine stress tests. Then I saw on the Mayo Clinic site that the nuclear medicine test may be more accurate and if the regular treadmill one isn’t conclusive, I might end up having to do the nuclear one anyway. It was an ECO stress test I had many years ago when the benign PVCs were discovered. I am really afraid of doing the nuclear test. Please guide me if you can.
Thank you.

Interested in more discussions like this? Go to the Heart Rhythm Conditions group.

Hi. I can only respond regarding the nuclear stress test which I reluctantly submitted to while in hospital for A-fib. I don’t know what long term side effects are but the actual test did not present anything serious or terribly uncomfortable for me. I remember a headache for a few minutes and a weird feeling for 15 minutes after an injection and that is all. This test was required for me in order to start flecainide for a-fib. I too am wary of tests like these and long term effects and assume that a treadmill test is less risky. I generally do have side effects to most drugs, possibly because I am small, only 100 pounds right now. I hope this helps. Karen

REPLY

Hi Gail,
@grandmajan posed a similar question and concerns about the nuclear stress test a while back. See the responses she got from a number of Connect members here: http://mayocl.in/2r7tJu0

I’m also tagging @predictable and @cynaburst on this discussion to help you find answers to the information on your report. Gail, when are you scheduled for the stress test?

REPLY

Your doctor probably just wants to make sure that you don’t have any parts of your heart which are damaged and are causing arrhythmia. PVCs are usually benign but with the symptoms you describe your doc is probably just wanting to be cautious and to rule out anything more dangerous.
Nuclear stress tests identify damaged areas in the heart. I haven’t had one but they are used to identify areas of the heart that are damaged. These may cause arrhythmia.

REPLY
@colleenyoung

Hi Gail,
@grandmajan posed a similar question and concerns about the nuclear stress test a while back. See the responses she got from a number of Connect members here: http://mayocl.in/2r7tJu0

I’m also tagging @predictable and @cynaburst on this discussion to help you find answers to the information on your report. Gail, when are you scheduled for the stress test?

Jump to this post

Thanks Colleen for getting me all these responses. These largely comport with my experience.

I had the nuclear stress test on Monday last week (May 22nd I believe). It was really no problem at all. They had me walk on the treadmill for just a couple of minutes after injecting me with the medicine that speeds up your heart and simulates the exercise portion because they said it minimizes the effects of the medicine. My legs got a little heavy for about a minute and I felt a little dizzy but it went away really fast. I was not nauseated or ill in any way. Worst part is not being able to eat beforehand so I was ready for a snack right afterward. Got the results on Tuesday and essentially at rest all the blood flow is fine which indicates no heart damage as I understand it. Under stress there is one small area at the Apex of the Heart where there may be some decreased flow (doctor said it is either that or a shadow from the breast which sometimes causes an artifact in women). So on Tuesday May 30th I am scheduled for an angiogram (heart catheterization) to identify whether there is really a clogged artery and how much. If it is blocked 70% or more they will put in a stent and I will stay one night in the hospital. If no blockage, I will recover for a few hours and go home. I could have gotten on blood thinner but I prefer not to do that if we can figure this out another way. If I don’t have a blockage I don’t want to be on a med I don’t need, plus I would have to keep on getting tested to see if the med was working or not. So I chose the catheterization which my doctor said would be her choice if she were in my shoes. I always ask them this (If it were you……). I am a little apprehensive but I need to get this done because I have to have an Endoscopy to check a couple of things every two years and my gastroenterologist won’t do it without a clearance from the cardiologist. If there is not blockage, it is likely my hiatal hernia that is causing the pressure in my chest. Only the endoscopy can tell us if the hernia has changed since we last looked. If anyone has had angiogram, I would be curious to hear their experience as well.

I thank everyone for their information and replies.

REPLY
@cynaburst

Your doctor probably just wants to make sure that you don’t have any parts of your heart which are damaged and are causing arrhythmia. PVCs are usually benign but with the symptoms you describe your doc is probably just wanting to be cautious and to rule out anything more dangerous.
Nuclear stress tests identify damaged areas in the heart. I haven’t had one but they are used to identify areas of the heart that are damaged. These may cause arrhythmia.

Jump to this post

@gailg, our friend @cynaburst is right on point, I think. Your initial diagnosis raised questions that are best answered by observing the heart doing its work. Some degree of coronary insufficiency may be suspected, and your follow up stress test and impending catheterization is providing important additional information. Stay at it! What did your doctor say about advantages and disadvantages of “blood thinners” in your situation? We’ll be interested in how things are going in the days ahead.

REPLY

I am new to Mayo Connect, posting because I am concerned about a nuclear stress test scheduled for 10 days from now. After wearing a heart recording device I was told the results were "crystal clear" that I have AFib and atrial flutter. Cardiologist told me I needed a Lexiscan nuclear stress test. I asked her if the heart recorder showed any episodes of abnormally low heart rate, and she said no. I know I've had episodes of bradycardia as well as tachycardia. I have a pulse ox monitor for COPD. When I feel faint or out of breath I use this and have seen a number of instances where my oxygen level was fine but heart rate was in 30's and 40's. Yesterday after exertion I felt unwell and pulse rate was between 29-44 for several minutes until I laid down.

I am wondering if the stress test is appropriate when it's not yet been determined whether my problem is one related to electrical activity in the heart? I had the feeling the doctor was not tuned in to what I was trying to say about having had bradycardia symptoms as well. I'd like to hear if anyone else has been through this scenario.

Bay20740

REPLY

I don't have the conditions you note, so this might not be reassuring, but did have a nuclear stress test with no difficulties, during or thereafter.

