Stress Test

[Guest guest]

the lemons... i dont get it.. but all i have to say is GO ME!..i made a new way of thinkin bout all of this!

Love Always

[Guest guest]

thanks Guin but i cant i live in kentucky and we have a regular weekend .. no days off..(BUMMER!) but i would love to go i think that would be alot of fun

Love Always

[Guest guest]

Kathie.. im katie and i said being sick sucks.. so yea

Love Always

[Guest guest]

dear Ks Di,

you poor thing - i feel so badly for you - and as a mom of a 25 year

old.... ah, how i understand all your worries..... so sorry you

are suffering so badly today... take care and all the very very

best regarding your daughter - i'll be thinking of you and sending

positive vibes all the way to KS.....

gentle hugs,

karen

>

> Unfortunately, I was able to perform an experiment on the stress

issue. I

> have been doing great on my new non-wheat diet and supplements. I

only have

> moderate pain in my knees and one hip and am totally off meds.

>

> Last night I got a call from my daughter--in route with her

boyfriend from

> Montana back to KS. They hit black ice and rolled the vehicle.

It was

> totally demolished--but they were wearing seatbelts and walked away

> unharmed. It was a very bad night for me, trying to help them

long distance

> get a hotel, AAA, and discuss how to get them back to KS. When I

woke up

> this morning, I could hardly walk. My knees are throbbing, feel

the size of

> basketballs and I can hardly go up and down stairs. It is not

just that I

> was tense--that would be the stiffness in shoulder, neck and

headache.

>

> So--I believe I have scientific proof that stress causes symptoms

to worsen.

>

> I hope when my daughter arrives home tomorrow, my pain will go

back to

> normal!

>

> Ks Di

[Guest guest]

Greetings all:

I understand that the risk of heart attack is increased 100x after a treadmill stress test. Does anyone have any mortality/morbidity information concerning chemical stress tests? I told my mother in Colorado to decline the treadmill test, and her cardiologist came back with this one. She has had no evidence of heart problems to date. She is 77 y.o., has long-standing hypertension, and some athlerosclerosis. Long history of inappropriately prescribed heart/statin medication. Thanks.

Glenn F. Gumaer

[Guest guest]

More specifically - It is the stress echocardiogram with dobutamine IV.

Glenn F. Gumaer

[Guest guest]

Glenn: I recently heard a couple of nuclear medicine docs talk at a lunch. They perform the stress test you are describing (adensosine?) and it sounded much less stressful (the chemical stressor breaks down in seconds) and more accurate in the population that includes your mother and of course those who cannot perform stress tests due to amputations, bad hips... Another interesting test these folks did was a bone scan-like test to evaluate gallbladder function. They were able to show significant dysfunction and /or blockage in the organ and ducts when diagnostic ultrasound showed "normal gallbladder". The interesting take on their part was that because what they did was so sensitive, they could detect problems that wouldn't be found for 5-10 more years, so these patients could have the problem organ removed earlier!!!! No mention of treatment natural or otherwise, just "we find it and the surgeons can remove it". Amazing "health" perspective Great tools for diagnosis and not a thought about the "whole" person. Seitz, DC RE: Stress Test Greetings all: I understand that the risk of heart attack is increased 100x after a treadmill stress test. Does anyone have any mortality/morbidity information concerning chemical stress tests? I told my mother in Colorado to decline the treadmill test, and her cardiologist came back with this one. She has had no evidence of heart problems to date. She is 77 y.o., has long-standing hypertension, and some athlerosclerosis. Long history of inappropriately prescribed heart/statin medication. Thanks. Glenn F. GumaerOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Glenn,

Read the following 5 abstracts about the safety of exercise testing as a means

of evaluating cardiac function; it is safe and very effective for assessing risk

of a future event. Whereever the 100 fold risk of MI statistic came from appears

to be misinformed. You may be doing your mom a disservice by steering her away

from the test.

Freeman

1: Int J Cardiol. 2000 Sep 15;75(2-3):239-43.

Utility and safety of immediate exercise testing of low-risk patients admitted

to the hospital with acute chest pain.

Sarullo FM, Di Pasquale P, Orlando G, Buffa G, Cicero S, Schillaci AM, Castello

A.

Division of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Via S.

Puglisi n.15, 90143, Palermo, Italy. fsarullo@...

It is common practice to hospitalize patients with chest pain for a period of

observation and to perform further diagnostic evaluation such as exercise

treadmill testing (ETT) once acute myocardial infarction (AMI) has been

excluded. This study evaluates the safety and efficacy of immediate ETT for

patients admitted to the hospital with acute chest pain. One hundred and ninety

non-consecutive low-risk patients admitted to the hospital from emergency

department with acute chest pain underwent ETT using Bruce protocol immediately

on admission to the hospital (median time 165+30 min). Fifty-seven (30%)

patients had positive exercise electrocardiograms, 44 (77.2%) of whom had

significant coronary narrowing by angiography. An uncomplicated anterior

non-Q-wave AMI was diagnosed in one patient. One hundred and eleven (58.4%)

patients had negative and 22 (11.6%) patients had non-diagnostic exercise

electrocardiograms. Of these 133 patients, 86 (64.7%) were discharged

immediately after ETT, 19 (14.3%) were discharged within 24 h, and 28 (21%) were

discharged after 24 h of observation. There were no complications from ETT.

During the 17+/-6 months follow-up no patients died, and only eight (7.2%)

patients with negative ETT experienced a major cardiac event (one AMI and seven

angina). In conclusion, our results suggest that immediate ETT of low-risk

patients with chest pain who are at sufficient risk to be designated for

hospital admission, is effective in further stratifying this group into those

who can be safety discharged immediately and those who require hospitalization.

1: J Am Coll Cardiol. 2002 Jul 17;40(2):251-6.

Immediate exercise testing to evaluate low-risk patients presenting to the

emergency department with chest pain.

Amsterdam EA, Kirk JD, Diercks DB, WR, Turnipseed SD.

Division of Cardiovascular Medicine, Department of Internal Medicine, Medical

Center, University of California-, Stockton Boulevard, Sacramento, CA

95817, USA. eaamsterdam@...

OBJECTIVES: Our purpose was to determine the safety and accuracy of immediate

exercise testing in low-risk patients presenting to the emergency department

(ED) with chest pain suggestive of a cardiac etiology. BACKGROUND: Safe,

efficient management of low-risk patients presenting to the ED with chest pain

is a continuing challenge. We have employed immediate exercise testing to

evaluate a large, heterogeneous group of low-risk patients presenting with chest

pain. METHODS: Patients presenting to the ED with chest pain compatible with a

cardiac origin and clinical evidence of low risk on initial assessment underwent

immediate exercise treadmill testing in our chest pain evaluation unit.

Indicators of low clinical risk included no evidence of hemodynamic instability,

arrhythmias or electrocardiographic signs of ischemia. Serial measurements of

cardiac injury markers were not obtained. RESULTS: Exercise testing was

performed to a sign- or symptom-limited end point in 1,000 patients (520 men,

480 women; age range 31 to 82 years) and was positive for ischemia in 13%,

negative in 64% and nondiagnostic in 23% of patients. There were no adverse

effects of exercise testing, and all patients with a negative exercise test were

discharged directly from the ED. At 30-day follow-up there was no mortality in

any of the three groups. Cardiac events in the three groups included: negative

group, 1 non-Q-wave myocardial infarction (MI); positive group, 4 non-Q-wave MIs

and 12 myocardial revascularizations; nondiagnostic group, 7 myocardial

revascularizations. BACKGROUND: Immediate exercise testing of patients

presenting to the ED with chest pain and evidence of low clinical risk is safe

and accurate for determining those who require admission and those who can be

discharged to further outpatient evaluation.

1: Ann Emerg Med. 1993 May;22(5):794-8.

Comment in:

Ann Emerg Med. 1994 Jun;23(6):1396.

Emergency cardiac stress testing in the evaluation of emergency department

patients with atypical chest pain.

Kerns JR, Shaub TF, Fontanarosa PB.

Department of Emergency Medicine, Northeastern Ohio Universities College of

Medicine, Akron.

STUDY OBJECTIVES: To determine the feasibility, safety, and reliability of

emergency cardiac treadmill exercise stress testing (CTEST) in the evaluation of

emergency department patients with atypical chest pain. DESIGN: Thirty-two

patients with atypical chest pain, normal ECGs, and risk factor stratification

having low-probability of coronary artery disease were evaluated prospectively

using outpatient, emergency CTEST. Study patients were compared with a

retrospectively selected sample of admitted patients diagnosed with atypical

chest pain who met the study criteria and were evaluated with CTEST as

inpatients. All patients had follow-up at three and six months after evaluation.

SETTING: University-affiliated community teaching hospital with 65,000 annual ED

visits. RESULTS: All patients had normal CTEST. No patient had evidence of

coronary artery disease, myocardial infarction, or sudden death during the

follow-up period. The average length of stay was 5.5 hours for emergency CTEST

patients versus two days for inpatients. The average patient charge was $467 for

ED evaluation with emergency CTEST versus $2,340 for inpatient evaluation.

CONCLUSION: Emergency CTEST is a safe, efficient, cost-effective, and practical

method of evaluating selected ED patients with chest pain. It is a useful aid

for clinical decision making and may help to prevent unnecessary hospital

admissions.

1: Arq Bras Cardiol. 2003 Aug;81(2):174-81, 166-73. Epub 2003 Sep 16.

Safety, feasibility, and results of exercise testing for stratifying patients

with chest pain in the emergency room.

[Article in English, Portuguese]

Macaciel RM, Mesquita ET, Vivacqua R, Serra S, Campos A, Miranda M, Gamarski R,

Dohman H, Bassan R.

Hospital Pro-Cardiaco e Universidade Federal Fluminense, Rio de Janeiro, RJ,

Brazil. macaciel@...

OBJECTIVE: To assess safety, feasibility, and the results of early exercise

testing in patients with chest pain admitted to the emergency room of the chest

pain unit, in whom acute myocardial infarction and high-risk unstable angina had

been ruled out. METHODS: A study including 1060 consecutive patients with chest

pain admitted to the emergency room of the chest pain unit was carried out. Of

them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%)

underwent the test. RESULTS: The mean age of the patients studied was 51.7 12.1

years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous

history of coronary artery disease, 244 (91%) had a normal or unspecific

electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour

interval. The results of the exercise test in the latter group were as follows:

34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive.

In the group of patients with a positive exercise test, 21 (62%) underwent

coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial

revascularization. In a univariate analysis, type A/B chest pain

(definitely/probably anginal) (p<0.0001), previous coronary artery disease

(p<0.0001), and route 2 (patients at higher risk) correlated with a positive or

inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in

whom acute myocardial infarction and high-risk unstable angina had been ruled

out, the exercise test proved to be feasible, safe, and well tolerated.

Publication Types:

Evaluation Studies

PMID: 14502386 [PubMed - indexed for MEDLINE]

1: Am J Cardiol. 1994 Nov 15;74(10):987-90.

