EP09: Treadmill Drugs and Preparation


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Welcome to Dr. Warrick's Podcast Channel. Warrick is a practicing cardiologist an author with a passion for improving care by helping patients understand their heart health through education work believes educated patients get the best health care discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, I'm Dr. Warrick, and I'd like to welcome you to my consulting room today. I'd like to talk about treadmill testing and in particular, the preparation that you may need to undertake with regard to treadmill testing and your medications. We do plenty of treadmill tests through this unit. That's a big part of the service we provide, and so it's not uncommon for me to have patients come in thinking that they have done the right thing by stopping their medication or taking medication before the test and they're not exactly sure what's right and what's wrong. I'm going to try and explain that today. When we do a treadmill test there are really two main things that we're looking to find out. In one situation, we're trying to see if a symptom of chest pain or shortness of breath is related to the heart. So we put a patient through a treadmill to invoke exercise because their history has been one of chest pain or shortness of breath on exercise. If they're able to reproduce that symptom of shortness of breath or chest pain during exercise and we can demonstrate an abnormality of the heart by the ECG being abnormal or when we ultrasound the heart seeing that the heart doesn't move normally, indicating a lack of blood flow then we can confirm the diagnosis. That lack of blood flow is the cause of the symptom. In that situation, the treadmill test is a diagnostic test. So one of the reasons we do treadmill testing is for diagnosis. In the setting of diagnosis, we want as much information as possible and we want the clearest information as possible to make that diagnosis. We don't want anything clouding the water. We want the patient's heart rate to go as high as possible and we want a really good feel of the patient “in their natural state”. Almost invariably we want the patient off any medication that could slow their heart rate down when we're doing a diagnostic test because slowing the heart rate down will make the test less precise and we might be less able to pick up abnormality because the test is less sensitive. So for diagnostic tests, across the board if you're on a tablet that could slow your heart rate down please check because there's a very good chance whoever is doing the test would want you not to be on it in the days leading up to that test so they can see your heart in its natural state and get your heart rate up as appropriate to give them the best sensitivity of that test, to give you the best information. So, stress testing for diagnostic purposes, well that’s the first reason, we do stress testing. The second reason we do stress testing is for prognosis. Prognosis is to tell how well you're going to do in the long term. In the prognostic setting more often than not we've clearly indicated or confirmed a diagnosis that there is a problem with the arteries and maybe some sort of flow limitation. For example, someone who's had a stent had a bypass or had a CT scan and there is evidence that we know that there may or may not be a blockage there. We put the patient on treatment to manage that in the prognostic setting. What we are interested in finding out more often than not is how does this patient behave in the real world on their usual tablets, when pushed to a high workload so that if on medication at a high workload does the heart appear to be working well. We as the doctors can be reassured that we've got that patient's heart well protected. So in the prognostic setting, we generally want to see patient not miss any of their usual medications. Those are the heart rate regulators and the anti-anginal tablets, the tablets that affect how the heart works and reduce the impact of the shortage of blood flow. The very thing we're trying to check and make sure is working properly for that individual. Also, we want to check that we've reduced that patient's symptoms. So that their chest pain or the shortness of breath is improved based on the therapeutic intervention. So, generally in the prognostic setting for stress testing, we want you on medication. So diagnostic off medication, prognostic on medication. If you are not sure….. please ask. A quick phone call and we'd love to tell you. I hope that makes a bit of sense. Thank you for joining me, and good health. You have been listening to another podcast from Dr. Warrick visit his website at DrWarrickBishop.com for the latest news on heart disease. If you love this podcast feel free to leave us a Review. Check out my book at http://drwarrickbishop.com/books/ 

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