REPLY

I have one tomorrow.Nervous as someone told me a scary story about someone dying after one .Of course know no details.I might have had one. Years ago. I gave AFib for years.fast.slow beats.pauses.on meds for years..recently had pounding heart.went to er .AFib but okey.will let u know of my experience.

REPLY

I have bradycardia (and afib with super high rates) and have had three nuclear stress tests with no problem.

REPLY
@bettysamny

I have one tomorrow.Nervous as someone told me a scary story about someone dying after one .Of course know no details.I might have had one. Years ago. I gave AFib for years.fast.slow beats.pauses.on meds for years..recently had pounding heart.went to er .AFib but okey.will let u know of my experience.

Jump to this post

Good morning, @bettysamny and @bay20740 Thought I’d pop into this conversation about having a nuclear stress test. I hope I can reassure you that it sounds much more intense and frightening than reality.

There will always be anecdotal stories by well meaning people, especially on the internet, of rare events that can happen. I’ve had several of these nuclear stress tests over the past several years, under some extreme health conditions, and breezed right through them.

In a large nutshell, you’ll be having some images of your heart and blood vessels taken at rest and after exercise. The radiotracer allows for a comparison of how your blood flows during those periods.

You’ll have a small IV line inserted in your arm. Mine is always just on the top of my hand and is painless.
Once that’s done you’ll have the radiotracer injected. It can feel a little cold but that’s all.
Next you’ll have some images of your heart taken by lying on a table. The camera moves over the top of you. This is not an MRI and you’re not enclosed. Though the camera is large and does come close to your chest. I asked the technician to talk with me during this so that I felt relaxed. I also closed my eyes the first time and kept focused on breathing. After that it was easy peasy.

After those first images, you’ll have some little EKG wires attached to your chest to monitor your heart. You might also be asked to do some breathing exercises, depending on the test.
Next, you’ll be on a treadmill to increase your heart rate. If you’re not able to walk on the treadmill, then there is a drug that’s given to increase your heart rate without exercise.
I’ve had it both ways and again, my anxiety was totally unfounded.
Once your heart rate is up, you’ll have another injection of the radiotracer and then have the final series of images. The first images taken with the radiotracer, allows the radiologist to see your circulatory system at rest. The second images show areas where your blood isn’t flowing freely during exertion and easily compared.
Then you get dressed and off you go! Drink plenty of fluids to help your body flush out the radiotracer.

I’m posting a link to the Mayo Clinic website that explains about the procedure. I’d like you to take your time and read through the entire article. It gives a great explanation as to why the test is done and what to expect during the procedure.
https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231
Also, you are never alone! There are technicians and a nurse present at all times who are fully capable of responding ‘in a heartbeat’…pun in tended. ☺️
Does this help a little to allay your fears? And will you both let me know how you faired after the tests?

REPLY

I will. I wasn't afraid but hearing that story upset me I spoke with nurse and she was reassuring.

REPLY
@loribmt

Good morning, @bettysamny and @bay20740 Thought I’d pop into this conversation about having a nuclear stress test. I hope I can reassure you that it sounds much more intense and frightening than reality.

There will always be anecdotal stories by well meaning people, especially on the internet, of rare events that can happen. I’ve had several of these nuclear stress tests over the past several years, under some extreme health conditions, and breezed right through them.

In a large nutshell, you’ll be having some images of your heart and blood vessels taken at rest and after exercise. The radiotracer allows for a comparison of how your blood flows during those periods.

You’ll have a small IV line inserted in your arm. Mine is always just on the top of my hand and is painless.
Once that’s done you’ll have the radiotracer injected. It can feel a little cold but that’s all.
Next you’ll have some images of your heart taken by lying on a table. The camera moves over the top of you. This is not an MRI and you’re not enclosed. Though the camera is large and does come close to your chest. I asked the technician to talk with me during this so that I felt relaxed. I also closed my eyes the first time and kept focused on breathing. After that it was easy peasy.

After those first images, you’ll have some little EKG wires attached to your chest to monitor your heart. You might also be asked to do some breathing exercises, depending on the test.
Next, you’ll be on a treadmill to increase your heart rate. If you’re not able to walk on the treadmill, then there is a drug that’s given to increase your heart rate without exercise.
I’ve had it both ways and again, my anxiety was totally unfounded.
Once your heart rate is up, you’ll have another injection of the radiotracer and then have the final series of images. The first images taken with the radiotracer, allows the radiologist to see your circulatory system at rest. The second images show areas where your blood isn’t flowing freely during exertion and easily compared.
Then you get dressed and off you go! Drink plenty of fluids to help your body flush out the radiotracer.

I’m posting a link to the Mayo Clinic website that explains about the procedure. I’d like you to take your time and read through the entire article. It gives a great explanation as to why the test is done and what to expect during the procedure.
https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231
Also, you are never alone! There are technicians and a nurse present at all times who are fully capable of responding ‘in a heartbeat’…pun in tended. ☺️
Does this help a little to allay your fears? And will you both let me know how you faired after the tests?

Jump to this post

Lori, thank you for your post. My biggest concern about the scan comes from this note in the Lexiscan prescribing information: "Do not administer LEXISCAN to patients with:
• Second- or third-degree AV block, or
• sinus node dysfunction
unless these patients have a functioning artificial pacemaker [see Warnings and Precautions (5.2)]"

I don't know if I have sinus node dysfunction or not. My doctor told me this was something that would be determined by the scan. But maybe there is some other test that should be performed first?

I should mention that I live in an area classified as "medically under-served." The cardiologists' reception room is almost always standing room only. I think the doctors are doing the best they can with an overwhelming patient load. Still, it is unsettling to be told, "Call if you have any questions," when voice mail may or may not produce a response.

REPLY
Please sign in or register to post a reply.
  Request Appointment