Jump to content
Rog

Heart checks, stress test etc

Recommended Posts

So we had an incident with a triathlon friend over the weekend and let's just say he's lucky to be where he was when his heart went otherwise he wouldn't be here to tell the story.

That has had an effect on a few of us, and we started talking about getting checked etc.

One of the things that is often suggested is a stress test but how relevant are they to the middle aged fit triathlete? I can see the point in doing one if you're a inactive / unfit but how would that help someone who basically does one of those on a weekly basis (figuratively speaking)?

Is there anything that is more conclusive / relevant for our demographic? What should I be looking at as an almost 40yo relatively fit guy?

Cheers,

Rog

Share this post


Link to post
Share on other sites

Hey Rog, I was there as well, I've been thinking the same thing ever since. It was also on my mind some time before that as a guy had a heart attack on the finish line at WS70.3 a couple of years back. I asked my GP but they are reluctant to do anything until I report an issue.

Not sure what to do either.

Share this post


Link to post
Share on other sites

Good call Rog.  My better 3/4 is with Warringah so I was in their tent when it all went down.  Bloody scary stuff, but also a wonderful demonstration of how the tri community comes together when the shit hits the fan

I've previously had the mindset that after 23 years and seven Ironmans if something was going to happen it already would have.  When you see someone much fitter than you go down like that though it makes you reassess things, and I'm certainly looking to get myself checked out

As Jess said your GP would be the logical place to start, with maybe an explanation of what you saw for context.  I'll let you know how I go

Share this post


Link to post
Share on other sites

I got a full checkup after having chest pain at a race a few years ago, and spending 6 hours hospital, with what turned out to be a false positive for heart damage. Never actually found out what happened that day.

But straight to my doctor when I got home for a full set of tests, bloodwork, cholesterol, and I went and had a cardio stress test.  This is the test where they plug you in, lie you down and take a heap of readings, then get you on a treadmill, walking, and it automatically increases the pace and elevation every minute or two.  They only wanted me to walk, but I can tell you it was hard work.  In the end they allowed me to get up to a bit of a jog, and told me they never get people to the point of running!  Clearly they only test old invalids ;) .  To give you an idea of my fitness level at the time, I did Mool is in 2:39 (my fastest time) and was at the fittest I've ever been.  Then they stop it quickly and immediately have you back lying on the bed to take more readings.  I was told this is the best most accurate form of test at that time (about 4 years ago).  Nothing at all showed up.  Out of pocket the test cost about $300 (full cost was about $600 I think), but I don't know if having a concession card helped.  

My mate also had a test a year or two ago.  He wore a device for 24hrs and had to go about his normal day.  I think he actually has it on for 30mins or an hour first and had to go for a walk, but in the end they had him do a 24hr stretch.

 

Found the link to the clinic I went to, so maybe they explain it better than me.  http://www.hearts1st.com/stress-echocardiogram-exercise

Edited by goughy

Share this post


Link to post
Share on other sites

Rog,

I've had the range of tests done a couple of times (including a holter monitor that Goughy talked about). The thing with stress testing is that it only measures/assess you ON THE DAY. It may pick up something but it may not. The echo testing is broadly the same, although it can provides more information. They can isolate a number of things but not all.

I suffer from a surging heart rate on occasions. It rises up to 190bpm for around 20 seconds then comes down. The funny thing is that it only happens after 3 hours of exercise (so it CAN happen in a race or training). The cardiologists (2 of them) told me it is not electrical, not due to blockages, not caused by hardening of the heart wall - it's just one of those things that happens. I don't get dizzy or suffer from anything. In fact, it's hard to detect if I haven't got a HRM on. I do have a slightly leaking valve (on occasions) - however, this is not an issue. I had my last check up with the cardiologist mid 2017 and the cardiologist told me to come back in 10 years !.

Whilst I am not a medical professional, I think they look for a number of markers as well as lifestyle to measure the potential risk factors. Sometime they do find things. These things can be from birth or acquired as we live.  

As with all high impact/low probability situations, it comes down to your appetite to  check for a problem (plus cost).

