Tag Archives: ejection fraction

Nuclear Exercise Stress Test and Results

I was very nervous preparing for my first stress test and unsure of what to expect.  Luckily, my facility provided me with a one-sheet of information that eased my mind.

I could not consume any caffeine, decaffeinated beverages, or chocolate for 24 hours prior to my appointment, and I could not have any food or drink (unless water to take medication) 4 hours prior to my appointment.  They were very strict on this.  They also suggested that I wear comfortable clothing and sneakers (or shoes you’d go walking/jogging in) and to plan on being there for up to 4 hours.

A nuclear exercise stress test is used to see how blood flows through the heart during exercise and at rest by using radioactive tracers.  Images are then taken of the heart to show the coronary artery circulation and which parts of the heart are receiving blood (marked by the radioactive tracers).

When I got to the facility, I checked in, made my co-pay, and was immediately called in by the Technologist.  They first took me into a room where I had to sign some forms and was asked a few general questions about my meds.  I made sure that he knew I had a stent.    Then the Tech inserted an IV into my arm (inside elbow) and the radioactive tracer which needs some time to circulate before they can begin taking images.  I was then escorted to a small waiting room and told to relax and drink 3 cups of water from the water cooler.  I probably waited about 15-20 mins and made conversation with a nice man in his 80s who must have been there for a similar test.  He told me how he used to be in the military, worked as an engineer, retired from NASA, and his grand daughter was going to Auburn University (the conversation began because I was wearing an Auburn shirt).  It helped the time go by quickly because the TV channel was boring.

The Technologist came in to get me and took me into the imaging room where I had to lie down on a narrow table with my arms above my head.  To the left of my chest was a large scanner that rotated over my chest so the Tech could position it accurately.  Once it was in the right position, he told me to hold still and breathe normal and that the scanner would take about 15 mins to take its images.  The computer monitor was in my line of sight, but it didn’t really show me anything that I could comprehend.  My arms got a little tingly from being over my head for so long, but I stayed as still as I could so they could get good images.  When the machine was done, the scanner rested to the left of my chest, and the Tech escorted me to the room with the treadmill.

There, I met a nurse (or maybe she was also a technologist) who began hooking me up to a 12-lead EKG whose pack was strapped to my stomach and had a long cord connected to the computer.  I was able to lie down on the bed to connect everything.  She had to enter lots of info into the computer and verified info with me and was also pleasantly conversational.  The room had lots of windows, so I had a great view of downtown while I was in there.  Finally, the first Tech came back in along with a doctor, and they helped me with my cords (so I didn’t trip) onto the treadmill.  It didn’t look like a normal treadmill.  It was basically a belt and bars.  No buttons or displays, which I thought was odd, but helped me focus.  They determined that they needed to get my heart rate to 153 to get the images they needed.  I let the nurse know that I had not gotten over 137 in cardiac rehab.  They turned on the treadmill, and let me start walking.  The EKG monitor was right next to me, so I could easily see my heart rate and the timer.  I told them that in cardiac rehab I normally walk for 15 mins at 3.0 and 3%.  They began this treadmill walk at about 1.6/1.7 and 10% (the max).  They needed to quickly get my heart rate up to its max.  I could completely tell a difference between this treadmill and cardiac rehab.  Within 1 or 2 mins, I could already tell I was getting winded.  They kept me talking the entire time (not sure if that was on purpose or if we were all just chatty), but I started to get out of breath pretty fast.  I told them that this was EXACTLY what I had been explaining to my doctor about how I feel when trying to walk up stairs or briskly walking through a parking lot, but I had never experienced this in cardiac rehab.  When I started to get really winded, the doctor asked the nurse to administer the second radioactive tracer so they could get it in there before they needed to stop me.  I had to continue on for about 2 or 3 more mins (I think).  I was hot and very winded and my heart rate was only 147.  Finally, the doctor told them to stop the test as he didn’t want me to overwork or push my heart too much and he got what he needed for the images without going up to 153.

Wow!  What a workout!!  I sat back down on the bed and the nurse took the leads off of me.  She then brought me a juice box (all natural, no added sugar) and a pack of peanut butter crackers, and had me wait back in the small waiting room for about 15 mins.  It was so great to finally eat and drink something!

