question about stress echo......

[kirstinherbs]

Hi Dr fett

I'm hoping to have a stress echo in London in two weeks, hopefully an exercise stress echo. I've never had great exercise tolerance, I can walk miles, up hills etc. and I'm not too bad on a bike but when It comes to running and swimming I can't manage very far at all! If your unconditioned and basically unfit will the stress echo show a decreased contractile reserve or would this be normal despite fitness level?

Thanks

Kirstin

[Stephanie'sbigheart]

Great question! I too am waiting for the answer.

[JAMESFETT]

In the exercise stress echo, we are looking for the LV EF at target exercise heart rate, as compared to resting heart rate echo LV EF. The difference represents an estimate of contractile reserve. So, first one does the resting echo, then one determines the target exercise heart rate, exercises on treadmill or bicycle, and at whatever time of exercise the heart rate is reached, that is when the stress echo is done. Simple but helpful. If your condition is so good that you never reach target exercise heart rate, then still interested in difference in LV EF at whatever rate you reach. But if your conditioning is not so hot, then the target exercise heart rate is reached sooner, and at that rate one does the repeat echo. So in this instance, conditioning is not so important.

JD

[kirstinherbs]

Thanks Dr Fett,

so regular exercise doesn't increase peak exercise ejection fraction/contractile reserve it just increases the time taken to reach these levels?

What is a normal Heart rate recovery time? I went for quite a strenous bike ride yesterday and probably reached a heart rate of about 180, 15 minutes after stopping exercise my heart rate was still 105 standing, 86 sitting, normal resting heart rate for me is between 62 and 78. How long after exercise should ones heart rate remain elevated for?

Thanks again

Kirstin

[JAMESFETT]

Conditioning is important, and may well add to all of those things, and especially to cardiac output and heart rate. But that is a different situation than in looking at recovered or recovering PPCM patients in trying to estimate contractile reserve. You may want to go into more detail about that with your cardiologist and other trusted exercise specialists.

JD

[kirstinherbs]

Thanks Dr Fett

Could you just clarify what the increase in ef should be under stress, I thought it should increase by 20 points but read on another post that it should increase by a minimum of 10 points.

I went for a run yesterday but wasn't able to run far due to stitch, is there anyway of preventing stitch and what would happen in an exercise test if you had to stop due to stitch?

Thanks again!

Kirstin

[JAMESFETT]

Still establishing the standards in recovered PPCM. I have defined "substantial contractile reserve" as a gain of 10 points in LV EF from resting echo to target heart rate echo. Below that would be less than normal. So, in establishing lowest risks for relapse in a subsequent pregnancy, I am looking for a gain of 10 or more points. To the best of my knowledge of review of the literature and observations, no one has established definite norms for PPCM. With time that will come. Less than 10 point gain would be concerning, and an actual drop would be very concerning, both pushing the risk for relapse with a subsequent pregnancy into higher ranges. It's all about estimates, this risk assessment. There are no guarantees.

JD

[kirstinherbs]

Hi Dr Fett

I was just wondering what happens to the ejection fraction in a normal healthy pregnancy, does it increase or stay the same?

Kirstin

[kirstinherbs]

Hi Dr Fett

I am disapointed to discover that Dr Walker has only arranged a resting echo and an exercise test to look at HR, O2 Level and recovery time when I go to the London heart hosp next week. How can I convince her that I need an echo immediately following the exercise test to calculate my cardiac reserve, how useful is an exercise test without the echo afterwards?

Thanks again

Kirstin

[JAMESFETT]

It takes but an instant to do the exercise stress echo at target heart rate. Nothing is lost by doing it, and valuable information may be gained. Because it is so simple to do you as a patient have the right to request this as a personal need. The other testing, for conditioning purposes, is useful, but not influential in decisions about subsequent pregnancy and risk for relapse of heart failure. There is a growing list of medical journal articles about the usefulness of exercise stress echos.

JD

[kirstinherbs]

The healthcare system in england is very different to the system in America. It is difficult to request what tests you want and need, all decisions have to be made by the doctor or consultant. I will do my best to persuade her, I know she knows of and respects your work so that should help!

I guess I can always offer to pay privately for the test.

Thanks again for all you do for us!