I was concerned because the surging HR happened a couple of times in training and once in a race. I decided to pay for the cost. In fact the holter monitor only picked up my resting heart rate is very low and occasions, I skip a beat whilst asleep B). I requested a referral from my doctor (wouldn't take know for an answer) to see a cardiologist. I was concerned and wanted to ensure I was OK (even though I am retired from racing :lol:).

There is nothing wrong with getting a referral to a cardiologist for peace of mind, even if nothing has happened to you. You can say because of the length of time/intensity you have completed sport and want to continue, you want peace of mind to ensure you are not doing damage. Again, the tests are not a 100% guarantee of "no problems", but it will help with your determination of your risk factors.

Cheers

FM

    

Share this post


Link to post
Share on other sites

Im no expert (obviously) and know very little but I think that a lot of the things that will kill us (as in relatively fit people) are things that dont normally get checked for or are not the "ordinary" test.

I think blockages and genetic issues would be the heart problems that will get us.

My boss just dodged a bullet, he is fit and healthy and had a shoulder injury. The anesthetist told him his heart was a bit funny and if he ever needs another anesthetic he should see a cardiologist first to get a clearance. Lucky for my boss the shoulder surgery was a balls up so he was looking at getting it done again. He did see a cardiologist and withing 6 days was on the table getting open heart surgery to get an aorta replaced. It was seriously enlarged and would have very soon just gone "pop"  any time and he would have pretty much died instantly. 

Share this post


Link to post
Share on other sites

On the other side of the equation, a friend of ours who was some type of medical scientist (at the top of his game) who specialised in cardio / heart abnormalities, with a focus on athletes, dropped dead one morning whilst on a rowing machine from a heart attack.

He was a very, very fit 52 yo and had only been tested 2 weeks prior for any heart issues and was found to be one of the fittest guys tested for his age, with zero issues. He looked after himself and still raced A grade cycling and was a competitor in long distance multi stage adventure racing.

You never know when your time is going to be up, make the most of every day.

BTW - I am not suggesting don't get tested, do whatever you can.

Share this post


Link to post
Share on other sites

While a stress test will look at the pattern of the heat beat and detect any issues with the heart itself, I think most highly active people would have decent heart activity. I think the risk lies in blockages throughout cardiovascular system. Therefore I think an angiogram would be more appropriate. Many active people can still have blockages for a variety of reasons and an episode caused by a blockage will still be included as a heart attack even though the actual performance of the heart was fine until it was stressed via the blockage. The small number of active people I have know that have had 'heart attacks' (some of whom have survived and others haven't) have had good  ECGs and Echiocardiagrams results prior to the incident but have had a blockage issue that only an angiogram would have detected. It's invasive and uncomfortable but I think after I am 50 I will probably get one very few years.

  • Like 1

Share this post


Link to post
Share on other sites

On many occasions when people just drop dead, these stress tests/ echos etc will not pick up any issue. It is just a freak incident sadly.

  • Like 1

Share this post


Link to post
Share on other sites
1 minute ago, hodgey said:

While a stress test will look at the pattern of the heat beat and detect any issues with the heart itself, I think most highly active people would have decent heart activity. I think the risk lies in blockages throughout cardiovascular system. Therefore I think an angiogram would be more appropriate. Many active people can still have blockages for a variety of reasons and an episode caused by a blockage will still be included as a heart attack even though the actual performance of the heart was fine until it was stressed via the blockage. The small number of active people I have know that have had 'heart attacks' (some of whom have survived and others haven't) have had good  ECGs and Echiocardiagrams results prior to the incident but have had a blockage issue that only an angiogram would have detected. It's invasive and uncomfortable but I think after I am 50 I will probably get one very few years.

Stress echos can detect blockages by comparing the performance of the heart muscle before and after exercise. I was a cardiac tech for several years so I performed hundreds, maybe thousands of these tests. It was very interesting to see the really obvious changes with some people.

Share this post


Link to post
Share on other sites

I asked this exact question to Andre Le Gerche at the finish of the Melb half marathon back in 2015, and his response that what I'd just done in the race was in excess of what he'd do in a test!! He went on to say that he could make $$$ cashing in on fear amongst certain people, but he leaves that for others to do!!