Utility and safety of immediate exercise testing of low-risk patients admitted

to the hospital for suspected acute myocardial infarction.

WR, Amsterdam EA.

Department of Medicine, University of California, School of Medicine,

Sacramento.

More than 2 million patients are admitted to U.S. hospitals annually for

clinical suspicion of acute myocardial infarction (AMI), and > 70% are found not

to have had a cardiac event. This study evaluates the safety and efficacy of

immediate exercise testing for patients admitted to the hospital for suspected

AMI. Ninety-three nonconsecutive low-risk patients admitted to the hospital from

the emergency department to rule out AMI underwent exercise treadmill testing

using a modified Bruce protocol immediately on admission to the hospital (median

time < 1 hour). Twelve patients had positive exercise electrocardiograms, 6 of

whom had significant coronary narrowing by angiography. An uncomplicated

non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients had negative and

22 patients had nondiagnostic exercise electrocardiograms. Of these 81 patients,

44 were discharged immediately after exercise testing, 17 were discharged within

24 hours, and 20 were discharged after 24 hours of observation. There were no

complications from exercise testing. There were 2 late noncardiac deaths and 1

late AMI. Thus, immediate exercise testing of low-risk patients with chest pain

who are at sufficient risk to be designated for hospital admission is effective

in further stratifying this group into those who can be safely discharged

immediately and those who require hospitalization.

PMID: 7977059 [PubMed - indexed for MEDLINE]

D Freeman PhD DC MPH

Forensic Trauma Epidemiologist

Department of Public Health and Preventive Medicine

Oregon Health and Science University School of Medicine

205 Liberty Street NE, Suite B

Salem, OR 97301

503-586-0127

cell 503-871-0715

drmfreeman@...

[Guest guest]

Hi Glen,

If she is asymptomatic, what leads them to believe it is necessary? In a 77

asymptomatic lady, something can always be 'found'...doesn't always means it

needs to be addressed.

If they are looking for a potential event, the high sensitivity C-reactive

protein test can provide an indication of that. Time Magazine had an

excellent lay article on that in the May 4, 2004 issue. It deals with the

systemic inflammation (due to our contaminated/toxic food supply?) and is

the current 'hot tool' for assessment of cardiac risk.

In our office, we have found the General INflammation microcurrent protocol

effective for lowering it 10 - 30%, after 3 treatments, one week apart.

Along with that, we encourage a fundamental regimen of liquid minerals (of

course) and strong levels of vitamin C and Bs along with decreasing the

amount of animal protein in the diet. (after Thanksgiving!)

Sunny ;'-))

Sunny Kierstyn, RN DC

Fibromyalgia Care Center of Oregon

59 Santa Clara St.,

Eugene, Oregon, 97404

541-689-0935

>From: " Dr. Glenn F. Gumaer " <gfgdc@...>

>< >

>Subject: RE: Stress Test

>Date: Wed, 24 Nov 2004 09:26:33 -0800

>

>Greetings all:

>

>I understand that the risk of heart attack is increased 100x after a

>treadmill stress test. Does anyone have any mortality/morbidity information

>concerning chemical stress tests? I told my mother in Colorado to decline

>the treadmill test, and her cardiologist came back with this one. She has

>had no evidence of heart problems to date. She is 77 y.o., has

>long-standing hypertension, and some athlerosclerosis. Long history of

>inappropriately prescribed heart/statin medication. Thanks.

>

>Glenn F. Gumaer

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

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[Guest guest]

Thanks everyone!

I don't recall where that statistic came from, but I do remember the

100-fold increase risk of cardiovascular damage following treadmill stress

testing as the number reported. I'll try to find that reference. Anyway, my

suggestion was to forego the treadmill, until after she completes her

chelation therapy and kidney dialysis treatments. She was on ZOCOR; ZESTRIL;

INDERAL; NORVASC; NITRO-BID; and ALLOPURINOL for many years and developed

stenosis in her right common iliac artery and atrophy of the right kidney -

probably precipitated in part by the prolonged administration of these

drugs. The list of adverse effects includes: rhabdomyolysis, elevated CPK,

liver dysfunction, aplastic anemia, agranulocytosis, methemoglobinemia,

renal failure, leukopenia, and thrombocytopenia, to name a few. She was

prescribed these medications from a Navy MD in San Diego in the 80's, while

she was a smoker, with high blood pressure and drank too much alcohol during

the years that these drugs were prescribed - a direct contraindication for

some of them. Anyway, when I heard that she was going on kidney dialysis, I

stepped in and referred her to a naturopath in Colorado, Dr. Flatland, who

provides chelation therapy. She was put on a diet and supplement regimen,

but couldn't begin chelation until her BUN, creatinine levels improved.

After six months, they seemed to level off and not improve enough. I then

found out that she was on these medications and sent her to a cardiologist,

who agreed to take her off of them. He now wants to perform a stress test.

In light of the dialysis and chelation, I felt it might be better to wait

until after chelation is finished. By the way, since discontinuing these

medications, her lab values have since all dramatically improved, and

dialysis treatments have been reduced.

Glenn F. Gumaer

Re: RE: Stress Test

> Glenn,

> Read the following 5 abstracts about the safety of exercise testing as a

means of evaluating cardiac function; it is safe and very effective for

assessing risk of a future event. Whereever the 100 fold risk of MI

statistic came from appears to be misinformed. You may be doing your mom a

disservice by steering her away from the test.

>

> Freeman

>

>

>

> 1: Int J Cardiol. 2000 Sep 15;75(2-3):239-43.

>

> Utility and safety of immediate exercise testing of low-risk patients

admitted

> to the hospital with acute chest pain.

>

> Sarullo FM, Di Pasquale P, Orlando G, Buffa G, Cicero S, Schillaci AM,

Castello

> A.

>

> Division of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Via

S.

> Puglisi n.15, 90143, Palermo, Italy. fsarullo@...

>

> It is common practice to hospitalize patients with chest pain for a period

of

> observation and to perform further diagnostic evaluation such as exercise

> treadmill testing (ETT) once acute myocardial infarction (AMI) has been

> excluded. This study evaluates the safety and efficacy of immediate ETT

for

> patients admitted to the hospital with acute chest pain. One hundred and

ninety

> non-consecutive low-risk patients admitted to the hospital from emergency

> department with acute chest pain underwent ETT using Bruce protocol

immediately

> on admission to the hospital (median time 165+30 min). Fifty-seven (30%)

> patients had positive exercise electrocardiograms, 44 (77.2%) of whom had

> significant coronary narrowing by angiography. An uncomplicated anterior

> non-Q-wave AMI was diagnosed in one patient. One hundred and eleven

(58.4%)

> patients had negative and 22 (11.6%) patients had non-diagnostic exercise

> electrocardiograms. Of these 133 patients, 86 (64.7%) were discharged

> immediately after ETT, 19 (14.3%) were discharged within 24 h, and 28

(21%) were

> discharged after 24 h of observation. There were no complications from

ETT.

> During the 17+/-6 months follow-up no patients died, and only eight (7.2%)

> patients with negative ETT experienced a major cardiac event (one AMI and

seven

> angina). In conclusion, our results suggest that immediate ETT of low-risk

> patients with chest pain who are at sufficient risk to be designated for

> hospital admission, is effective in further stratifying this group into

those

> who can be safety discharged immediately and those who require

hospitalization.

>

> 1: J Am Coll Cardiol. 2002 Jul 17;40(2):251-6.

>

> Immediate exercise testing to evaluate low-risk patients presenting to the

> emergency department with chest pain.

>

> Amsterdam EA, Kirk JD, Diercks DB, WR, Turnipseed SD.

>

> Division of Cardiovascular Medicine, Department of Internal Medicine,

Medical

> Center, University of California-, Stockton Boulevard, Sacramento, CA

> 95817, USA. eaamsterdam@...

>

> OBJECTIVES: Our purpose was to determine the safety and accuracy of

immediate

> exercise testing in low-risk patients presenting to the emergency

department

> (ED) with chest pain suggestive of a cardiac etiology. BACKGROUND: Safe,

> efficient management of low-risk patients presenting to the ED with chest

pain

> is a continuing challenge. We have employed immediate exercise testing to

> evaluate a large, heterogeneous group of low-risk patients presenting with

chest

> pain. METHODS: Patients presenting to the ED with chest pain compatible

with a

> cardiac origin and clinical evidence of low risk on initial assessment

underwent

> immediate exercise treadmill testing in our chest pain evaluation unit.

> Indicators of low clinical risk included no evidence of hemodynamic

instability,

> arrhythmias or electrocardiographic signs of ischemia. Serial measurements

of

> cardiac injury markers were not obtained. RESULTS: Exercise testing was

> performed to a sign- or symptom-limited end point in 1,000 patients (520

men,

> 480 women; age range 31 to 82 years) and was positive for ischemia in 13%,

> negative in 64% and nondiagnostic in 23% of patients. There were no

adverse

> effects of exercise testing, and all patients with a negative exercise

test were

> discharged directly from the ED. At 30-day follow-up there was no

mortality in

> any of the three groups. Cardiac events in the three groups included:

negative

> group, 1 non-Q-wave myocardial infarction (MI); positive group, 4

non-Q-wave MIs

> and 12 myocardial revascularizations; nondiagnostic group, 7 myocardial

> revascularizations. BACKGROUND: Immediate exercise testing of patients

> presenting to the ED with chest pain and evidence of low clinical risk is

safe

> and accurate for determining those who require admission and those who can

be

> discharged to further outpatient evaluation.

>

> 1: Ann Emerg Med. 1993 May;22(5):794-8.

>

> Comment in:

> Ann Emerg Med. 1994 Jun;23(6):1396.

>

> Emergency cardiac stress testing in the evaluation of emergency department

> patients with atypical chest pain.

>

> Kerns JR, Shaub TF, Fontanarosa PB.

>

> Department of Emergency Medicine, Northeastern Ohio Universities College

of

> Medicine, Akron.

>

> STUDY OBJECTIVES: To determine the feasibility, safety, and reliability of

> emergency cardiac treadmill exercise stress testing (CTEST) in the

evaluation of

> emergency department patients with atypical chest pain. DESIGN: Thirty-two

> patients with atypical chest pain, normal ECGs, and risk factor

stratification

> having low-probability of coronary artery disease were evaluated

prospectively

> using outpatient, emergency CTEST. Study patients were compared with a

> retrospectively selected sample of admitted patients diagnosed with

atypical

> chest pain who met the study criteria and were evaluated with CTEST as

> inpatients. All patients had follow-up at three and six months after

evaluation.

> SETTING: University-affiliated community teaching hospital with 65,000

annual ED

> visits. RESULTS: All patients had normal CTEST. No patient had evidence of

> coronary artery disease, myocardial infarction, or sudden death during the

> follow-up period. The average length of stay was 5.5 hours for emergency

CTEST

> patients versus two days for inpatients. The average patient charge was

$467 for

> ED evaluation with emergency CTEST versus $2,340 for inpatient evaluation.