The Tech came back in to get me to take me back to the imaging room where I got back onto the narrow table and let the scanner take pictures of my heart.  This lasted for about 15 mins again.  Then the IV line was taken out, I got a bandaid, and was released to go home.

So, the stress test was not as bad as I thought it would be.  I was afraid I would be running for a long time and not able to keep up.  But now, I feel like I want to conquer a treadmill at 10% incline!  But I’m sure my doctor won’t approve of that anytime soon.

The doctor overseeing the test said he would read the results the next morning and call me (even though it would be a Saturday).  He never did.  I went by his office after cardiac rehab that Monday to get my results.  A nurse called him on the phone and let me speak to him.  He said he was surprised at my results and had mostly good news for me.  The scar tissue is at the apex of my heart and estimated to be about 20% (originally estimated at 50%). My ejection fraction was a couple percentage points better than my echo, but that doesn’t mean it had improved in 2 weeks, it’s just that this is a different test measuring that. They are not sure how much of the 20% is permanent damage.  It will take 6 months to a year to better determine that. But I am still cleared to continue working out and to start jogging.  I will probably continue to have shortness of breath for a while (or even the rest of my life), but it could get better as I continue to work out and my body finds ways to compensate for the damage to my heart. This encourages me to want to work so much harder.  It is really disappointing when you’re told that you may never be the same again and may be limited in activities and quality of life.

More Test Results

I received the results of my 3rd heart echo.  It did not show any fluid around my heart, which the cardiologist was looking for since I’m still getting winded.  My ejection fraction has increased from 40-44% to 45-49%!!!  My cardiology team is ecstatic that my heart function has improved.  Normal range (according to my cardiac nurse) is 55-60+.  While I can’t believe it has ONLY increased 5% with all the changes I’ve made and all the cardiac rehab I’ve gone through, the cardiologist thinks this increase is huge…especially considering it was 15-20% after my heart attack.  Also, due to the damage that my heart has, it isn’t really expected to get back to normal from what I gather from the doctors.  They also say at least we are moving in the positive direction and any increase is great!  As for the results of my bloodwork for BNP and BMP, my BNP level was 114.  The PA (physician assistant) said that 100 or below is the normal range, but 114 was a good number for me.  They don’t start to really worry until the level gets to 300 or greater.  Within my BMP, my glucose was 99, which is good, so I shouldn’t be considered pre-diabetic anymore since the last my glucose was measured was in the hospital during all of my drama.

The kicker on this one is that I received a letter from my insurance company saying they will not cover the blood test for BNP because it is determined to be “experimental, investigational or unproven for the diagnosis” submitted with the claim, which is Coronary Atherosclerosis of Native Coronary Artery.  Of course, I think this is ridiculous.  Thank goodness it was only blood work, but I have NO CLUE what my bill will be!!!  If it is a small amount (like under $50) then I don’t have a huge problem with that; but if it’s a large amount, then I will have to appeal their decision, which is allowed.  It also says that health care professionals in my insurance network generally can’t bill me for services if they know they are not covered (yet necessary) and they tell me that in advance and I agree to it in writing.  No one advised me of such, so I’m wondering if I will get billed.  Maybe I will take it up with my doctor first if I do receive a bill.  Speaking of…I’m still waiting on a refund from the GI Surgeon for paying for my outpatient procedure in advance when everything was switched to in-patient/hospital stay.

On another positive note, my doctor did say that I can now ride roller coasters and start jogging (I asked about both!).  The jogging part is what excites me the most because it’s the only thing that will help me lose weight (I can’t believe I’m not losing weight with all of the changes over the past 3 months).  My doctor ordered another heart test, which I’m having done this week.  It will be a nuclear stress test while exercising.  He said it will help answer all of our questions as to why I’m getting winded when I go up stairs and why I’m having chest pains and tightness.  It will take pictures of my heart at rest and under stress to show how my heart is responding. Once the results are back from that, cardiac rehab will let me start jogging (based on the results) so they can monitor me before I start jogging on my own.  Ironically, my dad, who now sees my cardiologist, is going for a nuclear stress test (non-exercising) at the same time on the same day but at a different hospital.  Cardiac rehab told me that “no news is good news” when I’m waiting on results of the stress test.  The unfortunate thing about this stress test is it has a $200 co-pay.  Luckily, it’s happening on pay day.  Otherwise, not sure how I’d be paying.  Medical bills are adding up, and it’s taking a huge toll on my finances and budgeting.  Having a heart attack is expensive, people!