That said, my sports doc suggested I get an echo test done...along with blood tests...to see if there are any latent issues that might be detected.

Share this post


Link to post
Share on other sites

I thought calcium scoring was the best predictor of heart attacks?  It was my understanding that people tend to do other tests because it's cheaper than CS.   Last time I spoke to my doctor she said I didn't need to be checked out, but I decided the other day I'd rather be safe than sorry and it's only $300-400 which is nothing  in the scheme of things.

Share this post


Link to post
Share on other sites
9 hours ago, goughy said:

I got a full checkup after having chest poison at a race a few years ago, and spending 6 hours hospital, with what turned out to be a false positive for hey damage. Never actually found out what happened that day.

But straight to my doctor when I got home for a full set of tests, bloodworm, cholesterol

Too funny 

Do you not worm urself pre race like AP? 

  • Haha 1

Share this post


Link to post
Share on other sites
  • Check Family History of High Cholesterol
  • Get a Cholesterol Blood Test Done
  • Being Fit does not mean the arteries are not clogged
  • Some bodies over produce cholesterol

Share this post


Link to post
Share on other sites
37 minutes ago, Turts said:

Too funny 

 

F'n autocorrect!

Share this post


Link to post
Share on other sites

I thought there was a category of heart attacks caused by deposits in heart arteries bursting, then clogging smaller downstream arteries and capillaries. Small enough deposits that tests don't count them as problems, including angiograms as the deposits dont occlude that much. From a previous similar thread a few years ago.

Fair bit of  discussion of late about unnecessary tests and interventions, some of which are actually showing up as worsening rather than improving things, such as knee arthroscopes - and it was a surgeon who wrote a book about that - and just last week  treatments for back pain, etc.

Haven't had a stress test, but like other anecdotes, know someone who was told in great shape after having one, only to die of a heart attack a couple of weeks later. I'm sure there are some things they do pick up you'd want to know about if you have them, but it's the all clear which isn't really.

 

And I'm sure the incidence of sudden heart attack amongst the fit is (much) lower than the general population. And more, that all the statistics showing much lower rate of all manner of chronic conditions and extra longevity it's a good thing. Even more so when you do it because you enjoy it :)

Share this post


Link to post
Share on other sites

I have just receive results back from a full round of tests including CBC, Creatine, Urine analysis, fasting blood sugar, post prandial blood sugar, serum lipid profile ( cholesterol ) glycolsylated haemoglobin, testosterone PSA and sonography of vital organs.

Apparently I'm within the normal range overall. It doesn't say I won't cark it in my sleep tonite, but now at least I have a benchmark for annual testing during future years. 

Share this post


Link to post
Share on other sites
10 hours ago, softy said:

I have just receive results back from a full round of tests including CBC, Creatine, Urine analysis, fasting blood sugar, post prandial blood sugar, serum lipid profile ( cholesterol ) glycolsylated haemoglobin, testosterone PSA and sonography of vital organs.

Apparently I'm within the normal range overall. It doesn't say I won't cark it in my sleep tonite, but now at least I have a benchmark for annual testing during future years. 

What did you ask your doctor for to be able to get all those tests done, i had a stress test done on my heart a couple of years ago and all good, but my doctor said i didn't need any other testing done at my age.  34 at the time

Share this post


Link to post
Share on other sites

Without having any symptoms, really up to you and how much peace of mind you need. 

I had a stress echo done last year (33yo) and was probably the fittest I’d been. Pulled up lame in the pool one night, was like a switch was flicked and I didn’t know if I was going to make it to the end. I had been feeling pretty run down, but forced myself to go. 

Anyway over the next few days got tightness in the chest which over another week or so settled on the heart. Went to doc who diagnosed myocarditis and ordered rest - no problem as I struggled getting up stairs without being stuffed at the top. Lasted another couple of weeks, and found out had history in family of heart problems. Went back to doc who ordered stress echo due to lingering symptoms and family history. 

