Tag Archives: EKG

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.

Changes in Meds.

My cardiologist has decided to change some of my meds since I’ve been having so many reactions to them.  First of all, he decided to take me off of Lisinopril.  He believes it is what caused all of my severe abdominal pain when they doubled the dose.  Instead, I will now be taking Cozaar, which does the same thing but works differently in the body.  So far, so good.  I still have mild abdominal pain that comes and goes to the left and right of my belly button, but it hasn’t been severe enough to worry.  But I am worried – wondering if it is GI or related to my surgery.  

Since I’ve been off of a statin since I had severe reactions to both that I tried, my cardiologist consulted with a cholesterol expert and they found a new one for me to try.  It’s called Livalo (pitavastatin), and luckily, the office gave me samples for 3 weeks.  Every little bit of savings helps in case I’m allergic to this one, too.  I hate that I lost so much money on the Crestor.  Ugh.  Since I am taking the Cholestyramine (prescribed by my GI doctor), I cannot take the new statin at the same time.  Since statins work better at night, I am taking it around dinner time.  I take the Cholestyramine before bed when I take my other nightly meds.  On the Livalo, so far, I’ve had two hot flashes (I got really hot on the first statin I took) with no fever.  I have noticed that my chest tightness and pain is much more frequent and longer in duration than it was before.  Not sure if that is due to either of these new meds or if it is something else.  I’m documenting my symptoms to report back to the doctor at my appointment next week.  

I also learned that my EKG is still abnormal, even though someone said it was “beautiful” at a recent appointment.  When I asked the nurse about it, she said they aren’t sure what my new normal may be.  My current EKG, and I guess all EKGs since the heart attack, have had T inversions.  I’ll ask more questions about that at my next appointment since they do a new EKG every time.  

First Appointment With My Cardiologist.

The first appointment with my Dr. went as well as it could.  Everyone is so nice.  First, I met with a nurse who took my bp on both arms and did an EKG on me.  Next, I met a PA (Physician’s Assistant) who talked to me more about the tightness I’ve been experiencing in my chest and to go over other details of symptoms and side effects I’ve been having.  I explained all of the pain I’ve been experiencing (back, chest, arm) and let her know that I’ve still been very tired and worn down, especially when trying to walk for exercise.  I asked her how my EKG reading looked, and she said it was beautiful.  That felt great to hear!!  Then, I met with my Dr.  

I explained in detail everything I experienced over the weekend and anything I was still experiencing.  He said he will have to talk to a cholesterol expert to see what they recommend because I have to be on a cholesterol medicine.  In the meantime, he asked me to no longer take the Crestor and start taking 2 Advil every 8 hours to see if that helps.  He thinks the pain and tightness could be from the sac around my heart and wasn’t sure if the feeling was musculoskeletal or not.  He also wants me to start cardiac rehab, so I can learn my limitations.  Once again, he reminded me that he saved my life!  🙂 And he told some of the story again.  My dad came with me to my appointment (so he could make his own appointment with my Dr.) but waited outside.  The Dr. asked about my parents, and I let him know my dad was here, so the Dr. called him in so he could listen to everything he said to me.  It was good to have 2 sets of ears to remember everything.  I wish I could bring a voice recorder into my appointments so I remember everything.  

I had my list of questions ready, and before the Dr. left, I let him know I had a few more questions.  He said I can’t do roller coasters or go running 3 miles or do anything that would quickly increase my heart rate for a couple of months at least.  That is fair.  I also asked for clarification on the foods that he originally told me to remove from my diet.  Again, he said NO fried foods, NO egg yolks, and NO cheese.  I asked if that meant forever…he said I could have cheese on a rare occasion.  I told him I was trying the vegan route (but eating fish/seafood), and he told me he never said I couldn’t have meat.  I knew that, but I was taking it a step further.  He said his wife is a vegetarian and because vegetarians can’t eat meat, they supplement with a lot of cheese in most of their dishes.  As a result, his wife’s cholesterol is higher than his!  So, it didn’t sound like he was forcing me into the vegan lifestyle, which I’ve found very difficult.  I took that as my queue to relax a bit on the strict diet I was on.  Plus, I haven’t lost any weight.  

He decided to put me on a Holter Monitor for 24 hours, which I picked up a few days later.  I’m so glad he did that so he can see if everything is normal when I’m not at the Dr.’s office.  And he wants to see me again in a few weeks.  

It’s been a few days, and I haven’t heard from his office yet regarding the new cholesterol medicine.  They also haven’t contacted me about setting up my next appointment with him or Cardiac Rehab, so I will follow up with them tomorrow.  

My Story.

On Monday, June 16, I had what I thought was a gall bladder attack.  Two weeks earlier, I was diagnosed as having gall stones, so I scheduled an appointment to have my gall bladder removed.  (This would be my very first surgery ever, and I was so nervous.)  The pain was unbearable.  It started out as severe burning in my chest, like heartburn, and engulfed the entire top half of my body.  I couldn’t find a position that would make the pain go away.  Then I broke out into a sweat and started shaking.  I knew something was not right, and fearing for the worst, I contacted a colleague (I was staying in a local hotel for work) who dialed 911.  Once the paramedics arrived, most of the pain had gone away.  They took my vitals and checked my heart, and they dismissed it as a gall bladder attack.  They gave me the choice to go with them in the ambulance or come to the hospital later if I started feeling bad again.  I chose not to be transported by ambulance, and the paramedics left.  A friend of mine bought some heartburn medicine for me, which I took immediately.  However, the pain came back.  I concentrated really hard to make the pain go away again, and it did…mostly.  I contacted my GI doctor to get seen immediately.  I could hardly walk and couldn’t drive, so another colleague drove me to the doctor’s office.  There, I was prescribed heartburn medicine, pain medicine, and sent for blood work.  I also rescheduled my gall bladder surgery to Friday, June 20 (originally scheduled Wednesday, June 25, due to my work schedule).