Cardiac Rehab.

I finally began Cardiac Rehab, which will help me determine my limitations.  The past few times I’ve gone walking in my neighborhood, I’ve had some pain in my chest and back when breathing.  Cardiac Rehab will allow my heart to get stronger and will hopefully increase my stamina.  I will start off with 18 sessions, and then they will reassess to see if I need an additional 18.  My insurance covers it, but my copay is $40 per session, which is way more than I can really afford, but it’s something I have to do.  I can do 2 or 3 1-hour sessions per week, so I’ve agreed to start out with 3, and then I’ll drop down to 2 per week for financial reasons.

My first session was over 2 hours long because the nurse wanted to go over my file with me, discuss my prescriptions, and review my cholesterol numbers.  Then, I got to try out some of the machines.  I wear a heart monitor and there are nurses and exercise physiologists in the room that monitor your heart rate and check your blood pressure.  I started out walking on the treadmill for 5 minutes at a pace of about 2.1.  I had no problems!  Then, I tried 5 minutes on an elliptical-type machine where you are sitting down.  Finally, I tried 5 minutes on a stationery bike.  Even though everything was done at a slow pace, I still worked up a sweat.  It really is a great feeling to know that if something happens, I’m surrounded by a team of medical professionals.

During my second session, they increased my time on the 3 machines to 7 minutes and increased the pace.  I had no pain and worked up more of a sweat.  My heart rate and blood pressure exactly what they should be for someone my age.  In fact, I even went back on the treadmill a 2nd time for 6 more minutes and felt fine.

My goals from Cardiac Rehab are to ensure my heart heals, build up my stamina, and eventually get to the point where I’m healthy to run again.  Years ago, I was a runner and would run 3-5 miles a day.  I competed in 5Ks, 10Ks, and even completed a half marathon.  I believe that running for so many years is the reason that my heart bounced back so quickly after the heart attack.  The doctors are still amazed that my heart went from 15% EF to 40-44% EF in a matter of a few days.  I attribute this to running for so many years.

2 Weeks Post-MI.

MI stands for Myocardial Infarction (scientific name for Heart Attack), so you may hear medical staff refer to it as “MI”.  

I had my first appointment today with the Heart Clinic.  It wasn’t with any of the doctors who saved my life; this was with nurses from the Clinic to follow up and gather all of my information/medical history. This first appointment took a while, but they said it was because they needed to gather so much information at the initial appointment.  Everyone was extremely nice and only had great things to say about the cardiologists that worked on me in the hospital.  

I came in with a list of questions (as usual), but I hardly slept the night before because this appointment was like Christmas to me!  I couldn’t wait for this follow-up so I could ask questions that I hadn’t yet asked and talk about side effects, prognosis, etc.  They had a lot of questions for me, too.  First, they needed to get my medical history, then my family’s medical history (mainly my dad’s and my Uncle Edward’s).  Due to my strong family history of heart disease, the clinic will be watching me closely so I don’t have another MI.  My dad had a quadruple by-pass (it was an emergency open heart surgery when he went in for a routine appointment) when he was about 53.  He is still alive.  My Uncle (dad’s older brother by 2 years) had a quadruple by-pass (emergency open heart surgery when he was in surgery for stomach cancer).  He had also suffered a heart attack during the surgery for his stomach, which is how they caught his problem.  He was about 43.  He survived but went on to have another minor heart attack a few years later and then a massive heart attack, which killed him, when he was 60. I believe all of my dad’s siblings and both parents have had open heart surgery (multiple bypasses).  Only one Uncle is left (everyone else succumbed to ailments other than heart failure), and as a result of hearing of my “episode” and the symptoms I had leading up to it, decided to pay his doctor a visit the next week because he was having similar symptoms.  Turns out, he has a blockage (not an emergency) and will be getting another stent placed next week.  