By the time the test came around I was much better, but fark me the test was hard. Unlike goughy, I had to run for as long as I could, which was really a hill sprint on treadmill. Then back on table and having to hold breath while coming down from absolute max heart rate. Horrible. 

Anyway, everything sinister was ruled out and myocarditis confirmed as far as possible. Took about 10 months for all symptoms to disappear. Haven’t gotten back into real training since April last year. Has made me hyper aware of any niggles. 

Moral of my text book above, check family history, there’s a lot of things that can be passed down esp heart related. Get checked if any doubts and listen to your body!

If more tired than normal, maybe skip a session or two. 

Share this post


Link to post
Share on other sites

Don't forget blood pressure (hypertension) and the potential for strokes and aneurysms - another common cardiovascular killer.

Being reasonably fit tends to make the stress test a little too mild to bring out things, but I did the halter thing and gave myself a good pounding over 10ks and managed to bring on some things that would most likely not have come out from a stress test ( a brisk walk on the treadmmill). There is even a little button on the monitor to press if/when issues arise so they can zero in on it when analyzing  later.

 

 

Share this post


Link to post
Share on other sites
3 hours ago, KieranR said:

What did you ask your doctor for to be able to get all those tests done, i had a stress test done on my heart a couple of years ago and all good, but my doctor said i didn't need any other testing done at my age.  34 at the time

My wife told me what to ask for and I did some Googling. I just went into the doctor as asked for all of them. I did the Treadmill Test, not really a stress test, and maxed the HR out at 96 bpm :mellow: 

With Blood Pressure it changed in a week. When I first went it was 120/80, then last week it was 110/80. I'm sure it's one of those variables that changes week to week. They did find I have a B12 deficiency so I need to get some pills. It is common in over 50 vegetarians. 

Share this post


Link to post
Share on other sites
20 minutes ago, softy said:

With Blood Pressure it changed in a week. When I first went it was 120/80, then last week it was 110/80. I'm sure it's one of those variables that changes week to week.

Last time I went to my GP, he did the usual "you're over 50 so I'll check a few things". Have to head to QML for tests he gave me, but while there he did BP. He said it was a bit high (130/78) so could I get it checked a bit more often. We have a set at home as my wife has high BP, so I went a month checking it morning & evening. It was anywhere from 117/66 to 144/86, depending on what I'd been doing that day & the day before. What I did notice though, was that it was inversely related to HR. My higher BP would be when HR was low 40's, and low BP would be with HR in high 50's low 60's.

Share this post


Link to post
Share on other sites
On 28/03/2018 at 11:38 AM, IronJimbo said:

Good call Rog.  My better 3/4 is with Warringah so I was in their tent when it all went down.  Bloody scary stuff, but also a wonderful demonstration of how the tri community comes together when the shit hits the fan

I've previously had the mindset that after 23 years and seven Ironmans if something was going to happen it already would have.  When you see someone much fitter than you go down like that though it makes you reassess things, and I'm certainly looking to get myself checked out

As Jess said your GP would be the logical place to start, with maybe an explanation of what you saw for context.  I'll let you know how I go

7/8s

  • Haha 1

Share this post


Link to post
Share on other sites

I’m still a bit shaken by it. We were talking for a few mins before “he” got up to walk to the tent. Earlier that day,we were joking about him saving my life at huski a few years back ~ when I was choking on some food (post race!)  

It was a scary appx 12 mins when he was kept alive via CPR, a defibrillator and oxygen, 2 fine doctors and First Aiders.

3hours later I was at the hospital talking to his wife and he was in recovery (post a stent)  

Right time, right place, not his time etc.  I don’t want to see that happen again.  Scary. 

Edited by Mjainoz
  • Like 1

Share this post


Link to post
Share on other sites
On 28/03/2018 at 11:19 AM, Rog said:

What should I be looking at as an almost 40yo relatively fit guy?

Hey Rog, you're starting to suffer mid life crisis mortality issues now that you have a wife and kids :) Don't worry, everyone goes through it.

As far as tests are concerned, here's my take in my order of importance. I'm sure others will disagree but...