> CONCLUSION: Emergency CTEST is a safe, efficient, cost-effective, and

practical

> method of evaluating selected ED patients with chest pain. It is a useful

aid

> for clinical decision making and may help to prevent unnecessary hospital

> admissions.

>

> 1: Arq Bras Cardiol. 2003 Aug;81(2):174-81, 166-73. Epub 2003 Sep 16.

>

> Safety, feasibility, and results of exercise testing for stratifying

patients

> with chest pain in the emergency room.

>

> [Article in English, Portuguese]

>

> Macaciel RM, Mesquita ET, Vivacqua R, Serra S, Campos A, Miranda M,

Gamarski R,

> Dohman H, Bassan R.

>

> Hospital Pro-Cardiaco e Universidade Federal Fluminense, Rio de Janeiro,

RJ,

> Brazil. macaciel@...

>

> OBJECTIVE: To assess safety, feasibility, and the results of early

exercise

> testing in patients with chest pain admitted to the emergency room of the

chest

> pain unit, in whom acute myocardial infarction and high-risk unstable

angina had

> been ruled out. METHODS: A study including 1060 consecutive patients with

chest

> pain admitted to the emergency room of the chest pain unit was carried

out. Of

> them, 677 (64%) patients were eligible for exercise testing, but only 268

(40%)

> underwent the test. RESULTS: The mean age of the patients studied was 51.7

12.1

> years, and 188 (70%) were males. Twenty-eight (10%) patients had a

previous

> history of coronary artery disease, 244 (91%) had a normal or unspecific

> electrocardiogram, and 150 (56%) underwent exercise testing within a

12-hour

> interval. The results of the exercise test in the latter group were as

follows:

> 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were

inconclusive.

> In the group of patients with a positive exercise test, 21 (62%) underwent

> coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial

> revascularization. In a univariate analysis, type A/B chest pain

> (definitely/probably anginal) (p<0.0001), previous coronary artery disease

> (p<0.0001), and route 2 (patients at higher risk) correlated with a

positive or

> inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and

in

> whom acute myocardial infarction and high-risk unstable angina had been

ruled

> out, the exercise test proved to be feasible, safe, and well tolerated.

>

> Publication Types:

> Evaluation Studies

>

> PMID: 14502386 [PubMed - indexed for MEDLINE]

>

>

>

> 1: Am J Cardiol. 1994 Nov 15;74(10):987-90.

>

> Utility and safety of immediate exercise testing of low-risk patients

admitted

> to the hospital for suspected acute myocardial infarction.

>

> WR, Amsterdam EA.

>

> Department of Medicine, University of California, School of

Medicine,

> Sacramento.

>

> More than 2 million patients are admitted to U.S. hospitals annually for

> clinical suspicion of acute myocardial infarction (AMI), and > 70% are

found not

> to have had a cardiac event. This study evaluates the safety and efficacy

of

> immediate exercise testing for patients admitted to the hospital for

suspected

> AMI. Ninety-three nonconsecutive low-risk patients admitted to the

hospital from

> the emergency department to rule out AMI underwent exercise treadmill

testing

> using a modified Bruce protocol immediately on admission to the hospital

(median

> time < 1 hour). Twelve patients had positive exercise electrocardiograms,

6 of

> whom had significant coronary narrowing by angiography. An uncomplicated

> non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients had

negative and

> 22 patients had nondiagnostic exercise electrocardiograms. Of these 81

patients,

> 44 were discharged immediately after exercise testing, 17 were discharged

within

> 24 hours, and 20 were discharged after 24 hours of observation. There were

no

> complications from exercise testing. There were 2 late noncardiac deaths

and 1

> late AMI. Thus, immediate exercise testing of low-risk patients with chest

pain

> who are at sufficient risk to be designated for hospital admission is

effective

> in further stratifying this group into those who can be safely discharged

> immediately and those who require hospitalization.

>

> PMID: 7977059 [PubMed - indexed for MEDLINE]

>

>

>

>

>

>

>

>

>

>

>

>

>

> D Freeman PhD DC MPH

> Forensic Trauma Epidemiologist

> Department of Public Health and Preventive Medicine

> Oregon Health and Science University School of Medicine

> 205 Liberty Street NE, Suite B

> Salem, OR 97301

> 503-586-0127

> cell 503-871-0715

> drmfreeman@...

[Guest guest]

Glenn,

The American College of Sports Medicine Guidlines for Exercise Testing

and Prescription, 3rd edition....Exercise stress test risk is 1:10,000

for the general population.

Ted

Ted Forcum, DC, DACBSP, FICC, CSCS

Medical Director, 2005 Portland US Figure Skating Championships

Back In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

On Wed, 24 Nov 2004 15:31:31 -0800 " Dr. Glenn F. Gumaer "

<gfgdc@...> writes:

>

> Thanks everyone!

>

> I don't recall where that statistic came from, but I do remember

> the

> 100-fold increase risk of cardiovascular damage following treadmill

> stress

> testing as the number reported. I'll try to find that reference.

> Anyway, my

> suggestion was to forego the treadmill, until after she completes

> her

> chelation therapy and kidney dialysis treatments. She was on ZOCOR;

> ZESTRIL;

> INDERAL; NORVASC; NITRO-BID; and ALLOPURINOL for many years and

> developed

> stenosis in her right common iliac artery and atrophy of the right

> kidney -

> probably precipitated in part by the prolonged administration of

> these

> drugs. The list of adverse effects includes: rhabdomyolysis,

> elevated CPK,

> liver dysfunction, aplastic anemia, agranulocytosis,

> methemoglobinemia,

> renal failure, leukopenia, and thrombocytopenia, to name a few. She

> was

> prescribed these medications from a Navy MD in San Diego in the

> 80's, while

> she was a smoker, with high blood pressure and drank too much

> alcohol during

> the years that these drugs were prescribed - a direct

> contraindication for

> some of them. Anyway, when I heard that she was going on kidney

> dialysis, I

> stepped in and referred her to a naturopath in Colorado, Dr.

> Flatland, who

> provides chelation therapy. She was put on a diet and supplement

> regimen,

> but couldn't begin chelation until her BUN, creatinine levels

> improved.

> After six months, they seemed to level off and not improve enough. I

> then

> found out that she was on these medications and sent her to a

> cardiologist,

> who agreed to take her off of them. He now wants to perform a stress

> test.

> In light of the dialysis and chelation, I felt it might be better to

> wait

> until after chelation is finished. By the way, since discontinuing

> these

> medications, her lab values have since all dramatically improved,

> and

> dialysis treatments have been reduced.

>

> Glenn F. Gumaer

>

>

> Re: RE: Stress Test

>

>

> > Glenn,

> > Read the following 5 abstracts about the safety of exercise

> testing as a

> means of evaluating cardiac function; it is safe and very effective

> for

> assessing risk of a future event. Whereever the 100 fold risk of MI

> statistic came from appears to be misinformed. You may be doing your

> mom a

> disservice by steering her away from the test.

> >

> > Freeman

> >

> >

> >

> > 1: Int J Cardiol. 2000 Sep 15;75(2-3):239-43.

> >

> > Utility and safety of immediate exercise testing of low-risk

> patients

> admitted

> > to the hospital with acute chest pain.

> >

> > Sarullo FM, Di Pasquale P, Orlando G, Buffa G, Cicero S, Schillaci

> AM,

> Castello

> > A.

> >

> > Division of Cardiology, Buccheri La Ferla Fatebenefratelli

> Hospital, Via

> S.

> > Puglisi n.15, 90143, Palermo, Italy. fsarullo@...

> >

> > It is common practice to hospitalize patients with chest pain for

> a period

> of

> > observation and to perform further diagnostic evaluation such as

> exercise

> > treadmill testing (ETT) once acute myocardial infarction (AMI) has

> been

> > excluded. This study evaluates the safety and efficacy of

> immediate ETT

> for

> > patients admitted to the hospital with acute chest pain. One

> hundred and

> ninety

> > non-consecutive low-risk patients admitted to the hospital from

> emergency

> > department with acute chest pain underwent ETT using Bruce

> protocol

> immediately

> > on admission to the hospital (median time 165+30 min). Fifty-seven

> (30%)

> > patients had positive exercise electrocardiograms, 44 (77.2%) of

> whom had

> > significant coronary narrowing by angiography. An uncomplicated

> anterior

> > non-Q-wave AMI was diagnosed in one patient. One hundred and

> eleven

> (58.4%)

> > patients had negative and 22 (11.6%) patients had non-diagnostic

> exercise

> > electrocardiograms. Of these 133 patients, 86 (64.7%) were

> discharged

> > immediately after ETT, 19 (14.3%) were discharged within 24 h, and

> 28

> (21%) were

> > discharged after 24 h of observation. There were no complications

> from

> ETT.

> > During the 17+/-6 months follow-up no patients died, and only

> eight (7.2%)

> > patients with negative ETT experienced a major cardiac event (one

> AMI and

> seven

> > angina). In conclusion, our results suggest that immediate ETT of

> low-risk

> > patients with chest pain who are at sufficient risk to be

> designated for

> > hospital admission, is effective in further stratifying this group

> into

> those

> > who can be safety discharged immediately and those who require

> hospitalization.

> >

> > 1: J Am Coll Cardiol. 2002 Jul 17;40(2):251-6.

> >

> > Immediate exercise testing to evaluate low-risk patients

> presenting to the

> > emergency department with chest pain.

> >

> > Amsterdam EA, Kirk JD, Diercks DB, WR, Turnipseed SD.

> >

> > Division of Cardiovascular Medicine, Department of Internal

> Medicine,

> Medical

> > Center, University of California-, Stockton Boulevard,

> Sacramento, CA

> > 95817, USA. eaamsterdam@...

> >

> > OBJECTIVES: Our purpose was to determine the safety and accuracy

> of

> immediate

> > exercise testing in low-risk patients presenting to the emergency

> department

> > (ED) with chest pain suggestive of a cardiac etiology. BACKGROUND:

> Safe,

> > efficient management of low-risk patients presenting to the ED

> with chest

> pain

> > is a continuing challenge. We have employed immediate exercise

> testing to

> > evaluate a large, heterogeneous group of low-risk patients

> presenting with

> chest

> > pain. METHODS: Patients presenting to the ED with chest pain

> compatible

> with a

> > cardiac origin and clinical evidence of low risk on initial

> assessment

> underwent

> > immediate exercise treadmill testing in our chest pain evaluation

> unit.