I digress…so back to my Heart Clinic visit…

I mentioned to the nurses that I had what I thought were heart palpitations 2 days ago, along with a low blood pressure reading (80 something over 50 something).  They said that I should have contacted them right away so they could assess the problem.  I told them that I also have anxiety and wasn’t sure if it was actual palpitations or the fluttery anxious feeling I get when I’m stressed or nervous (nervous about my health!).  They said that palpitations could be brought on by low blood pressure and if it happens again to drink a lot of water (however, I cannot drink more than 2 liters of liquid in a 24 hour period) and to call them.  What I didn’t realize, and much to my RELIEF, is that the Clinic is 24 hours – rather, they have a night nurse.  So I can call at any time, day or night, and a nurse can assist me…unless I’m having a known emergency and then I should call 911.  They would rather treat me as an outpatient rather than put me in the hospital again.  I now need to program these #s into my phone.

They suggested that I could purchase a sphygmomanometer (fancy word for blood pressure cuff) online that could sync to my iPhone.  They also suggested that I get my current one calibrated (I’m using my dad’s) at the fire department as the readings seem to be low.  How exciting!

I also addressed the allergic reaction to my statin.  Last week, I broke out with a rash all over my torso.  I’ve never had a rash before.  I was told to stop taking my statin and to take Benadryl until my appointment today.  The rash has cleared up.  Although the nurses today didn’t really think the statin caused me to break out, they have changed my medicine to Crestor* (from Atorvastatin).  

During the appointment, the nurses were looking through my hospital records and discussed my ultrasound results with me.  The ejection fraction of my heart the night of my heart attack was about 15-20%…it should be at least 50%.  However, they were missing the results of the 2nd ultrasound that I had 3 days later.  Those results showed the ejection fraction to be about 45%, which shows my heart is healing and getting stronger; but it is still not strong enough.  The nurse had to call my Cardiologist to get this info, and my Cardiologist asked to say hello to me on the phone!  So the nurse handed her cell phone to me so I could speak with my Cardiologist!  What great and personalized service!  He did remind me that he saved my life and had it not been for him, I would not be alive.  I am forever grateful!!  He said he would like to see me next week in his office and he’d like for me to have a follow up with the nurses in 3 weeks.  This is great!  I want to see my doctors as much as possible so we can learn from each other, and so they can take every step to get me healthy again and track my heart’s progress.  

I asked about exercise to see what I can and can’t do and what I am capable of doing safely.  They recommended that I walk for 30 mins everyday.  Of course, I can build up to that with 10 mins a day to start.  They would like to see me gain my independence back.  And on that note, I moved back to my home today (was staying with my parents after the hospital).  

The nurses did give me homework until the next appointment; and although I’m not in school, I welcomed this homework with open arms!  I need to track my blood pressure, heart rate, and weight every single day.  This will help them gauge how well my meds are working and how my heart is responding to them.  They will also have a dietitian and a pharmacist meet with me on my next appointment so all of my diet and drug interaction questions can be answered.  For example, the doctor said I cannot eat dairy or fried foods anymore – does that mean forever??  It is so hard being a pescetarian vegan.  I want cheese SO BAD!  But let me take this moment to remind myself that CHEESE may be the reason that I had the heart attack!!

All in all, the visit to the Heart Clinic was great.  I look forward to my next appointment.  

*Crestor – the new statin they’ve prescribed me – is a brand name drug and was going to cost $48 with my insurance!  I paid $66 for all of my cardiac meds combined when I left the hospital!  Thankfully, I searched online and found a coupon from Crestor’s website for a free 30 day trial.  I took this to the pharmacy.  They were not able to process that 30 day free trial (for whatever reason), but they found another coupon for Crestor that brought my co-pay down to $18!  I would hate if I paid $48 for this and find out I am allergic to it, too.  It pays to do a little research, and it’s great to have a pharmacy that is patient with me.  🙂

I went to the fire department tonight hoping to meet a hot firefighter who could calibrate my blood pressure cuff.  Disappointment!!!  I was told that fire stations do not calibrate blood pressure cuffs!!  However, they were super nice and researched it online and called the cuff company to find out how to get it calibrated.  Turns out, it is cheaper for me to just buy a new one.  I will look into the ones that sync up to iPhone.  I wonder if my insurance will pay for it…

I apologize for not making this all so much more inviting and interesting with photos and such, but I just got a new iPhone today, so I will be sure to experiment with the camera function.