Calcium count - I've had this and it was fine. High numbers are a strong indicator of heart disease.

Triglycerides - Generally regarded as the best blood test indicator of heart attack risk. Mine is .7 (good).

Colonoscopy - if you're over 45 get on it. Same with PSA - although there's debate about the accuracy of PSA.

Stress tests - I've had a couple of them and BP and heart rate reacted as expected. I wouldn't expect to turn up anything unless there was a serious problem.

Blood Pressure - IMHO high BP is a far greater indicator for heart disease than Cholesterol - I test it every day (I'm a bit OCD) and FWIW my 2018 average is 125/74 with pulse 53

Body Screening - Last year I saw Parkside and got a body screening - tested all sorts of things regarding strength and flexibility. As we age I reckon this is an increasingly important component of health and often disregarded. Eventually a lack of core strength and balance will catch up via injury or a fall.

Blood Sugar - I wouldn't expect anyone with reasonable weight and diet to be troubled by this but if you're carrying some pud and eat a lot of refined carbs it's worth checking.

Cholesterol - I've never been particularly concerned about high cholesterol as I'm not convinced it's a great indicator of heart health. I read somewhere that 70% of people who have heart attacks have normal cholesterol levels. It seems many doctors now consider it a  poor indicator but it's been so ingrained it's hard to correct the dogma.  Having said that, I have familial high cholesterol and I'm on a trial medication to reduce it (self injected every fortnight).  Because I'm on the trial I get full blood tests every 12 weeks and everything is perfect.

I monitor blood ketones every couple of days just out of interest - my weight is good for my height and build. 

FWIW, here's what I actually do to try and stay healthy.

My attitude to training changed completely after a pulmonary embolism. My triathlon training is nil these days. 

Every day I walk a hilly 6km and at the 3km mark I hop on a bunch of machines at the local park and do 30 reps on 8 different machines involving legs, arms and core. Takes about 10-15 minutes but I feel strong and stable and my chronic back issues have essentially disappeared. I do yoga for flexibility. Core strength, muscle balance and flexibility will serve you well when you get older.

When I walk it's sometimes fast, sometimes slow, sometimes a run/walk. How I feel on the day determines how fast I move and I feel zero obligation to perform in any particular way. It's liberating to NOT follow a written regime. Of course I still ride and swim occasionally and I enjoy it a lot more because I want to do it. I still play touch footy and kick a ball around with the young bloke. 

I believe exercise is good for you but I'm still not sure that long term, high intensity exercise is. I look at people like Jabbs, Dean Mercer, Steve Folkes, Emma Carney, Welchy, John Hill etc and question the wisdom of training at their levels.  I've definitely converted to the paradigm of rest, enjoyment, moderation, variety and consistency.

Lastly, the thing with all these tests is they're unlikely to reveal that aneurism which could kill you before you hit the ground or the tiny build up of crap which could cause a fatal stroke.  But here's the rub, if you're constantly worrying about dying, you're not going to be living. What happens happens, get on with life.

I'm 59 and never give dying a passing thought - neither should you - especially at your age.

Edited by trinube
  • Like 3

Share this post


Link to post
Share on other sites

The stress test shows how well the valves are working too.  Once you see it done you'll get some confidence that you've been fairly thoroughly checked.

 

When I did the echo stress test I started walking on the treadmill, but my heartrate started to rise fairly quickly, I didn't want to look unfit so as I got faster I carefully controlled my breathing, increased my stride and relaxed.  The more I relaxed and the faster I went, the lower my heartrate went (to a point).  The nurse said quietly to the doctor "he must be fit."   The doctor then said to me "you do a bit of running do you?"

That was my finest pretend James Bond moment :-)

 

  • Like 2

Share this post


Link to post
Share on other sites
On 29/03/2018 at 10:01 PM, trinube said:

Hey Rog, you're starting to suffer mid life crisis mortality issues now that you have a wife and kids :) Don't worry, everyone goes through it.

As far as tests are concerned, here's my take in my order of importance. I'm sure others will disagree but...

Calcium count - I've had this and it was fine. High numbers are a strong indicator of heart disease.