The pain medicine seemed to help, and by the next morning, I felt I was okay to go into work and just take it easy most of the day.  That idea was quickly squashed, as another attack came on mid-morning!  This time, the pain was centered to my sternum and had moved to the left.  I also had shortness of breath, and it hurt to breathe deeply.  I immediately contacted my GI doctor who told me that my blood work had come back with elevated levels of WBCs, therefore, I had an infection.  We contacted the GI surgeon to see if he could work me in that day, which he did.  My surgery was scheduled for 4:00pm.  Before leaving for the outpatient facility, the surgeon contacted me and said he didn’t feel right about sending me to the outpatient facility in case something went wrong – since we already knew there was an infection – so he wanted me to be admitted to the hospital instead.  He would do my surgery at 4:00pm and I would spend the night so they could check and make sure all was okay before releasing me the next morning.  This would be my first surgery AND my first hospital stay ever!  I’m really nervous.

I had two of my friends drive me to the hospital to get checked in.  My breathing was very shallow and labored.  I was weak, didn’t feel well, was in pain, and my eye sight started getting blurry.  Once I was in the surgery prep room, I let all of the doctors and nurses know about my painful and shallow breathing.  All assured me that wasn’t a problem, and I would be feeling better in no time.  I don’t even remember being put to sleep with anesthesia.  The only thing I remember next was waking up after the surgery.

I was in recovery, and I woke up, very groggy, so someone saying my name, “Kim!”  I was then left alone and began to feel excruciating pain in the upper half of both arms.  I also felt nauseous.  I started to moan and groan and shake my arms and call for someone to please help me that I was nauseous and my arms were hurting really bad.  I think I was dozing in and out.  Someone asked me how long I’d had a heart problem.  I went into fighter mode and became very defensive.  I said, “I don’t have a heart problem!”  Someone else asked me if I knew I had a heart problem.  I said, “I don’t have a problem with my heart!  What is going on?”  The next thing I knew, people were all around me.  I heard whispers of “heart condition” but no one ever told me what was wrong.  Then someone started doing an echo of my heart and asking me about my “heart condition”.  Again, I exclaimed that nothing was wrong with my heart.  I remember a Dr. going around and thanking each person individually for staying late to help me.  Then I remember looking up and seeing a priest!  “Why is there a priest?!” I yelled out.  “Is the priest here for me????!!!”  Someone answered that there were normally lots of people around for surgeries.  But that made me mad that there was a priest!  Was I dying?  Did they think I was going to die??  And no one was telling me what was going on?

I remember being taken into another surgery.  I was afraid they might be cracking my chest for open heart surgery.  I asked, “am I going in for another surgery?”  “Yes,” was the reply from someone.  “Am I having 1 or 2 more surgeries?” I asked.  “Hopefully just 1,” someone replied.  “Will I need anesthesia?” I asked.  “No, you only need a local anesthetic for this procedure,” I heard.  And then I was moved to a hard and narrow operating table.  I was able to turn my head enough to see the X-ray monitor that showed everything that was going on!  I remember seeing my artery…with a large plaque that was broken up…and the balloon and stent being pushed through my artery to that area with the plaque.  Unbelievable!  I heard someone say there was a blockage.  I asked what percentage and was told 80%.  And then I started coughing.  I coughed so hard, and I was coughing up fluid…so much fluid!!  I was almost choking and gagging there was so much fluid that was gushing up through my throat from the coughing!!  It tasted so gross.  And the next thing I remember is being in ICU with a Cpap on my face and being yelled at to let it breathe for me.  But I felt suffocated.  Finally, I was able to relax and found my rhythm with this Cpap.  All of my family was there.  Why?  This was a simple gall bladder surgery that went horribly wrong, right?

I learned later that I wasn’t expected to survive throughout the first night.  The damage to my heart was about 50%.  My prognosis was grim.  When I was coughing in the OR, it was pulmonary edema, and my lungs were filling with fluid from heart failure!!  Heart failure?  I had had a heart attack!  My medical record is official – Myocardial Infarction!  What?  I had suffered a massive heart attack in the widow-maker – LAD – a large plaque had burst and collapsed my artery.  The doctors were called in and were at my side working on me within 5-7 minutes.  The cath lab was 2 doors down.  Every minute was critical to saving my life.  I was supposed to be at an outpatient facility!  I wasn’t even supposed to be in the hospital!  The cardiologists did not even practice in the hospital – they were there for a seminar!!  The heart attack was completely independent of the gall bladder surgery, so it would have happened no matter where I was at that time on that day.  Thankfully, all of the stars were aligned, and I was given a second chance at life…

The doctors had lots of questions for me the next day – what were my symptoms, where did it hurt, etc. They say I’m the luckiest person they’ve ever met.  This heart attack normally kills people instantly.  They said that most of my gall bladder symptoms were most likely heart attack symptoms.  Thank goodness I had a bad gall bladder problem to get me to the hospital!

With my new lease on life, I must now live a different way, eat a certain way, and exercise a certain way.  It has been a life-changing event, and I welcome you to follow me on my journey.  xoxo