> > Indicators of low clinical risk included no evidence of

> hemodynamic

> instability,

> > arrhythmias or electrocardiographic signs of ischemia. Serial

> measurements

> of

> > cardiac injury markers were not obtained. RESULTS: Exercise

> testing was

> > performed to a sign- or symptom-limited end point in 1,000

> patients (520

> men,

> > 480 women; age range 31 to 82 years) and was positive for ischemia

> in 13%,

> > negative in 64% and nondiagnostic in 23% of patients. There were

> no

> adverse

> > effects of exercise testing, and all patients with a negative

> exercise

> test were

> > discharged directly from the ED. At 30-day follow-up there was no

> mortality in

> > any of the three groups. Cardiac events in the three groups

> included:

> negative

> > group, 1 non-Q-wave myocardial infarction (MI); positive group, 4

> non-Q-wave MIs

> > and 12 myocardial revascularizations; nondiagnostic group, 7

> myocardial

> > revascularizations. BACKGROUND: Immediate exercise testing of

> patients

> > presenting to the ED with chest pain and evidence of low clinical

> risk is

> safe

> > and accurate for determining those who require admission and those

> who can

> be

> > discharged to further outpatient evaluation.

> >

> > 1: Ann Emerg Med. 1993 May;22(5):794-8.

> >

> > Comment in:

> > Ann Emerg Med. 1994 Jun;23(6):1396.

> >

> > Emergency cardiac stress testing in the evaluation of emergency

> department

> > patients with atypical chest pain.

> >

> > Kerns JR, Shaub TF, Fontanarosa PB.

> >

> > Department of Emergency Medicine, Northeastern Ohio Universities

> College

> of

> > Medicine, Akron.

> >

> > STUDY OBJECTIVES: To determine the feasibility, safety, and

> reliability of

> > emergency cardiac treadmill exercise stress testing (CTEST) in

> the

> evaluation of

> > emergency department patients with atypical chest pain. DESIGN:

> Thirty-two

> > patients with atypical chest pain, normal ECGs, and risk factor

> stratification

> > having low-probability of coronary artery disease were evaluated

> prospectively

> > using outpatient, emergency CTEST. Study patients were compared

> with a

> > retrospectively selected sample of admitted patients diagnosed

> with

> atypical

> > chest pain who met the study criteria and were evaluated with

> CTEST as

> > inpatients. All patients had follow-up at three and six months

> after

> evaluation.

> > SETTING: University-affiliated community teaching hospital with

> 65,000

> annual ED

> > visits. RESULTS: All patients had normal CTEST. No patient had

> evidence of

> > coronary artery disease, myocardial infarction, or sudden death

> during the

> > follow-up period. The average length of stay was 5.5 hours for

> emergency

> CTEST

> > patients versus two days for inpatients. The average patient

> charge was

> $467 for

> > ED evaluation with emergency CTEST versus $2,340 for inpatient

> evaluation.

> > CONCLUSION: Emergency CTEST is a safe, efficient, cost-effective,

> and

> practical

> > method of evaluating selected ED patients with chest pain. It is a

> useful

> aid

> > for clinical decision making and may help to prevent unnecessary

> hospital

> > admissions.

> >

> > 1: Arq Bras Cardiol. 2003 Aug;81(2):174-81, 166-73. Epub 2003 Sep

> 16.

> >

> > Safety, feasibility, and results of exercise testing for

> stratifying

> patients

> > with chest pain in the emergency room.

> >

> > [Article in English, Portuguese]

> >

> > Macaciel RM, Mesquita ET, Vivacqua R, Serra S, Campos A, Miranda

> M,

> Gamarski R,

> > Dohman H, Bassan R.

> >

> > Hospital Pro-Cardiaco e Universidade Federal Fluminense, Rio de

> Janeiro,

> RJ,

> > Brazil. macaciel@...

> >

> > OBJECTIVE: To assess safety, feasibility, and the results of

> early

> exercise

> > testing in patients with chest pain admitted to the emergency room

> of the

> chest

> > pain unit, in whom acute myocardial infarction and high-risk

> unstable

> angina had

> > been ruled out. METHODS: A study including 1060 consecutive

> patients with

> chest

> > pain admitted to the emergency room of the chest pain unit was

> carried

> out. Of

> > them, 677 (64%) patients were eligible for exercise testing, but

> only 268

> (40%)

> > underwent the test. RESULTS: The mean age of the patients studied

> was 51.7

> 12.1

> > years, and 188 (70%) were males. Twenty-eight (10%) patients had

> a

> previous

> > history of coronary artery disease, 244 (91%) had a normal or

> unspecific

> > electrocardiogram, and 150 (56%) underwent exercise testing within

> a

> 12-hour

> > interval. The results of the exercise test in the latter group

> were as

> follows:

> > 34 (13%) were positive, 191 (71%) were negative, and 43 (16%)

> were

> inconclusive.

> > In the group of patients with a positive exercise test, 21 (62%)

> underwent

> > coronary angiography, 11 underwent angioplasty, and 2 underwent

> myocardial

> > revascularization. In a univariate analysis, type A/B chest pain

> > (definitely/probably anginal) (p<0.0001), previous coronary artery

> disease

> > (p<0.0001), and route 2 (patients at higher risk) correlated with

> a

> positive or

> > inconclusive test (p<0.0001). CONCLUSION: In patients with chest

> pain and

> in

> > whom acute myocardial infarction and high-risk unstable angina had

> been

> ruled

> > out, the exercise test proved to be feasible, safe, and well

> tolerated.

> >

> > Publication Types:

> > Evaluation Studies

> >

> > PMID: 14502386 [PubMed - indexed for MEDLINE]

> >

> >

> >

> > 1: Am J Cardiol. 1994 Nov 15;74(10):987-90.

> >

> > Utility and safety of immediate exercise testing of low-risk

> patients

> admitted

> > to the hospital for suspected acute myocardial infarction.

> >

> > WR, Amsterdam EA.

> >

> > Department of Medicine, University of California, School of

> Medicine,

> > Sacramento.

> >

> > More than 2 million patients are admitted to U.S. hospitals

> annually for

> > clinical suspicion of acute myocardial infarction (AMI), and > 70%

> are

> found not

> > to have had a cardiac event. This study evaluates the safety and

> efficacy

> of

> > immediate exercise testing for patients admitted to the hospital

> for

> suspected

> > AMI. Ninety-three nonconsecutive low-risk patients admitted to

> the

> hospital from

> > the emergency department to rule out AMI underwent exercise

> treadmill

> testing

> > using a modified Bruce protocol immediately on admission to the

> hospital

> (median

> > time < 1 hour). Twelve patients had positive exercise

> electrocardiograms,

> 6 of

> > whom had significant coronary narrowing by angiography. An

> uncomplicated

> > non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients

> had

> negative and

> > 22 patients had nondiagnostic exercise electrocardiograms. Of

> these 81

> patients,

> > 44 were discharged immediately after exercise testing, 17 were

> discharged

> within

> > 24 hours, and 20 were discharged after 24 hours of observation.

> There were

> no

> > complications from exercise testing. There were 2 late noncardiac

> deaths

> and 1

> > late AMI. Thus, immediate exercise testing of low-risk patients

> with chest

> pain

> > who are at sufficient risk to be designated for hospital admission

> is

> effective

> > in further stratifying this group into those who can be safely

> discharged

> > immediately and those who require hospitalization.

> >

> > PMID: 7977059 [PubMed - indexed for MEDLINE]

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > D Freeman PhD DC MPH

> > Forensic Trauma Epidemiologist

> > Department of Public Health and Preventive Medicine

> > Oregon Health and Science University School of Medicine

> > 205 Liberty Street NE, Suite B

> > Salem, OR 97301

> > 503-586-0127

> > cell 503-871-0715

> > drmfreeman@...

>

>

>

>

[Guest guest]

Thanks Ted:

If the risk is one in ten thousand for the general population, I wonder what

the statistic might be for including only those in the over-medicated,

sedentary geriatric population? I'll bet they'd drop like flies!

Glenn F. Gumaer

Re: RE: Stress Test

> >

> >

> > > Glenn,

> > > Read the following 5 abstracts about the safety of exercise

> > testing as a

> > means of evaluating cardiac function; it is safe and very effective

> > for

> > assessing risk of a future event. Whereever the 100 fold risk of MI

> > statistic came from appears to be misinformed. You may be doing your

> > mom a

> > disservice by steering her away from the test.

> > >

> > > Freeman

> > >

> > >

> > >

> > > 1: Int J Cardiol. 2000 Sep 15;75(2-3):239-43.

> > >

> > > Utility and safety of immediate exercise testing of low-risk

> > patients

> > admitted

> > > to the hospital with acute chest pain.

> > >

> > > Sarullo FM, Di Pasquale P, Orlando G, Buffa G, Cicero S, Schillaci

> > AM,

> > Castello

> > > A.

> > >

> > > Division of Cardiology, Buccheri La Ferla Fatebenefratelli

> > Hospital, Via

> > S.

> > > Puglisi n.15, 90143, Palermo, Italy. fsarullo@...

> > >

> > > It is common practice to hospitalize patients with chest pain for

> > a period

> > of

> > > observation and to perform further diagnostic evaluation such as

> > exercise

> > > treadmill testing (ETT) once acute myocardial infarction (AMI) has

> > been

> > > excluded. This study evaluates the safety and efficacy of

> > immediate ETT

> > for

> > > patients admitted to the hospital with acute chest pain. One

> > hundred and

> > ninety

> > > non-consecutive low-risk patients admitted to the hospital from

> > emergency

> > > department with acute chest pain underwent ETT using Bruce

> > protocol

> > immediately

> > > on admission to the hospital (median time 165+30 min). Fifty-seven

> > (30%)

> > > patients had positive exercise electrocardiograms, 44 (77.2%) of

> > whom had

> > > significant coronary narrowing by angiography. An uncomplicated

> > anterior

> > > non-Q-wave AMI was diagnosed in one patient. One hundred and

> > eleven

> > (58.4%)

> > > patients had negative and 22 (11.6%) patients had non-diagnostic

> > exercise

> > > electrocardiograms. Of these 133 patients, 86 (64.7%) were

> > discharged

> > > immediately after ETT, 19 (14.3%) were discharged within 24 h, and

> > 28

> > (21%) were

> > > discharged after 24 h of observation. There were no complications

> > from

> > ETT.

> > > During the 17+/-6 months follow-up no patients died, and only

> > eight (7.2%)

> > > patients with negative ETT experienced a major cardiac event (one

> > AMI and

> > seven

> > > angina). In conclusion, our results suggest that immediate ETT of

> > low-risk

> > > patients with chest pain who are at sufficient risk to be

> > designated for

> > > hospital admission, is effective in further stratifying this group

> > into

> > those

> > > who can be safety discharged immediately and those who require

> > hospitalization.

> > >

> > > 1: J Am Coll Cardiol. 2002 Jul 17;40(2):251-6.

> > >

> > > Immediate exercise testing to evaluate low-risk patients

> > presenting to the

> > > emergency department with chest pain.

> > >

> > > Amsterdam EA, Kirk JD, Diercks DB, WR, Turnipseed SD.

> > >

> > > Division of Cardiovascular Medicine, Department of Internal

> > Medicine,

> > Medical

> > > Center, University of California-, Stockton Boulevard,

> > Sacramento, CA

> > > 95817, USA. eaamsterdam@...

