Stress Test Questions

[mtlieb]

Hi All,

I have a stress test scheduled a week from today. My doctor wants me to do it without beta-blockers to see how my unmedicated heart reacts, and this creates a couple of concerns for me.

Since i've been so symptomatic lately (with a trip to the hospital for chest pain and trouble breathing) even with 200mg of Atenolol, how in the heck am i going to get through two days without any beta-blockers at all? Is it okay to just suddenly stop taking them for two days? If my gradient is considered high now (64 to 144), while taking the atenolol, i can only assume that it's going to go through the roof without it, and even higher once i get on that treadmill. Is there any danger to this?

I'm not exactly freaking out or anything, just a bit concerned over the prospect of maybe doing some real damage to my heart by putting it through this.

Any input you may have would be greatly appreciated.

Thanks,

Jim

[Linda]

Re: Stress Test Questions

Jim, These are definitely questions to ask your doctor. It's been several years since we've been that route, but my son was hospitalized and monitored to clear the med and then restart it. He was pretty young and that may have made a difference. I will also be curious what others have done about this. Best wishes, Linda

[Richard Nelsen]

Re: Stress Test Questions

Hi Jim I would ask your Doctor alot of questions as well...If nothing at all to help to answer your concerns. Keep us posted. Rick

[Sarah]

Re: Stress Test Questions

Beta-blockers are NEVER to be stopped cold turkey. To do so can cause a rebound effect and make you worse. And yes, I've had doctors tell me to stop a beta-blocker without stepping down the dose. The one time I did go cold turkey, I had a reaction like you go through in detox--pains all over and cardiac problems. Not fun.

If you are ok with stepping down the dose to end at zero two days before and then resume right after the test, that would be up to you and how you feel.

My question is what is the benefit of knowing how much you can do unmedicated? Is there a reason for you to be unmedicated? How will it change your treatment plan? Really, what purpose is this going to serve?

I've never been asked to have an unmedicated stress test and most places wouldn't even want to face the potential lawsuit under those conditions. I'm really quite surprised.

good luck,

S

[mtlieb]

Re: Stress Test Questions

Thanks for your advice. I'll give him a call today and find out what's going on with this. The more i think about it the more it sounds like something i don't want to do. There may in fact be a mistake in my orders to stop the Atenolol, although they were pretty explicit about it.

[Laoshur]

Re: Stress Test Questions

Jim,

When I had a stress test last month Dr. Gilligan just told me to not take the beta blocker or calcium channel blocker the morning of the test. The nurse thought that this was why (because there was still beta blocker in my system) my heart rate stopped increasing at 111 and then dropped. But the doctor doing the test (not Dr. Gilligan) disagreed with her because my BP dropped and apparently my arrhythmias increased at the same time. They had an argument about it while the test was going on. So, I guess that might be the doctor's thinking - that is that he wants to see how your heart responds without the protection of the beta blockers.

However, last summer when I had the EP exam, Dr. Gilligan offered to hospitalize me to withdraw me (3 days, as I recall) from the beta blocker before the test. I did not accept that offer and did not seemingly have additional problems. But I noticed in the report that he thought that I had some problems he could not control during the test that he thought were caused by the withdrawal. So, I would certainly ask why and what should be done to ensure that you not have serious problems.

Hope it goes well whatever they decide!

Rhoda

[mtlieb]

Re: Stress Test Questions

I called into the hospital where i'm having the stress test done, and they do in fact want me to stop the beta-blockers 48 hours prior to the test. I'll take my last pill Saturday morning, and then not again until after the test on Monday, which will be around 4:30 pm when all is said and done. When i expressed my concerns, I was told that they do this all the time, and since i'm only stopping it for two days, there will be no problem.

[Dorothy]

Re: Stress Test Questions

Jim, hopefully you are doing it as a step-down procedure, not just stop taking them and wait the two days. Are you going to take one every-other day with Saturday being you last? That would be my method of step-down. I know all too well what can happen if you miss two dosages, two days in a row.

Good luck on your stress test. May your much-needed answers be found.

[Lisa Salberg]

Re: Stress Test Questions

Jim,
I would speak to the doctor doing the test directly. Voice your concerns and make sure that you feel comfortable with this befor you move forward.

Lisa

[Linda]

Re: Stress Test Questions

Jim, as Lisa said, speak to the doctor actually doing the test. The hospital staff does these tests all the time, but probably not that often on someone with the diagnosis of HCM. It makes a difference. The med doses are different for different problems and the withdrawl response is different. If he knows how concerned you are, even if it was his original instructions, he may rethink the whole thing. Safety is a big deal, and the stress from not really being comfortable with the situation will only make things worse for you. You want to be able to go into the test at ease, not already charged up with anxiety, and I can only imagine that all our advice here has only added to your concerns. You see, we all care about each other. Linda

[Ronnie]

Re: Stress Test Questions

In all the years of Stress tests, I have never been instructed to stop my Beta-Blockers. I agree, with the general consensus of discussing this directly with your cardiologist-what does he hope to benefit by this? I in fact think, that at a certain point, a stress Test is pointless & unnecessary to put the patient thru. If you've been diagnosed (over a long period of time) have increased symptoms & gradients (per echos), why do this? You know you're going to fell crummy-you know the diagnosis! I said this at my last Mayo appointment (I actually was anxious about taking a stress) and the Dr. agreed with me
RONNIE

[liona]

Re: Stress Test Questions

Frankly, if I was in this situation, I'd cancel the stress test and look for another Dr. You are receiving run-of-the-mill medical advice and you deserve better.

I only take 50mg a day of atenol, and I forgot my pill the day I went to see my GP. All my symptoms were coming back and we were really confused, until I realized that I had forgotten my pills----

You are not going to Doctors for them to satisfy their scientific curiousity by doing tests on you. You must insist that your own wellness is the priority, or else, they're FIRED!

[bryan]

Re: Stress Test Questions

My last stress test I had to do it unmedicated. It scared the heck out of me but I got through it.

[cynthiaG]

Re: Stress Test Questions

I had a thalium stress test just last May. I was on 50 mg. of atenolol. I was told by my doctor in Boston not to take it the night before...then I resumed taking the next day. Actually, I felt just fine with the skipped dose.....

[Reenie]

Re: Stress Test Questions

Jim, the stress test may not be out of the ordinary. I would just ask the doctor directly about stopping the meds. I think they can learn a lot through the stress tests. I think you haven't ever had one, right? It may help your treatment plan if they know more of what they're looking at.

Reenie