Passed Heart Stress Test but Still have Chest Pain?
I had a heart treadmill stress test because of chest and neck pain when I am mowing the yard, climbing a hill, etc. I passed it, but the pain continues on exertion (stops when I sit down). The cardiologist says I should have further testing. I guess what I am wondering is what the odds are that you can have blocked arteries if you passed a stress test (doctor was vague when I asked that question).
- 1 decade agoBest Answer
The answer is that chest pain with exertion is more diagnostic for blocked arteries than a stress test.
If you continue to have exertional chest pain, brought on by exertion, relieved by rest. Then the definitive test is an angiogram.
Stress testing is depending on which study you read is about 85% accurate. Depending on the artery and degree of blockage it can move up or down as far as accuracy. Smaller blockages in the 3 main arteries will tend to not be picked up. Typically has to be greater than 70% blockage or greater and about a coin flip if it is a 50% blockage. As it approaches 100% blockage, well the test nears 100% accuracy. Based on flow has to be diminished to cause a strees test failure.
Also there are limitations based on each individual stress test as well as interpretation errors. Like a nuclear stress test can show normal if you have a multivessel blockage as well as stress echocardiography. Poor windows of aquiring images as well as technologist not getting the images before the heart recuperates.
Given that stress testing is designed to separate the wheat from the chaff as 14 out of 15 patients with chest pain pass it and they are 20 times less expensive than an angiogram. They are very valuable.
But you clearly need an angiogram based on your complaint as stated here. I dont know a cardiologist who would not do one based on the fact you have continued chest pain with exertion.
Now if you said every time you laid down after eating a pepperoni pizza to go to bed you have chest pain. Itd be a harder sell, youd get a purple pill and be on your way.
But to answer your question, I say 15% wont be picked up based on research I have read. When someone comes back and passes with the symptoms and other hiistory taking rules other causes out. then the most prudent and easy thing to do is the angiogram.
A simple xray test and a day procedure. Its the gold standard for diagnosing blockages in the arteries. You can actually see them.
Stress testing indirectly measures whats called perfusion and also inducible ischemia or lack of blood to the heart. That means its indirect. They look at the muscle via ultrasound or radioacive absorption with a gamma camera. The stress actually does not look at the arteries at all.
64 slice ct angiogram can now do what an angiogram does but with a few hundred chest xrays so now were back to angiograms in the cath lab being the best test. 20 minute painless test.
They run a flexible "straw" a mm or so in diameter and inject iodine directly into the arteries of the heart.
They run an xray movie and the iodine absorbs the xrays illuminating the lumen of ther areteries. You can see the arterial blockages and count them.
If you flunk a stress test, that test would be done absolutely anyhow.
Stress testing is a cost saving test and a step in the diagnostic process to mainly alleviate patient concern. THe angiogram blows it out of the water as far as usefulness.
And besides. If you are say 50 years and you have an angiogram and your heart is clean as a whistle at that age. Well hell, thats not going to change, might as well start smoking and not worrying about your cholesterold>
I kid, I kid
As far as passing a stress test and having a heart attack. Stress testing only picks up "FLOW LIMITING" blockages, usually of 70% or greater.
Any blockage, even a 10% blockage can cause a heart attack and the reason why is that the blockage has a consistency of toothpaste covered by a single cell layer of endothelium. Its not very stable and often bursts. Then scars and you get calcium deposits.
Every time it ruptures, it spews chemical messengers into the bloodstream like a pimple bursting and the body sends platelets and others to clot it off like a cut on the finger.
So now you might have a 10% blockage ruptured with a 90% clot sitting on top of it causing a heart attack. Generally it is in people who are couch potatoes and not taking or following their cholesterol.
Taking a statin drug makes the toothpaste into fibrinolyzed structure and can rupture. Thats why drugs block heart attacks.
Now when someone is not used to exercise does a stress test. that can rip open the friable cap on the blockage and cause the plaque rupture and subsequent clot forming blockage.
That is why people are prescribed betablockers to prevent blood pressure surges ripping open blockages and causing clot to form over it.
4 drugs prevent heart attack
Stents and bypass only alleviate symptoms. The drugs prevent heart attack as well as exercise an hour a day to 70% of predicted maximum heart rate and eating properly. No cigarettes and ifthe person is diabetic, they have to get skinny.
Heart attacks are completely avoidable disease. Its a choice of lifestyle and laziness. With all we know about cardiac medicine, the joke is it all boils down to walking an hour a day and taking the meds. If you want a heart attack, the best way to do it is, smoke, be a couch potato, ignore taking the medications to prevent heart attacks
If you have failed to control risk factors. then arteries are damaged and once they are, there is no going back. The only forward course is to prevent further damageSource(s): cardiovascular expert
- Anonymous5 years ago
Me too. I passed stress test but I still have chest pain when I am stressed or when I am under physical pressure.
I experience chest pain 3 months now and I decided to check it out. I had a treadmill stress test last Monday which was signed as negative. But, there are some points that are not clear.
Before the test started I had a very high heart rate. 116 bpm which rose up to 179 during the end of 2nd exercise stage. That happened in 7:16 minutes. This is the maximum heart rate for my age (42 years) and the test was considered as complete. I had chest pressure at the 2nd part of the test which was worse during the third part and I managed to approach 179 bpm for 1 minute.
There was a ST depression shown at the 2nd part of the test of 1mm and it became 2,8mm at the 3rd part. But I had quite normal blood pressure and I did't have any arrythmias.
The point is that if I exert myself at a very short time as 7:16 minutes I don't have severe symptoms. When I have to do something that lasts more than 10 minutes things are very different. I can manage to do vigorus exercise for a very short time, but I can't tolerate a longer time even at 150 bpm. It is all a mater of time.
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- Anonymous3 years ago
3Source(s): Hypertension Treatment http://sparkindl.info/ControlYourBloodPressure
- 1 decade ago
Three years ago I was 41. I was submitted to a cardiologist's treadmill stress test on complaints of chest pains. He said I passed with flying colors. That was around 10am. Thirteen hours later my son had to call an ambulance which did an EKG right there on the couch and had me ready for transport to the hospital ASAP! I had complete blockage in the main artery. Once the stent was placed I felt back to normal. YES, you can pass a stress test and still have blockage. Insist on another means of testing.Source(s): personal experience.
- 1 decade ago
did you have chest pain during the stress test?? if not, and no ekg changes, the test is probably about 80 % accurate. however, you may need a nuclear stress test where they do nuclear x ray scans of your coronary artery circulation before and after exercise-painless and non-invasive, it is about 90% accurate. it will show if there are any areas of your heart not getting adequate circulation after stressing it to 90% of your target heart rate. if this is still inconclusive a heart cath is warrented which is the best test there is to physically see the heart arteries and their anatomy- this is invasive but quite safe.Source(s): experienced RN
- 1 decade ago
Stress tests miss at least 10 percent of patients who should have an angiogram. That is the definitive test for blockage. Go ahead and get it done. You're not going to know for sure until then.