> > >

> > > OBJECTIVES: Our purpose was to determine the safety and accuracy

> > of

> > immediate

> > > exercise testing in low-risk patients presenting to the emergency

> > department

> > > (ED) with chest pain suggestive of a cardiac etiology. BACKGROUND:

> > Safe,

> > > efficient management of low-risk patients presenting to the ED

> > with chest

> > pain

> > > is a continuing challenge. We have employed immediate exercise

> > testing to

> > > evaluate a large, heterogeneous group of low-risk patients

> > presenting with

> > chest

> > > pain. METHODS: Patients presenting to the ED with chest pain

> > compatible

> > with a

> > > cardiac origin and clinical evidence of low risk on initial

> > assessment

> > underwent

> > > immediate exercise treadmill testing in our chest pain evaluation

> > unit.

> > > Indicators of low clinical risk included no evidence of

> > hemodynamic

> > instability,

> > > arrhythmias or electrocardiographic signs of ischemia. Serial

> > measurements

> > of

> > > cardiac injury markers were not obtained. RESULTS: Exercise

> > testing was

> > > performed to a sign- or symptom-limited end point in 1,000

> > patients (520

> > men,

> > > 480 women; age range 31 to 82 years) and was positive for ischemia

> > in 13%,

> > > negative in 64% and nondiagnostic in 23% of patients. There were

> > no

> > adverse

> > > effects of exercise testing, and all patients with a negative

> > exercise

> > test were

> > > discharged directly from the ED. At 30-day follow-up there was no

> > mortality in

> > > any of the three groups. Cardiac events in the three groups

> > included:

> > negative

> > > group, 1 non-Q-wave myocardial infarction (MI); positive group, 4

> > non-Q-wave MIs

> > > and 12 myocardial revascularizations; nondiagnostic group, 7

> > myocardial

> > > revascularizations. BACKGROUND: Immediate exercise testing of

> > patients

> > > presenting to the ED with chest pain and evidence of low clinical

> > risk is

> > safe

> > > and accurate for determining those who require admission and those

> > who can

> > be

> > > discharged to further outpatient evaluation.

> > >

> > > 1: Ann Emerg Med. 1993 May;22(5):794-8.

> > >

> > > Comment in:

> > > Ann Emerg Med. 1994 Jun;23(6):1396.

> > >

> > > Emergency cardiac stress testing in the evaluation of emergency

> > department

> > > patients with atypical chest pain.

> > >

> > > Kerns JR, Shaub TF, Fontanarosa PB.

> > >

> > > Department of Emergency Medicine, Northeastern Ohio Universities

> > College

> > of

> > > Medicine, Akron.

> > >

> > > STUDY OBJECTIVES: To determine the feasibility, safety, and

> > reliability of

> > > emergency cardiac treadmill exercise stress testing (CTEST) in

> > the

> > evaluation of

> > > emergency department patients with atypical chest pain. DESIGN:

> > Thirty-two

> > > patients with atypical chest pain, normal ECGs, and risk factor

> > stratification

> > > having low-probability of coronary artery disease were evaluated

> > prospectively

> > > using outpatient, emergency CTEST. Study patients were compared

> > with a

> > > retrospectively selected sample of admitted patients diagnosed

> > with

> > atypical

> > > chest pain who met the study criteria and were evaluated with

> > CTEST as

> > > inpatients. All patients had follow-up at three and six months

> > after

> > evaluation.

> > > SETTING: University-affiliated community teaching hospital with

> > 65,000

> > annual ED

> > > visits. RESULTS: All patients had normal CTEST. No patient had

> > evidence of

> > > coronary artery disease, myocardial infarction, or sudden death

> > during the

> > > follow-up period. The average length of stay was 5.5 hours for

> > emergency

> > CTEST

> > > patients versus two days for inpatients. The average patient

> > charge was

> > $467 for

> > > ED evaluation with emergency CTEST versus $2,340 for inpatient

> > evaluation.

> > > CONCLUSION: Emergency CTEST is a safe, efficient, cost-effective,

> > and

> > practical

> > > method of evaluating selected ED patients with chest pain. It is a

> > useful

> > aid

> > > for clinical decision making and may help to prevent unnecessary

> > hospital

> > > admissions.

> > >

> > > 1: Arq Bras Cardiol. 2003 Aug;81(2):174-81, 166-73. Epub 2003 Sep

> > 16.

> > >

> > > Safety, feasibility, and results of exercise testing for

> > stratifying

> > patients

> > > with chest pain in the emergency room.

> > >

> > > [Article in English, Portuguese]

> > >

> > > Macaciel RM, Mesquita ET, Vivacqua R, Serra S, Campos A, Miranda

> > M,

> > Gamarski R,

> > > Dohman H, Bassan R.

> > >

> > > Hospital Pro-Cardiaco e Universidade Federal Fluminense, Rio de

> > Janeiro,

> > RJ,

> > > Brazil. macaciel@...

> > >

> > > OBJECTIVE: To assess safety, feasibility, and the results of

> > early

> > exercise

> > > testing in patients with chest pain admitted to the emergency room

> > of the

> > chest

> > > pain unit, in whom acute myocardial infarction and high-risk

> > unstable

> > angina had

> > > been ruled out. METHODS: A study including 1060 consecutive

> > patients with

> > chest

> > > pain admitted to the emergency room of the chest pain unit was

> > carried

> > out. Of

> > > them, 677 (64%) patients were eligible for exercise testing, but

> > only 268

> > (40%)

> > > underwent the test. RESULTS: The mean age of the patients studied

> > was 51.7

> > 12.1

> > > years, and 188 (70%) were males. Twenty-eight (10%) patients had

> > a

> > previous

> > > history of coronary artery disease, 244 (91%) had a normal or

> > unspecific

> > > electrocardiogram, and 150 (56%) underwent exercise testing within

> > a

> > 12-hour

> > > interval. The results of the exercise test in the latter group

> > were as

> > follows:

> > > 34 (13%) were positive, 191 (71%) were negative, and 43 (16%)

> > were

> > inconclusive.

> > > In the group of patients with a positive exercise test, 21 (62%)

> > underwent

> > > coronary angiography, 11 underwent angioplasty, and 2 underwent

> > myocardial

> > > revascularization. In a univariate analysis, type A/B chest pain

> > > (definitely/probably anginal) (p<0.0001), previous coronary artery

> > disease

> > > (p<0.0001), and route 2 (patients at higher risk) correlated with

> > a

> > positive or

> > > inconclusive test (p<0.0001). CONCLUSION: In patients with chest

> > pain and

> > in

> > > whom acute myocardial infarction and high-risk unstable angina had

> > been

> > ruled

> > > out, the exercise test proved to be feasible, safe, and well

> > tolerated.

> > >

> > > Publication Types:

> > > Evaluation Studies

> > >

> > > PMID: 14502386 [PubMed - indexed for MEDLINE]

> > >

> > >

> > >

> > > 1: Am J Cardiol. 1994 Nov 15;74(10):987-90.

> > >

> > > Utility and safety of immediate exercise testing of low-risk

> > patients

> > admitted

> > > to the hospital for suspected acute myocardial infarction.

> > >

> > > WR, Amsterdam EA.

> > >

> > > Department of Medicine, University of California, School of

> > Medicine,

> > > Sacramento.

> > >

> > > More than 2 million patients are admitted to U.S. hospitals

> > annually for

> > > clinical suspicion of acute myocardial infarction (AMI), and > 70%

> > are

> > found not

> > > to have had a cardiac event. This study evaluates the safety and

> > efficacy

> > of

> > > immediate exercise testing for patients admitted to the hospital

> > for

> > suspected

> > > AMI. Ninety-three nonconsecutive low-risk patients admitted to

> > the

> > hospital from

> > > the emergency department to rule out AMI underwent exercise

> > treadmill

> > testing

> > > using a modified Bruce protocol immediately on admission to the

> > hospital

> > (median

> > > time < 1 hour). Twelve patients had positive exercise

> > electrocardiograms,

> > 6 of

> > > whom had significant coronary narrowing by angiography. An

> > uncomplicated

> > > non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients

> > had

> > negative and

> > > 22 patients had nondiagnostic exercise electrocardiograms. Of

> > these 81

> > patients,

> > > 44 were discharged immediately after exercise testing, 17 were

> > discharged

> > within

> > > 24 hours, and 20 were discharged after 24 hours of observation.

> > There were

> > no

> > > complications from exercise testing. There were 2 late noncardiac

> > deaths

> > and 1

> > > late AMI. Thus, immediate exercise testing of low-risk patients

> > with chest

> > pain

> > > who are at sufficient risk to be designated for hospital admission

> > is

> > effective

> > > in further stratifying this group into those who can be safely

> > discharged

> > > immediately and those who require hospitalization.

> > >

> > > PMID: 7977059 [PubMed - indexed for MEDLINE]

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > D Freeman PhD DC MPH

> > > Forensic Trauma Epidemiologist

> > > Department of Public Health and Preventive Medicine

> > > Oregon Health and Science University School of Medicine

> > > 205 Liberty Street NE, Suite B

> > > Salem, OR 97301

> > > 503-586-0127

> > > cell 503-871-0715

> > > drmfreeman@...

> >

> >

> >

> >

[Guest guest]

That would place the risk of heart attack for the general population at

1:1,000,000 if it is 100 times greater - if that was the annualized risk for

adults there would be fewer than 200 heart attacks per year in the US. In

actuality the lifetime risk of a heart attack for the American population is

1:5.

Re: RE: Stress Test

Glenn,

The American College of Sports Medicine Guidlines for Exercise Testing

and Prescription, 3rd edition....Exercise stress test risk is 1:10,000

for the general population.

Ted

Ted Forcum, DC, DACBSP, FICC, CSCS

Medical Director, 2005 Portland US Figure Skating Championships

Back In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

On Wed, 24 Nov 2004 15:31:31 -0800 " Dr. Glenn F. Gumaer "

<gfgdc@...> writes:

>

> Thanks everyone!

>

> I don't recall where that statistic came from, but I do remember

> the

> 100-fold increase risk of cardiovascular damage following treadmill

> stress

> testing as the number reported. I'll try to find that reference.

> Anyway, my

> suggestion was to forego the treadmill, until after she completes

> her

> chelation therapy and kidney dialysis treatments. She was on ZOCOR;

> ZESTRIL;

> INDERAL; NORVASC; NITRO-BID; and ALLOPURINOL for many years and

> developed

> stenosis in her right common iliac artery and atrophy of the right

> kidney -

> probably precipitated in part by the prolonged administration of

> these

> drugs. The list of adverse effects includes: rhabdomyolysis,

> elevated CPK,

> liver dysfunction, aplastic anemia, agranulocytosis,

> methemoglobinemia,

> renal failure, leukopenia, and thrombocytopenia, to name a few. She

> was

> prescribed these medications from a Navy MD in San Diego in the

> 80's, while

> she was a smoker, with high blood pressure and drank too much

> alcohol during

> the years that these drugs were prescribed - a direct

> contraindication for

> some of them. Anyway, when I heard that she was going on kidney

> dialysis, I

> stepped in and referred her to a naturopath in Colorado, Dr.