Triglycerides - Generally regarded as the best blood test indicator of heart attack risk. Mine is .7 (good).

Colonoscopy - if you're over 45 get on it. Same with PSA - although there's debate about the accuracy of PSA.

Stress tests - I've had them a couple and BP and heart rate reacted as expected. I wouldn't expect anything unless there was a serious problem.

Blood Pressure - IMHO BP is a far greater risk for heart disease than Cholesterol - I test it every day (I'm a bit OCD) and FWIW my 2018 average is 125/74 with pulse 53

Body Screening - Last year I saw Parkside and got a body screening - tested all sorts of things regarding strength and flexibility. As we age I reckon this is an increasingly important component of health and often disregarded. Eventually a lack of core strength and balance will catch up via injury or fall.

Blood Sugar - I wouldn't expect anyone with reasonable weight and diet to be troubled by this but if you're carrying some pud and eat a lot of refined carbs it's worth checking.

Cholesterol - I've never been particularly concerned about high cholesterol as I'm not convinced it's a great indicator of heart health. I read somewhere that 70% of people who have heart attacks have normal cholesterol levels. It seems many doctors now consider it a  poor indicator but it's been so ingrained it's hard to correct the dogma.  Having said that, I have familial high cholesterol and I'm on a trial medication to reduce it (self injected every fortnight).  Because I'm on the trial I get full blood tests every 12 weeks and everything is perfect.

I monitor blood ketones every couple of days just out of interest - my weight is good for my height and build. 

FWIW, here's what I actually do to try and stay healthy.

My attitude to training changed completely after a pulmonary embolism. My triathlon training is nil these days. 

Every day I walk a hilly 6km and at the 3km mark I hop on a bunch of machines at the local park and do 30 reps on 8 different machines involving legs, arms and core. Takes about 10-15 minutes but I feel strong and stable and my chronic back issues have essentially disappeared. I do yoga for flexibility. Core strength, muscle balance and flexibility will serve you well when you get older.

When I walk it's sometimes fast, sometimes slow, sometimes a run/walk. How I feel on the day determines how fast I move and I feel zero obligation to perform in any particular way. It's liberating to NOT follow a written regime. Of course I still ride and swim occasionally and I enjoy it a lot more because I want to do it. I still play touch footy and kick a ball around with the young bloke. 

I believe exercise is good for you but I'm still not sure that long term, high intensity exercise is. I look at people like Jabbs, Dean Mercer, Steve Folkes, Emma Carney, Welchy, John Hill etc and question the wisdom of training at their levels.  I've definitely converted to the paradigm of rest, enjoyment, moderation, variety and consistency.

Lastly, the thing with all these tests is they're unlikely to reveal that aneurism which could kill you before you hit the ground or the tiny build up of crap which could cause a fatal stroke.  But here's the rub, if you're constantly worrying about dying, you're not going to be living. What happens happens, get on with life.

I'm 59 and never give dying a passing thought - neither should you - especially at your age.

This should be pinned somewhere - this is wisdom

 

Share this post


Link to post
Share on other sites

So..... I think about dying often and 6months ago I never had... I shared a recent heart health story and this journey was compounded by a CT scan of my heart picking up an unrelated abnormal mass /  tumour in my back.

A month of MRIs, seeing Cancer specialists and having a biopsy of a "mars bar" sized tumour resulted in a diagnosis of a benign ganglioneuroma. That was a bit scary! To finish things off.... I applied for life insurance and they promptly rejected me! :huh:

Back to the heart...

Mum nearly died a few years ago from Brugada syndrome (heart thingy); having not had a heart issue previously. It is disease you can inherit, so I was told to not exercise til "cleared" and had many many tests: bloods, physical, scans, ecgs, etc. I passed all with flying colours.

Fast forward... and I am now looking into surgery, ablation and on heart medication at the age of 38. 

Rather than worry about testing, if you have no reason to believe that you have an issue, get on with living. You have no idea when a quick ride on a trainer may be your last with complete mental freedom. 

 

  • Like 1
  • Thanks 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...