What’s a Stress Test Like?
While heart disease is an important topic for the medical community and for the well being of society in general, it hits a bit close to home for me personally. I have a pretty severe family history of heart disease—a grandfather who died of a heart attack and a father who had two minor heart attacks before age 60– so paying attention to things such as diet, exercise, cholesterol scores, etc. have always been at the forefront of my mind.
I’m 45 years old, weigh 175 pounds and 5’11’ tall, have been active my entire life and always focused on a healthy diet. Despite this, my cholesterol is inching upward as I age, prompting threats of drug intervention from my primary care physician—something I do not want to do. I recently had a Calcium Score Test, which measures calcium build up in the arteries of the heart. It was a simple CT-type procedure at a facility in central Phoenix and happily resulted in a score of “zero,” the best possible. And while that score is a good sign, it’s no guarantee against heart disease or a sudden heart attack.
I had never participated in a stress test however, so as part of this piece for SMDN on South Mountain Cardiology, Dr. Husain agreed to give me a stress test, a common procedure that gives cardiologists a good idea as to the overall health of the heart. The type I had was a treadmill exercise stress test without imaging. Although there are many types of stress tests, the ones that involve exercise are usually broken down into plain exercise like mine, or exercise combined with echocardiogram or a nuclear scan. The latter two compare images of the heart before and after exercise as well as the EKG while mine looked just at the EKG during exercise.
The test was straightforward and not overly complicated—walking on a treadmill while attached to various machines giving readouts of my heart’s function. Prior to the test, instructions were pretty simple: No food within three hours of the test, skip the morning coffee, wear comfortable clothes and don’t use any lotions on your chest (I don’t, but apparently the electrodes won’t stick to you chest if you do).
Once at the offices of South Mountain Cardiology, medical assistants placed six electrodes on my chest, put me on the treadmill and we began. The goal was for my heart rate to reach 160 beats per minute, in stages of three minutes each and a slightly higher grade on the treadmill with each progressive stage. I reached 160 beats per minute at 14:05 or Stage 5, followed by a gradual cool down. The test was not difficult, but I did get slightly winded, but nowhere near uncomfortable.
All told, the entire process took about 30 minutes and was back at my normal workday no worse for wear—after a cup of coffee of course.
According to Dr. Husain, my results were excellent, lasting into Stage 5, which he said was not typical for most patients, and sent me home with instructions to continue monitoring my health and continue with a healthy diet.
South Mountain Cardiology Helping Fight Heart Disease in Area
Editor’s Note: This is part one of a two-part series on South Mountain Cardiology.
Heart disease is the number one killer in the United States. If you’ve paid even cursory attention to national news, you probably know that fact. But a closer look and the statistics are even more sobering: According to the American Heart Association, cardiovascular disease claims 2,150 lives per day in the United States—one every 40 seconds. The Center for Disease Control reports that Americans suffer 935,000 heart attacks per year and place costs associated with coronary heart disease at $108.9 billion annually.
In short, heart disease is a giant problem. On the bright side, however, there are ways to help prevent the negative effects of the disease. Nutrition, exercise and regular medical attention are just some of the ways to stem the problem. And while South Mountain and Laveen residents are not immune to heart disease, they now have a new option to help fight it: South Mountain Cardiology and Dr. Nadeem Husain, M.D., F.A.C.C.
Husain, a board-certified cardiologist, opened South Mountain Cardiology in August 2012 after nearly three years as an Interventional Cardiologist in the East Valley. Prior to that he was an Interventional Cardiologist in Missouri where he went after completing his Interventional Cardiology fellowship at the Henry Ford Hospital in Detroit, Michigan. He has also spent a few years as an Assistant Professor of Medicine at the University of South Alabama. He has, to his credit, numerous presentations in national Cardiology meetings, publications, as well as co-authoring a book.