> Flatland, who

> provides chelation therapy. She was put on a diet and supplement

> regimen,

> but couldn't begin chelation until her BUN, creatinine levels

> improved.

> After six months, they seemed to level off and not improve enough. I

> then

> found out that she was on these medications and sent her to a

> cardiologist,

> who agreed to take her off of them. He now wants to perform a stress

> test.

> In light of the dialysis and chelation, I felt it might be better to

> wait

> until after chelation is finished. By the way, since discontinuing

> these

> medications, her lab values have since all dramatically improved,

> and

> dialysis treatments have been reduced.

>

> Glenn F. Gumaer

>

>

> Re: RE: Stress Test

>

>

> > Glenn,

> > Read the following 5 abstracts about the safety of exercise

> testing as a

> means of evaluating cardiac function; it is safe and very effective

> for

> assessing risk of a future event. Whereever the 100 fold risk of MI

> statistic came from appears to be misinformed. You may be doing your

> mom a

> disservice by steering her away from the test.

> >

> > Freeman

> >

> >

> >

> > 1: Int J Cardiol. 2000 Sep 15;75(2-3):239-43.

> >

> > Utility and safety of immediate exercise testing of low-risk

> patients

> admitted

> > to the hospital with acute chest pain.

> >

> > Sarullo FM, Di Pasquale P, Orlando G, Buffa G, Cicero S, Schillaci

> AM,

> Castello

> > A.

> >

> > Division of Cardiology, Buccheri La Ferla Fatebenefratelli

> Hospital, Via

> S.

> > Puglisi n.15, 90143, Palermo, Italy. fsarullo@...

> >

> > It is common practice to hospitalize patients with chest pain for

> a period

> of

> > observation and to perform further diagnostic evaluation such as

> exercise

> > treadmill testing (ETT) once acute myocardial infarction (AMI) has

> been

> > excluded. This study evaluates the safety and efficacy of

> immediate ETT

> for

> > patients admitted to the hospital with acute chest pain. One

> hundred and

> ninety

> > non-consecutive low-risk patients admitted to the hospital from

> emergency

> > department with acute chest pain underwent ETT using Bruce

> protocol

> immediately

> > on admission to the hospital (median time 165+30 min). Fifty-seven

> (30%)

> > patients had positive exercise electrocardiograms, 44 (77.2%) of

> whom had

> > significant coronary narrowing by angiography. An uncomplicated

> anterior

> > non-Q-wave AMI was diagnosed in one patient. One hundred and

> eleven

> (58.4%)

> > patients had negative and 22 (11.6%) patients had non-diagnostic

> exercise

> > electrocardiograms. Of these 133 patients, 86 (64.7%) were

> discharged

> > immediately after ETT, 19 (14.3%) were discharged within 24 h, and

> 28

> (21%) were

> > discharged after 24 h of observation. There were no complications

> from

> ETT.

> > During the 17+/-6 months follow-up no patients died, and only

> eight (7.2%)

> > patients with negative ETT experienced a major cardiac event (one

> AMI and

> seven

> > angina). In conclusion, our results suggest that immediate ETT of

> low-risk

> > patients with chest pain who are at sufficient risk to be

> designated for

> > hospital admission, is effective in further stratifying this group

> into

> those

> > who can be safety discharged immediately and those who require

> hospitalization.

> >

> > 1: J Am Coll Cardiol. 2002 Jul 17;40(2):251-6.

> >

> > Immediate exercise testing to evaluate low-risk patients

> presenting to the

> > emergency department with chest pain.

> >

> > Amsterdam EA, Kirk JD, Diercks DB, WR, Turnipseed SD.

> >

> > Division of Cardiovascular Medicine, Department of Internal

> Medicine,

> Medical

> > Center, University of California-, Stockton Boulevard,

> Sacramento, CA

> > 95817, USA. eaamsterdam@...

> >

> > OBJECTIVES: Our purpose was to determine the safety and accuracy

> of

> immediate

> > exercise testing in low-risk patients presenting to the emergency

> department

> > (ED) with chest pain suggestive of a cardiac etiology. BACKGROUND:

> Safe,

> > efficient management of low-risk patients presenting to the ED

> with chest

> pain

> > is a continuing challenge. We have employed immediate exercise

> testing to

> > evaluate a large, heterogeneous group of low-risk patients

> presenting with

> chest

> > pain. METHODS: Patients presenting to the ED with chest pain

> compatible

> with a

> > cardiac origin and clinical evidence of low risk on initial

> assessment

> underwent

> > immediate exercise treadmill testing in our chest pain evaluation

> unit.

> > Indicators of low clinical risk included no evidence of

> hemodynamic

> instability,

> > arrhythmias or electrocardiographic signs of ischemia. Serial

> measurements

> of

> > cardiac injury markers were not obtained. RESULTS: Exercise

> testing was

> > performed to a sign- or symptom-limited end point in 1,000

> patients (520

> men,

> > 480 women; age range 31 to 82 years) and was positive for ischemia

> in 13%,

> > negative in 64% and nondiagnostic in 23% of patients. There were

> no

> adverse

> > effects of exercise testing, and all patients with a negative

> exercise

> test were

> > discharged directly from the ED. At 30-day follow-up there was no

> mortality in

> > any of the three groups. Cardiac events in the three groups

> included:

> negative

> > group, 1 non-Q-wave myocardial infarction (MI); positive group, 4

> non-Q-wave MIs

> > and 12 myocardial revascularizations; nondiagnostic group, 7

> myocardial

> > revascularizations. BACKGROUND: Immediate exercise testing of

> patients

> > presenting to the ED with chest pain and evidence of low clinical

> risk is

> safe

> > and accurate for determining those who require admission and those

> who can

> be

> > discharged to further outpatient evaluation.

> >

> > 1: Ann Emerg Med. 1993 May;22(5):794-8.

> >

> > Comment in:

> > Ann Emerg Med. 1994 Jun;23(6):1396.

> >

> > Emergency cardiac stress testing in the evaluation of emergency

> department

> > patients with atypical chest pain.

> >

> > Kerns JR, Shaub TF, Fontanarosa PB.

> >

> > Department of Emergency Medicine, Northeastern Ohio Universities

> College

> of

> > Medicine, Akron.

> >

> > STUDY OBJECTIVES: To determine the feasibility, safety, and

> reliability of

> > emergency cardiac treadmill exercise stress testing (CTEST) in

> the

> evaluation of

> > emergency department patients with atypical chest pain. DESIGN:

> Thirty-two

> > patients with atypical chest pain, normal ECGs, and risk factor

> stratification

> > having low-probability of coronary artery disease were evaluated

> prospectively

> > using outpatient, emergency CTEST. Study patients were compared

> with a

> > retrospectively selected sample of admitted patients diagnosed

> with

> atypical

> > chest pain who met the study criteria and were evaluated with

> CTEST as

> > inpatients. All patients had follow-up at three and six months

> after

> evaluation.

> > SETTING: University-affiliated community teaching hospital with

> 65,000

> annual ED

> > visits. RESULTS: All patients had normal CTEST. No patient had

> evidence of

> > coronary artery disease, myocardial infarction, or sudden death

> during the

> > follow-up period. The average length of stay was 5.5 hours for

> emergency

> CTEST

> > patients versus two days for inpatients. The average patient

> charge was

> $467 for

> > ED evaluation with emergency CTEST versus $2,340 for inpatient

> evaluation.

> > CONCLUSION: Emergency CTEST is a safe, efficient, cost-effective,

> and

> practical

> > method of evaluating selected ED patients with chest pain. It is a

> useful

> aid

> > for clinical decision making and may help to prevent unnecessary

> hospital

> > admissions.

> >

> > 1: Arq Bras Cardiol. 2003 Aug;81(2):174-81, 166-73. Epub 2003 Sep

> 16.

> >

> > Safety, feasibility, and results of exercise testing for

> stratifying

> patients

> > with chest pain in the emergency room.

> >

> > [Article in English, Portuguese]

> >

> > Macaciel RM, Mesquita ET, Vivacqua R, Serra S, Campos A, Miranda

> M,

> Gamarski R,

> > Dohman H, Bassan R.

> >

> > Hospital Pro-Cardiaco e Universidade Federal Fluminense, Rio de

> Janeiro,

> RJ,

> > Brazil. macaciel@...

> >

> > OBJECTIVE: To assess safety, feasibility, and the results of

> early

> exercise

> > testing in patients with chest pain admitted to the emergency room

> of the

> chest

> > pain unit, in whom acute myocardial infarction and high-risk

> unstable

> angina had

> > been ruled out. METHODS: A study including 1060 consecutive

> patients with

> chest

> > pain admitted to the emergency room of the chest pain unit was

> carried

> out. Of

> > them, 677 (64%) patients were eligible for exercise testing, but

> only 268

> (40%)

> > underwent the test. RESULTS: The mean age of the patients studied

> was 51.7

> 12.1

> > years, and 188 (70%) were males. Twenty-eight (10%) patients had

> a

> previous

> > history of coronary artery disease, 244 (91%) had a normal or

> unspecific

> > electrocardiogram, and 150 (56%) underwent exercise testing within

> a

> 12-hour

> > interval. The results of the exercise test in the latter group

> were as

> follows:

> > 34 (13%) were positive, 191 (71%) were negative, and 43 (16%)

> were

> inconclusive.

> > In the group of patients with a positive exercise test, 21 (62%)

> underwent

> > coronary angiography, 11 underwent angioplasty, and 2 underwent

> myocardial

> > revascularization. In a univariate analysis, type A/B chest pain

> > (definitely/probably anginal) (p<0.0001), previous coronary artery

> disease

> > (p<0.0001), and route 2 (patients at higher risk) correlated with

> a

> positive or

> > inconclusive test (p<0.0001). CONCLUSION: In patients with chest

> pain and

> in

> > whom acute myocardial infarction and high-risk unstable angina had

> been

> ruled

> > out, the exercise test proved to be feasible, safe, and well

> tolerated.

> >

> > Publication Types:

> > Evaluation Studies

> >

> > PMID: 14502386 [PubMed - indexed for MEDLINE]

> >

> >

> >

> > 1: Am J Cardiol. 1994 Nov 15;74(10):987-90.

> >

> > Utility and safety of immediate exercise testing of low-risk

> patients

> admitted

> > to the hospital for suspected acute myocardial infarction.

> >

> > WR, Amsterdam EA.

> >

> > Department of Medicine, University of California, School of

> Medicine,

> > Sacramento.

> >

> > More than 2 million patients are admitted to U.S. hospitals

> annually for

> > clinical suspicion of acute myocardial infarction (AMI), and > 70%

> are

> found not

> > to have had a cardiac event. This study evaluates the safety and

> efficacy

> of

> > immediate exercise testing for patients admitted to the hospital

> for

> suspected

> > AMI. Ninety-three nonconsecutive low-risk patients admitted to

> the

> hospital from

> > the emergency department to rule out AMI underwent exercise

> treadmill

> testing

> > using a modified Bruce protocol immediately on admission to the

> hospital

> (median

> > time < 1 hour). Twelve patients had positive exercise

> electrocardiograms,

> 6 of

> > whom had significant coronary narrowing by angiography. An

> uncomplicated

> > non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients

> had

> negative and

> > 22 patients had nondiagnostic exercise electrocardiograms. Of

> these 81

> patients,

> > 44 were discharged immediately after exercise testing, 17 were

> discharged

> within

> > 24 hours, and 20 were discharged after 24 hours of observation.

> There were

> no

> > complications from exercise testing. There were 2 late noncardiac

> deaths

> and 1

> > late AMI. Thus, immediate exercise testing of low-risk patients

> with chest

> pain

> > who are at sufficient risk to be designated for hospital admission

> is

> effective

> > in further stratifying this group into those who can be safely

> discharged

> > immediately and those who require hospitalization.

> >

> > PMID: 7977059 [PubMed - indexed for MEDLINE]

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > D Freeman PhD DC MPH

> > Forensic Trauma Epidemiologist

> > Department of Public Health and Preventive Medicine

> > Oregon Health and Science University School of Medicine

> > 205 Liberty Street NE, Suite B

> > Salem, OR 97301

> > 503-586-0127

> > cell 503-871-0715

> > drmfreeman@...

>

>

>

>

[Guest guest]

The 1:10,000 risk for stress testing from the ACSM Guidelines is simply

for the test and has nothing to do with coronary risk for ay other period

of life.

Ted

Ted Forcum, DC, DACBSP, FICC, CSCS

Medical Director, 2005 Portland US Figure Skating Championships

Back In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

On Sat, 27 Nov 2004 08:48:37 -0800 (GMT-08:00) " Dr. Freeman "

<drmfreeman@...> writes:

> That would place the risk of heart attack for the general population

> at 1:1,000,000 if it is 100 times greater - if that was the

> annualized risk for adults there would be fewer than 200 heart

> attacks per year in the US. In actuality the lifetime risk of a

> heart attack for the American population is 1:5.

>

>

>

> Re: RE: Stress Test

>

> Glenn,

> The American College of Sports Medicine Guidlines for Exercise

> Testing

> and Prescription, 3rd edition....Exercise stress test risk is

> 1:10,000

> for the general population.

> Ted

>

> Ted Forcum, DC, DACBSP, FICC, CSCS

> Medical Director, 2005 Portland US Figure Skating Championships

> Back In Motion Sports Injuries Clinic, LLC

> 11385 SW Scholls Ferry Road

> Beaverton, Oregon 97008

>

> On Wed, 24 Nov 2004 15:31:31 -0800 " Dr. Glenn F. Gumaer "

> <gfgdc@...> writes:

> >

> > Thanks everyone!

> >

> > I don't recall where that statistic came from, but I do remember

> > the

> > 100-fold increase risk of cardiovascular damage following

> treadmill

> > stress

> > testing as the number reported. I'll try to find that reference.

> > Anyway, my

> > suggestion was to forego the treadmill, until after she completes

>

> > her

> > chelation therapy and kidney dialysis treatments. She was on

> ZOCOR;

> > ZESTRIL;

> > INDERAL; NORVASC; NITRO-BID; and ALLOPURINOL for many years and

> > developed

> > stenosis in her right common iliac artery and atrophy of the right

>

> > kidney -

> > probably precipitated in part by the prolonged administration of

> > these

> > drugs. The list of adverse effects includes: rhabdomyolysis,

> > elevated CPK,

> > liver dysfunction, aplastic anemia, agranulocytosis,

> > methemoglobinemia,

> > renal failure, leukopenia, and thrombocytopenia, to name a few.

> She

> > was

> > prescribed these medications from a Navy MD in San Diego in the

> > 80's, while

> > she was a smoker, with high blood pressure and drank too much

> > alcohol during

> > the years that these drugs were prescribed - a direct

> > contraindication for

> > some of them. Anyway, when I heard that she was going on kidney

> > dialysis, I

> > stepped in and referred her to a naturopath in Colorado, Dr.

> > Flatland, who

> > provides chelation therapy. She was put on a diet and supplement

> > regimen,

> > but couldn't begin chelation until her BUN, creatinine levels

> > improved.

> > After six months, they seemed to level off and not improve enough.

> I

> > then

> > found out that she was on these medications and sent her to a

> > cardiologist,

> > who agreed to take her off of them. He now wants to perform a

> stress

> > test.

> > In light of the dialysis and chelation, I felt it might be better

> to

> > wait

> > until after chelation is finished. By the way, since discontinuing

>

> > these

> > medications, her lab values have since all dramatically improved,

>

> > and

> > dialysis treatments have been reduced.

> >

> > Glenn F. Gumaer

> >

> >

> > Re: RE: Stress Test

> >

> >

> > > Glenn,

> > > Read the following 5 abstracts about the safety of exercise

> > testing as a

> > means of evaluating cardiac function; it is safe and very

> effective

> > for

> > assessing risk of a future event. Whereever the 100 fold risk of

> MI

> > statistic came from appears to be misinformed. You may be doing

> your

> > mom a

> > disservice by steering her away from the test.

> > >

> > > Freeman

> > >

> > >

> > >

> > > 1: Int J Cardiol. 2000 Sep 15;75(2-3):239-43.

> > >

> > > Utility and safety of immediate exercise testing of low-risk

> > patients

> > admitted

> > > to the hospital with acute chest pain.

> > >

> > > Sarullo FM, Di Pasquale P, Orlando G, Buffa G, Cicero S,

> Schillaci

> > AM,

> > Castello

> > > A.

> > >

> > > Division of Cardiology, Buccheri La Ferla Fatebenefratelli

> > Hospital, Via

> > S.

> > > Puglisi n.15, 90143, Palermo, Italy. fsarullo@...

> > >

> > > It is common practice to hospitalize patients with chest pain

> for

> > a period

> > of

> > > observation and to perform further diagnostic evaluation such as

>

> > exercise

> > > treadmill testing (ETT) once acute myocardial infarction (AMI)

> has

> > been

> > > excluded. This study evaluates the safety and efficacy of

> > immediate ETT

> > for

> > > patients admitted to the hospital with acute chest pain. One

> > hundred and

> > ninety

> > > non-consecutive low-risk patients admitted to the hospital from

>

> > emergency

> > > department with acute chest pain underwent ETT using Bruce

> > protocol

> > immediately

> > > on admission to the hospital (median time 165+30 min).

> Fifty-seven

> > (30%)

> > > patients had positive exercise electrocardiograms, 44 (77.2%) of

>

> > whom had

> > > significant coronary narrowing by angiography. An uncomplicated

>

> > anterior

> > > non-Q-wave AMI was diagnosed in one patient. One hundred and

> > eleven

> > (58.4%)

> > > patients had negative and 22 (11.6%) patients had non-diagnostic

>

> > exercise

> > > electrocardiograms. Of these 133 patients, 86 (64.7%) were

> > discharged

> > > immediately after ETT, 19 (14.3%) were discharged within 24 h,

> and

> > 28

> > (21%) were

> > > discharged after 24 h of observation. There were no

> complications

> > from

> > ETT.

> > > During the 17+/-6 months follow-up no patients died, and only

> > eight (7.2%)

> > > patients with negative ETT experienced a major cardiac event

> (one

> > AMI and

> > seven

> > > angina). In conclusion, our results suggest that immediate ETT

> of

> > low-risk

> > > patients with chest pain who are at sufficient risk to be

> > designated for

> > > hospital admission, is effective in further stratifying this

> group

> > into

> > those

> > > who can be safety discharged immediately and those who require

> > hospitalization.

> > >

> > > 1: J Am Coll Cardiol. 2002 Jul 17;40(2):251-6.

> > >

> > > Immediate exercise testing to evaluate low-risk patients

> > presenting to the

> > > emergency department with chest pain.

> > >

> > > Amsterdam EA, Kirk JD, Diercks DB, WR, Turnipseed SD.

> > >

> > > Division of Cardiovascular Medicine, Department of Internal

> > Medicine,

> > Medical

> > > Center, University of California-, Stockton Boulevard,

> > Sacramento, CA

> > > 95817, USA. eaamsterdam@...

> > >

> > > OBJECTIVES: Our purpose was to determine the safety and accuracy

>

> > of

> > immediate

> > > exercise testing in low-risk patients presenting to the

> emergency

> > department

> > > (ED) with chest pain suggestive of a cardiac etiology.

> BACKGROUND:

> > Safe,

> > > efficient management of low-risk patients presenting to the ED

> > with chest

> > pain

> > > is a continuing challenge. We have employed immediate exercise

> > testing to

> > > evaluate a large, heterogeneous group of low-risk patients

> > presenting with

> > chest

> > > pain. METHODS: Patients presenting to the ED with chest pain

> > compatible

> > with a

> > > cardiac origin and clinical evidence of low risk on initial

> > assessment

> > underwent

> > > immediate exercise treadmill testing in our chest pain

> evaluation

> > unit.

> > > Indicators of low clinical risk included no evidence of

> > hemodynamic

> > instability,

> > > arrhythmias or electrocardiographic signs of ischemia. Serial

> > measurements

> > of

> > > cardiac injury markers were not obtained. RESULTS: Exercise

> > testing was

> > > performed to a sign- or symptom-limited end point in 1,000

> > patients (520

> > men,

> > > 480 women; age range 31 to 82 years) and was positive for

> ischemia

> > in 13%,

> > > negative in 64% and nondiagnostic in 23% of patients. There were

>

> > no

> > adverse

> > > effects of exercise testing, and all patients with a negative

> > exercise

> > test were

> > > discharged directly from the ED. At 30-day follow-up there was

> no

> > mortality in

> > > any of the three groups. Cardiac events in the three groups

> > included:

> > negative

> > > group, 1 non-Q-wave myocardial infarction (MI); positive group,

> 4

> > non-Q-wave MIs

> > > and 12 myocardial revascularizations; nondiagnostic group, 7

> > myocardial

> > > revascularizations. BACKGROUND: Immediate exercise testing of

> > patients

> > > presenting to the ED with chest pain and evidence of low

> clinical

> > risk is

> > safe

> > > and accurate for determining those who require admission and

> those

> > who can

> > be

> > > discharged to further outpatient evaluation.

> > >

> > > 1: Ann Emerg Med. 1993 May;22(5):794-8.

> > >

> > > Comment in:

> > > Ann Emerg Med. 1994 Jun;23(6):1396.

> > >

> > > Emergency cardiac stress testing in the evaluation of emergency

>

> > department

> > > patients with atypical chest pain.