He was interested in opening his own practice and realized the closest cardiologist was miles away from anywhere in the South Mountain/Laveen area. “I was practicing in the East Valley, but decided to go on my own,” said Husain. “I came to South Phoenix because there was not a single full-time Cardiologist dedicating to providing services to the people here and surrounding areas.”
South Mountain Cardiology offers a full range of services, including cardiac consultation and evaluation, echocardiogram, stress testing, carotid Doppler, vascular ultrasounds, pacemaker and defibrillator evaluation, holter, event and MCOT monitoring, among others.
In a perfect world, you’ll never have to see a heart specialist like Dr. Husain, however the odds are against it. But, what does a trip to the cardiologist entail? Chances are, if you haven’t gone through the process it’s a foreign proposition.
The process generally starts with your primary care physician. Let’s say you have some chest pain, shortness of breath or heart palpitations. Depending on several factors, including the type of pain it is, family history or even high cholesterol, your physician may feel the need for further testing from a cardiologist such as Dr. Husain.
The first line of testing for a patient suspected of possible coronary problems is the EKG—one that measures the heart’s efficiency. Is it beating normal? Too fast or too slow? It can also detect other abnormalities such as the shape or size. It does not, however, measure accurately the heart’s pumping ability or function of the valves—that’s where the echocardiogram comes into play. If the EKG looks at all abnormal, the next step is most likely an echocardiogram.
“An echocardiogram is often referred to as an ultrasound of the heart,” said Dr. Husain. “It’s a lot like an ultrasound during a pregnancy.”
The non-invasive test takes about 15 minutes and gives an accurate reading of the internal structure of the heart and how blood is flowing through it and how the valves are functioning among other results.
“It looks at the size and function of the four chambers of the heart and its valves,” he said. “We look at what’s called an ‘Ejection Fraction (EF),’ the strength of the heart muscle and ventricles.”
There are generally two methods of stress testing—walking on a treadmill with adhesive electrodes, also known as either a nuclear stress test or a stress echocardiogram. The other option is to inject a chemical to stimulate exercise (mainly reserved for those individuals who are not able to walk on the treadmill) and a chemical nuclear isotope that is injected into the bloodstream and then the patient is placed under a scanner. Both of these methods evaluate the function of the heart before and after stress such as treadmill exercise or chemical. It allows the doctor to see if there is an abnormality in the blood flow through the heart possibly indicating a severe blockage of the coronary arteries.
The stress test itself is a fairly easy procedure that can take about 30 minutes total for the stress echo, or a few hours for the nuclear stress test that requires two different scans under the camera in addition to the a few minutes walking on a treadmill while connected to electrodes.
“We look at before and after stress and how the blood is flowing,” said Dr. Husain. “If there are signs of blockage, it will show during stress. For a positive or abnormal stress test, you generally need an artery to be blocked 70 percent. It is at that percentage where a person generally starts to feel symptoms called angina.”
Depending on the results of the testing and symptoms, Dr. Husain would then determine if the patient needs to undergo an angiogram, or heart catheterization, an imaging test that uses special x-rays and dye to view the heart’s arteries to see potentially narrowed or blocked arteries. This test is done in the hospital and is generally an outpatient test if no significant blockages are found.
And while residents of South Mountain and Laveen are lucky to have a convenient option such as South Mountain Cardiology, Dr. Husain cautions that a healthy diet and exercise are paramount to a healthy heart.
“If you have family history of heart disease, you have to be extra careful,” said Husain. Keeping a low weight, eating a proper diet low in saturated fat are important. Smoking only aids in speeding up this process. It has been shown smoking even a single cigarette can increase your chance of having a heart attack up by 40 percent.
“The American College of Cardiology recommends at least 30 minutes of moderate physical activity such as walking, at least five days a week.”
South Mountain Cardiology is located at 303 E. Baseline Road, Suite 105, at the southwest corner of Baseline Rd. and Jesse Owens Parkway. Contact the office at 602-254-6640 or www.southmountaincardiology.com