> > >

> > > Kerns JR, Shaub TF, Fontanarosa PB.

> > >

> > > Department of Emergency Medicine, Northeastern Ohio Universities

>

> > College

> > of

> > > Medicine, Akron.

> > >

> > > STUDY OBJECTIVES: To determine the feasibility, safety, and

> > reliability of

> > > emergency cardiac treadmill exercise stress testing (CTEST) in

> > the

> > evaluation of

> > > emergency department patients with atypical chest pain. DESIGN:

>

> > Thirty-two

> > > patients with atypical chest pain, normal ECGs, and risk factor

> > stratification

> > > having low-probability of coronary artery disease were

> evaluated

> > prospectively

> > > using outpatient, emergency CTEST. Study patients were compared

>

> > with a

> > > retrospectively selected sample of admitted patients diagnosed

> > with

> > atypical

> > > chest pain who met the study criteria and were evaluated with

> > CTEST as

> > > inpatients. All patients had follow-up at three and six months

> > after

> > evaluation.

> > > SETTING: University-affiliated community teaching hospital with

>

> > 65,000

> > annual ED

> > > visits. RESULTS: All patients had normal CTEST. No patient had

> > evidence of

> > > coronary artery disease, myocardial infarction, or sudden death

>

> > during the

> > > follow-up period. The average length of stay was 5.5 hours for

> > emergency

> > CTEST

> > > patients versus two days for inpatients. The average patient

> > charge was

> > $467 for

> > > ED evaluation with emergency CTEST versus $2,340 for inpatient

> > evaluation.

> > > CONCLUSION: Emergency CTEST is a safe, efficient,

> cost-effective,

> > and

> > practical

> > > method of evaluating selected ED patients with chest pain. It is

> a

> > useful

> > aid

> > > for clinical decision making and may help to prevent unnecessary

>

> > hospital

> > > admissions.

> > >

> > > 1: Arq Bras Cardiol. 2003 Aug;81(2):174-81, 166-73. Epub 2003

> Sep

> > 16.

> > >

> > > Safety, feasibility, and results of exercise testing for

> > stratifying

> > patients

> > > with chest pain in the emergency room.

> > >

> > > [Article in English, Portuguese]

> > >

> > > Macaciel RM, Mesquita ET, Vivacqua R, Serra S, Campos A, Miranda

>

> > M,

> > Gamarski R,

> > > Dohman H, Bassan R.

> > >

> > > Hospital Pro-Cardiaco e Universidade Federal Fluminense, Rio de

>

> > Janeiro,

> > RJ,

> > > Brazil. macaciel@...

> > >

> > > OBJECTIVE: To assess safety, feasibility, and the results of

> > early

> > exercise

> > > testing in patients with chest pain admitted to the emergency

> room

> > of the

> > chest

> > > pain unit, in whom acute myocardial infarction and high-risk

> > unstable

> > angina had

> > > been ruled out. METHODS: A study including 1060 consecutive

> > patients with

> > chest

> > > pain admitted to the emergency room of the chest pain unit was

> > carried

> > out. Of

> > > them, 677 (64%) patients were eligible for exercise testing, but

>

> > only 268

> > (40%)

> > > underwent the test. RESULTS: The mean age of the patients

> studied

> > was 51.7

> > 12.1

> > > years, and 188 (70%) were males. Twenty-eight (10%) patients had

>

> > a

> > previous

> > > history of coronary artery disease, 244 (91%) had a normal or

> > unspecific

> > > electrocardiogram, and 150 (56%) underwent exercise testing

> within

> > a

> > 12-hour

> > > interval. The results of the exercise test in the latter group

> > were as

> > follows:

> > > 34 (13%) were positive, 191 (71%) were negative, and 43 (16%)

> > were

> > inconclusive.

> > > In the group of patients with a positive exercise test, 21 (62%)

>

> > underwent

> > > coronary angiography, 11 underwent angioplasty, and 2 underwent

>

> > myocardial

> > > revascularization. In a univariate analysis, type A/B chest

> pain

> > > (definitely/probably anginal) (p<0.0001), previous coronary

> artery

> > disease

> > > (p<0.0001), and route 2 (patients at higher risk) correlated

> with

> > a

> > positive or

> > > inconclusive test (p<0.0001). CONCLUSION: In patients with chest

>

> > pain and

> > in

> > > whom acute myocardial infarction and high-risk unstable angina

> had

> > been

> > ruled

> > > out, the exercise test proved to be feasible, safe, and well

> > tolerated.

> > >

> > > Publication Types:

> > > Evaluation Studies

> > >

> > > PMID: 14502386 [PubMed - indexed for MEDLINE]

> > >

> > >

> > >

> > > 1: Am J Cardiol. 1994 Nov 15;74(10):987-90.

> > >

> > > Utility and safety of immediate exercise testing of low-risk

> > patients

> > admitted

> > > to the hospital for suspected acute myocardial infarction.

> > >

> > > WR, Amsterdam EA.

> > >

> > > Department of Medicine, University of California, School

> of

> > Medicine,

> > > Sacramento.

> > >

> > > More than 2 million patients are admitted to U.S. hospitals

> > annually for

> > > clinical suspicion of acute myocardial infarction (AMI), and >

> 70%

> > are

> > found not

> > > to have had a cardiac event. This study evaluates the safety and

>

> > efficacy

> > of

> > > immediate exercise testing for patients admitted to the hospital

>

> > for

> > suspected

> > > AMI. Ninety-three nonconsecutive low-risk patients admitted to

> > the

> > hospital from

> > > the emergency department to rule out AMI underwent exercise

> > treadmill

> > testing

> > > using a modified Bruce protocol immediately on admission to the

>

> > hospital

> > (median

> > > time < 1 hour). Twelve patients had positive exercise

> > electrocardiograms,

> > 6 of

> > > whom had significant coronary narrowing by angiography. An

> > uncomplicated

> > > non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients

> > had

> > negative and

> > > 22 patients had nondiagnostic exercise electrocardiograms. Of

> > these 81

> > patients,

> > > 44 were discharged immediately after exercise testing, 17 were

> > discharged

> > within

> > > 24 hours, and 20 were discharged after 24 hours of observation.

>

> > There were

> > no

> > > complications from exercise testing. There were 2 late

> noncardiac

> > deaths

> > and 1

> > > late AMI. Thus, immediate exercise testing of low-risk patients

>

> > with chest

> > pain

> > > who are at sufficient risk to be designated for hospital

> admission

> > is

> > effective

> > > in further stratifying this group into those who can be safely

> > discharged

> > > immediately and those who require hospitalization.

> > >

> > > PMID: 7977059 [PubMed - indexed for MEDLINE]

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > D Freeman PhD DC MPH

> > > Forensic Trauma Epidemiologist

> > > Department of Public Health and Preventive Medicine

> > > Oregon Health and Science University School of Medicine

> > > 205 Liberty Street NE, Suite B

> > > Salem, OR 97301

> > > 503-586-0127

> > > cell 503-871-0715

> > > drmfreeman@...

> >

> >

> >

> >

[Guest guest]

Hi Ursula,

My daughter has had a stress test. Basically she must wear a little clip on

her nose and put a mask covering her mouth so that they can monitor the air

she breathes out and possibly in while exercising--either bike or treadmill.

They strap electrodes all over and closely monitor blood pressure. There is also

a belt with some equipment attached that she remembers putting around her

waist. There is a cardiologist and exercise physiologist present in case there

is a problem. Other than getting really tired and sweaty and having quite a

number of palpitations (PVCs), the test was pretty tolerable. Hope 's test

goes well.

Martha

In a message dated 11/17/2005 8:41:12 AM Eastern Standard Time,

writes:

Date: Wed, 16 Nov 2005 12:35:18 -0500

From: " Ursula " <uahollem1@...>

Subject:

Our oldest daughter (13 , non-PID) has had something found wrong with

her heart. She has had several tests here locally and will have a stress test

in Atlanta at ish Rite whenever they can get it scheduled. It is the

kind that involves PFT's too. Has anyone with a heart child (or other) had this

done? How did it go?

Ursula

[Guest guest]

Ursula, We had almost the exact same experience as

Martha. Aly has a stress test about every 2 years and

she actually thinks they are fun. Aly usually runs

with on the tread mill with a person standing behind

her(they stand with their feet on the rails and arms

under Aly's armpits), in case she falls. She usually

has a pulse ox on, ECG electrodes, a mouth peice

connected to a hose, nose clips, and whatever else

they can find to stick on her-LOL! Aly usually does

PFT " s before and then afterwards until her FEV1 goes

back to her baseline. There are always a million

people in the room as support staff and they do a

great job of encouraging Aly to keep going. I think

that is why she likes it so much.

For Aly it turns out it isn't so much her heart as

it is her lungs. We still do them every 2 years

though:)

HTH and good luck with everything:) Cheryl

--- K979@... wrote:

---------------------------------

Hi Ursula,

My daughter has had a stress test. Basically she must

wear a little clip on

her nose and put a mask covering her mouth so that

they can monitor the air

she breathes out and possibly in while

exercising--either bike or treadmill.

They strap electrodes all over and closely monitor

blood pressure. There is also

a belt with some equipment attached that she remembers

putting around her

waist. There is a cardiologist and exercise

physiologist present in case there

is a problem. Other than getting really tired and

sweaty and having quite a

number of palpitations (PVCs), the test was pretty

tolerable. Hope 's test

goes well.

Martha

In a message dated 11/17/2005 8:41:12 AM Eastern

Standard Time,

writes:

Date: Wed, 16 Nov 2005 12:35:18 -0500

From: " Ursula " <uahollem1@...>

Subject:

Our oldest daughter (13 , non-PID) has had

something found wrong with

her heart. She has had several tests here locally and

will have a stress test

in Atlanta at ish Rite whenever they can get it

scheduled. It is the

kind that involves PFT's too. Has anyone with a heart

child (or other) had this

done? How did it go?

Ursula

[Guest guest]

I am the mother of a 26 year old autistic daughter who is currently undergoing

chelation

treatment.

She has recently been tested with the adrenal stress test which indicates

adrenal over

stimulation.

I was wondering if you could recommend any homeopathic / natural remedies to

counteract

these high levels?

Any help would be most appreciated.

[Guest guest]

Hello,

My son is 26 also! Welcome!

Barb

[ ] Stress Test

I am the mother of a 26 year old autistic daughter who is currently undergoing

chelation

treatment.

She has recently been tested with the adrenal stress test which indicates

adrenal over

stimulation.

I was wondering if you could recommend any homeopathic / natural remedies to

counteract

these high levels?

Any help would be most appreciated.

[Guest guest]

> She has recently been tested with the adrenal stress test which

indicates adrenal over

> stimulation.

>

> I was wondering if you could recommend any homeopathic / natural

remedies to counteract

> these high levels?

This page has info

http://www.drrind.com/adrensupport.asp

Dana

[Guest guest]

Thanks for all the help